Outbreaks have sparked riots and propelled public-health innovations, prefigured revolutions and redrawn maps
By Elizabeth Kolbert
What’s often referred to as the first pandemic began in the city of Pelusium, near modern-day Port Said, in northeastern Egypt, in the year 541. According to the historian Procopius, who was alive at the time, the “pestilence” spread both west, toward Alexandria, and east, toward Palestine. Then it kept on going. In his view, it seemed to move almost consciously, “as if fearing lest some corner of the earth might escape it.”
The earliest symptom of the pestilence was fever. Often, Procopius observed, this was so mild that it did not “afford any suspicion of danger.” But, within a few days, victims developed the classic symptoms of bubonic plague lumps, or buboes, in their groin and under their arms. The suffering at that point was terrible; some people went into a coma, others into violent delirium. Many vomited blood.
Those who attended to the sick “were in a state of constant exhaustion,” Procopius noted. “For this reason everybody pitied them no less than the sufferers.” No one could predict who was going to perish and who would pull through. In early 542, the plague struck Constantinople. At that time, the city was the capital of the Eastern Roman Empire, which was led by the Emperor Justinian.
A recent assessment calls Justinian “one of the greatest statesmen who ever lived.” Another historian describes the first part of his reignhe ruled for almost forty yearsas “a flurry of action virtually unparalleled in Roman history.” In the fifteen years before the pestilence reached the capital, Justinian codified Roman law, made peace with the Persians, overhauled the Eastern Empire’s fiscal administration, and built the Hagia Sophia.
As the plague raged, it fell to Justinian, in Procopius’ words, to “make provision for the trouble.” The Emperor paid for the bodies of the abandoned and the destitute to be buried. Even so, it was impossible to keep up; the death toll was too high. (Procopius thought it reached more than ten thousand a day, though no one is sure if this is accurate.)
John of Ephesus, another contemporary of Justinian’s, wrote that “nobody would go out of doors without a tag upon which his name was written,” in case he was suddenly stricken. Eventually, bodies were just tossed into fortifications at the edge of the city.
The plague hit the powerless and the powerful alike. Justinian himself contracted it. Among the lucky, he survived. His rule, however, never really recovered. In the years leading up to 542, Justinian’s generals had reconquered much of the western part of the Roman Empire from the Goths, the Vandals, and other assorted barbarians.
After 542, the Emperor struggled to recruit soldiers and to pay them. The territories that his generals had subdued began to revolt. The plague reached the city of Rome in 543, and seems to have made it all the way to Britain by 544. It broke out again in Constantinople in 558, a third time in 573, and yet again in 586.
The Justinianic plague, as it became known, didn’t burn itself out until 750. By that point, there was a new world order. A powerful new religion, Islam, had arisen, and its followers ruled territory that included a great deal of what had been Justinian’s empire, along with the Arabian Peninsula.
Much of Western Europe, meanwhile, had come under the control of the Franks. Rome had been reduced to about thirty thousand people, roughly the population of present-day Mamaroneck. Was the pestilence partly responsible? If so, history is written not only by men but also by microbes.
Just as there are many ways for microbes to infect a body, there are many ways for epidemics to play out in the body politic. Epidemics can be short-lived or protracted, or, like the Justinianic plague, recurrent. Often, they partner with war; sometimes the pairing favors the aggressor, sometimes the aggressed. Epidemic diseases can become endemic, which is to say constantly present, only to become epidemic again when they’re carried to a new region or when conditions change.
To this last category belongs smallpox, dubbed the speckled monster, which may have killed more than a billion people before it was eradicated, in the mid-twentieth century. No one knows exactly where smallpox originated; the virus part of the genus that includes cowpox, camelpox, and monkey poxis believed to have first infected humans around the time that people began domesticating animals.
Signs of smallpox have been found in Egyptian mummies, including Ramses V, who died in 1157 B.C. The Romans seem to have picked up the pox near present-day Baghdad, when they went to fight one of their many enemies, the Parthians, in 162.
The Roman physician Galen reported that those who came down with the new disease suffered a rash that was “ulcerated in most cases and totally dry.” (The epidemic is sometimes referred to as the Plague of Galen.) Marcus Aurelius, the last of the so-called Five Good Emperors, who died in 180, may also have been a smallpox victim.
By the fifteenth century, as Joshua S. Loomis reports in “Epidemics: the impact of germs and their power over humanity” (Praeger), smallpox had become endemic throughout Europe and Asia, meaning that most people were probably exposed to it at some point in their lives. Over all, the fatality rate was a terrifying thirty per cent, but among young children it was much higher more than ninety per cent in some places.
Loomis, a professor of biology at East Stroudsburg University, writes that the danger was so grave that “parents would commonly wait to name their children until after they had survived smallpox.” Anyone who made it through acquired permanent immunity (though many were left blind or horribly scarred).
This dynamic meant that every generation or so there was a major outbreak, as the number of people who had managed to avoid getting infected as children slowly rose. It also meant, as Loomis rather cavalierly observes, that Europeans enjoyed a major advantage as they “began exploring distant lands and interacting with native populations.”
