Sickness And Civilization

“The Great Shadow

 

By Susan Wise Bauer

 

St. Martin's, 352 pages, $30

 

Almost everyone knows the line "no man is an island." Most will have also encountered the moving words that soon follow: "never send to know for whom the bell tolls; / It tolls for thee." But few people have actually read John Donne's "Devotions Upon Emergent Occasions, and severall steps in my Sicknes" (1624). If they did, they would find that Donne's immortal lines are accompanied by a more visceral metaphor, in which the oft-ill poet compares the experience of disease to a precious ore that must be carefully mined and minted. The patient who fails to come spiritually closer to God through his physical suffering leaves treasure underground, lying "in his bowels, as gold in a mine."

 

Donne's intestinal treasure has not entered the pantheon of great metaphors. But the idea of turning disease into philosophical currency has inspired Susan Wise Bauer's "The Great Shadow." Ms. Bauer, who taught American literature at the College of William and Mary and is a prominent advocate of classical education, briskly surveys thousands of years of health and sickness, mostly of the infectious variety: that is, disease caused by invading organisms, usually microscopic. Plague, typhus and smallpox (all of which stalked Donne's England) loom large, but typhoid, influenza, polio, tuberculosis, dysentery, scarlet fever, cholera, measles and malaria round out Ms. Bauer's truly gruesome cast of characters.

 

It is easy to forget that, even in today's healthiest countries, we are only four or five generations removed from a world where most people, most of the time, died of infectious disease. Sometimes they were swept up in great waves of mortality, such as outbreaks of bubonic plague (most notoriously the 14th-century Black Death that killed about half the population in Europe and millions more in Africa and Asia). More often, the steady toll of pervasive endemic disease was enough to keep average life expectancy somewhere in the mid-20s. The burden of suffering always fell especially hard on children. In Donne's time, anyone who made it to adulthood would have survived a gauntlet of vicious microbes.

 

Ms. Bauer reminds us of the human dimensions of living in such a world. In the 1780s Thomas Jefferson was serving as a diplomat in France when the Marquis de Lafayette brought him a message of unwelcome news from Virginia: His young daughter Lucy had died of whooping cough. The letter did not spare the absent father the grim truth: "Her sufferings were great." Jefferson ultimately buried four of his children (including two girls named Lucy). He knew what he was saying when he wrote appreciatively to Edward Jenner, the English physician who discovered vaccination, that "medicine has never before produced any single improvement of such utility."

 

"The Great Shadow" benefits from Ms. Bauer's keen sense for the way the bodily experience of disease so readily takes on psychological and spiritual freight. The Greek medical tradition, starting with Hippocrates, tried to make sickness a secular matter. Health was a state of equilibrium, according to this view, a precarious balance among the body's four humors. But maintaining this equilibrium put the onus on the individual and his or her diet and regimen -- no small burden. It is human nature to project our phobias, prejudices and obsessions onto what is simply a biological contest between our immune system and the amoral pathogens trying to replicate themselves within us.

 

Ms. Bauer winsomely threads scenes and vignettes from contemporary life throughout her book, especially from our polarized landscape, still haunted as it is by the Covid-19 pandemic. Often, the point is to contrast how fortunate we are to live in a time when not every sniffle is a herald of doom, nor every cut and scrape a portal for merciless bacteria to enter and feast on our flesh.

 

The author appreciates what a terrific advance modern germ theory represents, but she also recognizes its tendency to generate absurd excesses. Her history of Kleenex tissues is a tour de force: We learn that the Kimberly-Clark Corp., which owns Kleenex, played on the fear that reusable handkerchiefs were essentially wads of tuberculosis germs. "Don't put a cold in your pocket," the ad campaign warned. Ms. Bauer points readers to the 1951 short film co-produced by Kleenex and the Walt Disney Co. to witness how disposable tissues won a lasting victory.

 

"The Great Shadow" has many merits, but it leans heavily on infectious-disease literature that is at least a generation out of date. That is a pity. In the past decade or so we have learned a great deal through advances in genome sequencing. Deciphering the DNA of our microbial adversaries has revolutionized our understanding of their evolutionary history. We now have a much clearer picture of how humanity's successes -- population growth, food production, urbanization, globalization -- have stoked pathogen evolution.

 

 Measles, for instance, emerged only a few thousand years ago, rising in lockstep with the growth of the great cities of antiquity; in the absence of massive urban populations, this highly contagious virus would go locally extinct.

 

It's an example that underscores how our gruesome microbial adversaries are not, after all, very old. We are like Alice in a kind of Red Queen's race, which makes modern control of infectious disease even more impressive -- and fragile.

 

Still, the virtues of "The Great Shadow" outweigh its faults. Ms. Bauer reminds us not to take for granted a world where we understand the biology of infectious disease and live free of the stalking horrors that prevailed until yesterday. The escape from suffering and premature death is one of the greatest accomplishments of our species. It was achieved by a combination of economic growth (which relieved us of basic misery), empiricist science (which gave us vaccines, antibiotics, etc.) and good public policy (which provisioned, among other things, clean drinking water).

 

Like Donne, we can mine wisdom from the frailty of our mortal bodies -- but be grateful that when the bell tolls for thee, plague, smallpox and typhus won't be to blame.

 

---

 

Mr. Harper is a professor at the University of Oklahoma and a member of the Fractal Faculty at the Santa Fe Institute.” [1]

 

1. REVIEW --- Books: Sickness And Civilization. Harper, Kyle.  Wall Street Journal, Eastern edition; New York, N.Y.. 24 Jan 2026: C7.