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Pandemics and the city: A brief history

THOUGHT LEADERSHIP | Llewellyn van Wyk, B.Arch; MSc. (Applied), Urban Analyst

The outbreaks of disease have historically devastated humanity to varying degrees often changing the course of history and occasionally heralding the end of a civilisation. Notwithstanding Adam Kucharski, a professor at the London School of Hygiene & Tropical Medicine, caution that if you’ve seen one pandemic, you’ve seen… one pandemic,[i] I would like to believe that somewhere in these past pandemic events lurks some commonality.

Pandemics throughout history

The oldest known pandemic impacts come from two prehistoric sites in China. Both reveal the devastating effect of early epidemics. Both are cities. Haman Mangha, one of the best-preserved prehistoric villages in north-eastern China dating back about 5 000 years, was hit by an epidemic that targeted all age groups. Archaeological research revealed a house – containing the bodies of juveniles, young adults, and middle-aged people – burned to the ground. The research indicates that the epidemic happened so fast that there was no time for proper burials. The other prehistoric site known as Miaozigou, also in north-eastern China, shows evidence of a mass burial too. Both these sites suggest an epidemic that ravaged the entire area.

Thousands of years later, between 426 and 429 B.C. following a war between Athens and Sparta, The Plague of Athens epidemic, lasting over five years, devastated the people of Athens resulting in the death of between 75 000 and 100 000 people. Cruelly, the epidemic that devastated a city also marks the beginning of Classical Antiquity: the epidemic is described in the opening book of Homer’s Iliad. The ancient Athenian leader, Pericles, not only provided a stirring oration to honour the dead after the first year of a destructive war against Sparta, but also gave a second famous speech a year later, in response to this devastating plague. Both orations were reported by the contemporary historian Thucydides, whose searing description of the Great Plague is worth reading for its literary virtuosity alone.

Of interest is the scholarly belief that overcrowding caused by the war exacerbated the epidemic.

Some five hundred years later it was the turn of the Roman Empire to feel the effects of disease. The Antonine Plague (A.D. 165-180), possibly caused by smallpox, devastated the Roman army returning from the war against Parthia, and resulting in the death of between 5- and 10-million Romans.[ii]The epidemic contributed to the end of the Pax Romana (the Roman Peace), a period from 27 B.C. to A.D. 180, when Rome was at the height of its power. Instability grew throughout the Roman Empire after A.D. 180 as it experienced more civil wars and invasions, especially by the so-called barbarians. Christianity was the unexpected beneficiary of this unfortunate circumstance and experienced a surge in popularity.

Unfortunately, this was not the last epidemic to hit Rome: seventy years later the Plague of Cyprian (A.D. 250-266), named after St. Cyprian, a bishop of Carthage in Tunisia, claimed the lives of 5 000 people a day in Rome alone with a total death estimate of over 1 million. Not surprisingly, Cyprian described the epidemic as signalling the end of the world. Archaeologists in Luxor in 2014 found what appears to be a mass burial site of plague victims, their bodies covered with a thick layer of lime (historically used as a disinfectant). Archaeologists found three kilns used to manufacture lime and once again the remains of plague victims were burned in a giant bonfire. [iii] It is not certain what disease caused the epidemic, but smallpox is suspected.

Two hundred and seventy-two years later, what’s often referred to as the first pandemic, began in the city of Pelusium, near modern-day Port Said, in north-eastern Egypt.[iv] 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 pandemic was fever. The suffering was terrible; some people went into a coma, others into violent delirium. 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.”

Two hundred and seventy years later (A.D. 541-542) it was the turn of the Byzantine Empire to be ravaged, this time by the bubonic plague. The Justinian Plague, named after the Byzantine Emperor Justinian (reigned A.D. 527-565), claimed the lives, by some estimates, of between 25- and 100-million people, roughly 40-50% of Europe’s population. As the plague spread, it fell to Justinian, in Procopius’ words, to “make provision for the trouble.”[v] The Emperor paid for the bodies of the abandoned and the destitute to be buried. However, it was not possible to keep up with the high death rate. (Procopius thought it reached more than ten thousand a day, though no one is sure if this is accurate.)[vi] John of Ephesus, a 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[vii]. Eventually, bodies were just tossed into fortifications at the edge of the city.

