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

by David P. Clark

  Financial motivations sometimes lurked behind these attitudes. For example, in 1547, Pope Leo X sold tokens bearing a cross and the inscription, “He who kisses it is preserved for seven days from falling sickness, apoplexy, and sudden death.” To be fair, most secular remedies of the day left much to be desired. The physician of the Habsburg Emperor Rudolf II (1552–1612) provided this recipe against plague: “Desiccated toads and pulverized chickens. The menstrual blood of a young maiden. White arsenic, pearls, and emeralds from the Orient. This concoction is to be baked into a toad cake and then worn next to the heart in an amulet.”

  The Protestant Reformation greatly improved matters by returning to the position of the early Church Fathers and emphasizing that disease came from Satan rather than being approved by God. When faced with the opinion that taking medicine was sinful, Luther asked, “Do you eat meat when you are hungry? Even so you may use physic, which is God’s gift….”

  Protecting the living from the dead

  Disease presented our ancestors with a ticklish technical problem: What to do with the corpses? The earliest hunter-gatherers constantly moved around. Whether they buried their dead within their territory, left their remains in a sacred cave, or merely abandoned them is lost in the mists of time. Later, when agriculture spread, and humans settled in one place, the problem became more acute. Corpses are a source of contagion. The earliest communities began to bury their dead. In the earliest cities, the dead were often buried beneath the floors of inhabited dwellings.

  Çatalhöyük (now in central Turkey) was the world’s first real city. Nine thousand years ago, it boasted several thousand occupants living in several hundred mud-brick buildings. It lasted for slightly more than 2,000 years and disappeared before the Bronze Age. It was apparently the center of local Neolithic culture, although its political relationships, language, and religion are still obscure. The remains of more than 60 people have been found in burial pits beneath the floors of the living quarters in Çatalhöyük. The bodies were tightly folded with the knees close to the chest, and the pits were plastered over. Some pits were reopened later to accept more bodies. Although this was better than leaving bodies exposed, burying them so close to where people lived and prepared food was not ideal. However, many infectious diseases emerged only after agricultural civilizations created dense populations. When Çatalhöyük first arose, few present-day epidemic diseases had yet appeared, so burying the dead under the floor was still relatively safe.

  As urbanization spread, infectious disease increased in frequency and corpses became steadily more of a liability to public health. In response, the dead were buried a safe distance from the living, and graveyards outside the town walls became standard. Later, cremation came in vogue in some societies. The ashes were sometimes kept in urns, sometimes buried, and sometimes scattered to the four winds. Whether burnt or buried, the dead were no longer a focus of infection. These activities were all dressed in religious trappings and given spiritual explanations. Members of those primitive societies often feared that the spirits of the recently deceased would come back to harm them. To avoid this, the dead were properly buried or cremated. Although our culture now thinks of ghosts having clanking chains and haunting castles, the original problem was that corpses were a public health hazard unless properly disposed of. Over the ages, ever more complex ceremonies have accreted around procedures such as burial, but avoiding the spread of disease has remained a critical issue.

  In many early societies, contact with dead bodies caused ritual uncleanness. Becoming ritually clean involved purification by washing, often followed by a period of quarantine. The relevance to public health is obvious. Thus, many religious rites, especially those for ritual purity, had positive effects on hygiene.

  Diverting evil spirits into animals

  A student of mine once claimed that the more people you give your cold to, the faster you recover yourself! Although this was meant as a joke, primitive cultures doubtless noticed that as one person recovered, others fell sick. One obvious interpretation was that evil spirits were moving from one person to another. So what could be more sensible than to break the chain of human infection by diverting the evil spirit into an animal. Even today, the people of the Ewe tribe of West Africa transfer disease-causing spirits to chickens and then chase away the chickens with brooms.

  In the Bible, we read of the scapegoat ceremony. A goat, chosen by lot, was designated for Azazel, a demon who lived in the wilderness. The chief priest laid his hands on the goat’s head and transferred the sins of the people of Israel into the goat. Such a transfer made the scapegoat unclean, so it could not be sacrificed to God. It was driven away into the desert. It is particularly noteworthy that the priest was instructed to remove his vestments and bathe his body immediately after driving away the scapegoat (Leviticus 16:20–25). Note that this use of animals to remove disease was not a form of sacrifice. The animals that received the disease-causing spirit were never killed, as their role was to carry the evil spirit far away.

  Other Middle Eastern cultures had similar rites to transfer sin or impurity into an animal, which was then banished. In the ancient world, where disease was regarded as a manifestation of divine displeasure, infection and iniquity were inextricably bound together. Although the biblical scapegoat carried “transgressions and iniquities,” we should remember that punishment for sin often came as pestilence.

  Ancient Hittite texts prescribe such rituals “if pestilence afflicts the army or the land of Hatti.” One such Hittite ritual used animals of two species, a bull and a ewe—the first in case a male deity had sent the plague, the second in case the deity was female. The scape-bull and scape-ewe were marked with colored wool and then, very sensibly, driven into enemy territory. Do we see here the beginnings of biological warfare?

