“We ought to give it [hydroxychloroquine] a try . . . feel good about it. That’s all it is, just a feeling, you know, smart guy. I feel good about it.” – Donald J. Trump, March 20, 2020
“I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning? Because you see it gets in the lungs, and it does a tremendous number on the lungs. So, it would be interesting to check that.” – Donald J. Trump, April 23, 2020
“So, supposing we hit the body with a tremendous — whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body?” – Donald J. Trump, April 23, 2020
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Viewed from the standpoint of history of medicine, the Great Influenza (aka the Spanish Flu) of 1918-1919 and the Coronavirus pandemic of today, separated by a century, share a basic commonality. Both are pandemics of the modern era, where treatments for specific diseases grow out of the findings of laboratory science and scientific medicine. The development of serology, which transferred to humans, via injection, whatever antitoxins resided in the purified blood of immune animals, had by 1918 proven effective, albeit to varying degrees, with diseases such as rabies, diphtheria, tetanus, and typhoid fever.
Today we anxiously await the development of a Covid-19 vaccine. In 1918, health professionals and the public waited impatiently for new serums to combat gas gangrene and the pandemic flu. And given the state of medical progress of the time – viruses had yet to be identified and differentiated from bacteria – their optimism was reasonable. By the spring of 1918, 5000 units of an anti-gangrene serum had reached AEF hospitals in Europe, of which 2,500 units had been used by the time of the Armistice. For the Spanish Flu, two different injectable serums were available to overseas American nurses by the fall of 1918.
The predictable failure of these serums should not obscure the fact that in 1918 management of the Spanish Flu was squarely in the hands of mainstream scientists and physicians. Then President Woodrow Wilson stood back from the whirl of suffering and death around him. He maintained a steely silence about the whole business, refusing to mention the pandemic in even a single public address. His preoccupation with the war and ensuing Paris Peace Conference was total, and precluded even the simplest expression of sympathy for stricken Americans and their families. Here he anticipated by a century President Donald Trump.
Wilson held his peace. Now we behold President Donald Trump, who, in his own preoccupation with self-promotion and self-congratulations, buttressed by denial of the pandemic’s magnitude, cannot remain silent. Not even for a day. But what is he telling us? How is he helping us cope with the fury of another global pandemic? His musings – contradictory, impulsive, and obsessively self-serving – would have stunned Americans of 1918. For Trump seems to have dispensed with scientific medicine altogether. To understand his “spin” on the pandemic, we must go back much further than the Great Influenza and look again at the Black Death of the mid-14th century.
In October, 1347, a vessel, probably originating off the Crimean Peninsula, docked in Messina, Sicily. It was laden with infected rats, themselves laden with infected fleas. Together, the rats and fleas brought the Black Death, likely a combination of bubonic and hemorrhagic plague, to Europe. Physicians of the time, wedded to Hippocratic and Galenic notions of illness and health, confronted plague with the therapeutics derived from this paradigm. Bleeding (venesection) was typically the first order of business, since blood was associated with body heat. Bleeding would cool down a body overheated by fever and agitation, thereby restoring balance among the four humors that corresponded to the four elements of the universe: black bile [earth], yellow bile [fire], phlegm [water], and blood [air].
When bleeding and the regulation of Galenic non-naturals (food and drink, motion, rest, evacuation, the passions) failed to restore health, physicians turned to what was to them an observable fact: that plague was literally in the winds. It was contained, that is, in miasmic air that was unbearably foul-smelling, hence corrupt and impure. For some, the miasma resulted from a particular alignment of the planets; for many others it was pinned on the Jews, a poisonous race, they believed, that sought to poison the air. But for most European physicians, no less than for priests and laymen, the miasmic air came directly from an enraged God who, disgusted with sinning humankind, breathed down the corrupt vapor to wipe them out.
How then, were 14th-century physicians to combat a pollution of Divine origin? Galen came to the rescue, with heat again at the center of plague therapeutics. Heat, it was known, had the ability to eliminate foul-smelling air, perhaps even lethally foul-smelling air. What was needed to combat plague was actually more heat, not less. Make fires everywhere to purify the air. This was the advice Guy de Chauliac, surgeon to the Papal Court in Avignon, gave Pope Clement VI, whose presumed sanctity did not prevent him from isolating himself from Court and servants and spending his days seated between two enormous log fires. Among the infected, a more draconian application of heat was often employed: doctors lanced plague victims’ inflamed buboes (boils) and applied red hot pokers directly to their open wounds.
Medieval thinking also led to treatments based on Galen’s theory of opposites. Purities cancel impurities. If you want to avoid the plague, physicians advised, drink copious amounts of the urine of the non-infected; collecting and distributing healthy urine became a community project throughout the continent. If you were of means and would rather not drink urine, the ingestion of crushed sapphires would work just as well.
