The Unwritten History of Sickness, From the Black Death to Modern Plagues

“ Moreover, every new plague has its peculiarities, which are the less easily discovered on first view, because, during its ravages, fear and consternation humble the proud spirit.
The physicians of the 14th century, during the Black Death, did what human intellect could do in the actual condition of the healing art; and their knowledge of the disease was by no means despicable. ”

“ Another cause of the high death-rate was superstition, which regarded disease as a “visitation” which had to be borne without question or inquiry.
With such an attitude towards epidemics, which by some were regarded as due to an unfortunate conjunction of certain planets, it is not to be wondered at that the epidemics were mismanaged; and it is certainly difficult to imagine any measure better calculated to cause the spread of the plague than that of forbidding those affected to leave their houses, and compelling them to stay indoors and infect the rest of the household. ”

“ Others copied from them, without seeing for themselves, as often happens in other matters which are equally evident; and thus the world believed in the miracle of an imperfection in the human body which had been caused by the Black Plague.
The people gradually consoled themselves after the sufferings which they had undergone; the dead were lamented and forgotten ”

“ The mental shock sustained by all nations during the prevalence of the Black Plague is without parallel and beyond description. In the eyes of the timorous, danger was the certain harbinger of death; many fell victims to fear on the first appearance of the distemper, and the most stout-hearted lost their confidence. Thus, after reliance on the future had died away, the spiritual union which binds man to his family and his fellow-creatures was gradually dissolved. ”

“ Hundreds of homes, isolated because of a victim of the plague found therein, became ghastly breeding-places of the disease, and then silent, disgusting graves. If a man shivered in fear, or staggered from weakness, or for very hunger turned sick, he was marked as a victim, and despite his protests was huddled away with the real victims to die the awful death. ”

“ The work of conversion is accomplished by vegetation; and this is consumed for the construction of higher organizations.
The laws which govern and control the universe, {180}are as definite and as wonderful among invisible atoms, as those which regulate the enormous masses floating in space; and the time will come when the advancing intellect of man will measure and weigh the morbid poisons, as he measures and weighs the stars. Why should the laws of Epidemics be less understood, than the laws which govern the course of comets? ”

“ The state, which founds its legislation on a knowledge of realities, which expects from the physical sciences information respecting human life collectively, considered in all its relations, has a right to demand from its physicians a general insight into the nature and causes of popular diseases. Such an insight, however, as is worthy the dignity of a science, cannot be obtained by the observation of isolated epidemics, because nature never in any one of them displays herself in all her bearings, nor brings into action, at one time, more than a few of the laws of general disease. ”

“ But, looking back at the history of the earlier ages, and carrying that survey down to the present time, we have experience in all ages of great masses of people being seized upon by these dominant ideas, accompanied with the excitement of some passion or strong impulse which leads to the most absurd results; and it is of these Epidemic Delusions I have to now speak. The word "epidemic" simply means something that falls upon, as it were, the great mass of the people—a delusion which affects the popular mind. ”

“ In this country great ignorance of the laws of Health has prior to the last fifty years prevailed, and consequently preventible diseases have been rampant, and have claimed innumerable victims. Each century has been marked by great epidemics, which have swept through the country, scattering disease and death in their course. In the fourteenth century, for instance, there was the Black Death, a disease so fatal that it left scarcely one-fourth part of the people alive ”

“ One of the great questions in which governments in all countries are interested is how to keep down the death rate in great cities. In olden times there were many plagues and epidemics. These often destroyed thousands of lives. People did not understand why the plagues came; they used to think them punishments for sin, or sent by some evil spirit out of hatred to humanity. They did not know how to meet them or how to take care of those whom the plagues attacked, and so whole cities were sometimes emptied by disease before which the science of those days was helpless. ”

