Plagues and Peoples (41 page)

Another remarkable by-product of the administrative innovations of World War II was improvement in health through food rationing. During World War I rationing was managed in ignorance of exact human dietary requirements, and came to be associated, especially in Germany, with malnutrition and intense human suffering. During World War II, hunger wreaked its ravages among some populations as before; but in Germany itself and still more in Great Britain, special allowances of critically short foods for children, pregnant women, and other specially vulnerable elements of the population, and a more or less rational allocation of vitamin pills, protein, and carbohydrates in accordance with scientifically established physiological needs for different classes of the population, actually improved the level of health in Great Britain, despite severe shortages and stringencies; and allowed the Germans to maintain a generally satisfactory level of health until almost the end of the struggle.
⁸⁷

Such triumphs of administrative rationality prepared the
way for the amazingly successful post-war international health programs that have fundamentally altered disease patterns in nearly all the inhabited world since 1948.

International medical organization of a formal and official kind dates back to 1909, when an International Office of Public Hygiene was set up in Paris to monitor outbreaks of plague, cholera, smallpox, typhus, and yellow fever. The office also attempted to define uniform sanitary and quarantine regulations for the European nations. Between the two great wars of the twentieth century, the League of Nations set up a Health Section. Several special commissions discussed world incidence of such diseases as malaria, smallpox, leprosy, and syphilis. But more important work was done during this period by the Rockefeller Foundation with its programs attacking yellow fever and malaria. Then in 1948, a new and more ambitious World Health Organization was set up. With substantial government support, WHO set out to bring the benefits of up-to-date scientific medical knowledge to backward parts of the world, wherever local governmental authorities would co-operate.
⁸⁸

Since the 1940s, therefore, the impact of scientific medicine and public health administration upon conditions of human life has become literally worldwide. In most places epidemic diseases have become unimportant, and many kinds of infection have become rare where they were formerly common and serious. The net increment to human health and cheerfulness is hard to exaggerate; indeed, it now requires an act of imagination to understand what infectious disease formerly meant to humankind, or even to our own grandfathers. Yet as is to be expected when human beings learn new ways of tampering with complex ecological relationships, the control over microparasites that medical research has achieved since the 1880s has also created a number of unexpected by-products and new crises.

One interesting and ironic development has been the appearance of new diseases of cleanliness. The chief example of this phenomenon was the rising prevalence of poliomyelitis in
the twentieth century, especially among the hygienically most meticulous classes. It seems clear that in many traditional societies minor infection in infancy produced immunity to the polio virus without provoking any very pronounced symptoms; whereas persons whose sanitary regimen kept them from contact with the virus until later in life, often suffered severe paralysis or even death.
⁸⁹
Fear of annual outbreaks of poliomyelitis crested in the United States in the 1950s, assisted by careful propaganda aimed at securing funds for research into its causes and cure. As in so many earlier cases, an effective vaccine was developed in 1954, whereupon the disease sank again to a marginal position in public attention, affecting only a very few who escaped or refused vaccination.

Another sort of epidemic disease whose fixture among mankind remains at least potentially significant is well illustrated by the influenza epidemic of 1918–19. Influenza has been around a long time, and is remarkable both for the rapidity of its spread, the brevity of the immunity it confers, and the instability of the virus that causes the disease.
⁹⁰
In 1918–19, the confluence of American with European and African troops in northern France provided the milieu for the emergence of an epidemic of unprecedented scope. New strains of virus were responsible, strains that proved unusually destructive to their human hosts. The disease spread throughout the earth, infecting almost the entire population of the globe, and killing twenty million or more. When the flu hit, medical personnel and facilities were immediately overburdened and health services generally broke down; but the acute phase passed rapidly because of the very infectiousness of the virus, so that within a few weeks human routines resumed and the epidemic faded swiftly away.
⁹¹

A generation of research subsequent to 1918 established the existence of three distinct virus strains; and it is possible to create vaccines against all of them. The problem, however, is complicated by the fact that the influenza virus is itself unstable and alters details of its chemical structure at frequent intervals. Any new and widespread epidemic is therefore almost
sure to originate with a virus that has changed enough to escape the antibodies last year’s vaccine can create in human bloodstreams.

