History of Epidemics

“And the Philistines took the ark of God and brought it from Ebenezer Unto Ashdod… And the hand of the Lord was heavy upon the azotans, and he smote them, and punished them with painful growths, in Azot and in its vicinity. And the azotans saw it, and said, let not the ark of the God of Israel remain with us; for his hand is heavy both for us and for Dagon our God. And they sent and gathered together all the lords of the Philistines, and said, what shall we do with the ark of the God of Israel? And they answered, let the ark of the God of Israel be carried about unto Gath. And they sent the ark of the God of Israel to Gath. After they had sent him away, the hand of the Lord was upon the city – and the terror was very great, and the Lord smote the inhabitants of the city, from small to large, and there were growths on them. And they sent the ark of God to Ascalon; and when the ark of God came to Ascalon, the ascalonites cried out, saying, they have brought the ark of the God of Israel to us, to kill us and our people. And they sent, and gathered together all the lords of the Philistines, and said, send away the ark of the God of Israel; let it return to its place, that it may not kill us and our people. For there was a deadly terror in the whole city; the hand of God was very heavy upon them. And those who did not die were stricken with growths, so that the cry of the city went up to heaven.”

It was an excerpt from the fifth Chapter of the First book of kings, describing the oldest epidemic in the history of mankind. The oldest we know, not the oldest at all. Infectious agents appeared long before Australopithecus began to turn into humans…

“What is your evidence? – the most meticulous readers will ask now. – How can you be so sure?»

The confidence is purely scientific. Evolution goes from simple to complex. Unicellular microorganisms are older than multicellular ones, because life on our planet began with a cell, and there was a time when multicellular organisms did not exist at all. The bacteria that cause many infectious diseases are representatives of the oldest single-celled organisms. Bacteria do not have a cell nucleus, and non-nuclear cells are older than those that have a nucleus. As for viruses, they most likely appeared in the era of single-celled life, because viruses that affect people and bacteria have many similarities that indicate their common origin. So the viruses appeared at about the same time as the bacteria.

Do you know how a virus differs from a bacterium?

Bacteria are single-celled organisms that are characterized by a very simple structure. They do not have a cell nucleus and a number of cellular organs that “nuclear” cells have. The cell nucleus stores molecules of deoxyribonucleic acid (DNA), carriers of hereditary information. In bacteria, a single DNA molecule is not Packed into the nucleus, but floats freely in the cytoplasm, the semi-liquid internal environment of the cell. Viruses are not cells. They are a deoxyribonucleic or ribonucleic acid (RNA) molecule Packed in a protective shell, in which hereditary information is recorded. In fact, this molecule is a matrix for the production of new viruses. That’s the whole virus-hereditary information in the shell. When a virus approaches a cell in the body, its DNA or RNA molecule penetrates the cell and causes it to replicate new viruses. This continues until the cell runs out of all its reserves and dies.

Let’s go back to the epidemic described in the Bible. Around 1200 BC, the Philistines who inhabited the coastal plains of Palestine brought the plague to the city of Ascalon with a war trophy. It is the plague, and not some other infectious disease. The growths in question are characteristic of plague bubons, enlarged lymph nodes as a result of inflammation. The fact that we are talking about the plague is indicated not only by growths, but also by phrases indicating the total spread of the disease: “the Lord struck the inhabitants of the city from small to large”,”and those who did not die were struck with growths, so that the cry of the city went up to heaven”. Only the plague affected everyone in a row, during epidemics of smallpox or cholera, there was no General defeat.

What determines the number of cases of infectious diseases?

From the damaging ability of the pathogen and how it spreads.

The plague is caused by a bacterium called plague Bacillus. This is a very aggressive microbe. Or to put it another way: the human body is very susceptible to the plague. For a long time, it was believed that rodents (marmots, ground squirrels, rats, mice, etc.) serve as a natural reservoir [1] of plague Bacillus, and fleas, which are blood – sucking insects, are carriers. For the time being, we will not develop the topic of natural reservoirs, but will return to it in the third Chapter for a thorough analysis.

