An artist’s rendition of a farming settlement at Clegyr Boia (on what is today St. David’s Peninsula, Pembrokeshire, Wales), about 4000 B.C. Credit 4
This turning point, called the Agricultural Revolution, placed new demands on people. Above all, it required the cooperation of several groups living close together. Of necessity, hunter-gatherers settled into permanent communities when they took up farming. With a larger, more reliable food supply, their numbers grew. Over the centuries, individual farms linked up to form villages, villages grew into towns, and towns into cities. The first cities arose in the fertile valleys of the Tigris and Euphrates rivers in what is today Iraq, and along the Nile River in Egypt, the Indus River in India, and the Yellow River in China. Farming and cities later emerged in the New World, chiefly in Peru and Mexico, based on crops like maize and potatoes.
Civilization is the product of cities. Farmers usually grew more food than they needed, and the surplus gave others the leisure to do other things. Craftspeople, artists, priests, architects, engineers, and astronomers thrived. Over the centuries, they invented writing and mathematics, studied the sky, and created the calendar, which enabled farmers to plant and harvest at just the right times. Eventually, rulers raised armies and built empires to expand their domains.
The Agricultural Revolution, however, was a mixed blessing. Scientist and author Jared Diamond has even called it “the worst mistake in the history of the human race.” Agriculture, Diamond argues, was harmful to health in several ways. Archaeologists—scientists who study early peoples through their physical remains and the things they built—have found that more food did not always mean better nutrition. Preserved teeth and bones show that the common people, the vast majority, were less healthy than their hunter-gatherer ancestors. A largely plant-based diet is high in sugars and starches but low in proteins, the chemical building blocks of life. This meant that the masses of farm folk were shorter than their ancestors—down from an average of five feet nine to five feet three for men and from five feet five to five feet one for women. Hunter-gatherers also lived longer, up to about forty years. Because of their diet and many hours of strenuous work, farmers were usually old at twenty-five and dead by thirty.2
Yet there were other culprits. To clear the land for planting, farmers cut down forests, plowed the soil, and dug irrigation canals. These activities displaced native bacteria from their environments, where they were harmless to humans, and created pools of stagnant water, breeding places for disease-carrying mosquitoes. Irrigation canals also allowed microscopic worms such as blood flukes to enter the body of anyone who walked in them barefoot. Dried worm eggs have been found in Egyptian mummies 3,000 years old.3
Oxen pull a plow during planting season in a painting from the tomb of Sennedjem, in Deir el-Medina, on the west bank of the Nile River in Egypt. (c. 1290–1213 B.C.) Credit 5
Farm settlements became magnets for infectious diseases in other ways. Grain mills and storehouses attracted hordes of rats, mice, and insects. To make matters worse, farmers lived close to their animals—close to their feces, urine, blood, breath, blisters, vomit, sweat, sores, spittle, and snot. To discourage thieves, they might bring prized animals into their homes. Farmers also collected human and animal waste to spread on their fields as fertilizer or to use in tanning hides into leather. Thus, by forcing people and animals to live close together, the Agricultural Revolution created ideal conditions for crowd diseases to take hold.
Close contact enabled the microbes that cause certain animal diseases to cross over to human hosts; hosts are living beings, animal or plant, on which or in which another organism lives. Today, we share no fewer than 300 diseases with domesticated animals. For example, humans get 45 diseases from cattle, including tuberculosis; 46 from sheep and goats; 42 from pigs; 35 from horses, including the common cold; and 26 from poultry. Rats and mice carry 33 diseases to humans, including bubonic plague. Sixty-five diseases, including measles, originated in man’s best friend, the dog. We can still get parasitic worms from pet dogs and cats. That is why it is not a good idea to kiss a pet on the mouth or sleep with it in bed.4
Enclosed by high stone walls, with houses jammed close together along narrow streets, ancient cities were even more prone to crowd diseases than farms. Sanitation services did not exist, and drains flowed into the cobblestone gutters. City dwellers threw human waste into the streets, where it rotted, stank, and attracted vermin. Gutters ran with urine and liquefied manure. Stockyards and animal holding pens, usually located in crowded neighborhoods, swarmed with flies, fleas, and lice. Butchers slaughtered animals outdoors, in front of their shops, leaving puddles of blood; wastes like brains and guts wound up in streams used for washing and drinking. So it is no surprise that, for thousands of years, animal-borne diseases killed more city dwellers than were born each year. For that reason, cities needed a steady influx of immigrants from the countryside to bolster their populations. Country folk came seeking adventure and opportunity.