Changes in the flu virus and mutations of other infectious organisms therefore remain a serious possibility. In 1957, for example, a new “Asian” strain of flu appeared in Hong Kong; but before it attained epidemic force in the United States, vaccine against the new variant had been produced in sufficient quantity to affect the incidence and intensity of the infection. This required, nonetheless, nimble footwork on the part of public health authorities and private entrepreneurs in recognizing the new influenza strain and starting vaccine manufacture on a large scale without delay.
⁹²

Even without mutation, it is always possible that some hitherto obscure parasitic organism may escape its accustomed ecological niche and expose the dense populations that have become so conspicuous a feature of the earth to some fresh and perchance devastating mortality.
⁹³
Recent cholera outbreaks in India and southeastern Asia, for example, are due to a new type of bacillus indigenous to the Celebes, which has been able to displace the “classical” cholera organism from nearly all of its original habitat in and around Bengal.
⁹⁴
Other recent examples of this sort of unpredictable biological fluctuation are the mysterious careers of Lassa fever in Nigeria and of O’nyong nyong fever in Uganda, referred to above.
⁹⁵

A third unpleasant possibility is that biological research aimed at discovering effective ways of paralyzing enemy populations by disseminating lethal disease organisms among them might succeed in unleashing epidemiological disaster on part—or perhaps on all of the world.

Apart from such conceivable catastrophes, it is clear that humankind remains subject to the limitations inherent in our place in the food chain. Galloping increases in human numbers that have resulted from the success of public health measures in the past 150 years create pressures on food supply. Other stresses created by population increases may manifest
themselves in innumerable ways—sociological, psychological, and political, as well as epidemiological.

Skill and knowledge, though they have profoundly transformed ordinary encounters with disease for most of humankind, have not and in the nature of things never can extricate humanity from its age-old position, intermediate between microparasites attacking invisibly and the macroparasitism of some men upon their fellows. To be sure, the simple polarity of older ages, whereby human societies were neatly divided between food producers and those who preyed upon them, has been profoundly altered by the development of scientific farming and the services and supplies food producers now receive from others who do not themselves directly produce food. Nevertheless, in a more complicated form the old problem of adjusting relations between producers and consumers remains, even in our mechanized and bureaucratized age. Certainly, no enduring and stable pattern has emerged that will insure the world against locally if not globally destructive macroparasitic excesses. World War I and World War II both led to locally destructive results; and wars or revolutions, launched with different purposes in mind, may again, as in times past, inflict starvation and death upon large segments of the world’s population.

From the other side, the galloping increase in human numbers practically guarantees that existing margins between food supplies and human hunger will swiftly disappear, leaving less and less in reserve for times of unusual crisis. As that occurs, the skills of doctors, farmers, administrators, and all those who take part in sustaining the familiar yet enormously complex flow of goods and services characteristic of modern society become critical for the maintenance of existing levels of human population.

In view of the truly extraordinary record of the past few centuries, no one can say for sure that new and unexpected breakthroughs will not occur, expanding the range of the possible beyond anything easily conceived of now. Birth control may in time catch up with death control. Something like a
stable balance between human numbers and resources may then begin to define itself. But for the present and short-range future, it remains obvious that humanity is in course of one of the most massive and extraordinary ecological upheavals the planet has ever known. Not stability but a sequence of sharp alterations and abrupt oscillations in existing balances between microparasitism and macroparasitism can therefore be expected in the near future as in the recent past.

In any effort to understand what lies ahead, as much as what lies behind, the role of infectious disease cannot properly be left out of consideration. Ingenuity, knowledge, and organization alter but cannot cancel humanity’s vulnerability to invasion by parasitic forms of life. Infectious disease which antedated the emergence of humankind will last as long as humanity itself, and will surely remain, as it has been hitherto, one of the fundamental parameters and determinants of human history.

