Plagues, Pandemics, Poxes and the Electric Toothbrush

By Kenneth Ring, Ph.D.

Elizabeth Kolbert is a longtime staff writer for The New Yorker, an expert on environment issues, particularly those pertaining to the climate crisis, and the author of one of the most terrifying books of our time, The Sixth Extinction. In that book, she describes in horrifying detail what human beings have done in the newly named epoch of our time, the anthropocene, to destroy nature. We have done a very good job.

But none of that, fortunately, is our concern here. What is, is an article of Kolbert's I recently read that had to do with the history of pandemics. That stimulated me to do a little research of my own into this matter, and that is what I would like to share with you here. At the outset, however, I need to acknowledge my indebtedness to Kolbert for some of the information I will be presenting in this blog.

Those of you who are older, or perhaps as old as hills as I am, may be familiar with some of this history, but for younger readers, this may be new territory. Let’s begin to explore it.

Almost all of us who have grown up during the past hundred years or so have not had any personal experience with pandemics until now. We have of course grown used to the seasonal flu, which causes many people to die every year. But the flu doesn’t stop the world; it goes on just minus thousands of people. A pandemic, however, not only stops the world but changes it in unpredictable and often decisive ways. History, as one author has recently suggested, is not just made by men, but by microbes. Of course, in our lifetime and relatively recently there have been outbreaks of serious respiratory diseases, also caused by coronaviruses, such as SARS and MERS, and the Ebola virus, the H1NI flu, and so on, but these were, fortunately, mostly regional illnesses and were relatively quickly quelled. Malaria, though a very serious disease (it kills about a half million people every year) is familiar to most of us only from reading about it. It is rare in the United States. So, by and large, we have been very lucky to live during these times. Most of us have emerged unscathed by serious widespread disease and life has gone on in its wayward way, as have we.

Needless to say, however (a phrase that always goes on to contradict itself), this has not invariably been the case. There is hardly anyone left on earth who survived the Spanish flu that began as World War I was ending in 1918 and didn’t burn itself out until 1920. During that time it killed an estimated 50 million people throughout the world, maybe more. By comparison,"only" about 20 million people perished in the war. That flu was a lot more deadly in scarcely more than a year than in the four years of "The Great War."

But pandemics like the Spanish flu go back a long way and it is sobering to become familiar with their history. These days almost everyone knows something about "The Black Death," the plague that after it started in Europe in 1347 was eventually to wipe out about one-third of the population of that continent. But plagues and other pandemics of world-changing consequence began to afflict vast populations of humanity long before that.

According to Kolbert and other sources, the first pandemic of which we have knowledge broke out in 541 near what is now Port Saïd in Egypt. It then spread to the west toward Alexandria as well as toward the east where it reached Palestine. And then it just kept going, and going. In early 542, it had reached Constantinople, which was then the capital of the Eastern Roman Empire under the rule of Justinian (who also caught the fever, but managed to survive it). The plague hit Rome the next year, Britain in 544, Constantinople several more times over the next forty years and didn’t burn itself out until the year 750, more than two centuries after it started. Can you imagine?

And what was it like for people who found themselves caught in the vicious vise of this devastating plague? Here is Kolbert's account of it:

The earliest symptom of the pestilence was fever. Often, [according to one contemporary historian] this was so mild that it did not "afford any suspicion of danger." But, within a few days, victims developed the classic symptoms of bubonic plague -- lumps, or buboes, in their groin and under their arms. The suffering at that point was terrible; some people went into a coma, others into violent delirium. Many vomited blood. Those who attended to the sick "were in a state of constant exhaustion. For this reason everybody pitied them no less than the sufferers." No one could predict who was going to perish and who would pull through.

When the plague came the first time to devastate Constantinople, Justinian had his hands full. Again, Kolbert:

The Emperor paid for the bodies of the abandoned and the destitute to be buried. Even so, it was impossible to keep up; the death toll was too high. [One historian thought it reached more than ten thousand a day, though no one is sure if this is accurate.] John of Ephesus, another contemporary of Justinian's, wrote that "nobody would go out of doors without a tag upon which his name was written," in case he was suddenly stricken. Eventually, bodies were just tossed into fortifications at the edge of the city.

That's what plagues were like for those who lived in those times. And of course they were far worse when the Black Plague broke out. It not only blasted many millions of lives and changed course of history in Europe but it never stopped. It just kept going year and after year, century after century. In those times, people had to learn to live and die not with the flu, but with the plague.

The plague repeatedly returned to haunt Europe and the Mediterranean throughout the 14th to 17th centuries. According to one historian, the plague was present somewhere in Europe in every year between 1346 and 1671.

If you were unfortunate enough to live in London in 1665 when the plague broke out there, you had a one in five chance of dying. That plague itself killed perhaps as many as 100,000 people.

And the plague is still with us. There were two outbreaks of it in San Francisco around the time of that city’s famous earthquake, and even in this century, there were two eruptions of it in Madagascar.

