Diseases and epidemics
Selection of gold and silver pomanders, Europe
The Black Death
'The ideal way to get rid of any infectious disease would be to shoot instantly every person who comes down with it.' H L Mencken
Humanity and disease share a long and eventful history. As we emerged and evolved, so did the diseases that blight our lives. Diseases exist in the fossil record, but our ancestors were actually less exposed to them. This changed around 10,000 years ago when they began living in more settled agriculturally based communities. Animals were a major part of this revolution. But settlement brought disease and epidemics. Close contact, often in overcrowded and unsanitary conditions, allowed some animal diseases to jump species and become deadly human infections.
What did early people think about disease?
Like their prehistoric ancestors, most Ancient Egyptians blamed evil spirits or angry gods. Some Egyptian doctors had other ideas. They blamed blocked channels within the body, a theory that has echoes in other medical traditions, particularly Traditional Chinese Medicine. In Ancient Greece Hippocrates proposed a theory about the body which centred on humours, a notion which has parallels elsewhere, most obviously in Ayurvedic medicine. This Greek medical philosophy eventually took root among Greece’s conquerors in Rome, from where the writings of Galen resonated across much of the world and remained influential for hundreds of years.
The decline of the Roman Empire and rise of the Islamic Empire
As the East Roman Empire declined, an Islamic Empire expanded westwards. Muslim scholars collected, translated and supplemented classical Greek works as well as texts from India and Northern Africa. To this body of learning they added their own innovative work, with physicians al-Razi and Ibn Sina among the most prolific and influential scholars of this period. These texts were archived at the House of Wisdom in Baghdad and other centres of study. Emerging from the early medieval period, Europe remained ignorant of much of this knowledge.
Galen and the spread of disease
Galen coined the word ‘plague’ to describe a quickly spreading fatal disease. He had lived through the Antonine Plague - one of the great epidemics of the ancient world. The Black Death that devastated Europe in the 1340s was just that and more, the most deadly pandemic in recorded history. As a recovering Europe enjoyed the cultural Renaissance of the following century, the ancient texts were rediscovered and newer texts from the Islamic world became accessible. But the older texts were not simply revered, they were also questioned.
New empires and epidemics
Despite more research into the nature of disease, little could be done in the face of frequent and deadly epidemics. New empires grew in this time of exploration and discovery. But armies, colonisers and traders all imported and exported disease. As citizens of a growing trading nation, thousands of British people succumbed to smallpox, sweating sickness and bubonic plague - all epidemic in the 1500s and 1600s. Old supernatural beliefs remained embedded, with thousands presenting themselves to Charles II believing only his touch could cure them of 'king's evil'.
Conquest and colonialism
But conquest and colonialism also brought exposure to new medical knowledge. Smallpox inoculation was successfully imported to Britain and America in the early 1700s, a procedure Edward Jenner would subsequently improve with his safer vaccination technique.
Germ theory and industrialisation
In the 1800s, laboratory research - notably by Pasteur, Koch and their pupils - significantly advanced our understanding of disease. The resulting germ theory gradually supplanted the prevailing miasma and contagion theories. Ironically, proponents of miasma theory had greatly influenced public health reforms. Industrialised and overcrowded, 19th-century cities were havens for diseases such as typhoid, tuberculosis and, increasingly, cholera. It was while researching a cholera outbreak in 1854 that London doctor John Snow produced his ground-breaking work on disease transmission.
Penicillin, the poor and the protection of the state
Despite some improvements, infant mortality rates in Britain in 1900 were actually higher than in 1800. Diphtheria, measles and whooping cough all took a cruel toll on poor and ill-nourished children. Fortunately, growing state intervention and the wider fruits of biomedical research reversed this trend. Germ theory focused research onto the newly identified disease pathogens and the results were new vaccines and ‘magic bullet’ antibacterial drugs which revolutionised treatment. The pinnacle of these achievements was the production of penicillin during the Second World War (1939-45).
The decline of disease in the developed world
The flu pandemic of 1918 was the last occasion a killer disease swept rapidly across the world. At least 50 million people died. Since that notable blip, infectious diseases have continued to decline in the developed world, although smaller epidemics have occurred. Polio notably brought a decade of post-war panic and with it the wheezing spectre of the iron lung. This machine helped patients to breath - a symbol of new life-saving technologies but also of the helplessness of many of polio’s victims.
