Plagues in World History (37 page)

entirely of our own making, whether by not taking the prescribed course of antibiotics or by mishandling our mass consumption of domestic poultry, and only behavioral changes will correct them. If a current disease like AIDS remains beyond our biomedical ability to cure it, then perhaps we should approach it as primarily a function of poverty, as the former South African president and AIDS

denier, Thabo Mbeki, has argued. Only, the poverty we need to channel our ingenuity into combating is the poverty of third world sufferers to afford antiretroviral therapies by which they can still be functioning members of society, or the poverty of their economic ability to change risky social behaviors that are responsible for ever more people contracting the disease. Certainly, the decline of tuberculosis even before the age of antibiotics seems to support such an approach. We may have to resign ourselves to making our own cultural peace with our own, new plagues, such as AIDS.

The other main thesis I have tried to emphasize in this book is to take a comparative approach to the study of plagues, which can draw out both the com-monalities and distinctive features among different diseases. Plague and cholera, for example, acquired the reputation of being particularly horrible diseases to die from, owing to the suddenness of their onslaught and the revolting nature of their symptoms. Societies responded to the uniquely terrifying aspects of these diseases with fevered campaigns against filth or hysterical accusations of poisoning. Tuberculosis and influenza, on the other hand, perhaps bred a certain degree of complacency as a result of the slow, latent progress the disease could take in the body or the relative mildness and ephemeral nature of the symptoms. The shock was then all the greater when fulminant forms of these diseases took hold, defying normal expectations to the point that perhaps societies simply denied their existence or else stigmatized and shunned their sufferers. Today, this denial or complacency has a real impact with the low completion rates of antibiotic treatments or low participation in vaccination programs, which only helps increase the virulence and propagation of these diseases. Smal pox demonstrated how a disease could wreak terrible havoc in a “virgin soil” population but also how other societies that were immune or less affected by the disease could use it as both a cultural and biological weapon. AIDS, much like syphilis in the past, has become a metaphor for all sorts of moral and ethical stigmas attached to a disease spread primarily (but in the case of AIDS not exclusively) by social y unacceptable behaviors, such as promiscuous heterosexual and homosexual intercourse and intravenous drug use.11 Yet, some would argue instead that this moral and sexual dimension to AIDS has blinded us to its underlying causes in poverty and that our ethical obligation is to combat such causes, rather than attempt to change “risky” social behaviors such as by encouraging greater condom use or sexual abstinence, especially in countries that have a cultural aversion to them.12

184 y Conclusion

I have chosen all these diseases for discussion in this book because of the many, particular lessons they have to teach. And yet these are lessons that, despite their particularity, can nonetheless be applied broadly to other diseases, both now and in the future, that happen to come our way. Let us hope we can learn to be sufficient pupils of disease.

y

Notes

1. This identification seems to have first emerged in the seventeenth century and then became more definite at the turn of the twentieth century when the Third Pandemic sparked concerted scientific study of the disease. See Lawrence I. Conrad, “Plague in the Early Medieval Near East” (PhD diss., Princeton University, 1981), 41.

2. Michael W. Dols,
The Black Death in the Middle East
(Princeton, N.J.: Princeton University Press, 1977), 315. Comparable terminology can be found in Arabic and Hebrew.

3. E. Fuller Torrey and Robert H. Yolken,
Beasts of the Earth: Animals, Humans, and Disease
(New Brunswick, N.J.: Rutgers University Press, 2005), 15–20, 28–30.

4. Torrey and Yolken,
Beasts of the Earth
, 38–43, 49–52; William H. McNeill, Plagues and Peoples, updated ed. (New York: Anchor Books, 1998), 54–93; Robert Sallares,
The Ecology of the Ancient Greek World
(Ithaca, N.Y.: Cornell University Press, 1991), 227–44.

5. McNeill,
Plagues and Peoples
, 62, 84–92; Sheldon Watts,
Disease and Medicine in World History
(New York: Routledge, 2003), 56.

6. Watts,
Disease and Medicine in World History
, 16.

7. Donald R. Hopkins, “Ramses V: Earliest Known Victim?” World Health Organization, May 1980, at http://whqlibdoc.who.int/smallpox/WH_5_1980_p22.pdf (accessed June 24, 2010).

8. Kenneth F. Kiple,
The Cambridge World History of Human Disease
(Cambridge: Cambridge University Press, 1993), 345–47.

9. A variety of words in the original Hebrew were used in the Bible when referring to disease epidemics. See Conrad, “Plague,” 43–44.