“ Much less is it necessary that the means of life should be prescribed in a dead language, or dictated with the solemn pomp of a necromancer. The effects of imposture, in every thing, are like the artificial health produced by the use of ardent spirits. Its vigour is temporary, and is always followed by misery and death.
The belief that the yellow fever and the plague are necessarily mortal, is as much the effect of a superstitious torpor in the understanding, as the ancient belief that the epilepsy was a supernatural disease, and that it was an offence against Heaven to attempt to cure it. ”

“ In London, statistics were collected on the number of plague victims and their places of death to try to determine the cause of the plague by correlation, a new method. This was a natural sequent to merchant John Gaunt's 1662 book "Natural and Political Observations Made upon the Bills of Mortality", which compiled yearly vital statistics from which to analyze, for instance, causes of death due to particular diseases. It reached conclusions such as that fall was the most unhealthy season; females had longer life spans than males ”

“ The whole period during which the Black Plague raged with destructive violence in Europe, was, with the exception of Russia, from the year 1347 to 1350. The plagues, which in the sequel often returned until the year 1383,98 we do not consider as belonging to “the Great Mortality.” They were rather common pestilences, without inflammation of the lungs, such as in former times, and in the following centuries, were excited by the matter of contagion everywhere existing, and which, on every favorable occasion, gained ground anew, as is usually the case with this frightful disease. ”

“ There is only one of the epidemics of the plague in the middle ages that has arrested the attention of the chroniclers, poets, and physicians of those days; and that interest was awakened by the enormous diffusion that it reached over the whole of the then known world, by its victims reckoned in millions, and by the shock to the framework of society which it brought with it and left behind it. ”

“ Unfortunately we know little of their condition, whether in the 17th century or in the 18th. But there must have been something in it most unfavourable to health; for we find from the Bills of Mortality that the cessation of plague made hardly any difference to the annual average of deaths, the increase of population being allowed for. This fact makes the disappearance of plague all the more remarkable. ”

“ The 'great mortality' was indeed no respecter of persons. It is true that the poor died in greater numbers in proportion to the closeness and insalubrity of their dwellings and to their lack of power of resistance from insufficient food. But the list of the great ones of the earth who died is a long one. One of the earliest victims of the plague on its entrance into Europe was Andronicus, the son of the Emperor at Constantinople. ”

“ The objection to that hypothesis of plague is that it involves a total disregard of facts. It is a mere formula, which saves all trouble, dispenses with all historical inquiry, and appears to be adapted equally to popular apprehension and to academic ease. The bubo-plagues of history have not, in fact, been all of the same descent; notably the Black Death was a wave of pestilence which Mohammedan countries, accustomed as they had been to native bubo-plagues for centuries before, recognized as an invasion from a foreign source, as an interruption of the sequence of their own plagues. ”

“ On the other hand, one may make too much of the increase of well-being among the labouring class which coincided with the cessation of plague. As a check upon population plague worked in a very remarkable way. In London, as well as in towns like Newcastle and Chester, plague towards the end of its reign arose perhaps once in a generation and made a clean sweep of a fifth or a fourth part of the inhabitants, including hardly any of the well-to-do. ”

“ All through the eighteenth century, smallpox, typhus, scurvy, and ague were rampant, and it is not till 1834 that we find the beginning of sanitary legislation. In 1837 the Act for the Registration of Births and Deaths was passed, which at once provided the indispensable foundation for reliable statistics; previous to that date all that there was to depend upon were the Baptismal Registers and the more or less accurate Bills of Mortality. This has been followed by a long series of Public Health enactments concerned with practically every department of life. ”

“ But while for centuries the nature and causes of the black death have been subjects of medical inquiry in all countries, it remained for our own time to discover a more scientific explanation than those previously advanced. The malady is now identified by pathologists with the bubonic plague, which at intervals still afflicts India and other oriental lands, and has in recent years been a cause of apprehension at more than one American seaport. ”

“ In these days of sanitary measures and successful public health activity, it is becoming more and more difficult for us to realize the terrors of the Black Plagues, the devastation, greater and more frightful than war, which centuries ago swept over Europe and Asia time and again, scarcely leaving enough of the living to bury the dead. Cholera, smallpox, bubonic plague, with terrifying suddenness fell upon a world of ignorance, and each in turn humbled humanity to the dust before its invisible enemies. ”

