Germs, Genes, & Civilization: How Epidemics Shaped Who We Are Today

by David P. Clark

  Widespread cult prostitution, with little social stigma attached, implies that promiscuity had little medical consequence in those days. In other words, there was low probability of catching venereal disease. Later, as populations got denser and infectious disease spread, the venereal diseases would have been amplified, too.

  Populations dense enough to support major epidemic disease originated around 1000–500 B.C. Before 500 B.C., essentially all religions were polytheistic and included mother goddesses and fertility rites. As towns grew and people crowded together, skin diseases doubtless spread. Soon, we may imagine, specialized venereal forms of some skin infections began to emerge. These were spread by fertility rites and sacred prostitution, which became steadily more hazardous.

  Recent experience tells us that military expeditions are a major factor in the spread of venereal disease. The imperial maneuvers of the Assyrians, Persians, ancient Greeks, and Romans doubtless helped spread many infections, venereal and otherwise, from 1000 B.C. onward. Increased trade and military campaigns took growing numbers of single males ever farther from their hometowns and villages. Venereal infections that might have burned out in isolated communities could now spread.

  The growing hazards of promiscuity led to a steady change in behavior over the next few centuries. Remember that venereal disease frequently causes sterility, even when its victims remain otherwise healthy. Those who clung to the old ways suffered a decline in health and had fewer children. This was reflected in the decline of fertility cults and female divinities. Buddhism began in the crowded cities of ancient India and spread over the densely populated regions of the Far East. Somewhat later, Christianity spread throughout the Roman sphere of influence.

  The collapse of the Earth Mother religions and fertility cults was largely complete before 324 A.D., when Christianity became the official religion of the Roman Empire. By this time, Christianity’s main competitor was no longer polytheism or mother goddess worship, but Mithraism, another fairly monotheistic cult. Some 300 years later, the emergence of Islam, the most monotheistic major religion of all, swept away the remaining fertility cults in the less populated parts of the Near East. Today’s world-view is basically that of celibate monotheism. The single gods of modern religions are male, like the chief gods of ancient pantheons. But they are no longer even married, let alone polygamous.

  8. Religion and tradition: health below or heaven above?

  Religion and health care

  Religion is often criticized for offering its adherents “pie in the sky when you die.” But do religions really hold the loyalty of their followers by offering an afterlife? Few religious believers, however devout, seem overly enthusiastic about moving onward and upward to paradise. I argue that whether a religion is successful in practice depends on protecting its followers from the hazards of life on planet Earth. For most of history, infectious disease was the major killer, so how religion responded to disease was a crucial aspect.

  We must distinguish between the supernatural and natural aspects of religion. Most religions offer prayers for the sick. In addition, most religions perform rites designed to prevent infection or cure disease. The intent in either case is to invoke supernatural intervention on behalf of the patient. Religious believers might accept these procedures as supernatural and believe that they cure disease, even if they do not work.

  In contrast to these supernatural aspects, religion also provides physical benefits to health, whether consciously intended or not. Religious rites, such as those for segregating the “unclean” or for removing ritual impurity by washing, often promote hygiene. These measures work even though the practitioners might not understand how infections are transmitted and are not even attempting to prevent the spread of disease. Whether dressed in religious trappings or not, medical care, nursing, and hygiene benefit the sick. Survival of the sick is noteworthy, and if any gods were invoked during the health-care process, they receive credit.

  Today in advanced nations, religious faith is dwindling. One factor could be that infectious disease is largely a thing of the past, and religion can do little for heart disease and cancer. Miraculous healing, as a formal part of religion, is often mocked nowadays, even by those who attend church. Yet Christian denominations that merely provide moral guidance and bingo sessions are losing their congregations. Despite its primitive aura, physical healing is in many ways the heart—or the lungs and liver—of religion. After all, if an omnipotent god truly exists, miraculous healing should present no problem.

