Plagues in World History (2 page)

1145 B.C.E.7 In addition to smallpox, Egyptian mummies have also pointed to the presence of tuberculosis, schistosomiasis, and poliomyelitis.

Before leaving the second millennium, we should not omit the oracle bones dating from the Shang dynasty in China between c. 1500 and 1050 B.C.E.

These contain, for their time, some quite remarkable conceptions of disease, centering around the
chi
, a logographic symbol depicting a man lying on a bed pierced by the arrow of disease. This obviously anticipates biblical and classical Greek references to “plague” in the sense of a blow sent down upon humans from on high, but in ancient Chinese culture, the notion of any higher power being responsible for disease seems to be absent, as the Chinese preferred to explain the origins of their civilization in purely humanistic terms going back to mighty ancestors. Instead, the disease agent is more rationally explained as due to a worm or insect of some kind, as in the
li
and
ku
symbols, perhaps referring to schistosomiasis. The ancient Chinese also identified diseases with fever or rash-like symptoms, such as malaria or scabies, and made more amorphous references to sensory, intestinal, and reproductive illnesses.8

In the last millennium before Christ, humankind entered a new era in writing about disease. References to disease epidemics multiply in the Bible, but its use of generalized terms such as “plague” make identification of specific illnesses difficult.9 Ful y half of the references to plague in the Bible occur in the first five books of the Old Testament, known col ectively as the Torah or Pentateuch, which were composed over the course of half a millennium from the tenth to the fifth centuries B.C.E. In Leviticus and Deuteronomy, which contain approximately sixty mentions of the term, plague is associated with a skin disease that may have been leprosy.10 While the sixth plague that afflicted the Egyptians in Exodus 9:10 and the plague that struck down the Philistines in 1 Samuel 4:6 are traditionally as-

sociated with true plague due to references to “boils” and “tumors,” it remains inconclusive whether the original Hebrew supports such an interpretation.11

Moreover, the Bible perpetuates older conceptions of disease causation, namely, that the source of illnesses is to be attributed to a higher power. At roughly the same time, however, alternative explanations of disease began to emerge in other cultures in India, China, and Greece. Remarkably, all three proposed similar systems that located diseases’ origins in humankind’s natural environment and defined the disease condition within the body as resulting from an imbalance of its core elements. This was undoubtedly the beginning of a truly rational approach to disease and medicine, which used dietary and other health regimens to prevent illness and natural compounds, bleeding, and other, human-inspired techniques to cure it. But it is important to remember that these same ancient societies by no means abandoned religious or supernatural methods of healing, such as prayers and magical incantations, since desperate patients would have been willing to try any remedy that might work, and the two realms of religion and medicine were not seen as incompatible.12

Most influential for the West, of course, was the Greek medical tradition founded by Hippocrates of Cos (c. 460–377 B.C.E.). Along with the body of works attributed to him, known collectively as the “Hippocratic corpus,” Hippocrates and his circle of physicians advocated the humoral theory as an explanation of disease occurrences in the body, namely, that any given illness resulted when the four humors of the body—blood, phlegm, yellow bile (
cholera
), and black bile (
melancholia
)—were in a state of imbalance, a condition the Greeks called
dyscrasia
, literally, “bad mixture.” But readers should know that very similar systems had also been proposed in ancient Indian and Chinese medicine. The Ayurvedic tradition, compiled around the sixth century B.C.E. as one of India’s sacred Veda texts, states that human health is connected to the three
dosas
, or humors: these include
Vayu
, a dynamic, kinetic principle associated with air; Pitta
, a thermal, explosive force identified with the sun; and
Kapha
, a cohesive principle that binds everything together. Balance of the
dosas
is to be maintained not only by diet and personal habits but also by mental attitudes and even social taboos that must be observed in accordance with the Hindu caste system.13

