The Transformation of the World (42 page)

A new plague cycle began in Central Asia in the middle of the eighteenth century—the third, after those of the sixth through eighth and fourteen through seventeenth centuries. In the Ottoman Empire this new wave joined up with stable plague centers in Kurdistan and Mesopotamia. Istanbul was considered the kingdom of rats and a dangerous focus of infection, while Ottoman troops ensured that the disease was transmitted all over the empire. The plague traveled by ship from ports such as Istanbul, Smyrna, Salonica, and Acre, as well as by land along the great highways.
⁷⁶
Bonaparte's troops became infected in 1799 during their advance from Egypt to Syria; their commander tried to raise morale with a staged visit to the plague house of Jaffa. Half of his army died of plague, dysentery, or malaria in the siege of Acre.
⁷⁷
Subsequent outbreaks were reported from Istanbul (in 1812, with 150,000 deaths), Syria (in 1812), Belgrade (in 1814), and Sarajevo (on several occasions). Helmuth von Moltke, then a young Prussian military adviser to the sultan, witnessed an epidemic in Istanbul in 1836 in which 80,000 people lost their lives, and on his return journey he had to endure the usual ten-day “detention” at the Austrian
cordon
-frontier.
⁷⁸
Moltke had observed the last fling of the plague. Within the space of twenty years—between 1824 and 1845—it rapidly disappeared from the Ottoman Empire, with the exception
of endemic areas in Kurdistan and Iraq. Tighter quarantines and new official health authorities played a key role in this, but the end of the plague in the Ottoman Empire, a turning point in the history of the disease, has not yet been fully explained. There remains an element of mystery.
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Despite Europe's successful protective measures, it continued to live in the shadow of the plague until 1845, when the last outbreak was recorded in the eastern Mediterranean. It could not drop its guard any earlier.
⁸⁰

The New Plague from China

The last great wave of plague spread from southwestern China in 1892. It reached the southern metropolis of Canton in 1893 and the nearby British colony of Hong Kong in 1894, unleashing a panic reaction in the international public. Ships carried the pathogen to India in 1896, to Vietnam in 1898, and to the Philippines in 1899. By 1900, ports as far away as San Francisco and Glasgow were affected. In Cape Town one-half of those infected died in 1901: a total of 371 fatalities.
⁸¹
The most surprising exception was Australia, where the plague struck ports a number of times but never grew into an epidemic, because the authorities instinctively targeted rats with the utmost energy.
⁸²
The pandemic continued to rage in the first decade of the new century—indeed, some medical historians argued that it burned itself out only around 1950. A later surge came in 1910, when a passenger ship carried the plague from Burma to Java, where it had never taken hold before; more than 215,000 Javanese died of it between 1911 and 1939. The long-term result was a major improvement in living conditions and health care in the colony.
⁸³

As in other epidemics of the age, experts set to work immediately on the spot. At first they were puzzled, because no one had been expecting the plague to reappear in Asia either. Japan had never been in contact with it. In India it was so little known that there had never even been a plague god (as there had in China). Soon British Hong Kong became the main focus of internationally competitive research: the worried government in Tokyo promptly sent the celebrated bacteriologist Kitasato Shibasaburō, who had been Robert Koch's assistant. Pasteur's Swiss disciple Alexandre Yersin hurried over from the Saigon branch of the Pasteur Institute. It was Yersin who in 1894 discovered both the plague pathogen and the essential role played by rats; soon afterward the flea was identified as the carrier.
⁸⁴
Rats were now in for a hard time. The Hanoi city authorities paid 0.20 piasters for each one caught during the epidemic of 1903—a successful measure that also served as an incentive to private rat catchers.
⁸⁵
In Japan isolated cases appeared in 1899, but they did not lead to an epidemic. The novelty of the disease there is shown by the lack of a term for it other than the phonetic loan word
pesuto
.
⁸⁶

