On the night of February 7, 1734, Elizabeth and John Byon lay in a rented room that they could barely afford. John was a fan painter and he paid two pence to Magdalen Jones for one night’s lodging so that he and Elizabeth could get off the street. Elizabeth was extremely sick. John tried to explain away his wife’s weakness by telling Magdalen that she was drunk. But when what a servant would later describe as “dismalgroans” emanated from Elizabeth’s bed, Magdalen came upstairs to check what was wrong. John was afraid that Magdalen would turn them out if she knew the nature of Elizabeth’s illness, so he lied again. Changing his story he now said that Elizabeth had a cold. He had good reason to worry. Magdalen was not fooled. She ordered them out, and refused to allow them to lie in the house, despite the couple’s pleas to let them stay until morning. “You told me your wife was only drunk, but she is rotten with the Pox, she shall not lye here, and so take your Groat again, and take your Time to dress her, and carry her out.” Magdalen’s husband became impatient for them to quit the house. Not allowing them to finish dressing, he forced them into the street. It was 10:30 at night, and it was February. John helped Elizabeth to a bench where he finished dressing her. They tried to move on but they had nowhere to go. Elizabeth made it just a few blocks before she collapsed in the street and died.

John and Elizabeth had lain for two nights on the pavement in front of a churchwarden’s door, but their settlement details were contested. They sought relief in St. Ann’s, but the officers would not acknowledge them as settled parishioners. St. Ann’s officers refused to accept them without a pass from St. Giles. So they gave up seeking alms in St. Ann’s and made their way across town and into St. Giles, where Magdalen Jones lived. They may have come into the parish too late in the evening to apply for relief. Perhaps they planned to apply at the workhouse in the morning.

People of means did not lack for medical options when they contracted the “foul disease” in early modern London. This book is not about people of means. However, an understanding of the experience of poverty and the pox demands a point of comparison. For that reason we should first consider the place of the foul disease within the oft-described medical marketplace of Stuart and Georgian London. If one had money to spend, what were their options? There is no doubt that there were plenty of customers for anyone who could relieve the suffering just described. There was a rich living to be made in the trade in pox-cures, and the powerful economic force of demand indeed spurred vibrant activity in London’s medical market. Few corners of the early modern medical market could challenge VD care for the range of therapies or providers. The range of the market response to the pox was driven, not just by the widespread incidence of the disease, but also because of the unique nature of the pox. Patients diagnosed foul tended to have particular demands that others who suffered from more banal ailments did not. Attempts to provide this huge customer base with services for these unique demands resulted in a rich range of medical services. Thus there were a wide array of options for the poxed, but they were frequently not cheap. And there is the rub. For early modern London had a two-tiered medical system, to use modern parlance; private fee-based care of the market existed alongside publicly funded care for the poor. The bulk of this book will explore the forms that such public care took. But to make the most sense of it we must first explore VD care in the private sector, and this means first studying care for middling and well-off Londoners.

In addition to the desire to ease their physical suffering, which all medical customers sought, venereal patients also made unique demands springing from the socio-cultural reactions specific to the pox, namely its stigma. There has been some disagreement regarding the relative stigma attached to the disease over the long period. Some scholars have asserted that early modern sensibilities regarded venereal infection with cavalier light-heartedness, particularly during the Restoration.

In the summer of 1746 London hospital provision for the poor with venereal disease entered a new phase. Surgeon William Bromfeild placed advertisements in the London Evening Post and the Daily Advertiser inviting donations for a new charitable hospital for impoverished patients suffering under the disease. Within six months his new charity had solicited enough support to launch the venture officially. The new London Lock Hospital opened its doors in January 1747. Unlike the royal hospitals supported by rents, or the workhouses supported by the public poor rates, the Lock was a private endeavor. That hospital would stand at the center of London, indeed of British hospital venereology for three centuries.

Why did Bromfeild open the Lock if there were already so many institutions treating the pox? If hospitals were not shunning venereal patients, as standard historical accounts have held for so long, then why did Bromfeild and his supporters embark on this endeavor? It was clearly not launched on a whim. The administration struggled mightily, but successfully, just to keep the hospital afloat during the difficult early decades. The hospital survived the turbulent eighteenth century and eventually found the stability to last all the way to 1952. This is an impressive record. We must ask what drove the founders? Why was this hospital, which seemed to offer services already offered by many other London institutions, considered necessary by the late 1740s? London charities were many and the competition for benefactions was stiff. How did the Lock Hospital convince English benefactors to support its mission? It is worth considering what was unique about the Lock Hospital and what niche it filled.