185

186 y Notes to Pages 4–9

10. James Orr, “Plague,” Bible History Online, at www.bible-history.com/isbe/P/

PLAGUE (accessed June 24, 2010).

11. Conrad, “Plague,” 42–63.

12. Jo N. Hays,
Epidemics and Pandemics: Their Impacts on Human History
(Santa Barbara, Calif.: ABC–CLIO, 2005), 5.

13. Kiple,
Cambridge World History of Human Disease
, 408–9.

14. Kiple,
Cambridge World History of Human Disease
, 347–53; Carol Benedict,
Bubonic Plague in Nineteenth-Century China
(Stanford, Calif.: Stanford University Press, 1996), 101–5.

15. Kiple,
Cambridge World History of Human Disease
, 263–69, 347–53, 373–75, 390–92, 409–12.

16. For discussions of the issues involved, see J. C. F. Poole and A. J. Holladay, “Thucydides and the Plague of Athens,”
Classical Quarterly
29 (1979): 282–300; Sallares, Ecology of the Ancient Greek World, 245–46; and James Longrigg, “Epidemic, Ideas and Classical Athenian Society,” in
Epidemics and Ideas: Essays on the Historical Perception of Pestilence
, ed. T. Ranger and P. Slack, 21–44 (Cambridge: Cambridge University Press, 1992), 33–36.

17. For works that attempt to identify the Plague of Athens with a specific disease, see those cited in Conrad, “Plague,” 64n59, to which should be added the article by James Longrigg, “The Great Plague of Athens,”
History of Science
18 (1980): 209–25, and Sallares,
Ecology of the Ancient Greek World
, 244–51. Discussion of the Plague of Athens as smallpox will be resumed in chapter 2.

18. Thucydides,
The History of the Peloponnesian War
, II:53, available in English translation by R. Crawley (London: Longmans, Green, 1874).

19. Sallares,
Ecology of the Ancient Greek World
, 246; Longrigg, “Epidemic,” 41–43.

20. Longrigg, “Epidemic,” 32–33.

21. See, for example, J. V. A. Fine,
The Ancient Greeks: A Critical History
(Cambridge, Mass.: Harvard University Press, 1983), 464; McNeill,
Plagues and Peoples
, 121; D. Kagan,
The Peloponnesian War
(New York: Viking Press, 2003), 78–79; Victor Davis Hanson,
A War Like No Other: How the Athenians and Spartans Fought the Peloponnesian War (New York: Random House, 2005), 65–88.

22. Thucydides,
History of the Peloponnesian War
, III:87; Sallares,
Ecology of the Ancient Greek World
, 258–59; Hanson,
A War Like No Other
, 79–80.

23. Hanson,
A War Like No Other
, 77–78.

24. For Thucydides’ influence upon other classical authors who wrote about disease, see Longrigg, “Epidemic,” 27.

25. General works on disease representative of the “positivist” approach include the following: Hans Zinsser,
Rats, Lice and History
(Boston: Little, Brown, 1934); Henry E. Sigerist,
Civilization and Disease
(Chicago: University of Chicago Press, 1943); and Frederick F. Cartwright,
Disease and History
(New York: Thomas Y.

Crowell Co., 1972).

26. See especially Charles-Edward Amory Winslow,
The Conquest of Epidemic Disease: A Chapter in the History of Ideas
(Princeton, N.J.: Princeton University Press, 1943); and Notes to Pages 9–12 y 187

L. Fabian Hirst,
The Conquest of Plague: A Study of the Evolution of Epidemiology
(Oxford, UK: Clarendon Press, 1953).

27. McNeill,
Plagues and Peoples
, 22–23.

28. William H. McNeill,
The Rise of the West: A History of the Human Community (Chicago: University of Chicago Press, 1963).

29. McNeill,
Plagues and Peoples
, 19–21. The importance of the “Columbian exchange,” not just in terms of disease pathogens, was first explored by Alfred W. Crosby, The Columbian Exchange: Biological and Cultural Consequences of 1492
(Westport, Conn.: Greenwood Press, 1972). Crosby later explored this theme on a global scale in Ecological Imperialism: The Biological Expansion of Europe, 900–1900
(Cambridge: Cambridge University Press, 1986), in which disease plays but one part of the story.

