How Pandemics Have Remade Societies, Wars, and Culture?

Frank M. Snowden 城读 2022-07-13

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How pandemics have remade societies, wars, and culture?

Epidemics reveal what our deepest vulnerabilities are in the world that we've made.

Frank M. Snowden, 2019. Epidemics and Society: From the Black Death to the Present, Yale University Press

Sources:

https://yalebooks.yale.edu/book/9780300192216/epidemics-and-society

https://blogs.plos.org/dnascience/2020/04/09/a-brief-history-of-plagues-and-pandemics-from-the-black-death-to-covid-19/

https://www.cbc.ca/radio/thesundayedition/the-sunday-edition-for-april-5-2020-1.5518735/how-pandemics-have-remade-politics-societies-and-culture-1.5518744

Last Friday, I introduced 6 books for Contextualizing Covid-19 recommended by Prof. Frank M. Snowden, Professor Emeritus of History and History of Medicine at Yale University. Today, I am going to talk about one of the books written by Prof. Frank Snowden, Epidemics and Society: From the Black Death to the Present. This book explores the impact of epidemic diseases and looks at how mass infectious outbreaks have shaped society, from the Black Death to today. In a clear and accessible style, Frank M. Snowden reveals the ways that diseases have not only influenced medical science and public health, but also transformed the arts, religion, intellectual history, and warfare.

Why study the interactions between epidemics and society?

This book began as an undergraduate lecture course at Yale University during the immediate aftermath of a series of public health emergencies—first SARS, followed by avian flu and then Ebola—that erupted at the outset of the twenty-first century and raised troubling issues regarding the unexpected vulnerability of modern society to sudden outbreaks of infectious diseases. Prof. Snowden developed the course using his perspective as a historian to address concerns about how vulnerable society is to diseases and pandemics and applying his expertise in the history of medicine and his own research on cholera and malaria.

One of the overall themes structuring Epidemics and Society is an intellectual hypothesis to be tested through the examination of widely dissimilar diseases in different societies over time. This hypothesis is that epidemics are not an esoteric subfield for the interested specialist but instead are a major part of the “big picture” of historical change and development. Infectious diseases, in other words, are as important to understanding societal development as economic crises, wars, revolutions, and demographic change.

Throughout human history until the twentieth century, infectious diseases have been far more devastating than other categories of illness. Epidemic diseases merit attention because their history is far from over.

Well into the twenty-first century smallpox remains the only disease to have been successfully eradicated. Worldwide, infectious diseases remain leading causes of death and serious impediments to economic growth and political stability. Newly emerging diseases such as Ebola, Lassa fever, West Nile virus, avian flu, Zika, and dengue present new challenges, while familiar afflictions such as tuberculosis and malaria have reemerged, often in menacing drug-resistant forms.

Many of the central features of a global modern society continue to render the world acutely vulnerable to the challenge of pandemic disease. Prominent features of modernity— population growth, climate change, rapid means of transportation, the proliferation of megacities with inadequate urban infrastructures, warfare, persistent poverty, and widening social inequalities—maintain the risk.

Microbes possess formidable advantages: they outnumber human beings a billionfold, they enjoy enormous mutability, and they replicate a billion times more quickly than humans. In terms of evolutionary adaptation, microbes are genetically favored to win the contest. Climate change enhances the potential for future disasters. This microbial threat is real. How severe is it? What are our defenses? What factors pro- mote vulnerability? How prepared are we to confront the challenge? How the global community deals with these issues may well be an important factor in determining the survival of our society, and perhaps even of our species.

Viruses are no longer named by presumed place of origin, but by taxonomic classification. This is SARS-CoV-2.

Epidemic diseases are not random events that afflict societies capriciously and without warning. On the contrary, every society produces its own specific vulnerabilities. To study them is to understand that society’s structure, its standard of living, and its political priorities. Epidemic diseases, in that sense, have always been signifiers, and the challenge of medical history is to decipher the meanings embedded in them.