Likewise, ancient Chinese medicine, culminating in the
Huangdi Nei Jing (
The Yellow Emperor’s Classic of Medicine
), dating to the first century B.C.E., proposed a sixfold classification system of diagnosis that, in its crudest, most simplified form, attempts to strike a balance between the two opposing yin-yang qualities of the body and explained illnesses as resulting from an imbalance in the body’s
qi
, a nearly untranslatable term that seems to encompass everything that maintains life. Chinese medical tradition, going back to the Chou dynasty (1050–256 B.C.E.), also relates the advent of diseases to the four seasons and to 6 y Introduction

any abnormalities in their cycle (such as cool spring weather in the summer or hot summer weather in the autumn). This is very similar to how works in the Hippocratic corpus, such as
On Airs, Waters, and Places
, explain disease. Like the Greeks, the Chinese also related the advent of disease to other factors including changes in the air and other aspects of the environment, excessive emotional states, and what the Greeks called bad regimen, such as overexertion, poor diet and hygiene, immoral behaviors such as drunkenness and sexual indulgence, and so on. But while the Greek miasmatic theory of bad air (the original
malaria
) allowed for the concept of contagion, or the direct spread of disease from person to person through the passing of the miasma, this never seems to have entered the classical Chinese medical tradition
.
And while the Greeks related their humors to four basic elements of the universe, namely, air, water, earth, and fire, the Chinese tradition lists five: wood, fire, earth, metal, and water.14 Altogether, this ancient heritage identifies an impressive galaxy of diseases; judging from the symptoms described, the ancients likely suffered from cholera, malaria, mumps, measles, leprosy, erysipelas, dysentery, epilepsy, diphtheria, smallpox, tuberculosis, typhoid fever, cancer, influenza, beriberi, rickets, pneumonia, cirrhosis, asthma, arthritis . . . the list goes on and on.15

Nonetheless, the real history of disease could be said to have begun in 430–426

B.C.E., when a plague struck the city of Athens at the very start of the Peloponnesian War with its rival, Sparta. For it was the Plague of Athens that inspired the famous account of it by the Greek historian Thucydides as part of his
History of the Peloponnesian War
. Many would regard Thucydides’ brief but compel ing narrative of the plague as the first example of historical writing about disease. This should be attributed to not only the rational, “enlightened” approach that he takes to disease (a path that was being concurrently blazed by the Hippocratics) but also the comprehensive way in which he discusses the plague’s impact, which he sees as affecting the entire body politic and not just the individual patient’s body.

Significantly, Thucydides states at the outset that he is eschewing all speculation about the plague’s origin or causes, perhaps because he has no wish to bring the gods into the discussion, as most other ancient authors would have been tempted to do. This rigorously scientific approach, while paralleling that in contemporary Hippocratic medicine, was probably an entirely unrelated and independent phenomenon.16 Above all, Thucydides’ preoccupation with disease could be described as quintessentially historical: to describe it in such a way that could prove useful to successive generations of his readers. Consequently, Thucydides’ first order of business is to enumerate the characteristic symptoms of the disease, by means of which it can be readily identified by future sufferers; it is a task for which Thucydides was uniquely qualified, as he himself had contracted the disease and survived to tell the tale. These symptoms include a burning fever,

inflammation of the throat and tongue, small pustules or ulcers on the skin, nauseating diarrhea and other discharges, and gangrene of the extremities, which, if they killed the victim, did so in about a week. Yet, despite this painstaking description, modern historians have endlessly debated exactly what kind of disease afflicted Athenians during the plague. While it assuredly was not the disease known as bubonic plague, since the characteristic symptom of the bubo is not present in Thucydides’ account, consensus opinion seems to have coalesced around smallpox, although other candidates, including typhus, typhoid fever, measles, and anthrax, also have been proposed.17

