A medical history

Seattle police during the Spanish Flu pandemic of 1918

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by Richard Nilsen
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It’s a strange time. Few of us have been through anything quite so comprehensively threatening. I lived through the 1960s and remember the Vietnam War, Civil Rights, and serial assassinations. There was the hovering blackmail of being drafted to go and die in the jungles of Southeast Asia. But that was aimed at only a fraction of young men at the time. This aims at all of us. And all of us on the whole planet.
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So, I wanted to take a look at how it all compares with past plagues. First, I rooted around to see how many pandemics have been recorded in history. Surely, many occurred before the invention of writing and history. I imagine disease decimating prehistoric populations, although the number of people on the globe was so much smaller, that although people didn’t practice social isolation, there was enough isolation between groups of people that disease probably didn’t spread as efficiently as it does today, with bugs riding ticketless on jet planes to “cover the globe” like Sherwin-Williams paint.
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There is some evidence that plague caused what is called the “Neolithic Decline” about 5000 years ago. In 2018, a skeleton of a 20-year-old woman was found in Sweden that contained DNA traces of Yersinia pestis, the pathogen that caused three other major outbreaks of plague through history.
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Two plagues of Egypt

 

The first recorded plagues I could find were probably fictional — the Ten Plagues of Egypt — but the fact there was a biblical word for “plague” indicates that such things were well known then.
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But the historical plague that enters the record first is that of Athens in the Fifth Century BCE. It was described by Thucydides in his History of the Peloponnesian War. It comes just after Pericles’ Funeral Oration and lists the symptoms of the plague that carried off something like 100,000 people, or a quarter of the population of the city. It is gruesome reading, but then, so are descriptions of all the plagues of humankind. Thucydides wrote:
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“Suddenly, without any apparent cause preceding and being in perfect health, they were taken first with an extreme ache in their heads, redness and inflammation of the eyes; and then inwardly, their throats and tongues grew bloody and their breath noisome and unsavory. Upon this followed a sneezing and hoarseness, and not long after the pain, together with a mighty cough, came down into the breast. And when once it was settled in the stomach, it caused vomit; and with great torment came up all manner of bilious purgation that physicians ever named.
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“Most of them had also the dry heaves which brought with it a strong convulsion, and in some ceased quickly but in others was long before it gave over. Their bodies outwardly to the touch were neither very hot nor pale but reddish, livid, and beflowered with little pimples and whelks, but so burned inwardly as not to endure any the lightest clothes or linen garment to be upon them nor anything but mere nakedness, but rather most willingly to have cast themselves into the cold water. And many of them that were not looked to, possessed with insatiate thirst, ran unto the wells, and to drink much or little was indifferent, being still from ease and power to sleep as far as ever.
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“As long as the disease was at its height, their bodies wasted not but resisted the torment beyond all expectation; insomuch as the most of them either died of their inward burning in nine or seven days whilst they had yet strength, or, if they escaped that, then the disease falling down into their bellies and causing there great ulcerations and terrible diarrhea, they died many of them afterwards through weakness.”
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Scholars disagree over what caused the Athenian Plague, Most often it is blamed on typhus, but more recent study leans toward a variety of the ebola virus.
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The numbers jump with the next major pandemic (there have been smaller outbreaks), beginning in 165 CE, was the Antonine Plague that swept the Roman Empire and killed off something like 10 million. It is guessed to have been an outbreak of smallpox.
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But that paled compared with the Justinian Plague of 541-542 CE, that wiped out between 40 percent and 50 percent of the people of Europe, meaning ten times the toll of the Antonine Plague — 100,000 million souls. Again, likely smallpox.
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We can add 2 million dead, or almost half the population of Japan in the smallpox epidemic of 735-737 CE.
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Of course, the granddaddy of them all is the Great Mortality, better known by its later name, the Black Death that first crippled Europe in 1348. It devastated not only Medieval Europe, but Asia and North Africa and wiped out something like half the population of Europe. (These are all estimates: No precise figures were kept at the time).
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Plague mask from the Black Death

