by Sean Martin
Smallpox’s early history is a matter of conjecture. Because it’s a crowd disease, and can only be passed from person to person, it couldn’t have survived among the scattered populations of the Americas; even if it had been present prior to the arrival of Europeans, its critical community size would never have been reached, and it would have died out. However, there’s no evidence for New World smallpox prior to Cortes. As we saw in Chapter 2, the Egyptian pharaoh Ramses V may have been a victim of smallpox. The Bible and the Greeks are also silent on the subject of smallpox, which leads us to the tentative conclusion that it may not have reached the Mediterranean by the time of Hippocrates (fifth and fourth centuries BC). It is possible that the disease was active in ancient China: a manuscript from 1112 BC refers to a disease which may have been smallpox, where it was referred to as ‘venom from the mother’s breast’185 but there is little firm evidence until we get to the fourth century AD. In the West, smallpox was once considered the disease behind the Plagues of Athens (430 BC), Antoninus (second century AD) and Cyprian (third century AD), but these epidemics are now generally thought to have been caused by something else (see Chapter 2). St Nicaise, Bishop of Rheims, is traditionally said to have suffered from smallpox – indeed, he was later made into the patron saint of those afflicted by the disease – although his death in 452 was not a result of his illness: the Huns beheaded him on the steps of his church. Marius, Bishop of Avenches in Switzerland, mentioned an outbreak of a disease he called variola in 570 AD, as did Gregory of Tours a decade later, and this is the name that medicine was to adopt for the virus.
Two strains were eventually identified in the twentieth century, Variola major and Variola minor.186 Both seem to be descendants of an earlier virus, the prehistoric taterapox. Of the two, V. major is by far the more lethal, with a 25 to 30 per cent mortality rate if untreated. But V. minor seems to have been the first to develop, possibly between 1,400 and 6,300 years ago in West Africa. The Yoruba, who came to live in the lands where V. minor originated, made supplications to a god of smallpox, Shapona, suggesting that the disease had been endemic there longer than anyone could remember. Some time between 400 and 1,600 years ago, V. major evolved, probably in Asia.187 This conjecture might help explain why ‘There is some indication of smallpox in China by the fourth century, and stronger evidence for its arrival in Japan in the 730s.’188 If this is correct, we could conjecture that the eighthcentury Japanese outbreak was the newly-evolved Variola major, and that the smallpox from which Ramses V suffered, and that noted by Marius and Gregory of Tours, was Variola minor.
From Japan in the 730s, smallpox began slowly creeping westwards. By the turn of the ninth century, it had reached Baghdad. The great Arab doctor Rhazes (Muhammad ibn Zakariyā al-Rāzī, 854–932) knew of both strains of the disease, described in his Treatise on Smallpox and Measles. Rhazes described smallpox as a prevalent childhood disease. It seems, by this time, smallpox existed in most of Asia, parts of northern Europe, sub-Saharan Africa and Indonesia.189 Towns, cities and trade routes, spreading across Asia from the Pacific to the Atlantic, were well enough established – and large enough – to give the disease a substantial reservoir. By the turn of the first Christian millennium, then, smallpox was a threat, but did not loom so large in mediaeval consciousness as leprosy, famine and the ever present ‘fevers’.