If it was not to provide care that was otherwise lacking, perhaps its mission was linked to a wider reforming agenda. Along with the idea that the Lock represented new tolerance, the idea that a reform program drove the charity has been one of the central assumptions of the scholarly work done on the Lock.

Many Londoners could not avail themselves of the services that the market provided. This posed a problem. What can be done, lamented surgeon Charles Peter in 1693, for “those poor unhappy wretches where the Pox and Poverty are complicated”? In a sense, that is the central question of the remainder of this book. Such folk were not entirely without options in the seventeenth century, as scholars have sometimes presumed. One of their main options lay in one of the two royal hospitals that offered venereal care, St. Bartholomew’s and St. Thomas’s. However, contemporaries did not always see these as a desirable choice. An anonymous commentator criticized hospital foul wards, claiming that “more rude Ignorance, and slighter Management in curing this disease, has not been heard of, than in these places.” He went on to claim that “some that have undergone their common unctions there, and come forth uncured, have protested they had rather chuse to dye, than to return thither again.” In 1696 a doctor named Wall similarly described the “Despised Hospitals and Lock Nursery” that represented the only resort for paupers who had been taken advantage of by ruthless quacks who took their meager pennies and sold them phony cures.

Wall’s depiction of seventeenth-century hospital VD care is notable for its lack of a clear opinion; it is a description that, though brief, captures well the tension and difficulty inherent in trying to sum up early modern hospital provision in simple terms. On the one hand, Wall offered rather little hope to the “captives” who resorted to the foul wards, where they might find themselves “reduc’d . . . to a dribling Condition” by the substandard care and “slack attendance” that characterized hospital therapeutics. Yet despite that grim picture he also acknowledged that the foul wards still “furnish[ed] out more Mercy to the Afflicted” than the dog-eat-dog market from which paupers were excluded. Wall’s depiction is generally accurate, exaggeration notwithstanding. There can be no question that hospital patients faced inferior care when compared on many counts to the care available to paying patients. However, before gauging that care we must first acknowledge the absolutely impressive scope of both hospitals’ provision for venereal patients, which has been largely unrecognized. The royal hospitals steered quite significant resources towards tackling the complicated problems of poverty and the pox, and saw venereal patients as worthy objects of that significant charity.

Extremely high incidence of the pox in the mid eighteenth century necessitated more ward space for London’s venereal poor. This may seem strange since the royal hospitals had large operations, and parishes treated an increasing number of patients within workhouses. By the 1740s there were more hospital beds for the city’s poxed poor than ever before, and thus the Lock’s emergence in that decade still confuses. Understanding the Lock’s original purpose ultimately rests on understanding how it related to the pre-existing network of medical institutions. When we consider the Lock within the wider context of the city’s medical welfare system, it becomes clear that its purpose was to fill a particular niche within that system. Despite the growing number of beds in London’s foul wards a particular portion of the city’s population remained neglected, and the Lock Hospital tried to fill the gap. It is only by considering the Lock in relation to the broader social welfare network that its unique character may be understood. Once understood, we can better compare the experiences of its patients to those we have already encountered.

The need for more hospital beds for venereal patients was acute in the early to mid eighteenth century. Demand continued to outstrip supply when it came to hospital beds for the pox. By the time William Bromfeild convened a meeting to found the Lock Charity, London had witnessed the establishment of yet two other major hospitals that cared for venereal patients, Guy’s Hospital in Southwark, and the London Hospital in the East End.

Guy’s Hospital, established in 1727 by famed benefactor Thomas Guy, originally intended to care for “incurables”—that is, those that other hospitals refused because their conditions seemed too desperate to cure successfully. Considering this original mission, it is surprising that foul wards came to house a significant portion of Guy’s patients. Unfortunately, the vast majority of Guy’s Hospital’s administrative records were not available for consultation at the time of this study.

An event that cannot be anticipated, an occurrence we might call a random happening, is inevitably a source of uncertainty, if for no other reason than we do not know when it will occur. At a personal level, we may be familiar with many such events: an automobile accident, a fire or burglary at home, the sudden death of the family breadwinner, and sadly, even a surprise terrorist attack. But there are other misfortunes that can occur on a regional or even global basis, equally sudden, equally catastrophic. We are familiar with such events also, although perhaps not through direct personal experience: a flash flood, a widespread power failure, a devastating earthquake, a major volcanic eruption. Whether personal or more widespread, all are events that we fervently hope never to experience. Yet we know that on any given day there is a small, but not infinitesimal, probability that our lives may be touched by one or another of such events. Accordingly, we have developed some common strategies to deal with their consequences. The mechanisms we employ to cushion us from the consequences of these unwanted and unanticipated events include emergency preparedness and insurance, both examples of our tendency to look to the future with caution.