The long-term impacts of epidemics on society

Epidemics and society examines and discusses plague, cholera, smallpox, tuberculosis, polio, typhus, dysentery, yellow fever, HIV/AIDS, and Ebola one by one. The reasons to include these epidemics are as follows:

First, it pays careful attention to those epidemics that have had the largest social, scientific, and cultural resonance.

Harmen Steenwijck, Vanitas stilleven (ca. 1640), which symbolically depicts the transience of life and certainty of death. The vanitas was a popular art form during the Black Death

Plague was often understood as divine punishment. Jules-Élie Delaunay, in The Plague in Rome (1869), depicts an angry messenger of God directing plague incarnate into an offender’s home.

Second, it considers diseases that encouraged the development of major public health strategies to contain them. A central concern of Epidemics and Society is to examine not just epidemics but also the strategies society deployed at various times to combat, prevent, cure, and even eradicate them.

Third, it is important to stress biological diversity. Some major epidemic diseases are bacterial; others are viral or parasitic. They are various in their mode of transmission—the air, sexual contact, contaminated food and water, excrement, or vectors such as mosquitoes, lice, and fleas.

The book’s emphasis is on a series of long-term developments. Of these, the most important are the following:

First, public health strategies: These strategies include vaccination, quarantine and sanitary cordons, urban sanitation, sanatoria, and “magic bullets” such as quinine, mercury, penicillin, and streptomycin. There is also the policy of concealment as a means to deny the presence of a disease.

Inside a Bombay plague hospital, 1896–1897.

Second, intellectual history: Epidemic diseases have played a leading role in the development of the modern biomedical paradigm of disease, the germ theory, and disciplines such as tropical medicine. Furthermore, medical ideas were often held not only for scientific reasons, but also because of the kind of society they promote, or the power they convey to nations and to strategically placed elites within them.

Third, spontaneous public responses: Under certain circumstances the passage of epidemic disease through communities has triggered large-scale and revealing responses among those at risk. These responses include stigmatization and scapegoating, flight and mass hysteria, riots, and upsurges in religiosity. Such events provide important lenses through which to examine the affected societies and the way in which they are constructed—the relations of human beings to one another, the moral priorities of political and religious leaders, the relationship of human beings to both the natural and the built environments, and the severely compromised standards of living that were ignored in more settled times.

Henri de Toulouse-Lautrec, Young Woman at a Table, “Poudre de riz” (1887). Some nineteenth- century women applied perfumed rice powder to their faces to mimic a fashionable consumptive pallor.

One of the themes that runs through the history of epidemic diseases is stigma and violence against groups who are blamed. In the plague years, this took the form of anti-Semitism, for example. For example, in Strasbourg, there was a Jewish population of 2,000. They were accused of poisoning the wells of Christendom and being responsible for the plague. They were rounded up by an irate citizenry, taken to the Jewish cemetery of the city and offered the choice of converting on the spot or being put to death. Half of them refused to convert and they were burned alive in the cemetery.

Witch-hunting, burning of witches, anti-Semitism programs, social tensions, riots have all been part of the history of plague. We see this through the ages. And it comes down to coronavirus, where we see people from Asia being stigmatized and some countries saying this must be the Chinese virus or the Wuhan virus. In Italy, where I am now, there was a hunt for patient zero — as if you could blame someone for the virus — and they wanted to turn on immigrants.

Fourth, war and disease: Armed conflict in an era of “total war,” which began with mass conscription during the French revolutionary and Napoleonic eras, involved the clash of military forces of unprecedented size, even of entire peoples. Warfare on such a scale created fertile conditions for epidemic diseases such as typhus, dysentery, typhoid fever, malaria, and syphilis to flourish. These afflictions often affected both military and civilian populations far from the clash of armies. In its turn, disease frequently had a decisive impact on the course of military campaigns and therefore on international politics and the fate of political regimes.