Contrary to what was thought at the time, the turn-of-the-century pandemic did not appear out of the blue, nor did it burst out of the still mysterious “central Asia.” The plague was already described in 1772 in Yunnan, a home of the yellowbreasted rat (
Rattus flavipectus
). It must have been present there for a long time,
but only the economic development of the region created the conditions for it to spread. The promotion of copper mining by the Qing Dynasty made the province a magnet for workers within a radius of several hundred kilometers. Between 1750 and 1800 a quarter of a million migrants turned the remote wilderness into a region of work camps and growing urban settlements. With mining came trade and transportation, and the demand for food stimulated rice production in neighboring Burma.
⁸⁷
The plague could spread only as a result of this greatly increased movement, which at first was entirely confined to China—or, more precisely, southwestern China, since there was little integration of the province into a countrywide market. For a time the problem therefore remained within China—out of sight for Westerners. An economic depression in the first half of the century had a dampening effect, but then the Muslim revolts that shook southwestern China between 1856 and 1873 rekindled the disease. Rebel forces and their Qing adversaries were the main carriers. At the same time, the opium trade from the coastal ports bound the province more than ever before to extensive international networks. Detailed reports in local Chinese chronicles allow us to follow the course of the plague from district to district.

Chinese medicine was not unprepared. One school of thought emphasized the importance of personal hygiene, while another focused on environmental factors, both the natural and social, in ways strongly reminiscent of the “miasma” theories that were common in Europe until mid-century. Neither school, however, considered that the disease was transmitted by infection. Collective efforts to combat it concentrated on ritual exorcism, public displays of atonement, and other symbolic acts. As in early modern Europe and the Muslim world, the plague was seen as a divine visitation or punishment, and here, too, people swept the streets, cleaned wells, and burned the possessions of plague victims. The big difference with premodern Europe was that neither leading doctors nor state officials believed in infection as the cause, and therefore in isolation of those suffering from or exposed to the disease. The West had been the first to demonstrate the effectiveness of such methods in the quarantining of affected ports. In 1894 the colonial authorities in Hong Kong applied another strategy. On the assumption that the plague bred amid the squalor of poverty, they intervened forcefully to keep Chinese and Europeans apart and to raze a number of districts inhabited by the poor. This provoked vigorous, sometimes violent, protests from the Chinese—not only among “the poor” but also among philanthropically inclined dignitaries.

What this resistance expressed was not premodern “Asiatic” superstition but a rational view that ruthless methods were of little avail. Western medicine was equally unable to offer a cure for the disease, and despite Yersin's discovery the word had not yet got about that rats and fleas should be the target of attack. In 1910–11 the plague reappeared in Manchuria with greater virulence, transmitted from Mongolia rather than southwestern China, in the last major outbreak to be seen in East Asia. Chinese authorities and doctors managed to bring it under
control without foreign help, using Western-style quarantines and health checks. In 1894 the Cantonese authorities had done little to face up to the problem, but now perceptions had changed and the imperial government recognized the fight against the plague to be an important task. The late Qing state advertised its successes in public health as a patriotic achievement, which among other things forestalled any new intervention by foreigners against the country's “backwardness.” China had dramatically narrowed its gap with Europe in the domain of plague control.

Nowhere was the plague more devastating than in India,
⁸⁸
where it appeared with epidemic force in 1896, first of all in Bombay. Of the 13.2 million deaths from the disease recorded worldwide between 1894 and 1934, 12.5 million were in India. Hunger and plague were mutually reinforcing. The British authorities acted at least as harshly as they had in 1894 in Hong Kong, and more so than in previous epidemics of smallpox and cholera. Victims were locked up in camps or forced into special hospices, where the mortality rate was as high as 90 percent. Houses were searched for the dead and infected, travelers were subjected to physical examination, roofs and walls were removed to let in air and light, and huge quantities of disinfectant were sprayed around.
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This heavy-handed approach was a result of international pressure to halt the spread of the disease and of a determination to prevent the complete breakdown of life in the big cities, but it also reflected the scientific self-confidence and image building of the medical profession. In any event, it proved as ineffectual in India as in Hong Kong. People ran away to escape the draconian measures and took the pathogen with them. The colonial authorities were flexible enough to correct their course in the end: whereas their main concern at first had been to protect the health of foreigners, they now—like the late Qing bureaucracy—took responsibility for the creation of a public health system.