EMERGENCY AND DISASTER PREPAREDNESS

In the immediate and personal environment of our home, we often take steps to forestall catastrophe.

Science, as Rachel Carson observed, is a part of the very fabric of life. It has its strengths and weaknesses, its successes and failures, its doubts and uncertainties. As scientists attempt to understand how a cell malfunctions to produce cancer, how a gene transmits information to guide an organism's development, how an ecosystem responds to urban sprawl, or how the entire Earth responds to long-term changes in the chemistry of its atmosphere, these investigations are enveloped with uncertainty at every stage. The uncertainty arises in many ways, and the nature of the uncertainty may change through time, but the scientific endeavor is never free of uncertainty.

Has science been debilitated by uncertainty? To the contrary, the successes of science, and indeed there are many, arise from the ways that scientists have learned to make use of uncertainty in their quests for knowledge.

At a fundamental level, scientific uncertainty begins when we make measurements. What do we use to make a measurement? How well can that tool accomplish a measurement? To what precision can we determine the size or mass or temperature of an object? If we repeat a measurement many times, how closely will the individual measurements agree with each other?

Professor Paulos' comment about measuring bacteria was made in an unusual context that I will tell you more about later. The remark underscores, however, the importance of selecting a measuring device appropriate to the task at hand. One does not need the experience of a laboratory scientist to recognize that the likelihood of obtaining an accurate measurement of the length of a bacterium using a yardstick is intrinsically low. The smallest subdivision of the yardstick, usually 1/16 of an inch, a little less than two millimeters, is so much greater than the dimension of a bacterium (actually about 10,000 times greater) that, on the one hand, one cannot say much more about the length of a bacterium other than it is very much smaller than 1/16 of an inch. On the other hand, a yardstick could, in principle, estimate the length of five million bacteria lined up end to end.

Most textbooks of physics or chemistry introduce uncertainty in the context of measurement.

Predicting the future … how enticing a prospect. Predicting the future has become a business for many. We can find, with only a little effort, fortune-tellers, clairvoyants, palm readers, astrologers, mystics, seers, psychics, and many others who will gladly reveal the future, for a price. But we all should be more than a little skeptical that any of these occult practitioners have special access to the future. Even economists and professionals who use less mystical tools – climatologists, actuaries and pension fund managers – find the distant future obscure and the pathway to it full of potholes. A principal theme of this chapter is that the future is a moving target, that divining its characteristics is always tough, and that it gets tougher the further ahead one tries to see. My philosophy for dealing with such uncertainty is to develop a long-term vision and make plans to move ahead – but to be prepared for many course corrections along the way, as the future unfolds quite differently than you have anticipated.

We all have heard that the only things certain about the future are death and taxes. This favorite adage surely captures the truism that most of the future is filled with uncertainty. The uncertainty is not uniform, however, and some aspects of the future are clearer than others.

The historical sciences such as archeology, geology, and astronomy are burdened with a special form of uncertainty known as non-uniqueness. When trying to understand why something happened the way it did, these scientists must try to reconstruct the circumstances of the event, and make hypotheses about the processes that governed the event. But as we try to reconstruct an historical event, we deal with an incomplete record. And with an incomplete record of an only partially understood process, there may be more than one way that the evidence can be explained. In other words, we must live in the shadow of non-uniqueness. At any given time, the incomplete evidence may admit many interpretations, and at a later time, additional evidence may eliminate some of those possibilities.

Dealing with uncertainty about the past is a way of life with geologists, who in their work of reconstructing natural history are always working with half a deck or less. Nature is not a mindful conservator, and the inevitable consequence of time is that the record of what happened long ago becomes degraded and fragmentary. In their efforts to understand and interpret incomplete information, geologists always work with a handful of provisional scenarios relevant to explaining their observations.

The very term ‘experiment’ implies uncertainty, because why would one want to conduct an experiment if the outcome is certain? The goal of experimentation is to learn something new about a system, something that is unknown, or only poorly understood. Experiments are a natural outgrowth of models, because a model, whether conceptual, physical or numerical, will always be a simplified representation of a system, and experiments with this model help us to understand its strengths and weaknesses. In terms of consequences, the simplifications embodied in the model may not matter under many circumstances, but then along comes the special situation when the model becomes vulnerable. In this context, models invite experiments that put them to the test, in a process of validation.