Plague can occur in various forms and can be transmitted in many different ways. When a flea bites, the plague Bacillus enters the blood and spreads through the body, affecting various organs. In contact with infected material (for example, when skinning an infected commercial rodent or when caring for a sick person) it is embedded under the skin, from where it enters the circulatory system with lymph. Spreading throughout the body with blood is a septic form of plague. In a more favorable case, the plague Bacillus lingers in the lymph nodes, which filter the lymph, clearing it of all unnecessary things, including the microbes in it. The fight against microbes causes an inflammatory process in the lymph nodes. The knot swells, turns red, and becomes painful. In this case, we are talking about bubonic plague. In septic and bubonic forms, the disease spreads in two ways: through fleas that transmit the pathogen from patients to healthy people, and through contact with a sick person, or his secretions, or objects on which the patient left the plague Bacillus.

But there is also a pulmonary form of plague, which is more terrible than other forms, both in severity and in the speed of its spread. The airborne pathway of transmission, in which the pathogen is released from the respiratory tract of the patient into the air and enters the body of a healthy person with inhaled air, is the fastest and most widespread method of spreading infectious diseases. One sneeze can infect many people.

In medicine, there is such a thing as contagiousness. This sonorous word refers to the property of infectious diseases to be transmitted from sick people or animals to healthy ones. The plague is highly contagious.

By the way, about rodents. The Bible says that the Philistines returned the stolen ark to the Israelites with gifts – Golden images of painful growths and Golden mice, which were “according to the number of all the cities of the Philistines.” Mice are not accidental here – even in ancient times, people associated the plague with rodents.

There is such a science – paleogenetics, which reveals the secrets of the past by studying the genetic material (DNA) from the remains of ancient organisms. Particles of plague Bacillus DNA have been found in fossils that are about 3,800 years old. But we can assume that humanity has been suffering from the plague for 20 thousand years. This is also established by geneticists. A comparison of the DNA of Yersinia pestis and other bacteria called “Bacillus pseudotuberculosis” showed that the plague Bacillus descended from Yersinia pseudotuberculosis about 20 thousand years ago. It’s scary to think what might have happened if the plague had broken out about 2 million years ago in East Africa, which is considered the cradle of humanity. All our distant ancestors would have died out, and there would have been no human civilization on Earth.

Previously, it was believed that the first historically reliable plague epidemic was the so-called Athenian epidemic, which struck ancient Athens in 430 BC. It was also called the plague of Thucydides after the ancient Greek historian Thucydides, who left us a detailed and colorful description of events in his Chronicles.

“Without any external reason, suddenly there was a strong fever in the head, redness and inflammation of the eyes,” Thucydides wrote. Inside, the throat and tongue would immediately turn blood-red, and the breath would become ragged and fetid. Immediately after these phenomena, the patient began to sneeze and wheeze, and after a while the disease passed to the chest with a strong cough. When the disease entered the abdominal cavity and stomach, nausea and bile secretion of all varieties known to doctors began, with vomiting accompanied by severe pain. Most of the patients suffered from a painful urge to hiccup, which caused severe convulsions. And in some cases, this was observed after the vomiting eased, while in others it continued later. The patient’s body was not too hot to the touch and not pale, but with a reddish-blue tinge and covered with small purulent blisters and boils, like a rash. Inside, the heat was so great that the patients could not bear even the thinnest blankets, muslin capes, or anything like that, and they could only lie naked, and the most pleasant thing was to plunge into cold water. Tormented by unquenchable thirst, the sick, left unattended, threw themselves into the wells; no matter how much they drank, it did not bring relief… ” [4].

According to Thucydides, this disease came to Athens from Ethiopia. Until recently, it was believed that Thucydides, describing the clinic of the plague (and you have now read only part of this detailed description), mixed several diseases into one pile. In reality, the plague has a slightly different clinic. But in 2006, a group of scientists from the University of Athens conducted a genetic analysis of material obtained from teeth found in the graves of victims of the Athenian plague. The remains of the DNA of the plague pathogen could not be found, but traces of the DNA of the typhoid pathogen were found. So the plague of Thucydides, probably, it is necessary to call fever of Thucydides.

The causes of several other epidemics described by ancient authors as plagues are questioned. But there is no doubt that the first pandemic in the history of mankind was a plague pandemic. The plague of Justinian, named after the reigning Emperor of the Eastern Roman Empire at that time, raged in Europe, North Africa, Central and South Asia in the VI century ad. However, some historians refer to this pandemic and later epidemics, and then it turns out that it began in 542 in the Egyptian city of Pelusium, which is mentioned in the Bible as “Sin, the fortress of Egypt”, and ended in England in 683. Almost a century and a half – what a pandemic!

