Blog Global Health Center

Contagion! Back to the past

Written by Corinne Treitel, PhD, professor in the Department of History at Arts & Sciences

Words carry the past. – I was reminded of this recently as I watched Contagion, a 2011 movie that follows a team of medical experts as they battle to stop a lethal airborne virus before it wipes out all of humanity. Who will win: the experts or the virus? We never find out, nor should we, for experts confronting emerging infectious disease is one of the recurrent and unfinished dramas of our own time. Think no further than Ebola. Given the contemporaneousness of the drama, however, the historian in me wondered about the title. Contagion is a very old-fashioned term. Why, I wonder, was it chosen to market a film about the present?

Movie poster.

Contagion follows the “outbreak narrative” through which Americans now manage their confrontation with emerging infectious diseases. Beautifully laid out in Priscilla Wald’s recent book Contagious, the outbreak narrative features standard characters and tropes. Among the characters are the human carrier (a woman returning to the United States from a business trip to East Asia), the people she infects (an old boyfriend, her young son), the medical experts who reconstruct the microbe’s route (epidemiologists at the CDC and WHO), the bench scientist who develops a vaccine, and the charlatan hawking a useless homeopathic remedy. The movie also contains familiar tropes: the virus comes to the United States from somewhere foreign and dirty (East Asia); the human carrier is depraved (she acquires the virus while gambling and drinking abroad, then spreads it while having an adulterous layover on her way home); her depravity leads to the death of the innocent (her young son, followed by other millions); magic bullets produced in high-tech laboratories are the best response to an emerging pandemic; and medical experts are heroes who risk their lives to protect public health while the sellers of secret nostrums are cynical opportunists who threaten it.

Contagion is a word with a very long and rich past, but no medical present.

Strangely, however, this biomedical morality tale comes to us under a decidedly non-biomedical title. At least since plague writings of the 16th century, contagion theory held that disease could be spread by touch, whether of infected cloth or food or people, and recommended quarantine as the best defense. Many doctors remained contagion skeptics until well into the 19th century. They attributed fevers (as many infectious diseases were called) not to touch but to poisonous vapors or “miasmas” released by rotting organic material, dirty soil, and stagnant water. Public hygiene, they believed, was the best prevention.

The onset of pandemic cholera in the 19th century strengthened the case for miasmatists, not least because the main defense offered by contagionists against cholera, quarantine, manifestly failed to halt the disease. The miasmatic injunction to clean up filth, in contrast, worked quite well. Contagion and miasma remained the medical words of choice for talking about epidemics until the late 19th century, when experimental work in German and French laboratories produced the germ theory of disease and its microbiological approach to understanding and controlling infection. Contagion and miasma, terms that had once structured passionate debates among medical experts, ceased to carry medical meaning by the early 20th century. JAMA and other medical journals, indeed, have long since dropped the term except, interestingly, to describe psychological and/or social phenomena of transmission. Contagion, in short, is a word with a very long and rich past, but no medical present.

So, why use an outdated medical term to title a movie that casts modern-day experts as its heroes? Consider the biomedical alternatives: bacteria or virus, say, or infection or even emerging infectious disease. Terms such as these pack little punch for viewers in the developed world. After all, we have antibiotics, vaccines, and well-developed public health systems. The high mortality associated with killer epidemics such as cholera or plague are no longer part of our lived experience and neither are the primal emotions–fear, panic, grief–conjured up by those epidemics. Contagion, in contrast, is an altogether different kind of word. It is a living legacy of a time when epidemics could and did wipe out entire families and decimate cities in a matter of days, regardless of whether one believed in miasmas, contagions, or in desperation, a mixture of both. Today, contagion has lost its medical meanings yet retained those emotions and traumas of a past age. It is the perfect hook for scaring us into seeing a movie about something we no longer fear.

This is a useful reminder to anyone involved in public health. The field is rooted deeply in scientific method and language, of course, yet the publics whose health it aspires to improve do not necessarily share its outlook. To mobilize the will that is so necessary to see modern public health initiatives through, it may be that older words, ones that have shed their medical meaning but not their popular emotional resonance, are still useful. Consider Laurie Garrett’s recent best seller The Coming Plague. Would you have read the book if it had been called The Coming Virus? I didn’t think so.