Plagues in World History (15 page)

as well as a daily newspaper, giving details of the service’s ongoing fight against the epidemic. In addition, Wu’s assistants “gave public lectures whenever possible and answered any questions that might be asked them by their audience” as part of his own education offensive in Manchuria.185 Wu’s counterpart in India was Dr. U. L. Desai, a native physician also educated in England posted at the plague hospital in Nasik, who recommended farther reaching measures against the plague than even the British Civil Service was willing to contemplate, to include improvements in sewage systems, better housing, educational schemes to promote hygiene, and compulsory registration of all medical practitioners, aimed particularly at native
vaids
and
hakims
.186 Some native newspapers also sided with the British government by urging their readers to submit to plague measures, even if they be distasteful, for the greater good of the public health. On the other hand, when newspapers did advance people’s objections to such measures, many did so primarily from a cultural, rather than colonial, point of view.

The
Bangavasi
of Pune, for example, cited a Hindu fatalism toward disease, somewhat akin to the Muslim one reported in Tunisia, when it rhetorically asked its readers, “Why prevent the helpless and long suffering Hindu from dying in peace? When death summons us we must die. Why disturb and distract us in the name of science?”187 When
Vyápári
objected to plague measures such as “the limewashing of houses, the destruction of huts, [and] the compulsory segregation of plague patients,” which it characterized as “nothing but folly and mad-Plague y 69

ness,” it likewise did so on the grounds that modern medicine was foreign to native customs and beliefs:

These may be the most approved means, according to Western sanitary science, of stamping out the plague, but it wil be very difficult to persuade an orthodox Native to believe in their efficacy. Our people, who are brought up in the old order of ideas, generally look upon such epidemic diseases as the result of Divine displeasure and so they seek to suppress them by offering oblations to the Deity and so forth.

Since “no one knows anything for certain about the plague and the proper means of suppressing it,” the editors felt that the government’s efforts as of February 1897 were a laughable “misdirection of energy.”188

A third view, however, claims that native objections to Western science and medicine as represented by British plague controls in India were not based on an inveterately hostile cultural response, which was never “uniform” or “homogenous” in any case, but rather on the fact that, even though it had now entered a promising new era, the modern medical tradition of the West was too often simply ineffective and incapable of curing or preventing the plague. When acces-sible and accommodating to native sensibilities, locals could in fact prove themselves quite willing to avail themselves of Western doctors and hospitals. This suggests that the political and cultural dynamics of the Third Pandemic in India were conditioned primarily by the disease of plague itself, which due to its uniquely dramatic history (particularly during the Black Death) and characteristics, set off a “panic” both in the British government and among its native subjects, who had to respond not only to the plague but also to the unusually oppressive measures devised to contain it.189 If true, such an interpretation would imply a continuity of historical responses to plague, but a possible objection is that native protests to plague controls in India were not exactly comparable to those made in Italy during the Second Pandemic, since the latter were based primarily on economic, rather than medical or cultural, grounds.

Although the case studies in India, China, and Senegal during the Third Pandemic of plague are the most studied and well known, the dynamics of modern efforts to control plague likewise played out at ports of cal al around the world.

For instance, significant native resistance to plague controls imposed by imperial or Western-leaning governments occurred in the British colony of Hong Kong in 1894; at Rio de Janeiro in Brazil, Honolulu in Hawai , and San Francisco in the United States in 1900; and at Cape Town in South Africa in 1901. However, at Alexandria in Egypt and Sydney in Australia, plague’s impact was minimal, and resistance to antiplague measures was muted in 1899–1900; in the former case, this was perhaps because the native Muslim medical tradition was somewhat compatible with the West’s and the government’s health policy respected its 70 y Chapter 1