Alfred W. Crosby, the historian who coined the phrase “the Columbian Exchange,” also coined the term “virgin soil epidemic,” defined as one in which “the populations at risk have had no previous contact with the diseases that strike them and are therefore immunologically almost defenseless.”
The first “virgin soil epidemic” in the Americas or, to use another one of Crosby’s formulations, “the first New World pandemic”began toward the end of 1518. That year, someone, presumably from Spain, carried smallpox to Hispaniola. This was a quarter of a century after Columbus ran aground on the island, and the native Taíno population had already been much reduced.
The speckled monster laid waste to those who remained. Two friars, writing to the King of Spain, Charles I, in early 1519, reported that a third of the island’s inhabitants were stricken: “It has pleased Our Lord to bestow a pestilence of smallpox among the said Indians, and it does not cease.”
From Hispaniola, smallpox spread to Puerto Rico. Within two years, it had reached the Aztec capital of Tenochtitlán, in what’s now Mexico City, a development that allowed Hernán Cortés to conquer the capital, in 1521.
A Spanish priest wrote, “In many places it happened that everyone in a house died, and, as it was impossible to bury the great number of dead, they pulled down the houses over them.” Smallpox seems to have reached the Incan Empire before the Spaniards did; the infection raced from one settlement to the next faster than the conquistadores could travel.
It’s impossible to say how many people died in the first New World pandemic, both because the records are sketchy and because Europeans also brought with them so many other “virgin soil” diseases, including measles, typhoid, and diphtheria. In all, the imported microbes probably killed tens of millions of people.
“The discovery of America was followed by possibly the greatest demographic disaster in the history of the world,” William M. Denevan, a professor emeritus at the University of Wisconsin-Madison, has written. This disaster changed the course of history not just in Europe and the Americas but also in Africa: faced with a labor shortage, the Spanish increasingly turned to the slave trade.
The word “quarantine” comes from the Italian quaranta, meaning “forty.” As Frank M. Snowden explains in “Epidemics and Society: From the Black Death to the Present” (Yale), the practice of quarantine originated long before people understood what, exactly, they were trying to contain, and the period of forty days was chosen not for medical reasons but for scriptural ones, “as both the Old and New Testaments make multiple references to the number forty in the context of purification: the forty days and forty nights of the flood in Genesis, the forty years of the Israelites wandering in the wilderness . . . and the forty days of Lent.”
The earliest formal quarantines were a response to the Black Death, which, between 1347 and 1351, killed one-third of Europe’s population and ushered in what’s become known as the “second plague pandemic.” As with the first, the second pandemic worked its havoc fitfully. Plague would spread, then abate, only to flare up again.
During one such flareup, in the fifteenth century, the Venetians erected lazarettos or isolation wardson outlying islands, where they forced arriving ships to dock. The Venetians believed that by airing out the ships they were dissipating plague-causing vapors. If the theory was off base, the results were still salubrious; forty days gave the plague time enough to kill infected rats and sailors.
Snowden, a professor emeritus at Yale, calls such measures one of the first forms of “institutionalized public health” and argues that they helped legitimatize the “accretion of power” by the modern state.
There’s a good deal of debate about why the second pandemic finally ended; one of the last major outbreaks in Europe occurred in Marseille in 1720. But, whether efforts at control were effective or not, they often provoked, as Snowden puts it, “evasion, resistance, and riot.”
Public-health measures ran up against religion and tradition, as, of course, they still do. The fear of being separated from loved ones prompted many families to conceal cases. And, in fact, those charged with enforcing the rules often had little interest in protecting the public.
Consider the case of cholera. In the ranks of dread diseases, cholera might come in third, after the plague and smallpox. Cholera is caused by a comma-shaped bacterium, Vibrio cholerae, and for most of human history it was restricted to the Ganges Delta. Then, in the eighteen-hundreds, steamships and colonialism sent Vibrio cholerae travelling.
The first cholera pandemic broke out in 1817 near Calcutta. It moved overland to modern-day Thailand and by ship to Oman, whence it was carried down to Zanzibar. The second cholera pandemic began in 1829, once again in India. It wound its way through Russia into Europe and from there to the United States.
In contrast to plague and smallpox, which made few class distinctions, cholera, which is spread via contaminated food or water, is primarily a disease of urban slums. When the second pandemic struck Russia, Tsar Nicholas I established strict quarantines. These may have slowed the spiral of spread, but they did nothing to help those already infected.
The situation, according to Loomis, was exacerbated by health officials who indiscriminately threw together cholera victims and people suffering from other ailments. It was rumored that doctors were purposefully trying to kill off the sick. In the spring of 1831, riots broke out in St. Petersburg. One demonstrator returning from a melee reported that a doctor had “got a coupl’ve rocks in the neck; he sure won’t forget us for a long time.”
