Plagues and Peoples

Acknowledgments

T

his book was composed in the spring and sum mer of 1974 and corrected in the spring of 1975. In between, a rough draft was circulated to the following readers for their expert criticism: Alexandre Bennigsen, James Bowman, Francis Black, John Z. Bowers, Jerome Bylebyl, L. Warwick Coppleson, Alfred W. Crosby, Jr., Philip Curtin, Allen Debus, Robert Fogel, Ping-ti Ho, Laverne Kuhnke, Charles Leslie, George LeRoy, Stuart Ragland, Donald Rowley, Olaf K. Skinsnes, H. Burr Steinbach, John Woods. The manuscript also benefited from a panel discussion at a meeting of the American Association for the History of Medicine, May 1975, at which Saul Jarcho, Barbara G. Rosenkrantz, John Duffy, and Guenter B. Risse commented on what they had read. Subsequently, in the autumn of 1975, Barbara Dodwell read
Chapter IV
and Hugh Scogin worked over Chinese data for me; between them they led me to adjust the way I understand the propagation of the Black Death. Fortunately it proved possible to insinuate appropriate adjustments into the text at the last minute.

This episode illustrates how tentative many of the assertions and suggestions of this book are and must remain until epidemiologically informed researches have been undertaken in Chinese and other ancient records. Suggestions and corrections from the entire array of readers permitted improvement of the original version in numerous details and steered me away from some silly errors; but needless to say, I remain responsible for what appears below, including any and all residual errors.

A generous grant from the Josiah Macy, Jr., Foundation permitted time away from normal academic duties for the completion of this essay. I was assisted by Edward Tenner, Ph.D., who looked things up for me in European languages, and by Joseph Cha, Ph.D., who consulted Chinese and Japanese texts on my behalf and compiled the roster of Chinese epidemics that appears in the Appendix. Without their help the task would have taken longer and, in particular, my remarks about the Far East would have been far sketchier. Marnie Veghte twice typed the text with cheerful accuracy and admirable speed. Charles Priester of Anchor Press/Doubleday asked suitably pointed questions to provoke me to improve the original manuscript in important ways.

To all who thus assisted in bringing this book to birth, I am sincerely grateful.

W
ILLIAM
H. M
C
N
EILL
15 December 1975

Preface

R

eaders of a book about epidemic infections, like this one, are sure to wonder why it contains no mention of AIDS. The reason is simple. That disease was identified and named only in 1981–82, some six years after
Plagues and Peoples
was published. Since then, the AIDS epidemic has been a major driving force behind the continued interest in what this book has to say about earlier epidemics and human responses to them, and perhaps it is time to acknowledge that fact and say something about the disease that has attracted so much attention since it was first identified.

The climate of medical opinion has changed considerably since this book came out, for in 1976 many doctors believed that infectious diseases had lost their power to affect human lives seriously. Scientific medicine, they supposed, had finally won decisive victory over disease germs. Newly discovered antibiotics and relatively simple prophylactic and public health measures had at last made infections easy to prevent and cure. The World Health Organization actually succeeded in eliminating smallpox from the face of the earth in the same year
this book was published, and optimists believed that other infections, like measles, might go the same way if sufficient medical effort were put into worldwide campaigns to isolate and cure each and every infection.

A glance at my concluding remarks on
this page
will show that I did not accept this view of what doctors had accomplished, and it is now clear that the elimination of smallpox in 1976 was the high point of the World Health Organization’s remarkably successful post-World War II campaign to reduce human deaths from infections. Thereafter, infectious organisms launched a counteroffensive. The appearance of AIDS was the first notable landmark of this process; and despite initial expectations, the subsequent identification of the HIV-1 virus that causes AIDS has not yet led to a cure.

Development of resistant strains of malaria, TB, and other familiar infections was a second, and in many ways more important, sign that twentieth-century victories over the parasitic microorganisms that feed upon our bodies was only an unusually dramatic and drastic disturbance of the age-old balance between human hosts and disease organisms. As the century comes to its close, it seems sure that infections are coming back, regaining some of their old importance for human life; and medical men have begun to recognize how their increasingly powerful interventions had the unexpected effect of accelerating the biological evolution of disease germs, making them impervious to one after another form of chemical attack.