Plagues and Peoples (37 page)

Secondly, although in the eighteenth century the major triumphs
of scientific medicine lay still in the future, it does not seem absurd to suggest that decreasing significance of epidemic disease, partly due to medical advances but mostly due to ecological adjustments of which men were entirely unaware, constituted an essential background for the popularization of “enlightened” philosophical and social views. A world where sudden and unexpected death remains a real and dreaded possibility in everyone’s life experience makes the idea that the universe is a great machine whose motions are regular, understandable and even predictable, seem grossly inadequate to account for observed reality. Epidemic disease, after all, strikes erratically as well as unpredictably, and can never be dismissed as insignificant by those exposed to it. Before the findings of the astronomers and mathematicians of the seventeenth century could become a basis for a popularized world view, therefore, epidemic disease had also to relax its dominion over human minds and bodies. The retreat of plague and malaria and the containment of smallpox were thus essential preparations for the propagation of deistic opinions of the kind that became fashionable in advanced circles in the eighteenth century.

A world in which lethal infectious disease seldom seized a person suddenly in the prime of life no longer stood so much in need of belief in Divine Providence to explain such deaths. Moreover, as in other orthogenetic evolutionary situations, newfangled mechanistic world views sustained the search for more effective methods for coping with disease, and made the medical profession increasingly systematic in testing new treatments empirically. Real improvements resulted; and the thought that human intelligence and skill could improve life not only in mechanical but also in health matters became increasingly plausible.

There seems therefore a clear correlation between Europe’s shifting encounter with disease and the phases of that continent’s cultural and political history. Between 1494 and 1648 the stresses upon older cultural traditions were especially acute because Europeans had to adjust to the initial impact of
transoceanic movement of men, goods, ideas, and diseases—all at once. The political and ideological storms of the Reformation and wars of religion manifested these strains. Only as the first shocks wore off, including, significantly, the decay of epidemic disease and its replacement by more predictable, less damaging patterns of infection, was it possible for the relaxed political and cultural style of life we call the Old Regime to establish itself. Obviously, the changing incidence of disease was only one, and not the most conspicuous, factor in bringing about such changes. Yet because it has usually been completely overlooked by historians, the experience of disease and of shifting encounters with lethal infections, seems worth emphasizing here.

In all ecological relationships, a significant breakthrough for one organism or group of organisms quickly creates new stresses in the system. These stresses usually are such as first to diminish and then contain the original disturbance. So it was with Australian rabbits, 1856–1960, and so it was in northwestern Europe between 1750 and 1850, as the industrial revolution began to gather headway. Living conditions in new industrial towns were, and long remained, notoriously un-healthful. On the other hand, improvements in transportation allowed increasingly efficient patterns of food distribution to fend off local famines. Food preservation was almost equally important. Canning, for instance, was invented in 1809 in response to an offer of a handsome reward by the French government; and Napoleon’s armies pioneered its large-scale use.
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The Napoleonic wars were, of course, among the most hard fought Europeans had experienced up to that time. Yet battle deaths were far less numerous than deaths from infectious diseases, especially typhus, that accompanied Napoleon’s armies and those of his enemies as they marched and countermarched across Europe.
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Nevertheless, population growth, which had gone into high gear all across Europe by 1800, quickly replaced such losses. By the 1840s limitations upon
the availability of food became critical in many parts of the Continent. The “hungry forties” became disastrous for millions after 1845 when a parasitic fungus, native to Peru, succeeded in establishing itself in Europe’s burgeoning potato fields.
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The result was widespread failure of the potato crop upon which millions of poverty-stricken Irish, Belgians, and Germans had come to depend. Famine accompanied by typhus and other diseases resulted. Millions died, and the extraordinary multiplication of Irish rural population came abruptly and lastingly to a halt, while in the following decades a world-girdling Irish diaspora profoundly affected North America and Australia, as well as other parts of the British empire.

Apart from such acute but short-lived crises as that which struck the potato fields of Europe, 1845–49, the acceleration of movement resulting from application of mechanical power to transport both by land and sea introduced a long series of disease exposures to European and world populations in the nineteenth century. Simultaneously human migration into larger and more numerous urban centers had a parallel effect of intensifying encounters with old and familiar infections. The result was a sort of race between the development of medical skills among Europe’s doctors and public administrators on the one hand and the intensification of infections together with chronic ills provoked by altered conditions of living.

Until near the end of the nineteenth century the race remained close in most of the world’s great cities. Growing urban centers that lagged in implementing sanitary reforms, like New York and most other American cities, actually saw a sharp increase in mortality.
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But from the 1880s onward, a series of dramatic triumphs accrued to medical researchers who succeeded in isolating and studying the “germs” of one infectious disease after another. Careful study usually allowed experts to devise effective ways of checking infection, whether by synthesizing new drugs or devising immunizing injections, introducing new sanitary practices, altering older patterns of
human encounter with insects, rodents, or other alternate hosts for the disease in question, or in some other fashion contriving to interrupt the established patterns of disease transmission. International organization supplemented urban and national measures aimed against infectious diseases, so that by the first decades of the twentieth century preventive medicine began to make a dent in the epidemiological experience of Asian and African as well as European and European-descended populations.

Success was sufficient so that by the second half of our century, professionals seriously proposed the global eradication of a number of mankind’s most formidable infections, and thought it a feasible goal for the near future.
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But as is their wont, such massive and fundamental successes in altering humanity’s experience of disease carried within them a potential nemesis: population crises on a continent-wide scale seemed likely to supplant the localized population crises afflicting the new industrial cities with which nineteenth-century medical reformers had to cope. The race between skills and ills was thus by no means decisively won—or lost; and in the nature of ecological relationships is never likely to be.