  Meanwhile, in many third-world countries, Christianity has displaced traditional religions. When people saw their own culture as inferior to European civilization in terms of life span and infant mortality, many concluded that the Christians’ god must be more powerful than their own. They then switched allegiance. Today, Christianity is numerically the largest religion, with Islam second and gradually closing the gap.

  Belief and expectation

  Why do some disasters shake religious beliefs while others have little impact? Expectation is a major factor. If you mostly live on hot dogs and hamburgers, you view steak or lobster as a treat. But if you live on cornmeal and greens, as many poor Africans do even today, a hamburger is a delicacy. All things are relative. Animals and humans respond not to constant stimulation, but rather to changes, whether in temperature, noise, diet, or prosperity.

  If you live in a society where infant mortality is greater than 50% and life expectancy is around 30 years, you are used to losing friends and relatives at an early age. In medieval England, children were not usually officially named until they had survived their first year. Mortality was so high that families avoided getting overly attached to newcomers whose chances of lasting a whole year were less than even. In contrast, in our modern industrial society, with life expectancy at over 70 years, we do not expect children to die before adulthood, and when this does occasionally occur, people become deeply upset.

  When a virulent epidemic rages through a population, its effects on religious faith depend on how long people normally expect to live and how frequently they expect to lose friends to infectious disease. Diseases such as malaria that take a steady toll each year in areas where they are endemic do not shock society. Endemic diseases are part of the natural scenery and are viewed much as other constant natural problems, such as the cold of winter or the barrenness of the desert.

  In contrast, virulent epidemics resemble earthquakes or hurricanes. An epidemic of bubonic plague gallops through society like the four horsemen of the apocalypse. Within a few weeks, half the population is dead and the corpses are piled too high for the survivors to bury. Society goes into communal shock. Religious belief is threatened. People might lose faith in their gods and look for other, stronger deities. Alternatively, they might blame their priesthood for failing to intercede successfully. A third possibility is that the priests might convince the people that the plague is divine punishment for sins committed by the people or their rulers.

  Observations on surviving hunter-gatherers illustrate the link between disease and religious rites. For instance, the majority of Navaho ceremonies concern disease, and a typical Navaho spent 25% to 30% of his waking time on religious activities. Among the San of the Kalahari Desert, the curing dance is the most important ritual. After entering the spirit world during a dance, the shamans plead with their god to cure the sick. In addition, the shamans chase away the evil spirits of the dead, who are believed to shoot the living with invisible arrows of disease.

  Roman religion and epidemics

  Before the days of the empire, the Romans responded to a series of severe but not devastating epidemics by switching their loyalty from the original Roman gods to Apollo, the Greek god of healing; then Asklepios; and finally Hygieia. Later, when the Roman Empire was devastated by a series of catastrophic plagues, the whole fabric of Greco-Roman polytheism came apart. Thus, between 150 and 500 A.D., the population of Rome fell from roughly one million to a mere 60,000; from 250 to 500 A.D.
, the population of the empire dropped by half after successive epidemics.

  In the early days of the Christian era, there was a massive emphasis on caring for the sick. Undoubtedly, such care greatly reduces the death rate for many diseases such as smallpox, typhoid, and malaria. Although these diseases are life-threatening, the death rate can be as low as 10% among patients who are kept clean, dry, warm, comfortable, and supplied with food and drink. Victims of the same infections who are shunned and left to fend for themselves are much more likely to die. Unlike many others at the time, the early Christians were willing to take the risks of nursing the sick, and their God was credited with great healing powers as a result. The Black Death is a different story. For those infected with bubonic plague, nursing has little effect. Ebolavirus is the same way. Outbreaks of swift, high-mortality diseases such as these proved beyond the control of man or god.

  Infectious disease and early religious practices

  If we regard disease as the consequence of sin, as many ancient cultures did, we might interpret the Garden of Eden as a memory of the disease-free days before urbanization spread a succession of pestilences. In biblical genealogies, the most ancient ancestors are credited with extremely long life spans. The records of ancient Middle Eastern kingdoms also give exaggerated life spans for the rulers of the earliest dynasties. Is this just hyperbole attached to the memory of heroes, or is it a half-forgotten memory of days gone by when life expectancy was indeed much longer?