CIVILIZATION’S PLAGUES
All ancient civilizations suffered from infectious diseases that crossed over from animals. The Old Testament tells how the Lord threatened to send plagues to the Egyptians unless Pharaoh, the ruler of Egypt, released the Hebrews from bondage. When Pharaoh refused to change his mind, the Almighty caused “sores that break into pustules on man and beast.”5 Pus is a yellow-white fluid that the body produces during infection; it consists of dead white blood cells and bacteria.
The first detailed description of an urban plague comes from ancient Greece. In 430 B.C., the city-state of Athens went to war with the city-state of Sparta. When the Spartan army invaded Athenian territory, thousands of farmers from outlying villages fled to the fortified city with their livestock. Already overcrowded and filthy, Athens became even more so. Within days of the refugees’ arrival, a disease more terrible than anything ever experienced broke out. The historian Thucydides, an eyewitness, described how Athenians died horribly, the sickness beginning with “violent heats in the head,” followed by furious coughing, bloody vomiting, and finally severe diarrhea. The Plague of Athens killed young and old, slaves and freemen, generals and common soldiers. “The bodies of dying men lay one upon another, and half-dead creatures reeled about the streets and gathered round all the fountains in their longing for water,” Thucydides wrote. By the time the plague ended in 427 B.C., one in three Athenians had perished.6
The Plague of Athens, a line engraving by James Fittler. (1811) Credit 6
Modern scientists have not determined the cause of the sickness. Whatever it was, it set the pattern for future mass disease events. As it raged, hysteria spread, the Athenian economy collapsed, family loyalties broke down, friends abandoned friends, and many expected the end of the world. The medical profession stood by, puzzled and helpless. In desperation, physicians devised “preventatives” and “cures,” which had no effect. The idea was to seem to know what to do—to do something, no matter how absurd, to try.
Centuries later, the capital of a vast empire also suffered from a mysterious plague. Rome, jam-packed with people and animals, was a city of luxurious villas of the rich and three-story apartment houses packed with the poor, the overwhelming majority. Disease was a regular visitor, even to the wealthy. The worst outbreak, known as the Antonine Plague, lasted on and off from A.D. 166 to 180. At its height, the disease took 2,000 Roman lives a day. It buried two emperors and wiped out nearby farming communities. Modern scientists are uncertain about its cause, except that it surely spread to people from domesticated animals.7
Dreadful as the Plague of Athens and the Antonine Plague were, they did not compare to the Plague of Justinian. Named for the emperor Justinian, who ruled the eastern part of the Roman Empire, it began in Constantinople (today’s Istanbul, Turkey). From there, between A.D. 542 and 547, it swept across the European and African lands bordering the Mediterranean Sea.
Constantinople saw the first recorded outbreak of bubonic plague. Bubonic comes from
the term buboes—swollen, inflamed lymph nodes as big as hens’ eggs that appear on a victim’s neck, groin, and armpits. Symptoms include high fever, pounding headache, delirium, and foul-smelling pus that escapes when a bubo bursts on its own or when a surgeon cuts it open. Often blood vessels rupture and blood leaks under the skin, forming black bruises, thus the plague’s other name: the Black Death.