It should be clarified that this pandemic was a combination of several epidemics. In other words, periodically the plague receded for a short time, and then there was another outbreak. And the higher the population density in the affected area, the more victims there were. This is a General law that applies to all epidemics. For example, in 544, at the height of the plague in Constantinople, up to 5 thousand people died daily, and on some days twice as many. And this is despite the fact that the most dangerous form of pulmonary plague in the VI century was not. According to the descriptions, Justinian’s plague was bubonic and septic. In the” Ecclesiastical history ” of the Antiochian Evagrius Scholasticus [5], who was ill with the plague, but survived, such symptoms as swollen face, diarrhea, fever, swelling in the groin, black ulcerative boils, insanity are indicated. “The methods of obtaining this disease were so diverse that they could not be counted,” Evagrius wrote. – Some died just from talking with the sick or eating with them at the same table. Others may have died just by touching the sick or just by being in the house where the sick person lived… but there were also those who lived with the sick, touched not only them, but also the dead, but still remained completely healthy.”By the way, about rodents. The Bible says that the Philistines returned the stolen ark to the Israelites with gifts – Golden images of painful growths and Golden mice, which were “according to the number of all the cities of the Philistines.” Mice are not accidental here – even in ancient times, people associated the plague with rodents.

There is such a science – paleogenetics, which reveals the secrets of the past by studying the genetic material (DNA) from the remains of ancient organisms. Particles of plague Bacillus DNA have been found in fossils that are about 3,800 years old. But we can assume that humanity has been suffering from the plague for 20 thousand years. This is also established by geneticists. A comparison of the DNA of Yersinia pestis and other bacteria called “Bacillus pseudotuberculosis” showed that the plague Bacillus descended from Yersinia pseudotuberculosis about 20 thousand years ago. It’s scary to think what might have happened if the plague had broken out about 2 million years ago in East Africa, which is considered the cradle of humanity. All our distant ancestors would have died out, and there would have been no human civilization on Earth.

Previously, it was believed that the first historically reliable plague epidemic was the so-called Athenian epidemic, which struck ancient Athens in 430 BC. It was also called the plague of Thucydides after the ancient Greek historian Thucydides, who left us a detailed and colorful description of events in his Chronicles.

“Without any external reason, suddenly there was a strong fever in the head, redness and inflammation of the eyes,” Thucydides wrote. Inside, the throat and tongue would immediately turn blood-red, and the breath would become ragged and fetid. Immediately after these phenomena, the patient began to sneeze and wheeze, and after a while the disease passed to the chest with a strong cough. When the disease entered the abdominal cavity and stomach, nausea and bile secretion of all varieties known to doctors began, with vomiting accompanied by severe pain. Most of the patients suffered from a painful urge to hiccup, which caused severe convulsions. And in some cases, this was observed after the vomiting eased, while in others it continued later. The patient’s body was not too hot to the touch and not pale, but with a reddish-blue tinge and covered with small purulent blisters and boils, like a rash. Inside, the heat was so great that the patients could not bear even the thinnest blankets, muslin capes, or anything like that, and they could only lie naked, and the most pleasant thing was to plunge into cold water. Tormented by unquenchable thirst, the sick, left unattended, threw themselves into the wells; no matter how much they drank, it did not bring relief… “.

According to Thucydides, this disease came to Athens from Ethiopia. Until recently, it was believed that Thucydides, describing the clinic of the plague (and you have now read only part of this detailed description), mixed several diseases into one pile. In reality, the plague has a slightly different clinic. But in 2006, a group of scientists from the University of Athens conducted a genetic analysis of material obtained from teeth found in the graves of victims of the Athenian plague. The remains of the DNA of the plague pathogen could not be found, but traces of the DNA of the typhoid pathogen were found. So the plague of Thucydides, probably, it is necessary to call fever of Thucydides.

