Brief history of plagues and pandemics

Uditha Devapriya

By the 14th century, trade routes between the East and West had made it easier for pandemics to spread, while conquests by the Spanish and the Portuguese in the 15th and 16th centuries would introduce several diseases to the New World. Trade and colonialism hence became, by the end of the Renaissance, the main causes of plague, which scientific advancement did little to combat, much less eliminate: a physician in the 17th century would have been as baffled or helpless as a physician in the 14th or 15th in the face of an outbreak.

No doubt rapid urbanisation and gentrification had a prominent say in the proliferation of such outbreaks, but among more relevant reasons would have been poor sanitary conditions, lack of communication and accessibility, and class stratifications which excluded the lower orders – the working class as well as peasants in the colonies – from a healthcare system that pandered to an elite minority. By 1805, the only hospitals built in Ceylon were those serving military garrisons in places like Colombo, Galle, and Trincomalee.

Among the more virulent epidemics, of course, was the notorious plague. Various studies have tried to chart the origins and the trajectory of the disease. There were two outbreaks in Rome: the Antonine Plague in 165 AD and the Justinian Plague in 541 AD. With a lack of proper inscriptional evidence, we must look at literary sources: the physician Galen for the Antonine, and Procopius and John of Ephesus for the Justinian.

Predating both these was an outbreak reported by the historian Thucydides in 430 BC Rome, but scholars have ascertained that this was less a plague than a smallpox contagion. In any case, by 541 AD plague had become a fact of life in the region, and not only in Pagan Rome; within the next few years, it had spread to the Arabic world, where scholars, physicians, and theologians tried to diagnose it. Commentaries from this period tell us of theologians tackling a religious crisis borne out of pestilence: in the beginning, Islamic theology had laid down a prohibition against Muslims “either entering or fleeing a plague-stricken land”, and yet by the time these epidemics ravaged their land, fleeing an epidemic was reinterpreted to mean acting in line with God’s wishes: “Whichever side you let loose your camels,” Umar I, the founder of the Umayyad Caliphate, told Abu Ubaidah, “it would be the will of God.” As with all such religious injunctions, this changed in the light of an urgent material need: the prevention of an outbreak. We see similar modifications in other religious texts as well.

Plagues and pandemics also feature in the Bible. One frequently referred to story is that of the Philistines, having taken away the Ark of the Covenant from the Israelites, being struck by a disease by God which “smote them with emerods” (1 Samuel 5:6). J. F. D. Shrewsbury noted down three clues for the identification of the illness: that it spread from an army in the field to a civilian population, that it involved the spread of emeroids in the “secret part” of the body, and that it compelled the making of “seats of skin.” The conventional wisdom for a long time had been that this was, as with 541 AD Rome, the outbreak of the plague, but Shrewsbury on the basis of the three clues ascertained that it was more plausibly a reference to an outbreak of haemorrhoids. On the other hand, the state of medicine being what it would have been in Philistine and Israel, lesions in the “secret part” (the anus) may have been construed as a sign of divine retribution in line with a pestilence: to a civilisation of prophets, even haemorrhoids and piles would have been comparable to plague sent from God.

Estimates for population loss from these pandemics are notoriously difficult to determine. On the one hand, being the only sources we have as of now, literary texts accurately record how civilians conducted their daily lives despite the pestilence, while on the other, writers of these texts resorted to occasional if not infrequent exaggeration to emphasise the magnitude of the disease. Both Procopius and John of Ephesus are agreed on the point, for instance, that the Justinian Plague was preceded by hallucinations, which then spread to fever, languor, and on the second or third day to bubonic swelling “in the groin or armpit, beside the ears or on the thighs.” However, there is another account, by Evagrius Scholasticus, whose record of the outbreak in his hometown Antioch was informed by a personal experience with a disease he contracted as a schoolboy and to which he later lost a wife, children, grandchildren, servants and, presumably, friends. It has been pointed out that this may have injected a subjective bias to his account, but at the same time, given that Procopius and John followed a model of the plague narrative laid down by Thucydides centuries before, we can consider Evagrius’s as a more original if not more accurate record, despite prejudices typical of writers of his time: for instance, his (unfounded) claim that the plague originated in Ethiopia.