To illustrate the relationship between war and epidemics, Prof. Snowden examines two examples of military conflict in two different hemispheres during the Napoleonic period. The first is the great military force that Napoleon Bonaparte sent to the Caribbean colony of Saint-Domingue in 1802–1803 to restore slavery and impose French rule. A virulent epidemic of yellow fever, however, destroyed Napoleon’s army and led to a cascade of consequences, including Haitian independence and the Louisiana Purchase.

The second case is the campaign of 1812 during which the French emperor invaded Russia with the largest military force ever assembled to that point. This titanic clash in eastern Europe provides an opportunity to consider the impact of the two classic epidemic diseases of warfare—dysentery and typhus. Together, these diseases annihilated the Grande Armée and played an important part in destroying the emperor himself and transforming the geopolitical balance of power. Napoleon’s 1812 campaign demonstrates the capacity of warfare to unleash epidemic diseases by creating precisely the sanitary and dietary circumstances in which they flourish. It also illustrates that the causal chain could operate in the opposite direction—in other words, that disease can determine the course of war.

The organization of Epidemics and Society

This book has 22 chapters, which include two distinct, though overlapping types— those concerned with thematic issues, and those devoted to individual epidemic diseases.

Chapter 2 analyzes the legacy of two of the most influential figures in the history of medicine, both of whom were Greeks: Hippocrates, of the fifth century BCE, and Galen, of the second century CE. Analyzing their philosophy of medicine illuminates the intellectual shock of those who lived through visitations of pestilence.

Bubonic plague is the first case study of a specific epidemic disease (Chapters 3–5).The discussion of plague, as for the other epidemics covered in this book, begins with an examination of its effects on the individual human body and then turns to its impact on society at large. The clinical manifestations of each disease are essential to the task of decoding the social responses of populations to medical crises—in the case of plague, flight, witch hunts, the cult of saints, and violence.

At the same time, however, plague also led to the first strategies of public health to combat epidemic disaster—measures that were often draconian in direct proportion to the magnitude of the perceived threat. These strategies included the establishment of boards of health with almost un- limited powers during emergencies, quarantine and the forced confinement of sufferers, lines of troops and naval blockades known as sanitary cordons intended to isolate entire cities or even countries, and pesthouses opened to take in the sick and the dying.

The other diseases considered throughout this book will be addressed in the same manner: they will be set in their intellectual contexts, followed by discussions of their etiology and clinical manifestations, of their social and cultural effects, and of the medical and public health measures deployed to contain them. The goal is to help readers understand the great variety of individual and societal responses to epidemics and introduce them to the study of the medical, social, and intellectual history of epidemic disease.

Historical lessons

Evaluating the interaction of epidemics and society in the past provides background necessary to confront the questions raised by the general public during the recent challenges of SARS, avian flu, Ebola and the Covid-19. What have we learned as a people from the experience of the past four centuries of recurring deadly epidemics?

Here is a set of questions to ask whenever a new infectious disease emerges. The aim is to specify the chief variables that govern the nature and extent of the effect that a particular infectious disease has on society. It is simply a starting point for orientation as we encounter each new disease, and it is hoped that a cascade of further issues will arise.

1. What is the causative pathogen of the disease?

2. What is the total mortality and morbidity of the epidemic?

3. What is the case fatality rate (CFR) of the disease?

4. What is the nature of the symptoms of the disease?

5. Is the disease new, or is it familiar to a population?

6. What is the age profile of the victims—does it affect the young and the elderly or people in the prime of life?

7. What is the class profile of the sufferers, that is, is it a disease of the impoverished and the marginal, or is it a “democratic” affliction?

8. What is the mode of transmission of the disease—through person-to-person contact? contaminated food and water? vectors? sexual contact? droplets in the air?

9. How rapidly does the disease normally progress in its course through the human body—that is, is its course slow and wasting or fulminant (coming on quickly and strongly)?

10. How is the disease understood or “socially constructed” by the population through which it passes?

11. What is the typical duration of an epidemic caused by the disease in question?

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