population’s pluralistic culture, while in the latter case, health authorities eventually shifted their focus to controlling the rodent population rather than quarantining the human one, which proved to be a more enlightened approach to combating plague. At Rio de Janeiro, Cape Town, Honolulu, and San Francisco, there was a markedly racial element to authorities’ plague measures, which disproportionately targeted native people of color and immigrant Chinese. In Rio, both the government’s policies toward plague and popular resistance to them, which ended with the demolition of the Afro-Brazilian district of the city, were influenced by roughly concurrent measures against two other diseases, yellow fever and smallpox. Honolulu’s Chinatown was accidentally destroyed by a fire set initially as a “controlled burn” to contain plague and for which the U.S. government never adequately compensated its victims. The forced segregation of black Africans by the British in Cape Town became an important precedent for the later apartheid policy in South Africa. And in both Buenos Aires, Argentina, and in San Francisco, authorities engaged in a counterproductive denial of the existence of plague, with the collusion of the local press.190

One of the three general lessons to be learned from all three pandemics of plague, and which we will see apply to other diseases as well, is therefore this one: that throughout the ages and into the foreseeable future, medicine will be limited in terms of its effectiveness in fighting some diseases, like plague. While modern medicine has proven its ability to eradicate certain illnesses, such as smallpox (discussed in the next chapter), a disease like plague is too extensively endemic in too many places around the world to simply disappear from human history.

This, of course, is not even counting the fact that newly emerging diseases, like the 2009 swine flu pandemic, will always arise to challenge medicine and that even older diseases like plague and tuberculosis can mutate into drug-resistant strains to elude our cures. But even when medicine was woefully impotent against plague, as it was during the First and Second Pandemics, doctors were still convinced they could make headway against the disease, and who knows, with some measures like self-imposed quarantine and mass evacuation that were adopted by Venice during a plague in 1576, perhaps they did.191 In turn, modern medicine during the Third Pandemic learned to be humble in the face of plague, when its very response to the disease, even when armed with its new knowledge about germs, provoked a reaction from its would-be patients that proved counterproductive to its efforts. Modern medicine thus needs to strike a balance with diseases like plague, particularly when its “miracle cures,” like vaccination or antibiotics, prove ineffective or are not at hand, so that it will be forced to fall back on what are now “traditional” measures, like quarantine. How will modern society react to such outdated methods to control disease when these may seem as culturally foreign and objectionable as the British plague hospitals did to na-Plague y 71

tive Indians during the Third Pandemic? Certain implications of plague controls, such as that family members might become separated or that economic livelihoods may be disrupted, probably will always be protested no matter how culturally predisposed a civilization or society is to them. This past year, for example, the Vermont department of health asked my wife and I in a phone survey if we would be willing to quarantine ourselves in our home for a whole month should an untreatable flu outbreak occur. While we have no ideological objections to such a measure, it did raise some eminently practical questions, like how would we stock up on enough food and survive an enforced unemployment for such a lengthy period of time? Our society, and each individual within it, will have to decide how far it is willing to go in order to safeguard itself from a terrifying, “plague-like” disease.

The second lesson of plague is that a disease that can follow in the wake of either animal or human migrations will always be global in scope, insofar as this is defined by the trade and travel patterns of the times. During the First Pandemic, plague was largely delineated by the sea networks of the Mediterranean region; during the Second Pandemic, by the overland trade routes of the Mongol Empire across Eurasia; and during the Third Pandemic and into modern times, there now seems to be no geographical limit to disease, what with the global reach of ship and airplane transport. So what once used to be a localized outbreak in some exotic corner of the globe is now our backyard epidemic. This necessitates, of course, ever greater and more sophisticated vigilance to try to contain pandemics, only to be led by agencies with transnational authority and clout, such as the World Health Organization (WHO). We can only hope they are up to the challenge.

The third and last lesson of plague is how there are always winners and losers to disease, both
within
a given society or culture and
between
rival civilizations.