Much water has flowed through the debate over where the plague originated. A study in 2010 concluded that the bacterium Yersinia pestis evolved in, or near, China. Historical evidence marshalled for this theory points at the fact that by the time of the Justinian plague the Roman government had solidified links with China over the trade of silk. Popular historians contend that the Silk Road, and the Zheng He expeditions, may have spread the contagion through the Middle East to southern Europe, a line of thinking even the French historian Fernand Braudel subscribed to in his work on the history of the Mediterranean. However, as Ole Benedictow in his response to the 2010 study points out, “references to bubonic plague in Chinese sources are both late and sparse”, a criticism made earlier, in 1977, by John Norris, who observed that it is likely that literary references to the Chinese origin of the plague were informed by ethnic and racial prejudices; a similar animus prevailed among the early Western chroniclers against what they perceived as the “moral laxity” of non-believers.

A more plausible thesis is that the bacterium had its origins around 5,000 or 6,000 years ago during the Neolithic era. A study conducted two years ago (Rascovan 2019) posits an original theory: that the genome for Yersinia pestis emerged as the first discovered and documented case of plague 4,900 years ago in Sweden, “potentially contributing” to the Neolithic decline the reasons for which “are still largely debated.” However, like the 2010 study this too has its pitfalls, among them a lack of the sort of literary sources which, however biased they may be, we have for the Chinese genesis thesis. It is clear, nevertheless, that the plague was never at home in a specific territory, and that despite the length and breadth of the Silk Road it could not have made inroads to Europe through the Mongol steppes. To contend otherwise is to not only rebel against geography, but also ignore pandemics the origins of which were limited to neither East and Central Asia nor the Middle East.

Such outbreaks, moreover, were not unheard of in the Indian subcontinent, even if we do not have enough evidence for when, where, and how they occurred. The cult of Mariammam in Tamil Nadu, for instance, points at cholera as well as smallpox epidemics in the region, given that she is venerated for both. “In India, a cholera-like diarrheal disease known as Visucika was prevalent from the time of the Susruta“, an Indian medicinal tract that has the following passage the illness to which reference is made seems to be the plague:

Kakshabhageshu je sfota ayante mansadarunah
Antardaha jwarkara diptapapakasannivas
Saptahadwa dasahadwa pakshadwa ghnonti manavam
Tamagnirohinim vidyat asadyam sannipatatas

Or in English, “Deep, hard swellings appear in the armpit, giving rise to violent fever, like a burning fire, and a burning, swelling sensation inside. It kills the patient within seven, 10, or 15 days. It is called Agnirohini. It is due to sannipata or a deranged condition of all the three humours, vata, pitta, and kapha, and is incurable.”

The symptoms no doubt point at plague, even if we can’t immediately jump to such a conclusion. The reference to a week or 15 days is indicative of modern bubonic plague, while the burning sensation and violent fever shows an illness that rapidly terminates in death. The Susruta Samhita, from which this reference is taken, was written in the ninth century AD. We do not have a similar tract in Sri Lanka from that time, but the Mahavamsa tells us that in the third century AD, during the reign of Sirisangabo, there was an outbreak of a disease the symptoms of which included the reddening of the eyes. Mahanama thera, no doubt attributing it to the wrath of divine entities, personified the pandemic in a yakinni called Rattakkhi (or Red Eye). Very possibly the illness was a cholera epidemic, or even the plague.

China, India, and Medieval Europe aside, the second major wave of pandemics came about a while after the Middle Ages and Black Death, and during the Renaissance, when conquerors from Spain and Portugal, having divided the world between the two countries, introduced and spread diseases to which they had become immune among the natives of the lands they sailed to. Debates over the extent to which Old World civilisations were destroyed and decimated by these diseases continue to rage. The first attempts to determine pre-colonial populations in the New World were made in the early part of the 20th century. The physiologist S. F. Cook published his research on the intrusions of diseases from the Old World to the Americas from 1937. In 1966, the anthropologist Henry F. Dobyns argued that most studies understated the numbers. In the 1930s when research on the topic began, conservative estimates put the North American pre-Columbine population at one million. Dobyns upped it to 10 million and, later, 18 million; most of them, he concluded, were wiped out by the epidemics.

And it didn’t stop at that. These were followed by outbreaks of diseases associated with the “white man”, including yaws and cholera. Between 1817 and 1917, for instance, no fewer than six cholera epidemics devastated the subcontinent. Medical authorities were slow to act, even in Ceylon, for the simple reason that by the time of the British conquest, filtration theory in the colonies had deemed it prudent that health, as with education, be catered to a minority. Doctors thus did not find their way to far flung places suffering the most from cholera, while epidemics were fanned even more by the influx of South Indian plantation workers after the 1830s. Not until the 1930s could authorities respond properly to the pandemic; by then, the whole of the conquered world, from Asia all the way to Africa, had turned into a beleaguered and diseased patient, not unlike Europe in the 14th century.

The writer can be reached at udakdev1@gmail.com