What can History tell us about Epidemics?

Can we learn from history about how diseases spread, and how we respond to them?

'Bring Out Your Dead': A street during the Great Plague in London, 1665, with a death cart and mourners. Wellcome Collection.


‘Strategies to cope with plague have formed the basis for later policies’

John HendersonProfessor of Italian Renaissance History at Birkbeck, University of London and author of Florence Under Siege: Surviving Plague in an Early Modern City (Yale, 2019)

News about the spread of and reactions to the coronavirus punctuates our daily lives, alternately creating fear and reassurance, as social media stirs feelings of panic, while the official line emphasises that the epidemic is under control.

But the phrases and themes which characterise official pronouncements are nothing new; they speak to centuries of reactions to epidemics, none of which is more vivid than plague. Indeed, strategies to cope with plague in pre-industrial Europe have formed the basis for later policies and are mirrored in current public health initiatives.

Policies of ‘containment’, ‘mitigation’ and ‘quarantine’ are nothing new. Ironically, given the current prevalence of the coronavirus in northern and central Italy, it was here that during the Renaissance some of the main public health strategies first evolved. Cordons sanitaire, staffed by soldiers along frontiers to prevent the introduction of plague into states, impacted negatively on the economy, as embargoes were introduced on industries, trade and commerce. Cities, perhaps better protected than now by their medieval walls, employed guards to challenge anyone attempting to enter.

Streets were disinfected with burning juniper branches, while ‘infected’ houses, furniture and bedding were purified with sulphur. Doctors wearing beaked plague masks circulated the streets, as medical personnel wear simpler masks today. Then, just as now, concern was expressed about people congregating together; public events were banned and schools and markets closed. The sick were taken to vast quarantine centres – ‘Lazaretti’ – while contacts were isolated for 40 days at home or in large institutions beyond the city walls.

These strategies emphasised the role of governments in containment and mitigation, while seeking to avoid creating panic and fear. Although this was an age before social media, rumours circulated and marginalised sectors of society were accused of spreading the disease, raising questions about the impact of official policies on human liberties.

 

‘Epidemics strike from the outside and are carried in’

Samuel Cohn, Professor of Medieval History, University of Glasgow and author of Epidemics: Hate and Compassion from the Plague of Athens to AIDS (Oxford, 2018)

I concentrate on one aspect of epidemics, in fact the one historical sources from antiquity to the 19th century reported most often – human reactions. At least since the early 1980s and HIV/AIDS, the reactions almost exclusively associated with epidemics across time have been suspicion, blame and violence towards the poor, the ‘other’ and victims of disease. This is easy to imagine. Epidemics often strike from the outside, are carried inside by foreign hosts and are perceived to arise from poverty and pollution. Even so, the varieties of hate and violence are more variegated than usually assumed.

Anger and violence travelled more often in the opposite direction, from the poor towards the state, especially when elites imposed brutal forms of quarantine and military searches on those perceived as incubators of disease – the poor – as with bubonic plague at the end of the 19th century in the Indian subcontinent. The poor were corralled into subhuman segregation camps resulting in riots and crowds amassing in the thousands against colonial elites and municipal governments. Lines of hate could extend in still other directions, as with cholera riots from the 1830s into the 20th century. Again, the poor were the perpetrators of violence, but health workers became the principal victims, accused of inventing the disease to cull populations of the poor.

History, however, shows that these violent reactions have been the exceptions, especially before the 19th century. Epidemics could instead end class strife – as between senatorial elites and plebes in fifth-century Rome. They could also fan plagues of compassion, as with the outpouring of mass volunteerism and self-sacrifice across the globe to the Great Influenza in 1918-20.

The question becomes: why the differences? Over the last 200 years, one variable stands strongest: rates of lethality (the proportion with the disease who die) and not mortality. With cholera in the 1830s and Ebola today, attacks against health workers and the state repeat a similar refrain: ‘People enter hospitals, but they don’t come out alive.’