The causes of several other epidemics described by ancient authors as plagues are questioned. But there is no doubt that the first pandemic in the history of mankind was a plague pandemic. The plague of Justinian, named after the reigning Emperor of the Eastern Roman Empire at that time, raged in Europe, North Africa, Central and South Asia in the VI century ad. However, some historians refer to this pandemic and later epidemics, and then it turns out that it began in 542 in the Egyptian city of Pelusium, which is mentioned in the Bible as “Sin, the fortress of Egypt”, and ended in England in 683. Almost a century and a half – what a pandemic!

In 2014, geneticists from the United States and Canada confirmed that the Justinian plague was a bubonic plague. Using DNA, you can not only “identify” the plague Bacillus, but also find out its preferences, that is, determine which form of the disease it mainly causes.

Humanity learned to treat the plague only in the middle of the twentieth century, when antibiotics that act on plague Bacillus, such as streptomycin, appeared. Before that, there was only one salvation: escape from the settlements to some remote, secluded places, and it was necessary to escape in advance, before contact with the sick.

It is not known for certain how many people died during the first plague pandemic. The estimated number of victims varies from 60 to 100 million. But even if you take the minimum figure, it is still terrifying, especially given the fact that in the Middle ages the population was much smaller than the current one.

Let’s leave Europe for a while to come back here in the Wake of the second pandemic, and move to China. The first information about epidemics similar to the plague, belong here to 224 BC. Geneticists have not yet spoken out about this epidemic, but judging by the fact that in a short time the disease covered a huge territory (about half of what is now China), it was still a plague. On average, about 10-12 “plague-type”epidemics broke out in Chinese States over a century. And in 1346, an epidemic broke out in China, which was then called the yuan Empire, which gave rise to the second plague pandemic, which in Europe was called the black plague or black death.

Why black? Yes, because the corpses of those who died from the plague quickly darkened and looked as if they had been in flames.

In due course, we will talk about the causes that lead to epidemics. So far, we have only a historical overview with minimal information that helps to understand the material. In the old days, epidemics were always associated with some kind of natural disasters, which was generally true. Cataclysms cause large-scale migrations of small rodents, which were considered natural reservoirs of plague Bacillus, to human habitats where it is easier for rodents to get food. In addition, this increases the crowding of animals. As a result, fleas feed intensively, jumping from one rodent to another, and in between (close!) bite-infect people, giving rise to a plague epidemic.

As for the rapid spread of epidemics in the old days (any epidemic, not just the plague), this was due to factors such as the lack of necessary knowledge on infection prevention and unsanitary conditions in which our ancestors lived. The worst situation was in medieval Europe, where unsanitary conditions were not large, but simply monstrous. Do you know where the fashion for wide-brimmed hats came from in Europe? The wide fields were supposed to protect them from the sewage pouring out of the Windows. Since this was unavoidable (and the filth spilled out all the time), it was better to leave the mud on the hat without soiling the face and clothes. It was also customary to throw garbage out of Windows or doors on the street, where it was “cleaned” by the rains. Does it need comments? It is unlikely, and without them everything is clear.

In addition, taking care of the purity of the body in the early middle Ages was considered sinful in Europe. On the one hand, it was not worth indulging such base whims of the body as the need to wash, and on the other – the inevitable contemplation of your own naked body could lead to temptation. Medieval treatises of Catholic theologians advised to wash as little as possible, and best of all-do not wash at all, because a healthy body does not need it at all.

I would like to make one clarification. Between the plague pandemics, the world did not rest from this scourge. Local epidemics broke out here and there. But they were of a limited nature and were not always honored to be recorded in the annals. The entire history of mankind, from the moment of its origin to the twentieth century, can be characterized by the rude phrase “not diarrhea, so scrofula” – one epidemic did not have time to end, as another began.

Yes, it is up to the twentieth century, and not to the XIX and certainly not to the XVIII. The enlightened city of London, the capital of the British Empire, in the enlightened nineteenth century was literally torn apart by cholera epidemics that broke out one after another. What else could you expect if the sewage from the cesspools was dumped into the Thames, and water was taken from there for drinking?

But about the cholera later, let’s finish with the plague first.