Appendix
Epidemics in China

A Check List Compiled by Joseph H. Cha,
Professor of Far Eastern History, Quincy College

T

he following list of epidemics in China is based on two much older compilations, one the work of Ssu-ma Kuang, a scholar who lived during the Sung Dynasty (960–1279), and the other the work of a staff of researchers, who compiled a general encyclopedia of traditional Chinese learning in the eighteenth century. These two lists of human and natural calamities were republished in 1940, but the editor made some errors in expressing traditional dates in the modern calendar. Professor Cha corrected such mistakes when he could, by checking against passages in ancient dynastic histories and other documents, whenever such sources were cited. In addition, he translated traditional place names into the modern provincial geography of China.

The result is not without faults. The choice of which modern province to equate with an ancient regional name that does not coincide with today’s provinces is sometimes arbitrary. Moreover, there undoubtedly remain additional references to epidemics in Chinese writings that escaped the previous compilers and are therefore missing here too. All
statements about how many died are paraphrases of ancient texts, and Professor Cha made no attempt to assess the credibility of each such remark; and though some do deserve credence, others may be wide of the mark. Yet despite such defects, it is clear that the following list is more accurate than any published before in any western language, and it seems unlikely that major disease disasters escaped being here recorded. Crude indication of major turning points ought therefore to be detectable from the following list, and for this reason it seemed well to reproduce it here.

The printed text from which Professor Cha worked may be transliterated as follows: Ch’en Kao-yung,
Chung Kuo Li Tai Tien Tsai Jen Huo Piao, 2
vols., Shanghai, 1940.