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.[viii] The plague marked the end of an empire which, at its peak, controlled territory that stretched from the Middle East to Western Europe. Although Justinian got sick with the plague but survived; his empire did gradually lose territory following the plague.[ix]

Then, after a lull of almost 800 years, a strain of the bacterium Yersinia pestis, spread by fleas on infected rodents, travelled from Asia to Europe, leaving devastation in its wake. Known as the Black Death (1331-1353), it is believed to have killed between 75-200 million people, 10-60% of Europe’s population. Once again, the bodies of victims were buried in mass graves.

Here too a plague changed the course of Europe’s history. With so many dead, it is argued that labour became harder to find, bringing about better pay for workers and the end of Europe’s system of serfdom. It is argued that the lack of cheap labour may also have contributed to technological innovation.[x]

The earliest known formal quarantines were a response to the Black Death, somewhere between 1347 and 1351[xi]. The word “quarantine” comes from the Italian quaranta, meaning “forty.” 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.”[xii]

Over the following 300 years, multiple pandemics broke out around the world including England, continental Europe (c1470), Mexico (c1520 and again c1576), London again (c1563 and again in 1592), the New England epidemic (1616), followed by the Great Plague of London (1664-1666). This major outbreak in Great Britain caused King Charles II to lead a mass exodus from London. The plague, spread by fleas from plague-infected rodents, spread rapidly through the hot summer months. At its conclusion, about 100 000 people, including 15% of the population of London, died.[xiii]

Over the ensuing decades the plague stroked France in 1668 (40 000 deaths); Malta in 1675 (11 300 deaths); Spain in 1676 (unknown death toll), Austria in 1679 (76 000 deaths); Iceland in 1707 (over 18 000 deaths); and the Great Northern War plague outbreak in Denmark, Sweden, and Lithuania in 1710 (unknown death toll).

Sixty years later it was the turn of Moscow to be hit by the Russian plague of 1770-1772. Only this time, the plague gave rise to social unrest leading to, among others, the murder of Archbishop Ambrosius for encouraging crowds not to gather for worship – perhaps the earliest call for social distancing. The empress of Russia, Catherine II (also called Catherine the Great), was so desperate to contain the plague and restore public order that she issued a hasty decree ordering all factories to be moved from Moscow. More than 50 000 people may have died before the plague ended. But more tragedy was to follow: Catherine struggled to restore order and in 1773, Yemelyan Pugachev, a man who claimed to be Peter III (Catherine’s executed husband), led an insurrection that unfortunately resulted in the deaths of thousands more.[xiv]

Twenty-one years later yellow fever seized the then capital of the United States’ Philadelphia. The disease is carried and transmitted by mosquitoes, which experienced a population boom during the particularly hot and humid summer weather in Philadelphia that year. It was not until winter arrived — and the mosquitoes died out — that the epidemic finally stopped but not before more than 5 000 people had died. In an act of gross injustice officials erroneously believed that slaves were immune and called for people of African origin to be recruited to nurse the sick.[xv]

Ninety-six years later and a flu pandemic rapidly spread from its origins in St. Petersburg before making its way throughout Europe and the rest of the world, largely aided by the new transport links developed by the modern industrial age.

Twenty-eight years later the big one came: the 1918 Spanish flu (incorrectly attributed to Spain) saw an estimated 500-million people from the South Seas to the North Pole fall victim with some indigenous communities pushed to the brink of extinction. The cramped conditions of soldiers and poor wartime nutrition that many people were experiencing during World War I heightened the flu’s circulation and lethality.

Almost seventy years later (although the exact date remains problematic) HIV, a virus that causes AIDS, made its way around the world claiming an estimated 35-million lives since it was first identified. It is highly likely that AIDS developed from a chimpanzee virus that was transferred to humans in West Africa in the 1920s already. Ongoing medical research resulted in the development of medication that allows people with the disease to experience a normal life span with regular treatment. Even more encouraging, two people have very recently been cured of the disease.