  In the ancient world, sickness was often thought to result from spirits of some kind invading the body. Some were merely spirits of the dead looking for a new home; others were genuinely evil spirits, or demons, with malevolent intent. Today we tend to think of evil spirits as an archaic explanation for mental disease. This could be because, in our own culture, explaining brain malfunction has lagged behind understanding other, more physical illnesses. But to those who lived long ago, swellings, spots, and rashes were just as mysterious as mental aberrations. We should also remember that many infectious diseases produce fever and delirium if left untreated, thus obscuring the gulf between physical and mental conditions.

  As late as the nineteenth century, diseases such as typhoid, diphtheria, and scarlet fever were blamed on invisible vapors from smelly drains and other sources of putrefaction. It was not just the poor whose dwellings stank:

  “I have met just as strong a stream of sewer air coming up the back staircase of a grand London house from the sink, as I have ever met at Scutari….”—Florence Nightingale, Notes on Nursing, 1859

  Blaming evil-smelling vapors is not so different from invoking evil spirits. Both are nebulous and invisible. And today, instead of invisible spirits, we have microscopic germs, carried through the air or water and still invisible to the naked eye.

  Worms and serpents

  The earliest form of infectious disease whose cause primitive people could actually see was infestation by parasitic worms. Consequently, worms that “poisoned” people from the inside, and snakes that poisoned people by biting, were regarded as relatives; the same terms were often used for both. Moreover, serpents were sometimes associated with the devil and sometimes with medicine. This derives from the ancient viewpoint that pestilence, or perhaps just a single disease, belonged to a particular god.

  It was not so much that disease was evil and healing was good. Rather, sending plagues and removing them both came under the authority of the same god, who used disease as a means of retribution for human disobedience. Although most deities could intervene if cajoled with prayers and sacrifice, it made most sense to beg the god who sent disease to remove it. Thus, in many ancient cultures, the god of pestilence is also the god of healing. Later, a division of labor generated deities concerned solely with the healing aspect of disease. For example, Apollo, who both dispensed and withdrew pestilence, was succeeded by Asklepios, who was concerned only with the healing aspect of disease.

  Sumerians, Egyptians, and ancient Greece

  Religion and medicine were not distinct in early civilizations, and treating disease involved religious incantations as often as procedures that we regard today as medical. The Sumerians, who founded urban Middle Eastern civilization around 4,000 B.C., generally considered sickness due to three main kinds of spirits. These were the ghosts of the dead, genuine demons, and spirits that were the hybrid offspring of demons and humans. Individual disease was wrought by evil spirits wandering around on their own, whereas large-scale plagues were sent by angered gods.

  Although any god could send disease, the specialist was Nergal, the Sumerian god of pestilence. Nergal represented the blazing sun at noon, as did his Egyptian opposite number, Sekhmet, the lioness goddess, who breathed fire at the Pharaoh’s enemies. She was also called Lady of Pestilence. The valleys of the Tigris and Euphrates and the marshlands of the Egyptian delta were fertile for both agriculture and disease. Nergal was kept so busy that he needed 14 assistants (more properly, 7 pairs) to give mankind fever. Sekhmet, too, is linked with the holy number seven. The seven arrows of Sekhmet brought evil fates, especially as disease.