“Among all other disasters, the plague is undoubtedly the most terrible and the most cruel. It can rightly be called ” Evil” with a capital letter, because there is no greater evil on earth than the plague, and nothing can compare with it. In the streets and squares, in churches, there are corpses, and this picture is so terrible that those who watch it envy the dead, for whom all the suffering is left behind. There is no pity even for those close to you, because pity is dangerous and inappropriate. Friendship and love are forgotten, all people are separated, parents don’t care about our children, husbands to wives, brothers to each other,” – wrote in the XVII century, a Portuguese monk, who was lucky to survive the next plague. So it was: there are corpses around that have no one to bury, and the living are jealous of the dead, who have already suffered.

Where the plague came from in the yuan Empire at that time is not known for certain. Some scientists believe that the primary focus was in the Gobi desert, while others place it on the Northern slopes of the Himalayas. But, one way or another, in 1330, the “pestilence” began in the Empire, which in 1336 reached Europe, and from there in 1352 came to Pskov and a year later to Moscow. If you are surprised by the speed of the pandemic’s spread, which is so slow from the point of view of modern man, then remember that we are talking about those times when people traveled on horseback or, say, camels, or even on foot, and did not travel for pleasure, but for business or trade needs, that is, not EN masse.

Almost all authors who described the second plague pandemic, along with bubons, noted such a pulmonary symptom as hemoptysis. Consequently, the second pandemic was represented by both bubonic and pneumonic plague. Of course, there was also a septic form, without which no epidemic can do. The famous French surgeon guy de Chauliac, who was caught by the plague in the city of Avignon, made a comparative analysis of the pulmonary and bubonic forms of plague and came to the conclusion that the pulmonary form is heavier than the bubonic form and has a greater contagion. He pointed out that the life expectancy of a patient with a pulmonary form of plague did not exceed three days from the onset of the disease, and in the bubonic form, death occurred on the average on the fifth day. Sholiak very much wanted to establish the cause of the plague and even asked Pope Clement VI permission to dissect the corpses of plague patients, but he could not achieve what he wanted, only he became infected, but, fortunately, survived. The plague wand, by the way, was discovered only in 1894.

Improper medical care also contributed to the spread of the plague. The same Shaliach recommended to open the buboes and clear them from the pus. This procedure did not contribute to recovery in any way, but the spread of the disease is even very much, because in the pus that was filled with bubons, figuratively speaking, a stick on a stick sat and drove a stick.

Please note! In the literature, you can find the name “plague Bacillus”. Do not think that we are talking about some other pathogen of the plague. Bacilli are all rod-shaped bacteria that can form spores. However, this rod-like shape is rather conditional, since among the bacilli there are coccobacilli that have a hemispherical shape. It is to coccobacilli that the plague Bacillus, which is scientifically called Yersinia pestis, belongs. Yersinia – in honor of its discoverer, the French bacteriologist Alexander Yersen, and pestis is translated from Latin as “infection”, “General disease”or ” death”.

It is not known how many lives were taken by the second plague pandemic, but a count of the number of victims carried out on the orders of Pope Clement VI gave a figure of 23,840,000, which was about 30% of the then European population (we are talking only about Western Europe).

The third plague pandemic, which some scientists consider the fifth peak of the second pandemic, also came from China, namely from the southern Chinese province of Yunnan. This pandemic, which began in 1855, lasted until the 20s of the twentieth century, and some echoes of it were recorded later. The last year of the last plague pandemic was 1959. Why the latter? Yes, because antibiotics and scientific measures to prevent the spread of the disease (including anti-plague vaccination) helped to curb the plague. Not to destroy, but only to curb, please note. Natural reservoirs of the plague continue to exist, but as soon as the plague raises its head, it is immediately hit on this head.

But the natural smallpox managed to lime clean, because its pathogen did not have a natural reservoir, it lived only in the bodies of sick people.

Currently, the smallpox virus exists only in two laboratories – Russian and American. Smallpox, like the plague, is a particularly dangerous infection. The only difference is that the plague kills every third person in the territories covered by it, and smallpox – every third of the sick. Previously, it was believed that smallpox accompanied mankind from ancient times and that smallpox was mentioned in the Bible among the ten plagues of Egypt: “and the Lord said to Moses and Aaron: take a handful of ashes from the furnace, and let Moses throw it to heaven in the eyes of Pharaoh; and the dust shall rise up over all the land of Egypt, and there shall be an inflammation on man and beast, with boils, in all the land of Egypt. They took the ashes from the furnace and stood before Pharaoh. Moses threw it up to heaven, and there was an inflammation with boils on people and on cattle.”