The disease originated somewhere in Central Asia, moving along the trade routes connecting Asia to the West. It is caused by Yersinia pestis, a rod-shaped bacterium that lives in the guts of fleas. The fleas, in turn, live on rodents, particularly rats. Rats are key, because they infest people’s homes, barns, and storehouses. Fleas feed on blood, and when an infected flea bites a rat, it injects its bacteria-tainted saliva. Before long, the infected rat dies of plague; dead rats lying in the open are sure signs that plague is in an area. Like those of all warm-blooded animals, rats’ bodies cool after death. Since fleas hate cold, they seek other, living rats to live on and bite. If none are available, they settle for the next best thing—humans.8
Credit 7
The Plague of Justinian blazed through Constantinople like fire in dry grass. One survivor, the historian Procopius, claimed that some 10,000 people died each day—so many that gravediggers could not keep up with burials. In desperation, Emperor Justinian had the roofs of the stone towers that were built at intervals along the city’s walls torn off and corpses thrown in, filling each in turn. Procopius recalled, “The whole human race came near to being annihilated….[The plague] embraced the entire world, and blighted the lives of all men.” Constantinople’s best physicians were stumped, for “in this disease there was no cause which came within the province of human reasoning…[and] no device was discovered by man to save himself.” The epidemic finally ended, no doubt because it ran out of vulnerable victims.9
Bubonic plague did not return for another eight centuries. The new epidemic, the worst yet, seems to have begun in China around the year 1342, then spread westward along overland trade routes and by sailing ship. From 1347 to 1352, it surged across the continent of Europe, reaching every country.
In a painting by Josse Lieferinxe, Saint Sebastian pleads for the life of an afflicted gravedigger during the sixth-century Plague of Justinian. (c. 1493–1508) Credit 8
Fourteenth-century European cities were pestholes—filthy, animal-filled, and rat-infested. As in the first cities, people threw garbage and wastewater out their windows; as a courtesy, they might shout to pedestrians, “Heads up!” or “Look out below!” Paris, continental Europe’s largest and grandest city, stank like a latrine. We get a hint of this from an odd fact: Parisians named streets for human waste. Merde, French slang for “excrement,” described reality. There was the rue Merdeux, rue Merdelet, rue Merdusson, and rue des Merdons—Street of Turds. Paris also had the rue du Pipi—Piss Street.10
The royal palaces were no cleaner than the city streets. Since there were no latrines in the Louvre (today a famous art museum), noble visitors relieved themselves on the marble floors and under the grand stairways. To mask odors, the wealthy used perfume and wore small bags of dried flower petals around their necks. From the king on down, everyone had fleas. Some aristocratic ladies held small dogs on their laps to draw fleas away from their own bodies. Rats scurried about as if they owned the French capital and its magnificent buildings.
The Black Death killed about one-third, or 27 million, of Europe’s 80 million inhabitants. Ignorant of its cause, people became confused, terrified, and vicious when it struck. Jews, a long-persecuted religious minority, became scapegoats, facing wholesale murder at the hands of frenzied mobs. Many Christians saw the plague as a sign of God’s wrath directed at sinful humanity. The following lines were written around 1370 by an English parish priest named William Langland in his famous poem Piers Plowman:
Nature killed many through corruptions,
Death came driving after her and dashed all to dust,
Kings and knights, emperors and popes,
He left no man standing, whether learned or ignorant;
Whatever he hit stirred never afterwards,
Many a lovely lady and their lover-knights
Swooned and died in sorrow of Death’s blows….
