Bad Bugs Bookclub Meeting Report: A Prayer for the Dying by Stewart O’Nan

The aim of the Bad Bugs Book Club is to get people interested in science, specifically microbiology, by reading books (novels) in which infectious disease forms some part of the story. We also try to associate books, where possible, with some other activity or event, to widen interest, and to broaden impact.

We have established a fairly fluid membership of our bookclub through our website In The Loop ( but we hope to encourage others to join, to set up their own bookclub, suggest books and accompanying activities to us, and give feedback about the books that they have read, using our website as the focus for communication.

Our bookclub comprises both microbiologists and members of the general public. We felt that this would encourage some discussion on the science – accuracy, impact etc – as well as about the book.

A Prayer for the Dying (1999) by Stewart O’Nan tells of the effect of a virulent epidemic on a Wisconsin town just after the Civil War (which finished in 1865). Jacob Hansen is the town’s sheriff, undertaker and pastor, and the novel describes the impact of the epidemic on him and his sanity.

Discussion

This is the first book we have read which is written in the second person and present tense, which gives the reader a different perspective – as if we sit on the shoulder of Hansen. We only have his view on what is happening.The novel is relatively short, yet slow paced, and easy to read in terms of language, if not of content. Being set in a small town in an agricultural/forested area, there are some unfamiliar terms used, but they did not distract from the flow. The novel develops into a darkness encompassing madness, violence, religion, cannibalism, necrophilia and death: the disease itself provides the cause of many deaths, but is the trigger for others.

The author acknowledges Michael Lesy’s Wisconsin Death Trip (1973) which is a non-fiction book comprising a collection of late 18th century photographs and accompanying local news reports (Black River Falls, 3000 population in 2010). There is a significant focus on death and disease as well as crime and mental illness.

The novel is described as ‘a deeply unsettling and sophisticated horror story...an exploration of evil and solipsism’ (the philosophical idea that only one’s own mind is sure to exist – illustrated by the first person/present tense narrative). Some of our members were indeed disturbed by the story ‘emotionally involving rather than enjoyable’: we considered the impact of his experiences in the Civil War (now recognised as post-traumatic distress syndrome) on his desire – atonement? - to support the town by looking after its criminal, spiritual and bodily nature – but the effect of the outbreak on the disintegration of his mind, and the destruction of his family, the town and its inhabitants reveal the fragility of humanity both in body and spirit. We agreed that it was a horror story, with some of the imagery being extreme, for example the inadvertent deaths of people trapped in ‘plague houses’ destroyed by fire, and the killing of the cow, and indeed the descriptions of cadavers.

In terms of infection, the disease is described by the townspeople as diphtheria. However, this outbreak is 100% lethal, whereas diphtheria, although highly infectious, is around 5-10% fatal. Perhaps it wasn’t diphtheria, but another manifestation of contagion; disease or otherwise. It seems to have originated from the isolated religious community, and a sexual encounter, and was spread extremely effectively by contact with inanimate objects (fomites), as well as directly from infected to uninfected individual. Animals also appear to be affected.The symptoms are not described in much detail, and they do not particularly replicate the symptoms of diphtheria.

The control strategy for prevention of spread of the outbreak was a self-imposed quarantine. Jacob prevented his wife and daughter from leaving, as well as the rest of the town. Numbers attending church decrease significantly – through death and through loss of belief in the pastor as leader. Isolation of households did not seem particularly successful when individuals are working freely about the town: the one hermit who had survived is killed after Jacob gives him a knife – which confirms Jacob as a (the?) key asymptomatic vehicle for the spread of infection. He deliberately ignores the essential cross-infection procedures when preparing bodies for burial, being torn between respect for the dead and the doctor’s instructions. The doctor is vehement that patients should not be touched. We felt that Jacob knew he was the carrier before the confirmation provided by the hermit: why did he continue to risk infecting others? [Mapping the transmission of disease and the spread of infection is a valuable epidemiological tool. In the week of our meeting, the BBC launched an app (BBC Pandemic), a citizen science project which would enable mapping of contacts, informing epidemiologists in preparation for influenza epidemics and pandemics.]

We have previously read novels where self-imposed quarantine was a strategy for disease control (Year of Wonders, describing Eyam in Derbyshire during the plague of 1666); in The Last Town on Earth (a lumberjack town on America’s west coast) the uninfected town isolated itself from the influenza pandemic that was prevalent all around. The success of these strategies is always questioned.

There seems to be little offered in the way of treatment (a mint plaster around the neck). There is no cure and no survival. Houses of the afflicted are burned. Animals are also affected: we checked, and found out that cats, dogs, horses, and cattle can be affected – and that raw milk is also a vehicle for transmission.

In England and Wales, in the 1930s, diphtheria was the third leading cause of death in children. Vaccination was introduced in the 1940s, and since 2010 there have been 20 recorded cases, indicating a successful vaccination protocol and the importance of coverage. Our meeting coincided with the declaration that measles had been eradicated in England and Wales (no cases for 3 years) – again due to the vaccine. In the 1990s when the Soviet Union broke apart, a breakdown in vaccination schedules resulted in 157,000 cases and 5,000 deaths.

Ultimately, fire cleanses the town of its remaining inhabitants and the disease. We assume that Jacob is lost with the town – but he has a strong drive for survival (avoiding the fire by immersion in water)...

Although the novel names the disease as diphtheria, we have no real evidence for this diagnosis: we could instruct students to find out about diphtheria and compare epidemiology and symptoms with this outbreak, but we felt that the other elements – psychology, madness – were less appropriate for undergraduate discussion.

Joanna Verran