EPIDEMICS IN CHINA TO A.D. 1911

B.C .	243	Epidemic throughout the empire
B.C .	48	Epidemic, flood and famine “east of the pass,” i.e., probably in Honan, Shansi and Shantung
A.D .	16	Epidemic; a general attacking barbarians to the south lost six to seven tenths of his troops from disease.
37	Epidemic in Kiangsu, Kiangsi, Anhui, Chekiang and Fukien
38	Epidemic in Chekiang
46	Famine and epidemic in Mongolia; two thirds of population died.
50	Epidemic, location undefined
119	Epidemic in Chekiang
125	Epidemic in Honan
126	Epidemic in Honan
151	Epidemic in Honan, Anhui, Kiangsi
161	Epidemic, location undefined
162	Epidemic broke out in ranks of army in Sinkiang and Kokonor; three or four out of ten died.
171	Epidemic, location undefined
173	Epidemic, location undefined
179	Epidemic, location undefined
182	Epidemic, location undefined
185	Epidemic, location undefined
208	Epidemic in an army in Hupeh; two thirds of troops died of disease and famine.
A.D .	217	Epidemic, location undefined
223	Epidemic, location undefined
234	Epidemic, location undefined
275	Epidemic in Honan; tens of thousands died.
291	Epidemic in Honan
296	Epidemic in Shensi
297	Epidemic in Hopei, Shense, Szechwan
312	Epidemic, locality undefined; following on earlier disasters from locusts and famine, northern and central China became a “great wasteland”; in Shensi only one or two out of a hundred taxpayers survived.
322	Epidemic; two or three out of ten died; location undefined.
330	Epidemic, location undefined
350	Epidemic, location undefined
351	Epidemic following rebellion in Honan
353	Epidemic, location undefined
379	Epidemic in Shensi
423	Epidemic in North China; in Honan two or three out of ten died.
427	Epidemic in Kiangsu
447	Epidemic in Kiangsu
451	Epidemic in Kiangsu
457	Epidemic in Kiangsu
460	Epidemic in Kiangsu
468	Epidemic throughout the empire; during a second outbreak later in the year in Honan, Hopei, Shantung, Hupeh, and Anhui 140,000 to 150,000 died.
503	Epidemic, location undefined
504	Epidemic in North China
505	Epidemic in North China
510	Epidemic in Shensi; 2, 730 died.
529	Epidemic in Shensi
546	Epidemic in Kiangsu
565	Epidemic in Honan
598	Epidemic in southern Manchuria during military campaign against Korea
612	Epidemic in Shantung and elsewhere
636	Epidemic in Shansi, Kansu, Ninghsia, and Shensi
641	Epidemic in Shansi
642	Epidemic in Shansi and Honan
A.D .	643	Epidemic in Shansi and Anhui
644	Epidemic in Anhui, Szechwan, and Northeast
648	Epidemic in Szechwan 655 Epidemic in Kiangsu
682	Epidemic in Honan and Shantung; land covered with corpses.
707	Epidemic in Honan and Shantung; several thousand died.
708	Epidemic in Honan and Shantung; one thousand deaths.
762	Epidemic in Shantung; more than half the population died.
790	Epidemic in Fukien, Hupeh, Kiangsu, Anhui, Chekiang
806	Epidemic in Chekiang; more than half the population died.
832	Epidemic in Szechwan, Yunnan and Kiangsu
840	Epidemic in Fukien, Chekiang
874	Epidemic in Chekiang
891	Epidemic in Hupeh, Kiangsu and Anhui; in Hupeh three or four out of ten died.
892	Epidemic in Kiangsu 994 Epidemic in Honan
996	Epidemic in Kiangsu, Anhui and Kiangsi
1003	Epidemic in Honan
1010	Epidemic in Shensi
1049	Epidemic in Hopei
1052	Epidemic in Hupeh, Kiangsu and Anhui
1054	Epidemic in Honan
1060	Epidemic in Honan
1094	Epidemic in Honan
1109	Epidemic in Chekiang
1127	Epidemic in Honan; half population of capital died.
1131	Epidemic in Chekiang and Hunan
1133	Epidemic in Hunan and Chekiang
1136	Epidemic in Szechwan
1144	Epidemic in Chekiang
1146	Epidemic in Kiangsu
1199	Epidemic in Chekiang
1203	Epidemic in Kiangsu
1208	Epidemic in Honan and Anhui
1209	Epidemic in Chekiang
1210	Epidemic in Chekiang
A.D .	1211	Epidemic in Chekiang
1222	Epidemic in Kiangsi
1227	Epidemics among Mongol armies in North China
1232	Epidemic in Honan; 90,000 died in less than fifty days.
1275	Epidemic with incalculable mortality, location undefined