“ The share which this cause had in the spreading of the plague over the whole earth, was certainly very great: and the opinion that the Black Death might have been excluded from Western Europe, by good regulations, similar to those which are now in use, would have all the support of modern experience; provided it could be proved that this plague had been actually imported from the East; or that the oriental plague in general, as often as it appears in Europe, always has its origin in Asia or Egypt. ”

“ But we cannot await idly in the knowledge that new epidemics of the dread disease will surely come, probably mild ones in the next few years, and certainly severe ones again within a few decades. We must amass all of the available information concerning the mode of action of the disease, its manner of spread, its degree of infectivity, its distribution and the mode of its recurrences, and try to formulate from a study of the available facts some means of protecting ourselves against the epidemic, if not of preventing it entirely. ”

“ Epidemics have been deprived of their worst sting, not by any political theories, nor by a statement of human rights, nor by a definition of man or woman, nor by a refusal to consider our physical organization, nor by any attempt to alter it, but by a careful study of the facts of Nature, and by placing humanity, such as it is, in a more favorable condition toward the outer world, such as it is. ”

“ There is little question that much of the ignorance abroad in the world, and much of the fatuous opposition to our experimental work and research, arise from this aloofness of ours. Here also lies the cause of much of the latent period in the application of acquired knowledge to great sociological problems, and the presence of untold sickness and death which could be easily prevented if only a scientific system of dealing with disease could be evolved. ”

“ It is not to our credit as a civilized Nation that human beings die and are buried without any legal recognition or record being made of the cause or manner of their death. It is in no sense to our credit that in many communities diphtheria, scarlet fever, and cerebro-spinal meningitis decimate the infant population yet no one knows, nor is it anyone's business to find out, how many deaths result from these epidemics, or how many persons die from various diseases in the course of a year. ”

“ There were always new ones coming to live in men’s bodies. Long and long and long ago, when there were only a few men in the world, there were few diseases. But as men increased and lived closely together in great cities and civilizations, new diseases arose, new kinds of germs entered their bodies. Thus were countless millions and billions of human beings killed. And the more thickly men packed together, the more terrible were the new diseases that came to be. Long before my time, in the middle ages, there was the Black Plague that swept across Europe. ”

“ Epidemics are, nevertheless, in the early stages, often misreported. If they were not—if early knowledge of threatening conditions were made public—the epidemics would seldom reach formidable proportions. But—and here is the national hygienic failing—the first instinct is to conceal smallpox, typhoid, or any other disease that assumes epidemic form. Repeated [pg 247] observations of this tendency have deprived me of that knock-kneed reverence for Business Interests which is the glorious heritage of every true American. ”

“ Mass attack.—Another argument formerly raised against the contagious character was the claim that it broke out in mass attack, and large numbers became ill on the same day without the occurrence of isolated antecedent cases. The first cases of such epidemic diseases as the plague and small pox became a matter of record because of the accompanying high mortality, while in influenza, with its relatively low death rate the record usually begins only after a comparatively large mass of individuals have been attacked. ”

“ In America we lack even the statistics of disease except in a limited area. In his Message to Congress, December 6, 1909, President Taft urged the institution of the proposed National Bureau of Health very cogently, in these words: "For a very considerable period a movement has been gathering strength, especially among the members of the medical profession, in favor of a concentration of the instruments of the national government, which have to do with the promotion of public health. ”

“ The failure of physicians to "socialize" or "humanize" their knowledge is due to two causes: (1) no one has been applying result tests to the profession as a whole and to the state in its capacity as doctor, testing carefully the sickness rate, the death rate, and the expense rate of preventable diseases; (2) physicians themselves have not needed to know, either at college or in practice, the tax levied upon their communities by preventable sickness. Public schools can do much to secure result tests for individual physicians, for the profession as a whole, and for boards of health. ”