Elsewhere, improvements have been slower. While smallpox has been eradicated, ancient diseases such as malaria still kill millions. And although AIDS causes fear and death in the West, its strongholds are mainly among the world’s poor. Because of limited access to health education programmes and expensive Western drugs, it is now predominantly a disease of poverty. Increasingly, the resources of rich nations have concentrated on disease at a more individual level, targeting cancer, heart and circulatory diseases, respiratory and nervous diseases, the faults of genes and heredity, the diseases of affluence and, increasingly, the diseases of old age.
Related Themes and Topics
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A J Bollet, Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos, 2004)
P Bourdelais, Epidemics Laid Low: a History of What Happened in Rich Countries (Baltimore: Johns Hopkins University Press, 2006)
J N Hays, Epidemics and Pandemics: Their Impacts on Human History (Oxford: ABC-CLIO, 2006)
M B A Oldstone, Viruses, Plagues, and History (Oxford: Oxford University Press, 1998)
R Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (London: Harper Collins, 1999)
S Watts, Disease and Medicine in World History (London: Routledge, 2003)
A sudden widespread occurance of an infection with high numbers of people affected.
An acute contagious fever with high levels of mortality. Both the 'Black Death' that swept Europe in the 1340s and the Great Plague of London in 1665 are believed to have been bubonic plague.
An epidemic that occurs over a wide geographic area and affects an exceptionally high proportion of the population.
Smallpox is an infectious virus unique to humans. It results in a characteristic skin rash and fluid-filled blisters. After successful vaccination campaigns throughout the 1800s and 1900s, the World Health Organisation certified the eradication of smallpox in 1979. Smallpox is the only human infectious disease to have been completely wiped out.
Thought to have been the cause of the Black Death, the bubonic plague is caused by a bacterial infection of the lymphatic system, the network of capillary vessels in the human body. The plague is most commonly transmitted via the bites of fleas. Characteristic symptoms include enlarged lymph glands (buboes).
A historic expression referring to the transmission of disease between people by means of direct contact.
An acute infection of the digestive system, resulting in general weakness, high fever, rash, chills and sweating. It is transmitted through food or drinking water contaminated by the faeces or urine of patients or carriers.
An infectious disease that is caused by a bacterium first identified by Robert Koch in 1882. The disease usually affects the lungs first, and is accompanied by a chronic cough.
An acute highly contagious infection, generally affecting the throat but occasionally other mucous membranes and the skin. Diphtheria has been largely eradicated due to world-wide vaccination efforts.
Disease caused by a virus most commonly found in children. Measles is spread through airborne fluids. In roughly the last 150 years, measles has been estimated to have killed 200 million people worldwide.
An acute highly infectious disease, primarily affecting infants. Whooping cough gets its name from the severe hacking cough followed by intake of breath that sounds like a ‘whoop’. A highly effective vaccine was introduced in the 1940s.
The name given to the medical practice that is based on the sciences of the body, such as physiology (the functioning of the body).
The first antibiotic drug to treat infections which is made from the mould penicillium. Its discovery is attributed to Alexander Fleming in 1928.
Acquired Immune Deficiency Syndrome (AIDS) is a disease caused by infections resulting from a weakened immune system due to the HIV virus. It leads to failure of the immune system and is usually fatal. It is spread through direct contact with bodily fluids.
Diseases Of Poverty
A phrase that refers to diseases that are seen to be more common in conditions of poverty. They are often contagious and can be associated with overcrowding, malnutrition or environmental and industrial factors. Three major diseases of poverty are AIDS, malaria and tuberculosis.
Part of the nucleus of a cell that determines how our bodies function. Genes are passed from parents to children.
Diseases Of Affluence
A phrase that refers to diseases that are considered to be a result of increasing wealth within a society. Unlike diseases of poverty, they tend to be non-infectious and include coronary heart disease, type-2 diabetes, certain cancers and clinical conditions such as obesity. However, as habits change within a society, strict definitions of what are diseases of affluence often change.
Diseases Of Old Age
Refers to a group of diseases whose appearance is more common in older people and therefore on the increase in societies where individuals are living longer. Examples include arthritis, Alzheimer’s disease and osteoporosis. The treatment and care of older people is known as geriatric medicine.