All this changed, however, by the time Cortes invaded Mexico. What happened remains a mystery: either there was a further mutation of the V. major virus; perhaps it did not appear in late antiquity or the Dark Ages at all, but was only now, in the early years of the sixteenth century, making its murderous appearance. Whatever viral changes were afoot, the result was catastrophic. The virus was possibly introduced into Mexico by an African slave in the spring of 1520, a few months after Cortes had entered the Aztec capital Tenochtitlán for the first time.190 What happened next is recorded by the Spanish friar, Fray Toribio Motolinía, in his History of the Indians of New Spain (1541):
... when the smallpox began to attack the Indians it became so great a pestilence among them throughout the land that in most provinces more than half the population died; in others the proportion was a little less. For as the Indians did not know the remedy for the disease and were very much in the habit of bathing frequently, whether well or ill, and continued to do so even when suffering from smallpox, they died in heaps, like bedbugs. Many others died of starvation, because, as they were all taken sick at once, they could not care for each other, nor was there anyone to give them bread or anything else. 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 in order to check the stench that rose from the dead bodies so that their homes became their tombs. This disease was called by the Indians “the great leprosy” because the victims were so covered with pustules that they looked like lepers. Even today one can see obvious evidences of it in some individuals who escaped death, for they were left covered with pockmarks.191
... it extended over all parts of their bodies. Over the forehead, head, chest. It was very destructive. Many died of it. They could no longer walk, they could do no more than lie down, stretched out on their beds. They couldn’t bestir their bodies, neither to lie face down, nor on their backs, nor to turn from one side to the other. And when they did move, they cried out. In death, many [bodies] were like sticky, compacted, hard grain… many [of the survivors] were pockmarked… some were blind… this pestilence lasted sixty days, sixty lamentable days.192
Nearly half the population of Mexico died of smallpox in six months. ‘Whatever the number of dead, this outbreak was a catastrophe, and of a scale far exceeding its earlier rampages on Hispaniola, Puerto Rico and Cuba.’193 The Aztec Empire could not withstand such an onslaught. Their gods had abandoned them, it seemed.
While it was doing its work in Mexico, the disease cut swathes of people down in Colombia, Cuba, Peru, Puerto Rico, Venezuela and Yucatan. By the time Francisco Pizarro arrived to conquer South America for the Spanish crown in 1532, he was effectively leading a rearguard force, mopping up what the Destroying Angel had started. The Incas, like the Aztecs before them, saw their world collapse around them. In the 1550s, Chile and Brazil fell to smallpox, with conquistadors and missionaries following in its wake. The Jesuits, keen to convert local populations, held mass baptisms. Like the Aztec practice of communal bathing, this only served to spread smallpox further.
North America survived relatively intact until the seventeenth century. This was due in large part to the fact that colonial attentions prior to this period had been directed elsewhere: at navigation, exploration, mapping and surviving the apocalyptic convulsions that Europe was going through, the crucible of Renaissance and Reformation. But almost as soon as colonists began to set foot in North America in earnest, the death toll began to mount exponentially. A smallpox epidemic began in New England in 1614, killing large numbers of Massachusett, Micmac, Pawtucket and Wampanoag. So drastically were Native American numbers cut, that when the Mayflower landed in 1620, the tide was already turning in favour of the white settlers (even if they didn’t know it at the time). Other tribes, such as the Algonquin and Abenaki, fell victim before the decade was out. As happened in Mexico, the indigenous populations believed their own gods had let them down, and the Europeans had little, if any, sympathy. Between the arrival of the Pilgrim Fathers and the end of the seventeenth century, it is thought that up to 90 per cent of North American native peoples were wiped out – millions died – a catastrophe on a par with the Black Death or both world wars. It was another triumph for Civilisation, and Christianity.
Why did it happen? The short answer is that, from 1492 onwards, explorers, conquistadors, missionaries, mercenaries, merchants and settlers carried their diseases across the ocean, taking the Old World disease pool with them. The native peoples of the Americas were a virgin population, ripe for infecting.
The Americas are thought to have been settled in prehistor
y by peoples crossing the Bering Land Bridge (c. 30,000 BC or later). Whatever viruses and bacteria that came over with them from Palaeolithic Asia were probably weakened by the cold of Siberia, Kamchatka and Chukotka and effectively finished off by the Alaskan climate. Only the hardiest could have survived – whether human, animal or bacteria. As a result of this isolation from the Eurasian landmass, the disease pool of the New World evolved along very different lines to that of the Old. There was no smallpox, as we’ve already noted. Tertian malaria, yellow fever, dengue, measles, diphtheria, typhoid, scarlet fever and influenza were also unknown. These would all be imported by the white man and his African slave; the Native Americans stood little chance of resisting infection.