During all three pandemics, some civilizations appeared to benefit from, or at least tried to profit by, the plague: the Islamic Umayyad caliphate rose to power during the First Pandemic; Europe emerged economical y and technological y superior to the Middle East by the end of the Second Pandemic; and the British Empire attempted to cement its rule in India during the Third Pandemic. In England during the Black Death, the peasant classes seemed to benefit economically the most from the plague, while the opposite was true in Egypt. Yet, these impacts were, for the most part, entirely unpredictable. When the British Civil Service, for example, intentionally tried to use the Third Pandemic as an opportunity to demonstrate the medical benefits of the empire and so further its influence among its native subjects, what it ended up with was, in the words of one scholar, “the greatest upsurge of public resistance to Western medicine and sanitation that nineteenth-century India had witnessed,” such that it represented “a 72 y Chapter 1

profound crisis for . . . the power of the colonial state.”192 While plague and its controls instil ed chaos, terror, and social tensions in towns and vil ages across India that brought everyday life to a standstil , some disreputable elements were nonetheless able to benefit by means of extortion and crime.193 By contrast, when the government of medieval England tried and failed to turn the clock back on the economic effects of the Black Death through its labor legislation, it benefited enormously from the economic power unleashed from its eventually liberated peasantry. With such unintended results as these, who indeed would wish to be visited by plague in the hope that somehow they will be the victor by it?

Of one thing we can be certain: plague, the most dramatic of all diseases in terms of its absolute mortality, has also had the most drastic cultural impacts upon the civilization or society that was made to feel, whether for good or ill, its wrath.

C H A P T E R 2

y

Smallpox

Smallpox is an ancient disease, perhaps even older than plague, that seems to have first arisen among the earliest human civilizations with settled populations large enough to sustain its epidemics, such as in Mesopotamia, Egypt, or the Indus River valley. Conclusive evidence of smallpox emerged during the second millennium B.C.E. in Egypt, with the physical evidence of its characteristic pustules on the skin preserved in the mummified remains of certain individuals, such as the Pharaoh Ramses V (reigned c. 1149–1145). Positive identification of the smallpox rash on Ramses’ mummy was made in 1979 by the medical special-ist and historian of smallpox Donald Hopkins.1 The contemporary Ebers Papyrus, one of the oldest medical manuscripts in existence, may also confirm the presence of smallpox in ancient Egypt, as it contains a brief reference to a skin ailment.2 Equally ancient evidence of smallpox seems to come from India, where the Sanskrit medical text, the
Susruta Samhita
, attributed to the Hindu physician Dhanwantari and dating to c. 400 C.E., but perhaps preserving some passages that go as far back as 1500 B.C.E., gives what appears to be a detailed description of the disease, including fever, backache, prostration, and, of course, the telltale inflamed and dimpled pustules.3

Smallpox is caused by a virus, a microscopic infectious disease agent that, unlike a bacterium, is an incomplete organism that needs to invade a host cell in order to reproduce and spread within the body. It consists of nucleic acid, either DNA or, more commonly, RNA, surrounded by a protein coat that allows the virus to attach itself to a host cell and then penetrate it in order to use the host cell’s biological mechanisms to replicate itself. Some viruses, instead of simply 73

74 y Chapter 2

duplicating the viral genome, use their RNA template to manufacture DNA, a process known as reverse transcription; one class of these viruses, known as retroviruses, which includes the human immunodeficiency virus (HIV) that causes AIDS (acquired immune deficiency syndrome), are particularly insidious as they incorporate their manufactured DNA into that of the host cell, thus making this “Frankenstein’s monster” practically indistinguishable from other, healthy cells.

Once assembled, the viral copies are then released when the host cell ruptures and dies, a process called lysis. Viruses are also prone to genetic mutations, called antigenic drift, as well as to recombinations with other viruses, or antigenic shift; it is by such processes that new, often deadly viruses are created, as typically happens with ever-changing influenza strains. This also makes it difficult to treat certain viruses or prevent infection by them. The smallpox or variola virus is an example of a DNA virus.