However, geneticists have established that the human smallpox virus originated from the camel pox virus about 2,000 years ago, that is, at the beginning of our era. Historical data do not contradict this: the first known epidemic of smallpox (namely smallpox, judging by the descriptions) took place in China in the IV century ad. Apparently, the Bible described some other disease, accompanied by boils on the body, it is possible that the bubonic form of the plague. But we can not exclude the fact that in ancient times, the camel pox virus, which today does not pose a danger to humans, could affect not only camels, but also people. Later, it changed and became what it is now. However, it is not so important when smallpox appeared, it is important that it was completely defeated. And this is still the only final and irrevocable victory over the disease in the history of mankind [6].

But let’s not get ahead of ourselves. In the sixth century, smallpox came to Europe, but until the eighth century there were no epidemics, which began only with the conquest of Spain by the Arabs. But once they started, they didn’t stop. We can say that from the eighth century to the beginning of the nineteenth century, Europe was covered with smallpox. Smallpox was always everywhere and everyone was sick with it. It is not for nothing that the Germans have a saying: few can escape smallpox and love.

Smallpox vaccination was invented by the Chinese!

We will talk about vaccination in detail, but for now we will only say that vaccination, or inoculation, is the introduction to a healthy person of material obtained from a sick person or animal in order to form immunity to the disease. The input material contains the causative agent of the disease (live, weakened, or dead) or some substances produced by it. In response to the introduction of this material, called a vaccine, the body begins to produce antibodies to this pathogen – proteins that bind strongly to the pathogen and thereby kill it or make it inactive.

Chinese doctors took the crusts of smallpox blisters and dried them in a dark and cool place. At the same time, there was a partial death of viruses, and those that remained alive, weakened and could no longer cause the disease in severe form. But for the formation of antibodies, a mild form of smallpox was enough. Immunity to smallpox is lifelong, and those who have had it do not get sick again. The old methods of vaccination were based on this observation, not on knowledge of immunology.

Dried crusts were ground into a powder, which was injected into the nostrils of the vaccinated on tampons. This method was adopted from the Chinese by the Hindus, from whom it spread throughout the Middle East in a somewhat modified form – a drop of liquid taken from the smallpox bladder of a sick person was applied to a scratch on the skin of the vaccinated person. However, it is possible that this method appeared in North Africa independently of the Chinese one, and from there it already came to the middle East.

In the early 18th century, Mary Wortley Montagu, the wife of the British Ambassador to the Ottoman Empire, became aware of the Eastern method of smallpox vaccination. In March 1718, she vaccinated her five-year-old son, who became the first European to be vaccinated against smallpox, and three years later, in London, her daughter was vaccinated. Mary Wortley Montagu actively promoted the Turkish method of protection against smallpox and managed to interest Princess Caroline of Wales in it. The Princess doubted the safety of the Turkish method, so she first tried it on seven criminals sentenced to death. All seven survived and were pardoned. In April 1722, two of the Princess of Wales’s daughters were successfully vaccinated against smallpox. King George I, who reigned at the time, saw that the vaccination of his granddaughters was successful, ordered all his other grandchildren to be vaccinated. The example of the Royal family had a convincing effect on the British, but in the rest of Europe, smallpox vaccinations were treated with great caution. People did not understand how they could voluntarily infect themselves and their children with such a dangerous disease as smallpox. The great French philosopher Voltaire in his” Philosophical letters ” wrote: “In Christian Europe, the English are quietly called fools and madcaps: fools, because they inoculate their children with smallpox in order to prevent them from getting sick with this disease; madmen, because they easily infect their children with the inevitable terrible disease, in order to prevent a dubious disaster. The British, in turn, object to this: “All Europeans except us are cowards and perverts; they are cowards because they are afraid of causing the slightest pain to their children, and perverts because they let them die of smallpox one day.” In order to be able to judge who is right in this dispute, I will tell the story of this notorious inoculation, which is spoken of with such horror outside of England.” This was followed by a description of the harm caused by smallpox, and the conclusion: “… if the practice of vaccination existed in France, the lives of thousands of people would be saved.”

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