Case Histories—An Introduction

Plagues, as everyone knows, lead to the erection of barriers— cordons sanitaires and quarantines that separate the sick from the well with the intention of enhancing both the letter and spirit of security. Less often considered is the measure of confidence lent to new voices of authority in time of plague. Public concern about the dangers of AIDS and the social impact of this unanticipated epidemic have, for example, prompted the media to ask historians about plagues of the past. Most often the question asked is quite general: "Are there precedents for the AIDS epidemic?" And most often historians shape their answers to meet the limitations of their own professional knowledge. We learn that outbreaks of bubonic plague in Europe and England from the late fifteenth to the late seventeenth centuries occurred in the context of constrained economic as well as scientific resources, and that religious belief shaped the responses of those in authority as well as popular sentiment. And historians of the nineteenth century explain that when cholera swept from the East to the West, an environment in which population density generated public sensitivity to social disorders paved the way for new concepts of disease causation and transmission. But not surprisingly, the question of whether there were "precursors" to AIDS remains unanswered, and the notion that natural history or human social history generates precedents revealing predictable patterns seems at best inadequate. One fundamental and striking novelty of the late twentieth century is the expectation of near-perfect protection from contagious disease.