The first and in many ways most significant manifestation of the altered disease relationships created by industrialization was the global peregrination of cholera. This disease had long been endemic in Bengal, and spread thence in epidemic fashion to other parts of India and adjacent regions from time to time. It was caused by a bacillus that could live as an independent organism in water for lengthy periods of time. Once swallowed, if the cholera bacillus survives the stomach juices, it is capable of swift multiplication in the human alimentary tract, and produces violent and dramatic symptoms—diarrhea, vomiting, fever, and death, often within a few hours of the first signs of illness. The speed with which cholera killed was profoundly alarming, since perfectly healthy people could never feel safe from sudden death when the infection was anywhere near. In addition, the symptoms were peculiarly horrible: radical dehydration meant that a victim shrank into a wizened
caricature of his former self within a few hours, while ruptured capillaries discolored the skin, turning it black and blue. The effect was to make mortality uniquely visible: patterns of bodily decay were exacerbated and accelerated, as in a time-lapse motion picture, to remind all who saw it of death’s ugly horror and utter inevitability.

The statistical impact of cholera was occasionally severe: in Cairo about 13 per cent of the total population succumbed in 1831 when the disease first affected that city.
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But this was unusual, and in European cities losses were never anything like that great. But this did not diminish the unique psychological impact of the approach of such a killer. Cholera seemed capable of penetrating any quarantine, of bypassing any man-made obstacle: it chose its victims erratically, mainly but not exclusively from the lower classes in European towns. It was, in short, both uniquely dreadful in itself and unparalleled in recent European experience. Reaction was correspondingly frantic and far-reaching.

The disease first came acutely to European attention when an unusually severe outbreak of cholera developed in the hinterland of Calcutta in 1817. Thence it spread to other parts of India, and soon transgressed the boundaries that had previously confined it to the subcontinent and immediately adjacent regions. What seems to have happened is that an old and well-established pattern for spreading cholera across the Indian landscape intersected new, British-imposed patterns of trade and military movement. The result was that the cholera overleaped its familiar bounds and burst into new and unfamiliar territories, where human resistance and customary reactions to its presence were totally lacking.

From time immemorial, it appears, Hindu pilgrimages and times of festival had drawn great crowds to the lower Ganges, where cholera was endemic. Consequently, the celebrants had been liable to pick up cholera along with other infections. Those who did not succumb on the spot were liable in turn to carry the infection back home, where it ran an accustomed if nasty and sometimes demographically destructive course.
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The association of cholera with pilgrimage and holy days in India continues to the present; and prior to 1817 one may safely assume that well-defined custom pretty well confined die dissemination of the infection to the range of Hindu pilgrimage, i.e., to India proper.
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Nevertheless, from time to time cholera infection reached as far afield as China, traveling by ship. This is attested by the fact that when cholera penetrated China early in the nineteenth century, the Chinese did not regard it as a new disease, even though it had not been seen on the China coast for some time previously.
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In 1817, however, when an unusually severe cholera epidemic started to re-enact its familiar pattern, English ships and troops were also on the scene; and their presence and movement to and from the primary focus in and around Calcutta, carried the infection to completely unfamiliar ground.

The expansion followed two routes. One was overland, and of relatively limited range. British troops fighting a series of campaigns along India’s northern frontiers between 1816 and 1818 carried the cholera with them from their headquarters in Bengal, and communicated the disease to their Nepalese and Afghan enemies. Far more dramatic were the movements by sea. Ships carried cholera to Ceylon, Indonesia, the southeastern Asian mainland, China, and Japan between 1820 and 1822. Muscat in southern Arabia encountered the disease when a British expeditionary force, intent on suppressing the slave trade, landed there in 1821; and from Muscat the cholera filtered south along the east coast of Africa, following the slave traders. The infection also entered the Persian Gulf, penetrated Mesopotamia and Iran, and continued north into Syria, Anatolia, and the Caspian shores. There it stopped short, more perhaps because the winter of 1823–24 was unusually severe than because of any action by either Russian, Turkish, or Persian authorities. It lingered longer in China and Japan; indeed it is not clear that the disease had disappeared from China before the second epidemic wave got going in 1826.
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The episode proved only a foretaste of the far more extensive
wanderings of the cholera bacillus in the 1830s, making the disease genuinely global. A new cholera epidemic emerged from Bengal in 1826 and quickly retraced its previous path into southern Russia. Military movements connected with Russia’s wars against Persia (1826–28) and Turkey (1828–29) and the Polish revolt of 1830–31, carried the cholera to the Baltic by 1831, whence it spread by ship to England. In the next year it invaded Ireland; and Irish emigrants carried the disease to Canada, whence it filtered southward into the United States (1832) and Mexico (1833).

More enduringly important than this first sally into the European heartlands was the fact that cholera established itself at Mecca in 1831 at the time of the Moslem pilgrimage.
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The inevitable result was the re-enactment of the patterns of epidemic dispersion long familiar within India, but this time on a much expanded geographic scale as followers of Muhammad headed homeward, whether west to Morocco or east to Mindanao, or to points between. Thereafter until 1912, when cholera broke out in Mecca and Medina for the last time, epidemics of this dread disease were a common accompaniment of the Moslem pilgrimage, appearing no fewer than forty times between 1831 and 1912, or every other year on the average.
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As cholera thus added the Moslem pilgrimage to its older Hindu pilgrimage dispersal routes, the exposure of peoples beyond India’s borders to the new disease became chronic. On top of this, after mid-century the swifter movement of steamships and railroads became increasingly able to accelerate the global diffusion of cholera from any major world center. As a result, cholera deaths beyond India’s borders certainly totaled millions in the nineteenth century, although no precise calculation seems feasible. In India itself the disease was and remains important, causing far more deaths than plague; but cholera in India, being thoroughly familiar, excited no special alarm or surprise.
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