The great fin-de-siècle Asian epidemic triggered a debate about how best to protect Europe. Earlier international health conferences that had been held since 1851 had been mainly concerned with cholera.
⁹⁰
The one that gathered in Venice in 1897, with the participation of Chinese and Japanese experts, looked at measures to ward off the plague. Several European countries also sent health officials to study the situation in Bombay, and the health organization of the League of Nations—the precursor of today's World Health Organization—had its ultimate origins in these efforts at plague control.

The international outbreak of the plague that first became evident in the early 1890s was scarcely more “global” than other epidemics of the nineteenth century and less so than the Black Death of the fourteenth century (which was most probably a different disease). Most of the victims were recorded in India, China, and Indonesia (Dutch East Indies), with 7,000 deaths in Europe, 500 in the United States, and approximately 30,000 in Central and South America. The fact that it more or less spared the West was not due only to better medical provision in the “developed countries”; the contrast between “first” and “third” worlds, core and
periphery, does not exhaust the subject. The new epidemic would not have been possible without the development of extensive international networks, without the linkup of southwestern China with overseas markets. When the rate of spread accelerated, “modern” cities such as Hong Kong and Bombay, accessible by either ship or rail, became for a time the most dangerous places on earth. Low standards of hygiene plus more tightly meshed networking created the basic conditions of which the plague could take advantage.

The official reactions did not vary along an east-west axis; the microbiological revolution and laboratory-based medical science were still so new and unfamiliar in their applications to health policy that Western authorities were no cleverer than their Asian counterparts. In a city like San Francisco people shut their eyes to the peril, while in Honolulu, newly annexed by the United States, districts inhabited by Chinese and Japanese were burned to the ground in a scapegoating reflex.
⁹¹
In a number of countries, foreign minorities, often with skin of a different color, were treated as carriers of infectious diseases and subjected to more intense health checks. One of the most rational approaches was that of the moribund imperial state in China, which avoided the pointless excesses of the British in India.

The Blue Death from Asia

At the end of the nineteenth century, Europe was by no means an island secure from epidemic disease. Just when the plague was spreading like wildfire in Hong Kong, the German port of Hamburg was hit hard by an outbreak of cholera. No other disease threw Europe into such fear and panic in the nineteenth century: it was not a passing shock, here today and gone tomorrow, but a constant threat to the quality of life in large parts of the world. Although Robert Koch discovered the bacillus responsible for it on a trip to Calcutta funded by the German government in 1884, thereby dispelling old speculative theories about its cause, another twenty years would pass before it was understood that replacement of the water and salt lost by the patient constituted a simple, cheap, and effective treatment. Until then people suffering from cholera, in Europe and elsewhere, had to endure often quite pointless and brutal medical procedures. Those who escaped the attention of doctors tried to make do with household items such as camphor, garlic, vinegar fumes, or burning pitch.
⁹²
In terms of medical knowledge, Europe before Koch had no decisive lead over China. The Shanghai doctor Wang Shixiong, in his “treatise on cholera” (
Huoluan lun
[1838; 2
^nd
ed. 1862]), stressed the importance of clean drinking water quite independently of John Snow and other European or Anglo-Indian luminaries.
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People in Europe were as helpless as elsewhere in the face of cholera; no “all clear” signal could be sounded at any time in the nineteenth century. Any disease has a distinctive chronology that differs according to location. This shows itself in the polarity of India and Europe. Over the centuries Europe had grown used to the
plague
, never ceasing to fear it yet gradually learning how to keep it in check. In India it was something
new in 1892; the only ones there who took countermeasures were Europeans. On the other hand,
cholera
came as an unpleasant surprise to both India and Europe in the nineteenth century. For decades European medicine was not much wiser than Indian when it came to explaining the disease and developing strategies to combat it.