For God is deaf nowadays and will not hear us,
And for our guilt he grinds good men to dust.11
A dance of death etching from The Nuremberg Chronicle by Hartmann Schedel. (1493) Credit 9
In Central Europe and Germany, devout men sought divine mercy by becoming “flagellants.” Crowds of these men roamed the countryside, each of them carrying a whip studded with bits of jagged metal. Upon reaching a town, they chanted prayers, stripped naked, and whipped themselves in imitation of Christ’s Passion. An eyewitness wrote, “[They] lashed themselves viciously on their naked bodies until the blood flowed, while crowds, now weeping now singing, shouted ‘Save us!’ ” Elsewhere, street artists covered walls with life-size drawings of the danse macabre, the “dance of death.” These portrayed grinning skeletons playing musical instruments, forcing the living to dance with them toward an open grave. According to the Italian merchant Agnolo di Tura, “All believed that it was the end of the world.” Though the main epidemic ended in 1352, it was a rare year in the Middle Ages in which the Black Death did not strike somewhere in Europe.12
The Four Horsemen of the Apocalypse by Albrecht Dürer. (1498) Credit 10
During this time, fear of the end of the world was a constant theme in European art. The German artist Albrecht Dürer portrayed the idea in his now-famous woodcut—a print made from a drawing cut into a block of wood—from 1498. Titled The Four Horsemen of the Apocalypse, the print illustrates a passage from the Bible (Revelation 6:1–8). The first rider carries a bow and arrows, symbolizing conquest. The second rider wields a sword, representing war. The third rider has an empty scale, a sign of famine. In the foreground rides Death with a trident to trample commoners and a bishop into the underworld.
The Great Plague of London, Europe’s last serious outbreak of bubonic plague, occurred in 1665. We know a great deal about this event thanks to Daniel Defoe (1660–1731). Now known as the creator of the English novel, Defoe is the author of Robinson Crusoe (1719), which is still enjoyed by readers the world over. Also still in print is his narrative A Journal of the Plague Year (1722), written as though it were an eyewitness report. Defoe, however, was only five years old when the Great Plague struck. He based his account on letters from that time, printed testimony, government records, and talks with elderly survivors. He was a fanatical fact finder. Nobody left a finer account of life in plague-ravaged London.13
Defoe’s narrator describes how people suddenly fell dead in the streets and how the great city was “quite abandoned to despair” and “all in tears.” To escape infection, the wealthy fled to the countryside, hoping it would not follow them. The common people often locked themselves in their homes and painted red crosses on the doors, with prayers begging the Lord to take pity on the inhabitants. No matter; the plague killed them anyhow. “Dead carts” made their daily rounds, each led by a man on foot ringing a bell and crying, “Bring out your dead.” However, many could not get a decent funeral because “coffins were not to be had for the prodigious numbers that fell in such a calamity as this.”14
An illustration of a plague doctor. Flowers and incense kept in the “beak” relieved wearers of the stench of death. (c. 1656) Credit 11
Physicians were baffled. To avoid infection, some advised inhaling the fumes of camphor and vinegar and making “a very strong smoke” by burning “pitch, brimstone or gunpowder.” When these measures failed, quacks, crooks, and phonies peddled charms, pills, and potions. These “remedies” went by such names as “Infallible preventive pills against the plague,” “Neverfailing preservatives against infections,” “universal remedy for the plague,” and “royal antidote against all kinds of infection.” Some quacks offered printed copies of magical formulas they said
would, when recited with sincerity, prevent or cure plague. One formula was printed in the shape of an inverted triangle. It went like this:
The 1665 plague peaked in August and September, when more than 7,000 Londoners died each week. In all, it claimed 100,000 lives, a quarter of the English capital’s population.15
Bubonic plague died out nearly everywhere in Europe after 1665, but it still exists in Asia and occurs elsewhere, though outbreaks are not as severe as in past centuries. San Francisco, the leading seaport on the U.S. Pacific coast, had a minor outbreak in the early 1900s. Today, in the United States, plague infects not only rats but also squirrels, chipmunks, prairie dogs, rabbits, and skunks. From ten to twenty people, mostly campers and hunters in the western states, contract the disease each year, and about one in seven dies. In August 2015, plague sickened a boy who visited Yosemite National Park in California and a visitor to Wyoming’s Yellowstone National Park. Both survived. Nowadays, if the infection is caught in time, various drugs can cure it. Health officials advise park visitors not to feed wild animals of any kind, or touch sick or dead ones and to use insect repellent.16
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