Giovanni Boccaccio wrote about the plague in Florence in words that sound oddly familiar: “The plague had arisen in the East some years before, causing the death of countless human beings. It spread without stop from one place to another, until, unfortunately, it swept over the West. Neither knowledge nor human foresight availed against it, though the city was cleansed of much filth by chosen officers in charge and sick persons were forbidden to enter it, while advice was broadcast for the preservation of health. Nor did humble supplications serve.” He goes on to describe the symptoms and the public panic. Much of which also sounds prescient.
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Over and over, there is a single place on the map where the number of people getting sick and dying increases dramatically. Those elsewhere take little notice. But the contagion spreads and other places begin to follow suit. The death tallies rise and the affected areas grow, but those in unaffected areas feel only that such disturbance is distant from them and their concerns. As the contagion spreads, the authorities attempt to downplay the seriousness of the problem, until the map is filled in and everyone is affected. They stay closed up in their homes, hoping to remain safe.
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This is a story from the Third Century, from the Sixth Century, from the 14th Century, 17th Century, 18th, 19th, 20th and now our nascent little century. I mean this month.
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Bubonic and Pneumonic Plague, caused by Y. pestis, probably began in Mongolia and swept west until it engulfed all the Old World. And it returned on average, although in less virulent form, every 10 or 15 years until the 17th century. The last major outbreak was the Great Plague of London in 1666 that was chronicled in the diary of Samuel Pepys. Some 100,000 died in that wave, in the city alone.
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But the New World had its chance, too. Blame the conquistadors. About 40 percent of the native population of central Mexico died in 1520 of small pox, that being 5 to 8 million dead. Twenty-five years later, the Cocoliztil Epidemic, also smallpox, wiped out between 5 and 15 million, or 80 percent of those who had survived the first wave. In 50 years, the native population went from 30 million to 3 million.
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In North America, the 1616 New England Epidemic wiped out as much as 90 percent of the Wampanoag people. It may have been a breakout of leptospirosis, although other guesses include yellow fever, plague, influenza, smallpox or hepatitis. Estimates of pre-Columbus Native American populations in North America range from about 3 to 18 million people. Most recent estimates favor the higher numbers. By 1890, that had been reduced to 250,000. Some of that destruction came by military action, but the vast majority was caused by disease.
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Smallpox was the greatest of the villains, and many of history’s worst epidemics have been of that now-extinct disease. But it is plague that gets all the glory. There have been three great waves of plague, each coming in an initial burst and reappearing intermittently for centuries. The first is the Plague of Justinian. The second is the Black Death and the third began in Yunnan, China, in 1855, and spread through Asia, taking out some 12 million people, mainly in India and China. Deaths from this wave continued into the 20th century.
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Plague also killed some 2 million in Persia in 1772.
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But joining smallpox and plague is cholera, which killed a million victims in Russia in the mid-19th century. That century finds cholera outbreaks all over the globe, popping up first there, then here.
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Temporary influenza hospital at Camp Funsten in Kansas in 1918

 

Now, in the 20th and 21st centuries the great threat is influenza. The first notable outbreak was the pandemic of 1889-1890, that killed 1 million worldwide. But then, the Spanish Influenza killed something like 100 million between 1918 and 1920. (That is five times the number killed in World War I, both military and civilian). That influenza was caused by the H1N1 subtype of Influenza A.
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The flu has returned in various forms several times. The Asian Flu killed 2 million in1957-1958; the Hong Kong Flu took out another million in 1968-1969; the London Flu in 1972-1973 killed 1,027, which may seem a small number, but it was big enough to put a scare in the populace.
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The most recent million-death pandemic was HIV/AIDS, which first became known about 1980 and has since then killed more than 32 million people.
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I have shoveled a lot of numbers into this essay and it is easy to think of them merely as numbers. The quote attributed to Josef Stalin is apt. Talking to a group of commissars about the starvation in Ukraine, he is reported to have said, “If only one man dies of hunger, that is a tragedy. If millions die, that’s only statistics.”
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To get past the mere piling up of numbers into haystacks of meaninglessness, there are many notable works of literature that humanize the pestilences. The first one you should read is the introduction to Boccaccio’s Decameron. It reads like modern journalism, with an accumulation of observed detail and a lack of sentimentality. The Decameron is a collection of short stories ostensibly told by a group of refugees hiding from the plague in Florence. But the introduction is blank fact and beautifully written.
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The Great Plague of London was covered by two writers. Samuel Pepys was an eye witness and he wrote about it in his Diaries. For Jan. 30, 1666, he wrote, “This is the first time I have been in this church since I left London for the plague, and it frighted me indeed to go through the church more than I thought it could have done, to see so many graves lie so high upon the churchyards where people have been buried of the plague.”
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Great Plague of London, 1666

