I’ve never written a column where the headlines so echoed the books. Take the day I began John Kelly’s “The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time” (Harper, 2005). That morning, I read online that Ebola cases, in our current outbreak, now outnumber those from all previous outbreaks combined. That’s a stunning fact. Still, besides shared horror, I didn’t think the Black Death and Ebola had any connection. In the 14th century, the plague virus — which killed an estimated third of Europe’s population — was seemingly carried by fleas who’d bitten infected rats. Ebola springs from primates and humans, not fleas. But then I hit this bit in the book: “[A] number of historians and scientists have recently begun to argue that the mortality was caused by a different infectious illness, perhaps anthrax, perhaps an Ebola-like ailment.”
An Ebola-like ailment. Could it be so? Both epidemics feature fevers that burst blood vessels, causing “buboes,” or welts, that give bubonic plague its name. In Ebola, blood can gruesomely leak from every opening in the body. Then there’s the matter of transmission rates. Bubonic plague spreads slowly, about 100 yards a year. But during the Black Death, the sickness (whatever it was) moved about 30 miles every three days, which more closely mimics the speed of viruses like Ebola, according to some researchers
There’s so much we don’t know here. But what “The Great Mortality” taught me is that every epidemic perches on a midden of precipitating factors. For instance, just before the Black Death, Europe’s climate grew wetter, making the earth more fertile, thus able to support more people, and so cities grew bigger. Diseases can’t go viral, as it were, without this critical mass. Meanwhile, Asia became drier, which forced Mongol herdsmen up to greener pastures in the Russian steppes. That’s where the virus was biding its time, replicating inside Russian marmots, eventually hitching onto the rats that hopped on merchant caravans and ships (especially those traveling from Genoa to the Crimea). Fleas bit infected rats and then bit humans, too.
Howard Markel’s “When Germs Travel: Six Major Epidemics that Have Invaded America and the Fears They Have Unleashed” (Pantheon, 2004) also follows bubonic plague as it turned up in San Francisco in 1900, plus typhus in the Mexican revolution, HIV in our time, and other maladies. In Europe, the Black Death was largely deemed God’s retribution for a sinful world, and gentiles scapegoated Jews for the outbreak. In America, fear of immigrants, plus racism and class warfare have often served as the underpinnings for public health initiatives. Thus the cycle of mistrust spurs the cycle of infection, as vulnerable groups resist help they find dubious. Buzzfeed headline, Aug. 16, 2014: “Mob Destroys Ebola Center in Liberia Two Days After It Opens.”
The week after that, Ebola dispatches focused on the new vaccines, promising but unproven, and this electrified my reading of “Pox: An American History” (Penguin, 2011). Indeed, author Michael Willrich says the field of immunology was founded on smallpox (the pox was “small,” by the way, because the greater pox was syphilis). Dairymen and milkmaids were judged to be more resistant, perhaps because they came into more frequent contact with another strain, cowpox. And so Dr. Edward Jenner mixed a medicine, which he called a “vaccine,” from cowpox to fight smallpox. Vaccine comes from the Latin word for cow.
Willrich opens with a gritty narrative of the smallpox epidemic of 1900 as it hits the immigrant-saturated “All Nations Block” on Manhattan’s West 69th Street. And he touches widely on civil liberties; this was an era when vaccines weren’t regulated (some were tainted with tetanus) and were forced against people’s wills. Anti-vaccine riots broke out in Montreal and Brazil. In Kentucky, African-Americans were rounded up, handcuffed, and vaccinated at gunpoint.
Kentucky Bioprocessing, ironically, is one of the companies now helping to make experimental Ebola drugs. A tall order, this. For viruses are “evolutionary masterpieces,” writes Molly Caldwell Crosby, which must adapt to other life forms or die out. A new group of hosts, lacking immunity, are “like a fresh burst of oxygen in a waning fire.” This is why smallpox decimated Native Americans when Europeans arrived here. And why yellow fever, jumping from Africa, via Cuba, latched on to North Americans, especially in Memphis in 1878. Or so I learned in Crosby’s “The American Plague: The Untold Story of Yellow Fever, the Epidemic that Shaped Our History” (Berkley, 2006).
How did it shape our history? After yellow fever devastated Philadelphia in 1793, we moved our capital to Washington D.C. After Napoleon lost 23,000 of his troops to the fever in Haiti, he left this “pestilent hemisphere” and conveyed the Louisiana Purchase to Thomas Jefferson at fire sale prices. In 1900, working off a theory of Cuban physician Carlos Finlay, US army surgeon Walter Reed set up two cabins in Cuba, one with bedclothes smeared with blood and excretions of yellow fever victims, one filled with suspect aedes aegypti mosquitoes. Medical volunteers lived in each cabin. The bit got sick, but the others did not, proving that “there was a connection between the pest and the pestilence.”
John Snow, a doctor, and Henry Whitehead, a minister, are the heroes of Steven Johnson’s “The Ghost Map: The Story of London’s Most Terrifying Epidemic — and How It Changed Science, Cities, and the Modern World” (Riverhead, 2006). It’s the story of London’s cholera outbreak of 1854, where urban density (432 residents per acre then, as opposed to 100 in Manhattan today) and lack of infrastructure (grossly inadequate sewer and garbage systems) created the perfect environment for water-borne bacteria to thrive. Don’t read this over breakfast: The descriptions of London filth are all too vivid. But take heart: Snow and Whitehead fearlessly interview hundreds of relatives of the victims to finally trace the source to one Soho water pump, which had absorbed leakage from a nearby cesspool, in which a mother tossed soiled-diaper laundry water from her baby girl, who had cholera. The pump handle was removed; the crisis ended.
Bad as they were, none of these epidemics rival the one in “Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It” (Farrar, Straus and Giroux, 1999). It affected more than 25 percent of the US population: In 1918, the average life expectancy dropped to an unbelievable 39 from about 51 the year before. This particular flu killed more than any other epidemic in history, with the virus hiking on to the world’s redeploying military divisions just after the end of World War I. (Fort Devens is a key to the story.) Author Gina Kolata reminds us that doctors knew about germ theory, but they didn’t yet know how to isolate viruses, and they were too small to see under the era’s microscopes, anyway. For decades, scientists thought all traces of this flu died with the epidemic’s demise. But in 1998, victims, buried in Alaskan permafrost, were exhumed, and virus specimens were found.
History and science also come together, excitingly, in Madeline Drexler’s “Emerging Epidemics: The Menace of New Infections, H1N1 Flu, SARS, Anthrax, E. Coli” (Penguin, 2009). She reports that scientists are pinpointing viral and bacterial culprits not only in outbreaks, but also in many chronic conditions. The Epstein-Barr virus, for instance, has been found in Hodgkin’s disease patients. Coxsackie B may jump-start Type I diabetes by damaging the pancreas.
However many linkages enlighten us, though, man vs. microbe is a never-ending grudge match. You can remove Memphis cisterns in 1878 and kick out yellow-fever-carrying mosquitoes, but encephalitis-carrying ones now breed in massive piles of old tires, sent here from Asia, for retreading. Penicillin once killed 89 percent of all bacteria. Now almost 100 percent of staph strains have turned penicillin-resistant. “The most menacing bioterrorist,” as Drexler writes, “is Mother Nature herself.” The people of Liberia, Sierra Leone, Nigeria, and counting, are relearning this right now, day after terrifying day.Katharine Whittemore is a freelance writer based in Northampton. She can be reached at katharine.whittemore @comcast.net.