‘Fear and suspicion multiply more rapidly than any virus’

Patricia Fara, Former President of the British Society for the History of Science and Emeritus Fellow of Clare College, Cambridge

Epidemics breed fear and suspicion that multiply more rapidly than any virus. When a mysterious illness erupts, the first unhelpful reaction is to panic – the second is to identify a culprit. Instead of leading to a remedy, blaming supposed sources reveals pre-existing faultlines within society. In the early 1980s, when the cause of AIDS was still unknown, the American press accused Africans of having sex with chimpanzees, while Soviet agents located its origins in US research laboratories. But as homophobia escalated internationally, the most virulent hatred was directed against Patient Zero, a gay airline steward who was unjustifiably named as the source of the onslaught.

In 1665, during England’s most notorious bacterial invasion, the prime suspect was God. Lacking any other explanation, crowds flocked to churches, praying for deliverance from what they interpreted as divine retribution for their sins. In his semi-novel, Journal of a Plague Year, Daniel Defoe described the mounting chaos as enforced isolation proved counterproductive. Too often, he argued, ‘private mischief’ won the battle against ‘general benefit’. Worried about being infected, deceptively healthy prisoners broke down locked doors to obtain food, looted deserted properties or fled to the countryside, spreading the contagion still wider.

For those who could afford the luxury, rural seclusion sometimes provided the equivalent of a productive sabbatical. Liberated from his duties at the Royal Society, the microscopist Robert Hooke indulged in experimentation and speculated about the marine fossils he found on the Surrey Downs. Meanwhile, a Cambridge undergraduate temporarily confined in his Lincolnshire cottage allegedly sat under an apple tree to conceive the theory of gravity and used prisms to prove that sunlight contains the colours of the rainbow.

Yet science was unable to explain the plague. Despite his detailed drawings of fleas, Hooke denied their influence and modern scientists can still not guarantee protection. Whether we blame God or an innocent human, many will inevitably die when normality is interrupted.

 

‘Smallpox remains the only human disease to be eradicated’

Sandra Hempel, Author of The Atlas of Disease: Mapping Deadly Epidemics and Contagion from the Plague to the Zika Virus (White Lion, 2018)

In the 1970s, a student who would go on to become one of the world’s foremost clinical microbiologists was advised against doing research into infectious diseases. There was no point, his professor told him. Thanks to vaccination and antibiotics, deadly epidemic diseases, such as smallpox, plague, typhus and malaria, were finally in retreat.

Nearly 50 years later, however, smallpox remains the only human disease to be eradicated. In the meantime, new pathogens have emerged, jumping species from animal hosts to humans, or bursting out of their traditional habitats in isolated parts of the world and going global.

In 2002, a previously unknown type of pneumonia appeared in China. Severe Acute Respiratory Syndrome, or SARS, a coronavirus-like COVID-19 and the common cold, killed over 700 people in North and South America, Europe and Asia. Ebola was first identified in 1976 but was confined to small outbreaks in central Africa. Then suddenly, in 2014, it struck in west Africa and then across the world. And by 2016 the HIV and AIDS pandemic, which came to worldwide notice in the 1980s, had been responsible for at least 35 million deaths. For anything on a comparable scale, we have to go back to the 14th century and the Black Death.

Then there have been strange manifestations of more established diseases. In 1916 poliomyelitis, previously known only for small, containable outbreaks, broke out in New York and killed 6,000 people across the US. By the 1940s and 1950s, polio was paralysing or killing over half a million people annually worldwide. And we still do not understand why, in 1918, influenza suddenly began killing millions of young fit people in a global pandemic. Until then, flu deaths had been mainly confined to the old and the frail.

Despite extraordinary advances in medical science since the late 19th century, the pathogens responsible for epidemic diseases are proving more resilient, agile and unpredictable than the 1970s’ professor could ever have imagined. The fight to overcome them clearly has some way to go.