  The Hittites were Indo-European intruders into the Middle East. Did they borrow the idea of a scape-animal from the Semitic peoples of the Middle East, or did they import it? It is interesting that the ancient Vedic culture of India, also Indo-European in origin, practiced similar rites. Demons blamed for disease were transferred to animals, not during official communal ceremonies, as with the Hittites and Israelites, but on an individual basis using small animals that ordinary people could afford or catch. For example, the demon Takman, which caused assorted fevers, was often banished into a frog, which hopped away:

  “Homage be to the deliriously hot, the shaking, exciting, impetuous Takman! Homage to the cold Takman, to him that in the past fulfilled desires! May the Takman that returns on the morrow, he that returns on two days, the impious one, pass into this frog!”

  —Atharvaveda VII: 116

  In the Odyssey, when Homer refers to the long illness of Odysseus, he uses the phrase “wasting long away.” The term for “wasting away” is tekomenos, a word remarkably similar to the Takman of the Vedas. Although historians have sometimes guessed that “tekomenos” refers to malaria or tuberculosis, there is no way to be certain.

  Cheaper rituals for the poor

  Few people in ancient times could afford to eat meat except on special occasions. Nor could most victims of disease afford an expensive animal for a healing ritual. So the Assyrians, and probably most other Middle Eastern cultures, had a down-market, vegetarian, version of the procedure. In the “surpu” ritual, the priest smears the patient with flour. The flour is then wiped off and thrown into the fire. The idea is that the flour absorbs the impurity (or evil spirit), which is then destroyed by the fire. Finally, the priest sprinkles the patient with water.

  In China during the Ming period (1368–1644), fever was attributed to malevolent spirits, and a similar but more vulgar rite was performed to expel them. The patient was given a pill of cinnabar plus the seeds of plants containing emetics, held together by bee’s wax. A fire was lit and cinders placed all around the patient. When the emetic started to work, the patient was supposed to vomit into the fire. As the fire consumed the vomit, the priest made a magical sign over the fir
e and the evil spirits were killed.

  Rather more radical was the practice of cutting a hole in the skull. This procedure, referred to as trepanation, was practiced as early as the Bronze Age. It started as a ritual performed on corpses, presumably to help speed the spirits of the dead on their way to the afterlife. Then it was used on the living to allow evil spirits to exit. Remarkably, many of the victims survived, to die later of something else, as indicated by the signs of healing around the holes in their skulls. By the time of Hippocrates (around 400 B.C.), trepanation was used to treat bruising or fracture of the skull, mostly due to being bashed on the head during war. As late as the nineteenth century, certain primitive tribes still trepanned cases of convulsions or chronic headache to allow evil spirits to escape. Be grateful for aspirin!

  Vampires, werewolves, and garlic

  Among the “evil spirits” seen on TV today are werewolves and vampire bats. It is widely known, at least to those who imbibe their medical information from the silver screen, that garlic protects against these terrors of the dark side. Sadly, however, the characters in modern-day horror movies have forgotten how to use their garlic correctly. Onions and garlic, especially, contain allicin and related smelly sulfur compounds. Despite the risk of bad breath, garlic should be eaten, not festooned in bunches around the heroine’s bedroom. Allicin is a potent antimicrobial agent; in particular, it cures amebic dysentery. In ancient times, garlic was widely used to drive away the “evil spirits” that caused intestinal disturbances. This is remembered in distorted form in folk tales and the modern Hollywood legend.

  In eighth-century Japan, eating large amounts of onions and related vegetables to combat diarrhea was not merely a folk remedy, but was recommended in official state directives. In the year 737 A.D., Japan suffered a great smallpox epidemic. Among the directives issued by Ki no Ason, Great Liaison of the Right, senior 4th rank, lower grade, was the following: “If diarrhea should develop, boil onions and scallions well and eat many.” (Note that the diarrhea was due to secondary intestinal infections of those weakened by smallpox.) Allicin works well against intestinal infections because it is poorly absorbed and much of it remains in the intestines.

  Divine retribution versus individual justice

  Who should be punished for a sin or a crime? Should only the criminal be punished, or should his family be included? Ancient writings often give the impression of great injustice, in the sense that innocent people were frequently punished along with the guilty. Many law codes of the ancient world reveal an apparent contradiction. Most punishments carried out by human authorities were inflicted on the guilty individual alone. Thus, Deuteronomy 24:16 commands, “The fathers shall not be put to death for the children, nor shall the children be put to death for the fathers; every man shall be put to death for his own sin.” In contrast, when the gods themselves punish someone, both in the Bible and in other ancient cultures, they often strike down the criminal, his family, servants, and even domestic animals.

  This paradox is readily understood once we remember that infectious disease was regarded as the means by which the gods usually punished mankind. It was a matter of simple observation that infections appeared mysteriously and generally affected several people in close contact. If the gods struck someone with a virulent infection, chances were good that his wife and children would catch it, too. In the Bible, divine punishments are often reserved for those whose sins were secret and would have gone unpunished if God had not seen and acted. The book of Leviticus calls for those whose impurity goes unnoticed by the priesthood to voluntarily give sacrifices. The implication is that sins can be hidden from man, but if God intervenes, the punishment will be worse. This was a strong inducement to wrongdoers to confess, even when crimes were unsolved. Unfortunately, this way of thinking led to the belief that those who were struck down by infections must have committed hidden sins. Worse, they must also have declined the opportunity to confess and make voluntary restitution by sacrifice.