1308	Epidemic in Chekiang; more than 26,000 died.
1313	Epidemic in Hopei
1320	Epidemic in Hopei
1321	Epidemic in Hopei 1323 Epidemic in Hopei
1331	Epidemic in Hopei; nine tenths died.
1345	Epidemic in Fukien and Shantung
1346	Epidemic in Shantung
1351–52	Epidemic in Shansi, Hopei, Kiangsi; 50 per cent mortality among troops in the, Huai Valley.
1353	Epidemic in Hupeh, Kiangsi, Shansi, Suiyuan; in part of Shansi more than two thirds of the population died.
1354	Epidemic in Shansi, Hupeh, Hopei, Kiangsi, Hunan, Kwangtung, and Kwangsi. In part of Hupeh six or seven out of ten of the population died.
1356	Epidemic in Honan
1357	Epidemic in Shantung
1358	Epidemic in Shansi and Hopei; over 200,000 died.
1359	Epidemic in Shensi, Shantung, and Kwangtung
1360	Epidemic in Chekiang, Kiangsu, and Anhui 1362 Epidemic in Chekiang
1369	Epidemic in Fukien; corpses in heaps on the roads.
1380	Epidemic in Chekiang
1404	Epidemic in Hopei
1407	Epidemic in Hunan
1408	Epidemic in Kiangsi, Szechwan, and Fukien; 78, 400 died.
1410	Epidemic in Shantung (6,000 died) and Fukien (15,000 households perished)
1411	Epidemic in Honan and Shensi
1413	Epidemic in Chekiang
1414	Epidemic in Hopei, Honan, Shansi, and Hupeh
1445	Epidemic in Chekiang, Shensi, and Fukien
1454	Epidemic in Kiangsi and Hupeh
A.D .	1455	Epidemic in Shensi, Kansu, and Chekiang
1461	Epidemic in Hunan, Hupeh, Kwangtung, and Shensi
1471	Epidemic in Kweichow
1475	Epidemic in Fukien and Kiangsi
1480	Epidemic in Fukien
1481	Epidemic in Kiangsi and Kweichow
1486	Epidemic in Fukien
1489	Epidemic in Hunan; whole villages and towns perished.
1492	Epidemic in Chekiang
1495	Epidemic in southeastern China
1500	Epidemic in Kwangsi
1504	Epidemic in Shansi
1506	Epidemic in Hunan, Hupeh, Kwangtung, Kwangsi, Yunnan, and Fukien; extremely high mortality.
1511	Epidemic in Chekiang
1514	Epidemic in Yunnan
1516	Epidemic in Hupeh
1517	Epidemic in Fukien
1519	Epidemic in Hopei, Shantung, Chekiang
1522	Epidemic in Shensi
1525	Epidemic in Shantung; 4, 128 persons died.
1528	Epidemic in Shansi
1529	Epidemic in Hupeh, Szechwan, Kweichow
1532	Epidemic in Shensi
1533	Epidemic in Hupeh, Hunan
1534	Epidemic in Chekiang, Hupeh, Hunan
1535	Epidemic in Fukien
1538	Epidemic in Kwangsi
1543	Epidemic in Shansi
1544	Epidemic in Shansi, Honan
1545	Epidemic in Fukien
1554	Epidemic in Hopei
1556	Epidemic in Fukien
1558	Epidemic in Kweichow
1560	Epidemic in Shansi
1561	Epidemic in Hupeh
1562	Epidemic in Fukien; seven tenths died.
1563	Epidemic in Kiangsi
1565	Epidemic in Hopei and Chekiang
1571	Epidemic in Shansi
1573	Epidemic in Hupeh
A.D .	1579	Epidemic in Shansi
1580	Epidemic in Shansi
1581	Epidemic in Shansi
1582	Epidemic in Hopei, Szechwan, Shantung, and Shansi
1584	Epidemic in Hupeh
1585	Epidemic in Shansi
1587	Epidemic in Shansi and Kiangsi
1588	Epidemic in Shantung, Shensi, Shansi, Chekiang, and Honan
1590	Epidemic in Hupeh, Hunan, and Kwangtung
1594	Epidemic in Yunnan
1597	Epidemic in Yunnan
1598	Epidemic in Szechwan
1601	Epidemic in Shansi and Kweichow
1603	Epidemic in Chekiang
1606	Epidemic in Chekiang
1608	Epidemic in Yunnan
1609	Epidemic in Fukien
1610	Epidemic in Shansi and Shensi
1611	Epidemic in Shansi
1612	Epidemic in Shensi and Chekiang
1613	Epidemic in Fukien
1617	Epidemic in Fukien
1618	Epidemic in Shansi, Hunan, Kweichow, and Yunnan; corpses lying side by side in Shansi.
1621	Epidemic in Hupeh
1622	Epidemic in Yunnan
1623	Epidemic in Yunnan and Kwangsi
1624	Epidemic in Yunnan
1627	Epidemic in Hupeh
1633	Epidemic in Shansi
1635	Epidemic in Shansi
1640	Epidemic in Hopei and Chekiang
1641	Epidemic in Honan, Hopei, Shantung, and Shansi; corpses lying side by side throughout.
1643	Epidemic in Shensi
1644	Epidemic in Shansi, Kiangsu, and Inner Mongolia
1653	Epidemic in Inner Mongolia
1656	Epidemic in Kansu
1665	Epidemic in Shantung
1667	Epidemic in Kansu
1668	Epidemic in Hopei
A.D .	1670	Epidemic in Inner Mongolia