Monday, April 10, 2006
You Give Me Fever: Pandemic, Passion, and Public Health in 1940s Gotham
BY NANCY BERLINGER

The first sentence of Albert Camus's The Plague reads: "The unusual events described in this chronicle occurred in 194- at Oran." The first sentence of Vincent McHugh's I Am Thinking of My Darling (1943) could be identical, except for the location. McHugh's novel is set in New York City, during the week after a virus, known as hlehhana, "the happy or laughing disease," arrives in town via a cruise ship from the Caribbean. The locals call it "the fever." The symptoms: euphoria and loss of inhibition. The cure: unknown. That McHugh's novel is also unknown to the medical humanities is a pity, for this is a cracking good read - a Jazz Age hybrid of detective novel and screwball comedy that just happens to be about public health ethics.

The city's commissioner of health views the "mass epidemic of good feeling" as a "problem of public order." All over town, spouses are leaving home, stores are giving away merchandise, and almost no one is showing up for work: "People who liked their jobs stuck with them. People who didn't cut loose. The proportion was about twenty-eighty." The public health challenge was not only to prevent the spread of a highly contagious virus, but to keep the city running. Even the mayor walked off the job, to dedicate his time to his real passion, model trains.

The hard-boiled hero and narrator of Darling is Jim Rowan, acting commissioner of the Department of City Planning. His passion, fortunately, is city planning. Author McHugh shared his hero's enthusiasm for urban infrastructure. After editing the acclaimed New York City Guide for the Federal Writers' Project, McHugh wrote a follow-up book called Under New York City. According to legend, a book about sewers, subways, and power plants couldn't find a publisher in 1941, due to fears about wartime saboteurs using it as their own guidebook. So McHugh converted unpublishable nonfiction into publishable fiction by adding sex, jazz, and an epidemic.

Darling is more than a period romp, though it will appeal to fans of Hammett, Chandler, and other detective novelists whose fast-paced plots unfold over improbably short periods. McHugh, who was also a staff writer for The New Yorker, is sincerely interested in the way civic leaders respond to urban public health crises. As Rowan tells one of his colleagues, "A city is just a lot of people who've agreed to live together in a certain general way. But if enough people - especially the key ones - decide they can't be bothered, the whole thing stops running." Appointed crisis manager by the City Council, Rowan draws up plans for consolidating crucial functions and quarantining essential personnel in each neighborhood to ensure equitable access to health and safety services. He consults with the physicians observing the cruise ship passengers to determine the course of the virus in humans, and with the researchers studying the virus itself, so he can take effective public health measures. By the end of the week, with nearly two million reported cases in the quarantined city, masks are being handed out on the street, and crude antiviral tablets are being distributed via packets stapled to newspapers. (Reporters and editors have stayed on the job, too.) Rowan reaches out to the pharmaceutical companies who will be enlisted to get a vaccine into production should one be developed. He searches for his wife, Niobe, who has a particularly bad case of the fever and has been spotted all over town, doing an Aimee Semple McPherson turn as evangelist for the Society for the Preservation of Happiness. He comes down with the fever himself, and mourns a colleague who drops dead of exhaustion in the midst of the crisis. He fends off posturing out-of-town politicians: the governor wants to declare martial law, while Congress has convened a Joint Subcommittee and sent him a subpoena.

Rowan also debates medical ethics with biologists and psychiatrists who are grappling with the need to prevent and cure happiness. In the interest of civic order, how far do you go to constrain personal autonomy? He reflects on his own professional ethics, taking exhausted "pride in being used, even used up, for the city." He learns about the history of quarantine, about 1918 and London's Great Plague, and about the extent to which contagion-control practices had - and had not - advanced since past catastrophes. He broods about the entrenched public health problems that existed before the fever and would remain after the fever had run its course: he describes Harlem as "the place where babies weren't allowed to live." He knows "every last statistic" about infant mortality, the "thing that canceled out all the other things we tried to do." And he finds time for inhibition-free sex with two fellow-sufferers. (Everybody's got the fever.)

The issues McHugh raises are the same ones bioethicists and public health officials are pondering today, as we conduct tabletop exercises to prepare for a pandemic, debate the ethics of vaccine distribution and ventilator allocation, and note, with mounting dismay, that rapid human-to-human transmission of avian flu is possible as the virus continues to mutate. No one dies of this fictional fever, but by showing us how even a "happy" pandemic plays havoc with society and diverts resources and attention from a city's poorest communities, McHugh reminds us that preexisting health care disparities must be taken into account when planning for and responding to disaster. Through his hero, he also reminds us of the particular heroism of those public servants who are willing, like Pericles in Athens, be "used up" for their polis.

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