Plagues are not only horrible and horrifying to those who catch the virus; they can be just as deadly for those who are innocent of doing any harm. This is because during such times, it is easy and tempting to find scapegoats for the spread of the disease. Jews, of course, have always been a handy scapegoat in the history of Christendom. Here’s just one example provided by Kolbert concerning what happened to the Jews of Strasbourg during the during the Black Death in 1349:

Local officials decided that they were responsible for the pestilence -- they had, it was said, poisoned the wells -- and offered them a choice: convert or die. Half opted for the former. On February 14, 1349, the rest "were rounded up, taken to the Jewish cemetery, and burned alive." Pope Clement VI issued papal bulls pointing out that Jews, too, were dying from the plague, and that it wouldn’t make sense for them to poison themselves, but this doesn’t seem to have made much difference. In 1349, Jewish communities in Frankfurt, Mainz, and Cologne were wiped out. To escape the violence, Jews migrated en masse to Poland and Russia, permanently altering the demography of Europe.

Now although we now longer kill scapegoats, some people have begun to blame the Chinese for what President Trump, our leading xenophobe -- and germophobe -- likes to call "the foreign virus."

Returning to history, we move now from pandemics and plagues to poxes, specifically smallpox. Many people today associate smallpox with the kind of pustules (actually called macules) that afflicted the faces of 18th century European aristocrats or even some of our own "royal personages," such as George Washington. Far from it. Smallpox is one of the deadliest and most dreaded scourges ever to torment the lives of human beings, and it is still with us. During the 20th century alone, it is estimated to have killed anywhere between 300 and 500 million people. Kolbert says it may have resulted in the deaths of a billion people during the course of its history, which goes back thousands of years to the time of the Egyptian pharaohs. It kills about one-third of those it infects.

Smallpox, too, has played a leading role in shaping the course of history, particularly in what used to be called "the new world."

Each race and many peoples have contributed their share of horrors to our world, but certainly the Europeans have done more than their share of heinous depredations in literally decimating (a word that is often misused since it means to reduce to one-tenth) the native populations of the Americas and Australia by bringing, and in cases deliberately inflicting, deadly diseases against which the indigenous people had no immunity.

For example, the Spanish inadvertently owed much of their success in conquering the Aztecs and Incas in Mexico in the 16th century to smallpox. Unlike the Spanish, the native Indians had no immunity to the disease, having never encountered it. It was far more fatal to them than the Spanish themselves as many native peoples succumbed to the disease. A century later, the North American Indians suffered a similar fate from a smallpox epidemic. True, the Europeans had the guns and brought the horses, but did you know that it is estimated that perhaps 90% of American Indians died of germs that the European invaders brought with them, most of all, it seems, from smallpox?

According to one historian:

"The discovery of America was followed by possibly the greatest demographic disaster in the history of the world."

Without question it changed the course history in permanent ways, as we have all now long realized, and native people, while they survived, realized most of all to their enduring sorrow. 

And this same shocking story played out elsewhere as well, for in the 18th century, smallpox also took many of the lives and destroyed the culture of the aborigines when it reached Australia, the last corner of the world to have escaped its ravages.

Perhaps that is enough about pandemics, plagues and poxes, though I could of course numb you into insensibility by discussing still other deadly and persisting diseases, such as cholera, likewise still very much with us, as we all will remember from its outbreak in Haiti in 2010 following the horrendous earthquake there. Eventually, some 800,000 people contracted the disease and 10,000 died. But I don’t need to belabor the point that, as John Irving made clear in his novel of a few years back, The World According to Garp, the world is not safe. And it certainly has been and will continue to be plagued by disease (no pun intended). There is no immunity from life on this planet.

So, finally, what are we to make of all this and what does this history, brief and selective as it had to be (a blog after all is not a book), have to teach us as we navigate our way through COVID-19, the pandemic of our own lifetime? Well, here are just some of my own personal reflections on the matter.

First, these diseases began with the domestication of animals and with people living in cities. I didn’t have to read Yuval Harari's Sapiens to learn that our hominid ancestors made a big mistake when they climbed down from their trees to the savannas of Africa and became biped primates (our back problems stem from that decision) and then, to compound their folly, as humans to invent agriculture ten thousand years ago from which all the subsequent calamities and misfortunes of civilization derive. But of course there is no going back. History does not follow a progressive track, but it does not go in reverse. We are stuck with it, and stuck with disease. And to be fair, civilization has brought us some wonderful things, such as the invention of the electric toothbrush. It’s not all been bad.

As for our current virus, one good thing about it is that has temporarily slowed the climate crisis express train before it hurdles over the cliff. It’s done wonders to stymie the production of carbon dioxide and methane into the atmosphere. But can we learn from this experience before it is too late? Time will tell.

But what I have mainly endeavored to show in this little essay is that as disruptive to our daily lives as COVID-19 has been -- and granting it could end up killing hundreds of thousands of people and sickening millions more -- in light of what our forbearers throughout history have had to endured, it hardly compares with the horrors of the plagues, pandemics and poxes of the past. For most of us, fortunately, we are chiefly being inconvenienced and forced to undergo isolation for a few months. I don't mean to discount all the suffering that our health professionals and others have had to undergo to deal with this virus. Many will have given their lives to protect the rest of us, and we will always have cause to give enduring thanks to them. They have been the frontline soldiers on this war. But in the end the great preponderance of humanity will emerge sobered by the experience but intact. We will survive. The world will start again. The economy will take a while to recover, but we will make it.

But apart from the lessons from history, the question is, what will you have made of it? What will you have learned from having gone through this? And for those of you who survive this temporary ordeal, how will you choose to live once this is over and you can finally rejoin the world? What kind of world would you want to see blossom then?