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Diseases and epidemics

Selection of gold and silver pomanders, Europe

Selection of gold and silver pomanders, Europe

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The Black Death

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'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 PasteurKoch 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 typhoidtuberculosis 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. Diphtheriameasles 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.

Disease today

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.

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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)


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