Twenty-eight years later a contemporary swine flu pandemic emerged, caused by a new strain of H1N1, that originated in Mexico in the spring of 2009 before spreading to the rest of the world. In one year, the virus infected as many as 1.4-billion people across the globe and killed between 151 700 and 575 400 people.[xvi] The 2009 flu pandemic primarily affected children and young adults, and 80% of the deaths were in people younger than 65, the Center for Disease Control (CDC) reported.[xvii] That was unusual, considering that most strains of flu viruses, including those that cause seasonal flu, cause the highest percentage of deaths in people ages 65 and older. But in the case of the swine flu, older people seemed to have already built up enough immunity to the group of viruses that H1N1 belongs to, so were not affected as much.

Only four years later the West African Ebola epidemic ravaged West Africa, with 28 600 reported cases and 11 325 deaths. The first known cases of Ebola occurred in Sudan and the Democratic Republic of Congo in 1976, and it is thought that the virus may have originated in bats.[xviii]

Lessons

What can we deduce from this?

First, the primary impact on society regrettably is the loss of life. Secondary impacts range from civil unrest to socio-economic collapse caused either by internal distresses or by opportunistic invasion by external forces, or both.

Second, almost without fail, the spread of pandemics is the result of the movement of people and goods. All in all, imported diseases probably killed tens of millions of people. As William Denevan, a professor emeritus at the University of Wisconsin-Madison has noted, “The discovery of America was followed by possibly the greatest demographic disaster in the history of the world.” This disaster changed the course of history not only in Europe and the Americas but also in Africa where the emergence of the slave-trade flourished in response to the resulting labour shortage in the Americas.

Third, diseases are recurrent. Epidemics and pandemics do not fit into neat paragraphs bracketed by a beginning and an end and a place – as we are now learning from Covid-19. They ebb and flow, recurring when conditions are favourable, mutating when they are not, travelling to new destinations as opportunities arise.

Fourth, zoonotic diseases – diseases which are transmitted from animals to humans – have resulted in 2.5-billion cases of human illness and 2.7-million deaths each year globally.[xix] Diseases such as HIV, Ebola, Sars, Mers and Zika are believed to have originated in animals. Our appalling treatment of nature has much to do with this – a subject I will cover in a later article.

Fifth, a review of the recent past raises cause for much concern, namely the increase in the number of pandemic events and a shortening of time between those events: over a period of 60 years – since the outbreak of the AIDS pandemic in 1960 – there have been 76 recorded epidemics and pandemics. Much of this can be ascribed to a combination of all the points identified above.

Sixth, people are unlikely to learn from past experiences. This is the first lesson Thucydides himself intended. What does not change, wrote the historian, is human nature; you can expect people to react in similar ways when they encounter events like those that have occurred in the past. He embarked on his work, he says, because a clear grasp of the events he was living through could hopefully guide responses to similar events in the future.[xx]This is the second lesson left by Thucydides – data gathering. Both he and the physician Hippocrates, one of the most innovative medical practitioners of the day, were visiting sick patients, meticulously noting their symptoms, and keeping track of how they responded to prescribed treatments such as sleep, exercise, and the regulation of diet. The third lesson provided by Thucydides was emphasising that one of the worst aspects of the plague was the despair into which people fell on finding they had the disease. Those who were convinced they had no hope were much quicker to “give up and die,” observed Thucydides. The fourth lesson was the rate of infection among those who flocked to care for others: they died in droves and had the highest incidence of mortality.[xxi] An interesting exception was the philosopher, Socrates. He cared for the sick and dying without contracting the disease himself. Socrates, it is thought, acquired immunity from his earlier exposure to the disease, just as Thucydides himself, who had survived infection, recognised that this made him immune from reinfection. It was to be thousands of years later before medical immunity was properly understood, but the historian implies that historical hindsight can itself be a kind of vaccine.

Conclusion

What could be driving these diseases to reappear more frequently? Here a parallel can be drawn to storms and climate change: climate scientists continuously stress that any one storm does not prove their theory of climate change, but increasingly frequent and violent storms are consistent with climate change theory.

One view is that pandemics have historically been more likely to occur at times of social inequality and discord. The socially marginalised generally suffer from poor health and inadequate living conditions, making them more likely to succumb to infection. They are also the group more likely to be forced to move in search of work, including migrating to cities in search of job opportunities.

Another view is that the increase in the frequency of pandemic and epidemics is related to the greater global movement of people and goods. As the world becomes more tightly connected through trade, viruses, people, and goods travel together along trade routes that connect cities.