 

The other, written some years later by Daniel Defoe is his A Journal of the Plague Year, published in 1722, more than 50 years after the event. The author of Robinson Crusoe was just 6 years old when the plague hit London, but he carefully researched the event and although his Journal technically fiction, it very closely hews to the journalistic truth.
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He describes the weekly and daily numbers of reported dead, which sounds eerily familiar, and the sequestering of families and the quarantines. He also chronicles the quack cures being touted.
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“It is incredible, and scarce to be imagined, how the posts of houses and corners of streets were plastered over with doctors’ bills and papers of ignorant fellows, quacking and tampering in physic, and inviting the people to come to them for remedies, which was generally set off with such flourishes as these, viz.:
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“ ‘Infallible preventive pills against the plague.’ ‘Never-failing preservatives against the infection.’ ‘Sovereign cordials against the corruption of the air.’ ‘Exact regulations for the conduct of the body in case of an infection.’ ‘Anti-pestilential pills.’ ‘Incomparable drink against the plague, never found out before.’ etc”
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All of it sounds familiar, now that there is talk of drinking bleach or silver. But he also brings the individuals to life: “I wish I could repeat the very sound of those groans and of those exclamations that I heard from some poor dying creatures when in the height of their agonies … and that I could make them that read this hear, as I imagine I now hear them, for the sound seems still to ring in my ears.”
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He describes the cart bringing the corpses to the graveyard, “a becloaked, muffled figure comes in to view, ‘oppressed with a dreadful weight of grief indeed, having his wife and several children all in the cart … no sooner was the cart turned round and the bodies shot into the pit promiscuously … but he cried out aloud, … the buriers ran to him and they led him away to the Pie Tavern, over against the end of Houndsditch, where it seems the man was known’.”
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The fear struck everyone. One man, self-quarantined in the second floor of his home, took precautions with his mail: “His letters were brought by the postman, or letter-carrier, to his porter, when he caused the porter to smoke them with brimstone and with gunpowder, then open them, and to sprinkle them with vinegar; then he had them drawn up by the pulley, then smoked again with strong perfumes, and, taking them with a pair of hair gloves, the hair outermost, he read them with a large reading-glass which read at a great distance, and, as soon as they were read, burned them in the fire; and at last, the distemper raging more and more, he forbid his friends writing to him at all.”
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There is simple fiction, too. Mary Shelley, who wrote Frankenstein, wrote in 1826 a novel called The Last Man, about an apocalyptic world ravaged by a plague. Poe’s Mask of Red Death tells of the wealthy and aristocratic hiding in luxury from the pestilence until “a figure arrives wearing a mask made so nearly to resemble the countenance of a stiffened corpse that the closest scrutiny must have difficulty in detecting the cheat.” The visitor is the Red Death itself and all die.
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The Red Death is taken up by Jack London in The Scarlet Plague, from 1912, in which a survivor in postapocalyptic America of 2073 recalls a pandemic from 2013.
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There is a whole trove of more recent postapocalyptic narratives, including Michael Crichton’s The Andromeda Strain, Stephen King’s The Stand, Jose Saramago’s Blindness, and Jim Crace’s The Pesthouse. Most are meant as thrillers, but there is a deep moral core to Albert Camus’ Le Peste (“The Plague”), published in 1947, which it is hard not to keep in mind when you watch doctors, nurses, paramedics and other hospital workers risk their lives in the current Covid-19 pandemic. It should be required reading for everyone.
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And holed up in your homes, there is plenty of time for good reading until this current angel of death passes overhead and moves on.
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Richard Nilsen inspired many ideas and memories at the salons he presented through the years when he was an arts critic and movie, travel, and features writer at The Arizona Republic.   A few years ago, Richard moved to North Carolina.   We want to continue our connection with Richard and have asked him to be a regular contributor to the Spirit of the Senses Journal.   We asked Richard to write short essays that were inspired by the salons.

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