But what elevates Thucydides’ narrative to far above the ordinary is his ensuing discussion of the social effects of the plague. In a profoundly perceptive analysis, Thucydides notes how the plague overturned the conventions of his society, whether these be in terms of funerary rites, religious observances, respect for the laws and morals, or even the obligations of family members to care for sick loved ones. It was Thucydides who first advanced the idea that people typically respond to the threat of mass death from disease with a “live for the moment” attitude as they await the imminent prospect of their own potential demise. As he puts it in a justly famous passage, Men now coolly ventured on what they had formerly done in a corner and not just where they pleased, seeing the rapid transitions produced by persons in prosperity suddenly dying and those who before had nothing succeeding to their property. So they resolved to spend quickly and enjoy themselves, regarding their lives and riches as alike things of a day. Perseverance in what men called honor was popular with none, it was so uncertain whether they would be spared to attain the object; but it was settled that present enjoyment, and all that contributed to it, was both honorable and useful. Fear of gods or law of man there was none to restrain them.

As for the first, they judged it to be just the same whether they worshipped them or not, as they saw all alike perishing; and for the last, no one expected to live to be brought to trial for his offences, but each felt that a far severer sentence had been already passed upon them all and hung ever over their heads, and before this fell it was only reasonable to enjoy life a little.18

However, it should be noted here that other Greek sources also record a more conservative reaction to the plague, one that reaffirmed the role of the gods in terms of being able to both cause and cure disease, as evidenced by the rising popularity of the healing cult of Asclepius, son of Apollo, in the decades following the Plague of Athens. Not surprisingly, this reactionary attitude receives almost no mention from Thucydides.19

Perhaps the greatest contribution of Thucydides to the history of disease is his implied notion that a disease not only infects individuals but also makes all of 8 y Introduction

society, an entire community, its victim. For a disease, he makes clear, not only affects people’s health and well-being but also can determine the fate of large-scale events and situations, even if only in an indirect way. Although he doesn’t say so explicitly, Thucydides does seem to suggest that the Plague of Athens altered the whole course of the Peloponnesian War, as indicated by his insertion of the narrative of the disease directly following his account of the funeral oration of Pericles that laid out Athenians’ justification for fighting the war.20 Whether the plague had longer-term effects, however, that resulted in the decline and ultimate fall of the Athenian empire by the end of the war in 404 is a subject that continues to be debated by historians.21

Somewhat later in his account, Thucydides does say that nothing did as much harm to the Athenian war effort as the plague: in purely military terms, the disease wiped out 4,400 hoplites and 300 cavalrymen, who most likely represented roughly a third of available forces. Although Thucydides asserts that the plague’s decimations among the general population are undiscoverable, modern calculations—assuming a death rate commensurate with that among the army—yield figures in the tens of thousands.22 With its manpower thus sharply curtailed, Athens was severely hampered in terms of the scope of both land and sea operations; it was not until more than a decade later, in 415, that the Athenians felt capable of launching the ill-fated Sicilian expedition.

But beyond mere numbers, the plague may also have affected how the Athenians fought the entire rest of the war, even though the disease occurred so early in the conflict.23 Thucydides seems to credit the plague with inculcating a moral failing, or “lawlessness,” in the Athenian character, which was to show up later in the war in the form of ruthless and ultimately self-destructive policies, such as its brutal conduct toward the neutral island of Melos in 416, which in Thucydides’ famous “dialogue” foreshadows inhumane treatment of Athens’ own soldiers when taken prisoner at Syracuse. Yet, it’s hard to know if this is really the case, since Athens already revealed a ruthless streak early in its empire when it refused to allow the island of Naxos to secede from the Delian League in 467.

Thucydides also notes that the plague was worldwide in its scope; for example, he states that it started in Ethiopia in sub-Saharan Africa and progressed from there northward and westward to Egypt and Libya and eastward to the Persian Empire. Therefore, in so many ways, Thucydides’ history of the Plague of Athens provides a model for all other histories of disease that were to follow.24

If we now shift our focus to modern historical writing about disease, it quickly becomes apparent that we have expanded considerably upon Thucydides’ revolutionary rationality. In terms of the scope, importance, complexity, diversity, and a host of other factors to consider about disease, we have gone well beyond Thucydides’ original speculations, even when following the basic