English peasants adopted a more benign path to purification: they stuffed their dwellings with sweet scented flowers and aromatic herbs. Here they followed the example of Europe’s plague doctors, those iconic bird-men who stuffed the huge beak extensions of their masks with dried flowers and odoriferous herbs to filter out pestilence from the air they breathed. Good smells, after all, were the opposite of airborne foulness.
a 14th-century plague doctor, dressed to ward off the miasma
On the other hand, in another variation of Galenic thinking, physicians sought a dissonant foulness powerful enough to vanquish the foulness in the air. Villagers lined up to stick their heads in public latrines. Some physicians favored a more subtle variant. They lanced the infected boils of the stricken and applied a paste of gum resin, roots of white lilies, and dried human excrement. The synergism among the ingredients, they believed, would act as a magical restorative. This, in any event, was the opinion of the eminent Italian physician Gentile da Foligno, whose treatise on the Black Death was widely read and who, inter alia, was among the first European physicians to study plague victims by dissecting their corpses. Needless to say, the treatment did him no good, and he died of Plague in 1348. Other physicians developed their own topical anodynes. Snakes, when available, were cut up and rubbed onto a plague victim’s infected boils. Pigeons were cut up and rubbed over the victim’s entire body.
Now, 672 years after the Black Death wiped out more than 40% of world population, we behold an astonishing recrudescence of the medieval mind: we are led through a new plague by a presidential medievalist who “feels good” about nonscientific remedies based on the same intuitive search for complementarities and opposites that medieval physicians proffered to plague patients in the mid-14th century. Heat kills things; heat obliterates atmospheric impurities; heat purifies. Perhaps, then, it can rid the body of viral invaders. Disinfectants such as bleach are microbe killers. We wipe a counter top with Clorox and rid it of virus. Can’t we do the same thing by injecting bleach into the human body? What bleach does to healthy tissue, to internal organs, to blood chemistry – these are science questions an inquiring 8th grader might put to her teacher. But such questions could not arise to a medieval physician or to Donald Trump. They simply fall outside the paradigm of Galenic medicine in which they operate. In this world, with its reliance on whole-body states calling forth whole-body, re-balancing interventions, there is no possibility of weighing the pros and cons of specific treatments for specific ailments (read: different types of infection, local and systemic). The concept of immunological specificity is literally unthinkable.
Injecting or ingesting bleach has an internal logic no greater than that of the 14th-century Flagellants, who roamed across continental Europe in a frenzy of penitential self-abuse that left them lacerated if not dead. It made perfectly good 14th-century sense – though not, be it noted, to Clement VI, who condemned the practice as heretical. Withal, the Flagellants believed that self-mortification and the excruciating pain it entailed could assuage a wrathful God and induce Him to stop blowing death down on humankind. But science belied their self-purifying intentions. The roving Flagellants, leaving paths of infected blood and entrails behind them, became a vector for the transmission of plague. For our medieval president, the path is one of toxic verbal effluvia no less dangerous than infected blood and entrails in spreading Covid-19.
We want to believe that no one living in 2020 can possibly lend credence to anything Trump has to say about infectious illness, virology, pandemics, scientific research, and post-medieval medicine. When it comes to Covid-19, he is an epistemic vacuity whose medieval conjectures would never make it past the family dinner table or the local bar. But he is the president, and he speaks with the authority of high office. So his musings, grounded in Galenic-type notions and feelings, have an apriori valence. As such they will continue to lead many astray – away from prudent safeguards, away from mainstream medicine, indeed, away from an appreciation of the scientific expertise that informs these safeguards and treatments.
Hippocratic-Galenic medicine, with its notions of balance, synergy, complementarity, and opposites, retains its appeal to many. But prescientific, feeling-based intuitions about disease are always dangerous, and positively deadly in a time of global pandemic. In the aftermath of Trump’s pronouncement about the logic of injecting household disinfectants to combat Covid-19, poison control centers across the country were flooded with inquiries about the advisability of imbibing household bleach. As to hydroxychloroquine, “More Deaths, No Benefit from Malaria Drug in VA Virus Study,” reported AP News on the first use of hydroxychloroquine in a small-scale nationwide study of VA patients hospitalized with Covid-19.
Is this surprising? Whether or not hydroxychloroquine or any other drug or household disinfectant or chopped up animal remains is safe and effective against Covid-19 is an empirical question subject to laboratory research and clinical study. But who exactly sets the agenda? Who, that is, decides which existing pharmaceuticals or household products or smashed animal parts are worthy of scientific investigation? Experts with knowledge of pharmacology, infectious disease, and virology or an intellectually null and void president for whom science matters only as a handmaiden to political objectives? Pity those who follow him in his medieval leap of faith.
By fanning the flames of Hippocratic-Galenic notions about heat, light, the neutralizing effect of opposites, the shared efficacy of substances with complemental or analogical properties, Trump himself has become a vector for the transmission of plague. Bleach kills microbes on a counter top. Shouldn’t it therefore kill the Covid-19 virus in the human body? Hydroxychloroquine kills the protozoan parasite Plasmodium that causes malaria. Shouldn’t it therefore kill Covid-19 viruses within the human body? Wouldn’t a really “solid” seasonal flu vaccine provide people with a measure of resistance to Covid-19? No, no, and no. Would that Mr. Trump would “feel good” about a more benign medieval variant, perhaps donning a garland of garlic cloves at press briefings. Better still, following the example of the plague doctors, he could wear a mask in public, if only to satisfy those of us whose heads are not buried in medieval muck. Given the clear and present danger of his treatment preferences to public health, however, we would be best served if he were simply muzzled until election day.
Copyright © 2020 by Paul E. Stepansky. All rights reserved. The author kindly requests that educators using his blog essays in their courses and seminars let him know via info[at]keynote-books.com.
Medicine, Health, and History 