20 FEBRUARY 1959, Page 18

A Doctor's Journal

Today's Plagues By MILES HOWARD A NICE account of the Black Death, in the current number of the University College Hospital Magazine, by Dr. Gautier Smith. (In passing, what a fine cover design this number has, and indeed, a series of past numbers—the credit is due, I believe, to Jonathan Miller.) The account begins : 'In October 1347, a number of Venetian galleys sailed into the port ofNessina, and so introduced into Europe a pestilence the severity of which had never been equalled in the past, and until now has never been approached.' No fewer than 60,000,000 people (between a quarter and a third of the population of the world) died between 1334, when the pandemic began in China, and 1364, when it finally. 'ended. The plague took no account of climate, and killed off the citizens in the cold of Iceland as well as those in the Italian heat. Guy de Chauliac, the most famous surgeon of the Middle Ages and physician to Pope Cleffient VI, stayed in Avignon all through the epidemic there—seven months—himself survived a severe attack and was the first to separate the two types' of plague : pneumonic and bubonic. It is a tribute to his clinical judgment that he thought 'the degree of debility of the individual victim' was an important determination of the illness, but he (like most others) believed the prime cause to be the disposition of Saturn, Jupiter and Mars. As has so often happened, a scapegoat was sought in the' Jews: the story got round that they were poisoning the population, and these hapless folk were butchered in thousands. Most of the doctors hid, to avoid infection, but a few stayed and did what they could, though in the end most of them died of the disease. De Chauliac wrote, 'And 1, to avoid infamy, not daring to absent, myself, with continual fear, I treated myself as much as 'I could, using the said remedies'—such as cupping, scarifying and blood-letting. (There is a parallel here to the activities of doctors during the recent war—some. joined in, though 'in con- tinual fear,' as they felt it to be their duty, and others stayed out.) To read about this thirty years in the history of mankind does something to keep events and people in perspective. As the author says, the emotional after-effects of the Black Death on the family and the individual were profound and long-lasting. A greater disaster than the First World War?—certainly, I think, greater than the second. And what of the plagues of our time? —in terms of germs, the viruses of influenza are near the top of the list, because of the large num- bers of victims they claim; though the diseases caused by them (just now, influenza A, A-prime and B) are not lethal and dramatic, as was the plague of the fourteenth century. But they do cause an enormous amount of misery, discomfort, inefficiency and depression; an attack of 'flu can set off a long chain of physical maladies, not in themselves related to the virus, and also (though seldom) an acute mental illness.

A plague of the spirit?—surely it is apathy, dis- interest, `couldn't-care-less-ness.' As many well- meaning and otherwise respectable Londoners will say, apropos of Notting Hill—Too bad, but what can we do about?' There is an answer to this question, in the work of Captain Desmond Hoare—but that must await a column to itself.

Apropos of my note on the brain's, electrical net and the suggestion that it contains, coiled away within itself, a complete record of every- thing that has ever happened to the owner of the brain, a reader proposes a fresh concept of Hell. The new arrival, she says, will be cor- dially received and shown into a rather small and overheated private cinema; when the door closes behind him, it is at once locked. He is bidden (through a loudspeaker) to sit down and face the screen, on which is then shown, in full and unabridged,, a transcript in film (with sound) of the entire contents of his cortex, from birth onwards. Of course, everyone has his own notion of Hell, but this one was, I thought, subtle and rather Russian. One could take issue, how- ever with it, or any similar notions, on the ground that the state of Hell is not something that comes after our lives, but is in the here-and-now, just as Heaven is. I am not, at this moment, defending such a proposition, but it is certainly arguable. After all, you make your own life. If you need to make a hell out of it (one might say), that's your affair—and what right has anyone else to inter- fere? Is this not one of the basic freedoms, to run your own life?