Prior to Columbus, there seem to have been few epidemiological disasters. It’s possible that the main disease-related crisis was the collapse of the Mayan empire in the eighth and ninth centuries AD. This has been attributed to, variously, drought, famine, war, poor trade and unsustainable population growth. All of them may have played their part. We should also consider the role of Mayan farming practices. Maize and beans were Mayan dietary staples for centuries, so much so that it seems to have led to iron deficiency anaemia. Skeletal evidence from Mayan children shows that they had been suffering from an acute form of iron-deficient anaemia.194 In addition, the soil was poor in iron, leading to less iron in crops and mothers’ milk. The Mayan diet was also low in vitamin C, which the body needs to absorb iron. Further vitamins were lost through the Mayan custom of soaking maize in water, which created a deficiency in folic acid and vitamin B12. Factor in further iron loss through sweating, suffering from hookworm, tapeworm and other parasites that were an unavoidable hazard of Mayan farming. Mayan diet also lacked zinc, which stunted growth and the ability to resist infection. The combined effects of poor diet, anaemia, vitamin deficiency and parasite infestation produced a weakened people, much less able to withstand disasters both natural and man-made. When adverse circumstances began to pile up during the eighth and ninth centuries, it spelled the end of the great period of Mayan civilisation.
The dwindling of the Mayans notwithstanding, Aztec codices contain references to disease, but these could be famine- and cropfailure related, ‘and may not have been the result of the sort of humanto-human infectious chain that existed in the Old World.’195 Three disasters are mentioned by the codices, dated to the years 780, 1320 and 1454, ‘but the decipherment of Aztec codices is an inexact science at best.’196 In general, native Americans, regardless of where they lived, enjoyed good health in comparison with Europeans and also a longer life expectancy – some even reached the grand old age of fifty.
However, the ‘good health’ seen by the first explorers was relative. Arno Karlen notes that ‘when native peoples first met Europeans, their societies ranged from hunter-gathering to advanced Neolithic, their health from good to adequate to wretched.’ Evidence from bones, mummies and coprolites shows high rates of dysentery, intestinal parasitic diseases, infections from wounds, non-pulmonary tuberculosis (probably caught from birds, cattle or horses), and pinta, a non-venereal skin disease linked to syphilis. They possibly had syphilis as well – see below – pneumonia (in bacterial and viral forms), and hepatitis A. The jury still appears to be out on malaria.197
Advocates of pre-Columbian malaria point to the fact that the Aztecs gave quinine to malarial Jesuits in the 1620s. This drug, still used today, is derived from the bark of the cinchona tree. But at what stage did the Aztecs acquire this knowledge? Some suggest malaria was either brought over the Bering Land Bridge with the first settlers, or, in a more controversial theory, was imported by Japanese explorers to Ecuador when they are thought to have made contact with the Valdivian culture at some point between 3500 BC and 1800 BC. What we can say for certain is that, when Europeans arrived in the New World at the end of the fifteenth century, malaria travelled with them, largely carried by African slaves.
Two diseases were totally unknown in the Old World: Chagas’ disease and Carrión’s disease, or Oroya fever (bartonellosis). Chagas’ disease, while similar to African trypanosomiasis (sleeping sickness), seems to have originated in northeastern Brazil and evolved independently. It is at least two thousand years old: mummies from the Tarapaca Valley in northern Chile have revealed Chagas’ signature digestive tract problems, and it remains endemic in that part of Chile to this day.198 Carrión’s disease is similarly old; indeed it seems to have been represented on pieces of pre-Columbian Peruvian pottery known as huacos. Originating in the Andes, it is a parasitic condition that can cause fever and anaemia and can lead to unsightly boils known as ‘Peruvian warts’.
