Christopher Hamlin - More Than Hot: A Short History of Fever

MORE THAN HOT

JOHNS HOPKINS BIOGRAPHIES OF DISEASE
Charles E. Rosenberg, Series Editor

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Christopher Hamlin, More Than Hot: A Short History of Fever

A Short History of Fever

Christopher Hamlin

2014 Johns Hopkins University Press

All rights reserved. Published 2014

Printed in the United States of America on acid-free paper

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Library of Congress Cataloging-in-Publication Data

Hamlin, Christopher, 1951

More than hot : a short history of fever / Christopher Hamlin.

pages cm (Johns Hopkins biographies of disease)

Includes bibliographical references and index.

ISBN-13: 978-1-4214-1502-4 (pbk. : alk. paper)

ISBN-13: 978-1-4214-1503-1 (electronic)

ISBN-10: 1-4214-1502-X (pbk. : alk. paper)

ISBN-10: 1-4214-1503-8 (electronic)

1. Fever. 2. EpidemicsHistory. 3. Public healthHistory. I. Title.

RB129.H36 2014

614.5'112dc23 2013050172

A catalog record for this book is available from the British Library.

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, by Charles E. Rosenberg

Disease we have always had with us. Our ancestors suffered pains in their joints, debilitating coughs and exhausting diarrheas, sore throats and bloody urine, painful and sometimes mortal swellings. Ancient bones tell us that pathological processes are older than written records. And written records tell us that there has never been a time when men and women have not elaborated ways of explaining the incidence and nature of such illsoften in connection with ideas about their prognosis and treatment. Medical and social historians, historical demographers and epidemiologists, all have sought to diagnose past sicknessbut rarely in the terms in which past actors understood those ailments. Most older descriptions and terminology do not track easily onto twenty-first-century categories and understandings.

Such terms as dropsy, continued fever, old age, and bloody flux no longer populate our death certificates. They seem vague, imprecise, even quaint; we take for granted a rather different repertoire of specific disease entities. We have come to think of these disease entities as having a characteristic clinical picture, that picture the consequence of an underlying mechanism of some sortwhether it be a microorganism, a malfunctioning kidney, or a genetic mutation. And we have come to think of these entities apart from their manifestation in the bodies of particular men and women. Of course each of these specific entities has a history and a geographical distribution connected to that history. Thus the rationale underlying the Johns Hopkins University Presss biographies of disease. The very term biography implies a coherent identity and narrative, a discernible movement through time.

But it can in some ways make it difficult to reconstruct the past in the past actors terms. Men and women in classical Athens or Chaucers England or Samuel Johnsons London did not share our notions of disease causation or our assumption of specific disease categories. This may seem no more than a statement of the obvious, but retrieving those historical assumptions and linked perceptions is no easy taskand can in fact be made more difficult by our natural tendency to retrieve the past history of disease in twenty-first-century terms. It brings with it the mixed blessing that comes with shining a flashlight into a murky basement. The flashlights beam serves as a useful kind of sampling device, but one that illuminates only a portion of an otherwise elusive reality.

Christopher Hamlin has embraced a rather different strategy. In writing a biography of fever, he has chosen a subject that most readers today would call a symptomand not a disease at all. Yet for most of written history, fever was an omnipresent and protean reality, a brutally real reality that threatened incapacity and often death and was an unavoidable part of everyday domestic experience. Fevers were not marked by heightened temperature alone as the twentieth- or twenty-first-century reader might automatically assume. As Hamlin emphasizes, fevers before the mid- to late nineteenth century included heightened sensory perception, often a feeling of burning heat and sometimes subsequent chills, disorientation and even delirium. Some fevers could have a short, intense course, others a long-drawn-out and anxiety-provoking clinical history, before the patient died or recovered; some were associated with skin lesions, others not. Some showed characteristic patterns of what a modern physician might describe as recurrent spiking. And this protean condition was not associated primarily with infectious disease (itself a comparatively modern and thus anachronistic category) and the bodys reaction to it, but was primarily an individual, aggregate, multicausal response to a peculiar configuration of circumstancesincluding, as in certain intermittent fevers, for example, proximity to damp and swampy environments. Fever was very much a thing in history, even if we would today call it a symptom, a tactic deployed by the body as it responds to a stressful stimulus or internal disorder.

Hamlin traces a complex history of ideas about fever over time, from classical antiquity through the nineteenth century and into the twentieth. For much of this time it is necessarily a story of texts talking to texts as concepts of fever were passed on, modified, elaborated, controverted. Such constructions and reconstructions of fever reflected the very omnipresence of the phenomenon they sought to describe and explain. Thinking about fever meant thinking with fever. What did its incidence reflect about the styles of life and social and physical circumstances in which the feverish body was shaped into being? Was it diet, imprudent work, an inimical physical environment? In the late eighteenth and nineteenth centuries were certain fevers a response to the unnatural and thus pathogenic world of the crowded city and of industrial work?

All this was to change. By the late nineteenth century the capacious and inclusive thing called fever was being disaggregated into a series of discrete entitiesmalaria, typhus and typhoid fevers, influenza and childbed fever. Fevers were by the end of the nineteenth century not phenomena that needed to be understood primarily in terms of the unique characteristics and life events of individual bodies but things that could be understood and imagined outside those individual sufferers. Pathology and bacteriology, the tools of the laboratory, had extracted entities defined by mechanism and clinical course from what seemed to later scholars the seemingly formless mass of pre-nineteenth-century fevers. The thermometer and antipyretics had helped narrow and shape the ancient experience of fever into