  Although monotheism is usually regarded as a step upward from polytheism, from a medical viewpoint, it was a step backward. The idea that assorted evil spirits inflicted infections comes closer to the germ theory of disease than later rationalizations. Under monotheism, the victims of disease were thought guilty of secret sins, despite lack of evidence. In contrast, polytheism often regarded the sick as unlucky victims of some passing demon rather than as evildoers. Consequently, treatment of the sick was more humane. In practice, the common people have tended to retain a belief in spirits and demons even in officially monotheistic societies. Is having a demon driven out any less rational than being assumed guilty of invisible sin? During the European Middle Ages, when the educated establishment regarded disease as the result of an imbalance among the four humors (blood, phlegm, bile, and black bile), the common herd stuck to a “primitive” belief in contagion.

  The Middle Ages reveal another uneasy compromise between official monotheism and popular polytheism, namely witchcraft. When humans or cattle miscarried or produced offspring with genetic defects, and when infectious disease or food poisoning struck, especially if the symptoms were unfamiliar, witchcraft was often blamed. Blaming such misfortunes on witchcraft allowed the victims to be declared innocent of sin while retaining belief in a single all-seeing God. Although this Jesuitical maneuver relieved the victims of infection and poverty from being blamed for their own misfortunes, it also implied that somewhere there lurked witches who needed to be hunted down. A new form of scapegoat was thus born.

  The rise of Christianity

  As discussed earlier in this book, around 500 B.C., the first major population centers became large enough to keep virulent epidemic diseases in circulation. Several major population crashes largely lost to history probably occurred. During and following this general period, major religious changes happened. Local city-state and fertility cults were replaced with religions shared by both aristocracy and commoner and both urban and rural populations. I have already argued in Chapter 7, “Venereal Disease and Sexual Behavior,” that the emergence of sexually transmitted infections played a major part in the transition away from fertility cults.

  The decline of classical civilization and its replacement by Christianity was one of the greatest cultural changes in European history. The two main aspects were the collapse of the Roman Empire and then the loss of faith in traditional polytheistic religion. Christianity grew up during a period when overcrowding was followed by pestilence. The success of Roman culture resulted in territorial expansion and population growth. Population density and the ease of communications, especially via the famous Roman roads, increased markedly. Both factors prompted the growth and spread of infectious disease.

  The debilitation of large sectors of the population by endemic malaria greatly weakened the Roman Empire. Several massive outbreaks of pestilence followed, culminating in bubonic plague, which exacerbated the situation. These diseases affected both agricultural production and the availability of recruits for the military, leading to political decline. The failure of classical religion to cure the sick or halt the spread of pestilence caused many to lose faith in the gods of traditional religion. Why did Christianity emerge triumphant from this historical hot zone? Why not polytheism, with a new family of healing deities? Why not a mother goddess cult? Why not Mithraism?

  We have relatively little information about history’s losers, and much of this is biased. Presumably each of these other religions failed in some way, although we can only guess how.

  In his The History of the Decline and Fall of the Roman Empire, Edward Gibbon cites the zeal of the early Christians, their doctrine of future life, and their pure and austere morals, among other reasons. More recently, Daniel Reff in Plagues, Priests and Demons (2005) has compared the demographic collapse at the time when Christianity was adopted in Europe with the population crash on the American continent triggered by the arrival of the Spanish. He regards epidemics as the “most powerful evangelisers of all.”

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nbsp; To its credit, Christianity did tackle the issue of disease. The Gospels place heavy emphasis on healing the sick, and early Christians had a reputation for caring for those who were ill. Miraculous healing was an integral part of early Christianity, not merely in theory, but in practice. Even if we assume that miracles are impossible, can we still explain the success of Christianity when faced with ancient epidemics? I think so.

  First, let’s remember that no one expected early Christians to heal broken legs or cure tumors. Second, early Christians sincerely believed that they would go to heaven and that life on Earth was merely a temporary interlude. Nonetheless, they also believed in helping the sick and, due to their belief in an afterlife, were willing to take risks that nonbelievers avoided.

  I believe that the critical point lies in the Christian custom of caring for the sick. Even severe infectious diseases are rarely anywhere near 100% fatal. Thus, diseases such as smallpox and typhoid can kill anywhere from 10% to 50% of their victims. The death rate depends partly on the strain of microorganism causing each particular epidemic. Nevertheless, the actual survival rate is also greatly affected by whether the afflicted are abandoned to their fate or cared for. Members of a Christian community who fell ill with virulent infections were much more likely to receive care than the rest of the population. Consequently, their probability of surviving was much greater. Furthermore, for those unfortunates who did lose their families to disease, the church provided a new family.