History need not simply recall the horrors of the past. It can guide us towards adopting precautions, remind us that accurate observation is vital to ensure a better response in the future, and reassure us that normal life will one day return. It may be that history is not only written by men but also by viruses.

Meanwhile, we should also remember that history never repeats itself exactly, even if it can offer valuable lessons for posterity. The reality is that disruptions to systems are inevitable. Our long-term ability to exist will be defined by how well and how quickly we distil essential learning that will carry our society forward in the most humane and life-affirming way so that we reduce the catastrophic impact of the next disturbance.


[i] Kolbert, E. 2020. “Pandemics and the shape of human history.” The New Yorker. Available from: https://www.newyorker.com/magazine/2020/04/06/pandemics-and-the-shape-of-human-history?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_040520&utm_campaign=aud-dev&utm_medium=email&bxid=5be9f5bd2ddf9c72dc879e86&cndid=48809828&hasha=4c2641b64be4fbc96d3272bb1a96ae71&hashb=c9c1dba6c170b93151f4dd39d2d298d2cb950fd6&hashc=122c6030809ad6616af10d52091c32b56f95b8f727c69a827fdfdd7af1aa3c83&esrc=right_rail_magazine&utm_term=TNY_Daily. Downloaded: Monday, 06 April 2020.

[ii] April Pudsey, a senior lecturer in Roman History at Manchester Metropolitan University, in a paper published in the book “Disability in Antiquity,” Routledge, 2017)

[iii] Ibid.

[iv] Kolbert, E. 2020. “Pandemics and the shape of human history.” The New Yorker. Available from: https://www.newyorker.com/magazine/2020/04/06/pandemics-and-the-shape-of-human-history?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_040520&utm_campaign=aud-dev&utm_medium=email&bxid=5be9f5bd2ddf9c72dc879e86&cndid=48809828&hasha=4c2641b64be4fbc96d3272bb1a96ae71&hashb=c9c1dba6c170b93151f4dd39d2d298d2cb950fd6&hashc=122c6030809ad6616af10d52091c32b56f95b8f727c69a827fdfdd7af1aa3c83&esrc=right_rail_magazine&utm_term=TNY_Daily. Downloaded: Monday, 06 April 2020.

[v] Ibid.

[vi] Ibid.

[vii] Ibid.

[viii] Ibid.

[ix] Larus, O. 2020. “20 of the worst epidemics and pandemics in history.” Available from: https://www.livescience.com/worst-epidemics-and-pandemics-in-history.html. Downloaded: Monday, 06 April 2020.

[x] Ibid.

[xi] Kolbert, E. 2020. “Pandemics and the shape of human history.” The New Yorker. Available from: https://www.newyorker.com/magazine/2020/04/06/pandemics-and-the-shape-of-human-history?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Daily_040520&utm_campaign=aud-dev&utm_medium=email&bxid=5be9f5bd2ddf9c72dc879e86&cndid=48809828&hasha=4c2641b64be4fbc96d3272bb1a96ae71&hashb=c9c1dba6c170b93151f4dd39d2d298d2cb950fd6&hashc=122c6030809ad6616af10d52091c32b56f95b8f727c69a827fdfdd7af1aa3c83&esrc=right_rail_magazine&utm_term=TNY_Daily. Downloaded: Monday, 06 April 2020

[xii] As Frank M. Snowden explains in “Epidemics and Society: From the Black Death to the Present” (Yale),

[xiii] Ibid.

[xiv] Ibid.

[xv] Ibid.

[xvi] Ibid.

[xvii] Ibid.

[xviii] Ibid.

[xix] Salyer SJ, Silver R, Simone K, Barton Behravesh C. Prioritizing zoonoses for global health capacity building—themes from One Health zoonotic disease workshops in 7 countries, 2014–2016. Emerg Infect Dis. 2017 Suppl. https://doi.org/10.3201/eid2313.170418

[xx] D’Angour, A. 2020. Coronavirus: What Boris Johnson’s Greek hero teaches us about epidemics. Available from: https://www.bbc.com/news/uk-52236388. Downloaded: Tuesday, 14 April 2020.

[xxi] Ibid.

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