30. McNeill,
Plagues and Peoples
, 24–27.

31. For works in the relativist school, see Robert P. Hudson,
Disease and Its Control: The Shaping of Modern Thought
(Westport, Conn.: Greenwood Press, 1983); Claudine Herzlich and Janine Pierret,
Illness and Self in Society
, trans. E. Forster (Baltimore: Johns Hopkins University Press, 1987); Allan M. Brandt, “AIDS and Metaphor: Toward the Social Meaning of Epidemic Disease,” in
In Time of Plague: The History and Social Consequences of Lethal Epidemic Disease
, ed. A. Mack, 91–110 (New York: New York University Press, 1991); and Charles E. Rosenberg,
Explaining Epidemics and Other Studies in the History of Medicine
(Cambridge: Cambridge University Press, 1992), esp. 278–318.

32. Hudson,
Disease and Its Control
, x.

33. McNeill,
Plagues and Peoples
, 291–95.

34. McNeill,
Plagues and Peoples
, 9–17.

35. See, in particular, Richard Preston,
The Hot Zone
(New York: Random House, 1994); and Laurie Garrett,
The Coming Plague: Newly Emerging Diseases in a World Out of Balance
(Harmondsworth, UK: Penguin, 1994). These have been joined by such films as
Outbreak
(1995) and
I Am Legend
(2007). A far more balanced and temperate view of the topic is taken up in Jo N. Hays,
The Burdens of Disease: Epidemics and Human Response in Western History
(New Brunswick, N.J.: Rutgers University Press, 1998), esp.

240–77; and Arno Karlen,
Man and Microbes: Disease and Plagues in History and Modern Times
(New York: Putnam, 1995), esp. 1–11, 215–30.

36. Sallares,
Ecology of the Ancient Greek World
, 224.

37. For classic works in this vein, see David Arnold,
Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India
(Berkeley: University of California Press, 1993); O. A. Bushnell,
The Gifts of Civilization: Germs and Genocide in Hawaii (Honolulu: University of Hawaii Press, 1993); Sheldon Watts,
Epidemics and History: Disease, Power and Imperialism
(New Haven, Conn.: Yale University Press, 1997); and Suzanne Austin Alchon,
A Pest in the Land: New World Epidemics in a Global Perspective (Albuquerque: University of New Mexico Press, 2003). McNeill specifically rejects the colonialist/imperialist argument (albeit even before it was made by the above champions) in
Plagues and Peoples
, 215.

38. See especially P. D. Curtin,
Death by Migration: Europe’s Encounter with the Tropical World in the Nineteenth Century
(Cambridge: Cambridge University Press, 1989).

188 y Notes to Pages 12–16

39. McNeill,
Plagues and Peoples
, 194; William H. McNeill, “Migration Patterns and Infection in Traditional Societies,” in
Changing Disease Patterns and Human Behavior
, ed.

N. F. Stanley and R. A. Joske, 27–36 (London: Academic Press, 1980), 34.

40. David Herlihy,
The Black Death and the Transformation of the West
, ed. S. K. Cohn Jr. (Cambridge, Mass.: Harvard University Press, 1997); and Samuel K. Cohn Jr.,
The Black Death Transformed: Disease and Culture in Early Renaissance Europe
(London: Arnold, 2002). For a reevaluation of this “silver lining” thesis about the Black Death, see John Aberth,
From the Brink of the Apocalypse: Confronting Famine, War, Plague and Death in the Later Middle Ages
, 2nd ed. (London: Routledge, 2010), 206–10.

41. Sallares,
Ecology of the Ancient Greek World
, 262.

42. See, for example, Brian Fagan,
The Little Ice Age: How Climate Made History, 1300–1850
(New York: Basic Books, 2000), and Brian Fagan,
The Great Warming: Climate Change and the Rise and Fall of Civilizations
(New York: Bloomsbury Press, 2008).

43. It is perhaps a significant sign of the shift in disease studies that Alfred Jay Bollet, in the second, 2004 edition of his book,
Plagues and Poxes
, changed the subtitle from
The Rise and Fall of Epidemic Disease
to
The Impact of Human History on Epidemic Disease
, albeit the main thrust of his new focus is on disease as a weapon of bioterrorism. See Alfred Jay Bollet,
Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos, 2004), 1–13.

44. Sallares,
Ecology of the Ancient Greek World
, 262.

45. Jo N. Hays, “Historians and Epidemics: Simple Questions, Complex Answers,” in Plague and the End of Antiquity: The Pandemic of 541–750
, ed. L. K. Little, 33–58 (Cambridge: Cambridge University Press, 2007), 42–46.