Plague Plots: Dispatches from Sinclair Lewis

Can a novel's depictions of healthcare workers in a plague-ravaged land inform our thinking about the lives of those who try to save lives?

Ebola - well treated and countered here - is still taking a deathly count over there; with doctors and nurses succumbing.

Injecting an experiment, amid plagues of doubt, and plagues of resistance

Ninety years ago, Sinclair Lewis novelized two medical researchers and a nurse hurrying to test an experimental bacteriophage that might stem a Bubonic plague epidemic on an imagined island in the Caribbean.

In the novel - Arrowsmith - the reader is injected with an appreciation for
• the risks of contagion and contraction;
• the cultivated disbelief of local officials, exporters, and tourism promoters bent on protecting commercial interests;
• the financial stakes prized by a scientific institute with a big pharmaceutical bet on the outcome of a clinical trial; and
• the control-group dilemma weighing on the infectious-disease researcher who has to withhold his possibly life-saving solution from many doomed suffers, so that he can amass definitive scientific proof of the effectiveness of his injections.

St. Hubert, West Indies. 1919 - 1920.
Three-quarters of the way through Sinclair Lewis' Pulitzer Prize winning novel, nurse Leora Arrowsmith accompanies her husband, the brilliant medical researcher Dr. Martin Arrowsmith, to a fictional Caribbean island overwhelmed by Bubonic plague.

For the novel's Caribbean chapters, Sinclair Lewis also invented a character who seems to be the precursor of Dr. Paul Farmer - years before that self-sacrificing for-real infectious-disease warrior (Infections and Inequalities: The Modern Plagues, 1999) and his Partners in Health non-profit came on the scene in Haiti (to deal with TB and HIV).

This character, Dr. Gustaf Sondelius, is the novel's "soldier of science." Like the 21st century Dr. Paul Farmer, Sondelius is an admirable eccentric who travels around the world fighting disease without concern for his livelihood or his life. Buoyant, tireless, stubborn, he charges into the domains of disease-carrying rats - hell-bent on their extermination. With abandon, incautiously, does he charge too often?

To treat, perchance to cure
Can Martin Arrowsmith's infectious-disease-destroying bacteriophage turn back the contagion? Should he maintain the controls his sponsoring institute requires for scientific proof of his injection's effectiveness, which would most certainly bring honor and commercial renown? Could he live with glory bought at the expense of lives lost, as a result of withholding and depriving? To spare himself plagues of conscience, should he abandon clinical trial protocols, and fully treat all those afflicted? And, back in the island's lab, have safeguards been sufficient and rigorous so that his wife (a nurse) will not contract the disease by mishap?

The Geography of Transmission

In the novel, disease-bearing rats (and their fleas) have migrated from China to India, then by sea on to France, then (tramp-steamer long haul) to Uruguay, before traveling by cargo schooner to St. Hubert, an island near Barbados.

Denial can be an infectious disease
St. Hubert's surgeon general is in denial, first maintaining that a plague "did not and could not exist" in the Lesser Antilles climate. When carts stacked with corpses trundle the streets, he declares, "Even if it was plague, which is not certain, there's no reason to cause a row and frighten everybody. It was a sporadic case. There won't be any more." This is followed by a cable: "No real epidemic. No need for help."

The governor of the island is a denial-ally who is keen on protecting business interests - the island's export and tourism enterprises. His pronouncement is meant to veto talk of quarantine: "There's only been a few deaths and I think it's all passed over."

Preventative measures
But the island was "belching a hot miasma" and conveying "the scent of the tomb." Cargo ships leaving the island have to be halted and anchored at sea to halt the spread, and dispose of their dead.

In New York, in his microbic-pathology lab, handling "test-tubes charged with death," Dr. Arrowsmith is ridiculed for wearing "rubber gloves, high leather boots, straps around his sleeves...."

His lab associate, Dr. Gustaf Sondelius, who will become on-island chief of rat-extinction, will take only modest precautions against scampering rats and their agile fleas; he'll stomp around in high boots, wrapping straps around his wrists, and fashioning a rubber neck band. He'll refuse to take the phage injections until all sufferers have received it.

Sondelius, rat-exterminator extraordinaire, is also an insistent promoter of isolation protocols. He cajoles by recalling epidemic-fighting challenges in Mongolia and India. To convert and win over opponents of quarantines, "He assured them that if they did not cease being politicians, the plague might cling to St. Hubert forever, so that they would no more have the amiable dollars of the tourists and the pleasures of smuggling."

Quarantining one's humanity, to advance science

Sealed in tiny ampules is the "stuff of salvation" fresh from beakers and flasks in a special lab funded by an institute which hopes to parlay its science so as to recoup its "investment."

On "the death-haunted isle," Dr. Martin Arrowsmith waivers, then stiffens, and then waivers. He has been told that to advance science, he must not yield to compassion, but must harden his heart and "willfully withhold salvation."

He had long labored in a lab trying to conceive antibodies and immunotoxins that would "make the world aseptic." Protocols and prospects contaminate his thoughts.

Will Ebola remedies be likewise challenged?