Just as model building begins with a concept, a mental image of how something is constructed or functions, so also does experimentation begin with what are called ‘thought experiments’. These experiments are mental forays that explore the consequences of assumptions or possible paths of action. Albert Einstein was a firm advocate of thought experiments; many of his early concepts about relativity stemmed from his attempts to visualize how the universe would appear if he were to hitch a ride on a beam of light.

Experiments essentially pose questions and seek answers. A good experiment provides an unambiguous answer to a well-posed question.

The previous chapter focused on measurements. Here we will talk more about how to extract quantitative information from a collection of measurements. The discussion will lead us into topics as diverse as flood and earthquake frequencies, election polls, and census taking. What can a poll of a small number of registered voters tell us about the likely outcome of a forthcoming election? What can we learn from the past history of flooding along a river that will give some indication of what we might expect in the future? Uncertainties are associated with each topic, uncertainties that arise from different sources and are quantified in different ways.

There are many processes and pathways that lead to ensembles of measurements. One very common source is simply making a number of measurements on a single object – each student in a class at the local elementary school measures the height of their teacher, or all seismograph stations in a region estimate the magnitude of yesterday's earthquake. A second common ensemble comprises one-time measurements of a number of different objects – perhaps the weight of each student in the class on the first morning of the new school term, or the concentration of arsenic in each water well in the county on a given day.

We have walked a long way through the garden of uncertainty and have seen a multitude of flowers and a few weeds, much elegance and a little untidiness. The garden is not a formal garden, laid out geometrically, tended immaculately. It is a garden with many hidden recesses, in places a maze full of surprises, with each plot revealing something not seen before. As we near the end of our tour, we have come to recognize that uncertainty, just like a flower, can be found in many places and presents itself in different colors and intensities.

Throughout this walk through the garden of uncertainty, we encountered many aspects of global climate change: taking Earth's temperature, local trends and global averages, flood probabilities, ozone depletion, science education, industrial propaganda and obfuscation, media confusion, reconstructions of past climate, computer models of the week's weather and the century's climate, and insurance for an uncertain future. In each domain of the garden, the tie to climate change was bundled into a discussion of other natural phenomena and human activity, with uncertainties that paralleled or shared characteristics with the uncertainties of climate change. In this final chapter, I will pull together these components of climate change and address the attendant uncertainties cohesively, as a representation of both the struggles and achievements of climate science, and of the hills yet to climb.

This is a book about uncertainty, particularly the uncertainty we associate with science. Over the years, scientific uncertainty has been addressed by natural scientists, engineers, medical researchers, social scientists, and philosophers. But for all the perspectives that have been laid out in everything from short essays to scholarly monographs, the richness of scientific uncertainty has often been unappreciated and/or misunderstood by the general public, people not regularly engaged in science.

Uncertainty, of course, is not confined to the world of science. It is an everyday fact of ordinary life as well. We regularly face uncertainty in a myriad of ways. Will it rain today? Will Aunt Dorothy's plane arrive on time? Will the stock market tumble? Will an accident snarl the freeway during rush hour? These day-to-day uncertainties come and go, and we move on through life, sometimes preparing for them, but more often just plowing through them.

But uncertainty also colors longer-term concerns. Will my pension program be sufficient two decades from now to enable the full and comfortable life that my wife and I hope for? Will our health allow a free and independent life-style thirty years in the future? These longer-term questions are harder to answer and are cloaked in greater uncertainty. Because we have only one life to live we cannot return to ‘Go’ and take another path.

Is it really essential that the public understand science? Why not let scientists do their thing, and let the rest of the world get on with their business too? Unfortunately, in the modern world, that is a path we can ill afford to follow. Whether we realize it or not, science is too much a part of the fabric of our lives to be shunted aside as a curious sideshow. The economy, national defense, environment, and our health are more than ever before dependent on scientific progress. The emergent role of information technology in our economic productivity, the feasibility of a ballistic missile defense shield, the human contribution to climate change through the combustion of fossil fuels, the implications of the newly mapped human genome all should be reminders that we cannot divorce ourselves from science, even if we might like to. And yet for all of the obvious relevance of science to our daily lives, many people remain ill equipped to assimilate much beyond the rudiments of science.

If, as I have argued in the previous chapter, our schools have generally failed to develop an awareness and appreciation of science, one can envision a second line of defense against scientific illiteracy: scientists working closely with the mass media to inform and educate the public.