The following spring, cholera riots broke out in Liverpool. Once again, doctors were the main targets; they were accused of poisoning cholera victims and turning them blue. (Cholera has been called the “blue death” because those suffering from the disease can get so dehydrated that their skin becomes slate-colored.) Similar riots broke out in Aberdeen, Glasgow, and Dublin.
In 1883, during the fifth cholera pandemic, the German physician Robert Koch established the cause of the disease by isolating the Vibrio cholerae bacterium. The following year, the pandemic hit Naples. The city dispatched inspectors to confiscate suspect produce. It also sent out disinfection squads, which arrived at the city’s tenements with guns drawn.
Neapolitans were, understandably, skeptical of both the inspectors and the squads. They responded with an impressive sense of humor, if not necessarily a keen understanding of epidemiology. Demonstrators showed up at city hall with baskets of overripe figs and melons. They proceeded, Snowden writes, “to consume the forbidden fruit in enormous quantities while those who watched applauded and bet on which binger would eat the most.”
Eight years later, while the fifth pandemic raged on, one of the most violent cholera riots broke out in what’s now the Ukrainian city of Donetsk. Scores of shops were looted, and homes and businesses were burned. The authorities in St. Petersburg responded to the violence by cracking down on workers accused of promoting “lawlessness.” According to Loomis, the crackdown prompted more civil unrest, which in turn prompted more repression, and, thus, in a roundabout sort of way, cholera helped “set the stage” for the Russian Revolution.
The seventh cholera pandemic began in 1961, on the Indonesian island of Sulawesi. During the next decade, it spread to India, the Soviet Union, and several nations in Africa. There were no mass outbreaks for the next quarter century, but then one hit Peru in 1991, claiming thirty-five hundred lives; another outbreak, in what is now the Democratic Republic of the Congo, in 1994, claimed twelve thousand.
By most accounts, the seventh pandemic is ongoing. In October, 2010, cholera broke out in rural Haiti, then quickly spread to Port-au-Prince and other major cities. This was nine months after a magnitude-7.0 earthquake had devastated the country. Rumors began to circulate that the source of the outbreak was a base that housed United Nations peacekeeping troops from Nepal. Riots occurred in the city of Cap-Haïtien; at least two people were killed, and flights carrying aid to the country were suspended.
For years, the U.N. denied that its troops had brought cholera to Haiti, but it eventually admitted that the rumors were true. Since the outbreak began, eight hundred thousand Haitians have been sickened and nearly ten thousand have died.
Epidemics are, by their very nature, divisive. The neighbor you might, in better times, turn to for help becomes a possible source of infection. The rituals of daily life become opportunities for transmission; the authorities enforcing quarantine become agents of oppression. Time and time again throughout history, people have blamed outsiders for outbreaks. (On occasion, as in the case of the U.N. peacekeeping troops, they’ve been right.)
Snowden recounts the story of what happened to the Jews of Strasbourg during the Black Death. Local officials decided that they were responsible for the pestilence they had, it was said, poisoned the wells and offered them a choice: convert or die. Half opted for the former. On February 14, 1349, the rest “were rounded up, taken to the Jewish cemetery, and burned alive.”
Pope Clement VI issued papal bulls pointing out that Jews, too, were dying from the plague, and that it wouldn’t make sense for them to poison themselves, but this doesn’t seem to have made much difference. In 1349, Jewish communities in Frankfurt, Mainz, and Cologne were wiped out. To escape the violence, Jews migrated en masse to Poland and Russia, permanently altering the demography of Europe.
Whenever disaster strikes, like right about now, it’s tempting to look to the past for guidance on what to do or, alternatively, what not to do. It has been almost fifteen hundred years since the Justinianic plague, and, what with plague, smallpox, cholera, influenza, polio, measles, malaria, and typhus, there are an epidemic number of epidemics to reflect on.
The trouble is that, for all the common patterns that emerge, there are at least as many confounding variations. During the cholera riots, people blamed not outsiders but insiders; it was doctors and government officials who were targeted. Smallpox helped the Spanish conquer the Aztec and Incan Empires, but other diseases helped defeat colonial powers.
During the Haitian Revolution, for example, Napoleon tried to retake the French colony, in 1802, with some fifty thousand men. So many of his soldiers died from yellow fever that, after a year, he gave up on the attempt, and also decided to sell the Louisiana Territory to the Americans.
Even the mathematics of outbreaks varies dramatically from case to case. As Adam Kucharski, a professor at the London School of Hygiene & Tropical Medicine and the author of “The Rules of Contagion” (forthcoming in the U.S. from Basic Books), points out, the differences depend on such factors as the mode of transmission, the length of time an individual is contagious, and the social networks that each disease exploits.
“There’s a saying in my field: ‘if you’ve seen one pandemic, you’ve seen . . . one pandemic,’ ” he writes. Among the few predictions about COVID-19 that it seems safe to make at this point is that it will become the subject of many histories of its own.
Elizabeth Kolbert has been a staff writer at The New Yorker since 1999. She is the author of “The Sixth Extinction: An Unnatural History,” which won the Pulitzer Prize for nonfiction in 2015.