  The ancient Egyptians had several solar deities. In addition to the supreme sun god, Re, several goddesses represented aspects of the sun. Bastet, the cat goddess, was the friendly warmth of the sun, whereas Sekhmet was the noontime sun. Hathor, the great mother goddess, usually depicted as a cow, also represented the all-seeing sun, or “eye of Re.” As such, she was sent by Re to punish mankind. As Re got old, he started to worry that mankind was plotting against him. So Hathor went down to Earth and started to slaughter the conspirators. She drank their blood, which transformed her into Sekhmet. Naturally, sun gods and goddesses work only during the day, so Sekhmet went back to heaven for a good night’s rest. Meanwhile, Re and the other gods had got cold feet. If mankind was wiped out, who would provide the gods with sacrifices? So Re told his priests to put red dye into 7,000 pitchers of beer. They poured it out in the desert, and when Sekhmet came down the next morning, she lapped up the red beer, thinking it was blood. In her drunken stupor, Sekhmet forgot about exterminating the rest of the human race and reverted to the kinder and gentler Hathor.

  At their New Year’s festival, held just before the flooding of the Nile in July, the ancient Egyptians attempt to appease Sekhmet and ward off her “seven arrows.” In addition to the main sacrifices are many offerings of alcoholic drinks. The drunken feast that follows supposedly re-enacts Sekhmet’s distraction by using red-dyed beer. The timing is appropriate. Although the flooding of the Nile is vital to agriculture, it also spreads epidemics. For several weeks, slow-moving water covers everything. Bacteria and viruses that cause dysentery and diarrhea are spread by contaminated water. Malaria-carrying mosquitoes breed in stationary or slow-moving water, and water snails spread the parasitic worms of schistosomiasis (bilharzia).

  In ancient Greece, Apollo was both sun god and archer god. As with Sekhmet, his arrows represented pestilence, and he was invoked for healing together with his son Asklepios and granddaughter Hygieia. The Greeks felt it was unmanly for Apollo to shoot women, so they became the first to introduce affirmative action into medicine. Artemis, the twin sister of Apollo, carried a bow and arrows, which she used for bringing disease upon women. The general idea of demons spreading disease by shooting invisible arrows lasted through the centuries. In medieval England, sick animals were referred to as “elf-shot” and were treated by holy water and singing masses.

  Hygiene and religious purity

  One practical advantage of attributing sickness to spirit possession was that the sick were seen as unclean from a religious viewpoint. In the biblical book of Leviticus, religious impurity itself is viewed as at least partially contagious. Thus, menstruating women, who were ritually impure, could spread their impurity to other persons they contacted. Here again, we see the overlap between a “spiritual” condition and infection. Those regarded as unclean were often quarantined or excluded from society until their symptoms (or their souls) departed. Thou
gh often cruel, quarantine greatly reduced the spread of contagious disease. Because most people in antiquity died from infections, quarantine was beneficial overall.

  The Sumerians regarded the spirits of the dead as homeless rather than malicious. Sickness then resulted from the misfortune of providing refuge for a homeless spirit rather than deliberate sin. The more rigid Semitic cultures that followed were less tolerant of the sick. Disease was seen as divine punishment, and sickness and sin became intertangled. Sometimes the individual was guilty; sometimes the guilty party was the parents or the tribe or nation as a whole. Somewhere there was sin, and, increasingly, the priest’s job was to uncover it and pin the blame on someone.

  A similar change from a freewheeling outlook to a narrower attitude occurred during the growth of the Christian church. Most early church fathers believed that demons assaulted even innocent Christians because the demons were evil. According to St. Augustine (354–430), “All diseases of Christians are to be ascribed to these demons; chiefly do they torment fresh-baptized Christians, yea, even the guiltless, newborn infants.” Thus, caring for the sick, by either secular or spiritual means, opposed the demons and was therefore commendable.

  Later the church saw disease more as punishment from God. This at times led to the extreme position, rarely stated explicitly, that curing disease by nonreligious means was a blasphemous attempt to usurp God’s authority and, therefore, was itself sinful. This attitude sometimes had disastrous effects. Even as late as 1885, during a smallpox epidemic in Montreal, the Catholic Church opposed vaccination. The Abbé Filiatrault expressed the official view, “If we are afflicted with smallpox it is because we had a carnival last winter, feasting the flesh…it is to punish our pride that God has sent us smallpox.” Eventually, the rising death toll prompted a reversal of the official position.