The Great Pox
One disease that quite possibly travelled back to Europe on Columbus’s ships made an appearance after the Battle of Fornovo on 6 July 1495. Charles VIII of France, fighting to claim the throne of Naples, inflicted a decisive defeat on the forces of the Holy League, a group of powers including the Papal States, the Duchy of Milan and Venice. Following the battle, Marcello Cumano, a military physician serving with Venetian forces, noted that:
Several men-at-arms or foot soldiers, owing to the ferment of humours, had pustules on their faces and all over their bodies. These looked rather like grains of millet and usually appeared on the outer surface of the foreskin or on the glans, accompanied by a mild pruritis [a desire to scratch]. Sometimes the first sign would be a single pustule looking like a painless cyst, but the scratching provoked by the pruritis subsequently produced a gnawing ulceration. Some days later, the sufferers were driven to distraction by the pains they experienced in their arms, legs and feet, and by an eruption of enormous pustules which lasted… for a year and more if left untreated.199
Another doctor, Alessandro Benedetti, noted how the new disease was spread:
Through sexual contact, an ailment which is new, or at least unknown to previous doctors, the French sickness, has worked its way in from the West to this spot as I write. The entire body is so repulsive to look at and the suffering so great, especially at night, that this sickness is even more horrifying than incurable leprosy or elephantiasis, and it can be fatal.200
It was called the great pox to differentiate it from smallpox, although it is better known as syphilis.
It seems to have first reached Europe two years before the siege of Naples. The Spanish physician Ruy Diaz de Isla attended Columbus and his crew in Barcelona in March 1493, shortly after their return from the New World. Some of the crew were clearly ill with something, although the sailors themselves attributed it to the rigours of the voyage. It soon began to spread in Barcelona, and was to follow in the wake of Columbus and his men as they made their triumphant progress. Diaz de Isla dubbed the disease the Serpent, equating syphilis with the serpent in the Garden of Eden, and the pox with the Edenic island of Hispaniola. This intuition proved to be accurate, as syphilis was eventually found to be caused by a snake-shaped bacterium, Treponema pallidum. Diaz de Isla would go on to treat 20,000 syphilis victims, during which time he identified the three stages of syphilis, primary, secondary and tertiary (see below).
Some of Columbus’s sailors – either from the historic 1492–3 voyage, or more likely the second voyage of 1493–4, which saw the Admiral take many more slaves – were thought to have fought in Charles’s army at Naples, and they then infected prostitutes after the city was taken in February 1495. By the time of the engagement at Fornovo, syphilis had passed into the ranks of Holy League troops, possibly due to the same prostitutes maximising their business opportunities by servicing both sides in the conflict.
This first European syphilis was much worse than its modern descendant. In other words, it behaved like any new disease hitting a virgin population (a rather unfortunate phrase in this context) for the first time. Smallpox, making its first American landfall at the same time as syphilis began to rampage through Europe, behaved with equal ferocity for exactly the same reasons. (No prior experience of a disease meant there was no immunity in the host populat
ion.)
Because of its perceived origin within the ranks of Charles’s army, syphilis was dubbed ‘the French disease’, or, as Alessandro Benedetti put it, ‘the French sickness’. The name ‘syphilis’ was coined by the Italian humanist-physician Girolamo Fracastoro (also known by the Latinised form of his name, Fracastorius), in his poem Syphilis, sive morbus gallicus (1530), although the name didn’t start to gain wide usage until the late eighteenth century.201 Fracastoro describes how the shepherd Syphilus falls foul of the gods by cursing them for sending a heat wave that kills his cattle. The gods respond by striking Syphilus down with the ‘unspeakable disease’, giving the shepherd the unfortunate distinction of becoming the first human to suffer from syphilis.
Syphilis is caused by a spirochetal bacterium, Treponema pallidum. (A spirochete simply means a bacterium that is spiral-shaped. Yaws, Lyme disease and relapsing fever are also caused by spirochetes. They are most often found in mud or water, or, within the body, in blood, lymph or sweat.)202 It is transmitted mainly by sexual contact, although it can be passed by a mother to her foetus; this hereditary form is known as congenital syphilis.
When Europeans reached the Americas, syphilis seems to have adapted especially for them. As Andrew Nikiforuk noted, ‘for the Arawaks the disease was probably a mild yet common skin infection that was no more irritating than a case of scabies.’203 They could pass it by skin-to-skin contact or by sharing eating utensils. (This endemic form of syphilis is sometimes known as bejel.) But in Europeans, who not only generally wore more clothes but lived in a colder climate, the bacteria made their home in ‘the most hospitable environment they could find: European genitals.’204