Disease, and the fear of it, has evolved with cities. One of the fundamental themes of the literature of cities is the nature of proximity and connection, and disease frequently indicates to us the subsequent dangers of gathering in cities. The Bible seems to smite every city with plague, notably Sodom and Gomorrah, the “cities on the plain” of the Canaanites, and what many consider to be the very first cities, in the Levant. Whether the Bible is fundamentally anti-urban is an interesting question, that better-qualified religious scholars have addressed here, but there are many other examples of disease in cities. Arnold Weinstein writes about this so well in his passionate and excellent book, and articulates this theme terrifically in his lectures on the city (offered here), that I will simply quote him:
“Private illness makes its fateful itinerary to collective disaster and plague, writing large the mystery of human connection/infection and the crucial social mechanisms enlisted to save the community. Once again, Sophocles' Oedipus (among other works) comes to the fore, this time as the master plot for how a community copes with catastrophe. The apparent backdrop of the Greek play, plague -- people dying like flies in Thebes, the Oracle's tracing of the scourge to a concealed murder -- provokes a central question that recurs throughout history: who is responsible for the epidemic? The great Sophoclean theme of illicit connection, at once political and sexual -- a man kills his father the king, sleeps with his mother the queen -- is also understood bacterially. Of course, Sophocles was no epidemiologist, but his account of mass deaths intrigues us because it turns on the key issue of secrets, both erotic and communal, and thus tells us (in the way literature tells us things) that the story of plague is a shockingly broad, social story, a revelatory story that thrusts the culture's connections, both licit and illicit, into full view.”Disease can also be understood as the simple biological consequence of our decision to gather in cities. Many books in recent years have described the potential consequences of new and terrifying transmitted dieases in cities, as comprehensively described in The Coming Plague by Laurie Garrett, luridly pictured in The Hot Zone by Richard Preston, or recently connected to environmental change, as in Six Modern Plagues by Mark Jerome Walters. My favorite among these books is certainly Laurie Garrett's book, which despite its rather sensational title, manages to be simultaneously both well-researched and passionate, dryly humorous and sometimes simply outraged at human stupidity. In her chapter titled “Microbe Magnets”, she writes:
“The Sophoclean story of a city or culture threatened with plague -- with apocalypse -- is replayed throughout history. In narratives by Daniel Dafoe and Charles Dickens we see London under siege, and these stories echo strangely still today, evoking for us what it might well have looked like, had we been citizens of Thebes, of Sodom or Gomorrah, of Dresden or Hiroshima or Grozny, or what it could look like in the wake of bioterrorism, with its threats of anthrax and smallpox and other toxins.”
“The very word 'plague' has -- or used to have -- a yesteryear ring to it, an archaic condition located either in the past or in underdeveloped societies where medicine has not made the advances we take for granted in the West. But we are increasingly aware that mass disease and lethal infection cannot be ruled out of modern life. For just this reason my chapter closes with several stunning works of the twentieth century: Albert Camus's allegorical novel, The Plague; Ingmar Bergman's ground-breaking film of 1956, The Seventh Seal; and Tony Kushner's epochal play about AIDS, Angels in America. All of these works face up to apocalypse, but they use the specter of mass death to posit human connection -- the mysterious bonds of love -- as civilization's most precious legacy” (A Scream Goes Through the House, introduction)
“Cities afforded the microorganisms a range of opportunities unavailable in rural settings. The more Homo Sapiens per square mile, the more ways a microorganism could pass from one hapless human to another. People would pass the agent to other people in hundreds of ways every minute of every day as they touched or breathed upon one another, prepared food, defecated or urinated into bodies of water with multiple uses, traveled to distant places taking the microbes with them, built centers for sexual activity that allowed microbes to exploit another method of transmission, produced prodigious quantities of waste that could serve as food for rodent and insect vectors, damned rivers and unwittingly left cisterns of rain water about to create breeding pools for disease-carrying mosquitoes, and often responded to epidemics in hysterical ways that ended up assisting the persistent microbes.... Cities, in short, were microbe heavens, or, as British biochemist John Cairns put it, 'graveyards of mankind'. The most devastating scourges of the past attained horrific proportions only when the microbes reached urban centers, where population density instantaneously magnified any minor contagion that might have originated in the provinces. And microbes successfully exploited the new urban ecologies to create altogether novel disease threats” (page 235)Garrett then goes on to detail disease in the cities of ancient Egypt, Greece, the Roman Empire, China, India, including typhus, the plague, smallpox, pneumonic plague, leprosy, tuberculosis, and syphilis. Pandemics caused by bubonic or pneumatic plague struck Europe in the 14th century, with catastrophic results:
“Rumors of the Asian scourge preceded its arrival in Europe, and it was said that India, China and Asia Minor were literally covered with dead bodies. The Chinese population plummeted from 123 million in 1200 to 65 million in 1393, probably due to the plague and the famine that followed.... As the plague made its way across Europe and North Africa, each city anticipated its arrival and tried by a variety of means to protect itself.... outright slaughter of tens of thousands of Jews and alleged devil worshippers were staged. The city of Strasbourg alone savagely slew 16,000 of its Jewish residents, blaming them for spreading the Black Death.”Our fascination with the catastrophic effects of disease continues right up today, whether in books like Jared Diamond's Guns, Germs and Steel, which makes an argument for the pivotal effects of germs on the course of human history; to “28 Days Later”, a movie that profoundly transcends its zombie movie origins with its depiction of fundamental relationships gone awry, either between ourselves and our origins (the apes); society and the uses of technology; the terror of connection with strangers; and the loneliness of cities when social bonds are broken. There is also the always shocking vision of a city burning (in this case, Manchester). There is a intriguing review of the movie by Harold Varmus, a Nobel Prize laureate in medicine, here.
“The daily death rates were staggering: 400 in Avignon; 800 in Paris; for Pisa, 500; Vienna buried or burned 600 bodies per day; and Givry, France, 1,500 daily. By the end, London, with a pre-plague population of 60,000, had lost 35,000. Half of Hamburg's and two-thirds of Bremen's populations perished. Most historians believe that at least one-third of Europe's total human population (20 to 30 million people) died of the plague between 1346 and 1350. The highest per capita losses were consistently in the cities” (page 238)
Urban planning, of course, has its roots in public health. London for most of its history killed a substantial fraction of its inhabitants, a figure astonishingly (and inevitably) offset by continued in-migration and urbanization. The impact of disease in Industrial Revolution cities can be found in this account. The Anglo-American school of urban planning arose out of Victorian concerns with public health, and the earliest heroes of urban planning were in fact, not urban planners. Dr. John Snow stopped the cholera epidemic of London of 1854, when he located the source of the epidemic with the help of maps and plotting (in a famous example of graphical thinking, recounted by Edward Tufte). When the authorities removed the handle of the Broad Street pump, Snow simultaneously stopped the means of transmission (by infected water) and settled the medical argument over the causes of cholera infection. Sir Joseph Bazalgette is credited with saving more lives and shaping the city more than any other person, with the construction of the Albert and Victorian Embankments, that for the first time provided the city with a functioning sewer system.
Contemporary urban planners are still quite interested in the links between urban form and health, in particular with a recent interest in obesity. A good contemporary summary of public health information in U.S. cities is in the Gotham Gazette here. A particularly interesting body of work is the U.N./World Health Organization's Healthy Cities movement, with many local projects and initiatives underway.
Technorati Tags: cities, environment, science, sustainability, urban
No comments:
Post a Comment