Pandemics of bygone days
On March 11, 2020, the World Health Organization (WHO) declared the current spread of the COVID-19, Corona virus epidemic as a pandemic. In the natural history of an infectious disease, a ‘pandemic’ is the most dangerous scenario. When an epidemic crosses the borders of a country it is officially declared as a pandemic.
Most of the historical pandemics we hear about are those due to plague (mahamariya) caused by a bacillus that is transmitted to humans by a biting rat flea. Whatever the agent responsible for a pandemic, the terror, social and political disruption and subsequent human misery experienced are the same, still valid to this day. In order to understand the magnitude of the misery and social disruption during pandemics, there is no better example than those caused by the plague bacillus Yersinia pestis. Brawls, fisticuffs and abusive behaviour over toilet paper in supermarkets we read of in Western countries in current times are closely reminiscent of the picture depicted by Giovanni Boccaccio in his Decameron during the second plague pandemic.
Our historical chronicles Mahawamsa or Chulawamsa make no reference to pandemics or even epidemics that could possibly be identified as those due to plague.
The Old Testament refers to plagues frequently. Some believe that the “emirods” with which the Lord smote the Philistines were in reality the “bubos” (swellings) of plague. The pestilence is believed to have killed more than 50,000 inhabitants of Bethshemesh. It struck terror and panic among whole communities as people, rich and the poor, awaited the call of death, heralded by a messenger in the form of a black cloaked skeleton riding a black horse, identical to one of the three horsemen of the Apocalypse in St John’s allegory in the book of Revelations, Chapter 1 in the Bible.
History records three great pandemics of plague. The first was the Plague of Justinian in 542 AD. It started in Ethiopia and spread to Egypt. From there it spread throughout the known world. The pandemic decimated the population and the highest mortality was in the years 542 and 543. The scourge lasted until the close of the 6th century. Procopius, the historian described this plague which was named after the reigning Emperor, as, “… the whole human race was near being exterminated”. Procopius was able to trace the origin of the plague to China and the subsequent route that the plague took to reach Rome. He publicly placed the blame for the plague on the unrighteous emperor implying the wrath of Gods. The fall of the Byzantine Empire following the Plague of Justinian was similar to the part played by malaria in the fall of the Roman Empire.
The second pandemic started around 1340 and peaked in the year 1348. The pestilence spread widely across Europe and in the years 1345 to 1350 half the population had succumbed to the scourge. It is mentioned that 200,000 market towns and villages in Europe were completely depopulated. The dwellings of the dead, scattered with decomposing corpses were taken over by wild beasts. Pope Clement the VI consecrated the Rhone at Avignon so that bodies could be cast into it. Statistics forwarded to the Pope estimated the death toll for whole world as 42,836,486. The plague reached England in 1348 and within a few years one third to half the population perished.
The panic, the terror and the total disarray of social order were described vividly by Giovanni Boccaccio in his Decameron written in 1348. The social and economic effects of plague were universal and long lasting. Boccaccio’s own words are, “…one neighbor had not any care of another, parents nor children ever visiting them, but utterly they were forsaken on all sides; this tribulation pierced in to the hearts of men, and with such a dreadful terror, that one brother forsook another, the uncle, the nephew, the sister, the brother and the wife, the husband; nay, a matter much greater, and almost incredible fathers and mothers fled away from their own children”.
The pestilences unleashed a flood of violence and passion. ‘Quacks’ appeared in hordes prescribing chants, charms and other application. The stringent sanitary laws and practices by the Jews led to lesser number of plague cases among them. This led to the rumour that they were behind the pestilence. Jews were massacred right across Europe except in England and Lithuania.
Medieval times also saw the emergence of preventive measures. Ships arriving at Venice from ports of Egypt were isolated in special ports and all travellers were detained for a period of 30 days at first and then for 40 days to make it the same as the days spent by Jesus wandering in the desert. The term ‘Quaranta Giorni’ used for this procedure subsequently became – quarantine meaning isolation.
The third pandemic of plague originated in Yunnan Province of China in early 1890s. It killed nearly 100,000 in and near Yunnan. Marmot trappers brought it from Manchuria. This epidemic reached pandemic level when it crossed the borders into neighbouring countries including Hong Kong. A landmark in the history of medicine about this time was the discovery of the agent responsible for plague, independently by Shibasaburo Kitasato, a pupil of Koch, and by Alexandre Yersin, a pupil of Pasteur in 1894 during the plague of Hong Kong. From Hong Kong plague spread to Bombay, India in 1896. Then it spread to Calcutta, Poona and along the western coast of India. The death toll in India the following year was 12 million. From India the plague was disseminated worldwide. During this terrible period it was discovered that scourge was disseminated by ships carrying infected rats from stricken ports. The role of the rat flea as the transmitter was discovered much later. Finding of dead rats prior to the appearance of plague had been noted from ancient times. The Old Testament refers to plague and dead rats so does Charaka in India.
Historically major pandemics of infectious diseases have occurred due to plague, typhus, smallpox, cholera, influenza and a host of viral agents including HIV/AIDS. As mentioned earlier irrespective of the causative agent the resulting misery, disarray of social and economic order remain the same.
(The writer is a retired Comsultant Parasitologist)