Anthropology: Mankind’s History of Illness and Epidemiology

The role of illness in human history

Like all beings of nature, humans have faced illness since the dawn of humanity. However no other species have come to understand the body and health as well as the Homo Sapiens Sapiens. Medicine and hygiene practices have, without a doubt, unabled humans to expand their life expectancy and build very complex civilization. Health, further than being a simple biological matter, carries significant cultural, sociological and political relevance in human societies. And the Covid-19 pandemic sure proves it.

Called the “China Virus” by former US President Donald Trump – and not just him – the Coronavirus crisis led to an onslaught of racist and xenophobic attacks against people of Asian descent. The simple act of wearing a mask has become politically loaded. The long a waited solution, the vaccine, has now become decried by a significant part of the population…

All this begs the question: why is a pandemic so political? To comprehend the different reactions to the spread of the Covid flu, we will have to take a trip back time. Our views on health and hygiene have been shaped by history, close and distant. The memory of previous epidemics might seem far away for some. But they still hold a huge signifcance in our culture, along with the evolution of medical practices around the world.

The angel of death striking a door during the plague of Rome.
The angel of death striking a door during the plague of Rome. Engraving by Levasseur after J. Delauney.

Curing illness in Prehistory

As a species which heavily relies on social bonds, humans have tried to treat the sick and nurture the meak for a very long time. In fact, archeological findings have shown that humans have attempted to heal illnesses and injuries since prehistory. Humans have experimented with surgical operation from as early as the Neolitic period (10 000 – 7 000 BC), with evidence of trepanation found on numerous skulls in France, Latin America and China.

The procedure of trepanation consists in drilling or scraping a hole inside the skull to either treat skull injuries or pain, or mental disorders. Which means that humans already attempted to treat people who showcased mental or behavioral inaptitudes despite their lack of knowledge in science and psychiatry. Evidence also shows that humans started using herbs and plants prior to that period, even though nothing shows for certain that they truly knew how to derive healing properties from said plants.

Majority of the most severe diseases we know of today have originated from prehistoric Africa. They have left a significant impact on indigenous cultures. In fact, some prehistoric artifacts convey the deep sense of frustration felt by early societies from their helplessness in front of such illnesses.

Nigerian mask representing symptoms of leprosy.
Nigerian mask representing symptoms of leprosy.

The presence of animals, in particular mammals, is a decisive factor of epidemiology. Mammals, are what epidemiologists call a typical reservoir of disease, as they tend to retain pathogens within their population and infect others easily. Unfortunately, some of the most common animal reservoirs also happen to be the animals that proved easier to domesticate. Namely: cows, sheep, dogs, pigs, etc.

Ancient medicinal knowledge and traditional medicine

Before modern science helped humans diffuse some of the most severe epidemics and chronic conditions, people used traditional medicine. It consists in a form of medicine that relies on knowledge of plants and other natural substances as well as spirituality. Before colonization, traditional medicine was the main way for people to treat their illnesses in many areas of the world.

In subsaharan-Africa, traditional medicine was revived in the 20th century, due in parts to the expensive price of modern medication and medical supplies. Actually, in spite of the propagation of modern medicine, many countries still incorporate traditional medicine to their medical practices. That is very much the case of China, for instance.

Excerpt from a Chinese herbal medicine guide.
Excerpt from a Chinese herbal medicine guide.

But despite being “natural”, traditional medicine has its shares of downsides. Actually, the dangerous cocktail of non science-based knowledge and spiritual beliefs can, and often do lead, to dire consequences. Due to supersition, this alternative medicine often leads to harmful practices. In many Asian countries, body parts of rare animals are collected to be sold as medicine. Even though, their health benefits remain questionable.

Another brutal example of superstition leading to violent behaviors would be the abuse – or killing – of people with albinism. For instance, in Zimbabwe, some hold the belief that having intercourse with an albinistic woman will cure a man from HIV. People with albinism deal with persecution and threats of murder, as witch doctors use their body parts as remedies or for potions.

Illness and hygiene in the Middle-Ages

Health is one of the most pivotal aspect of human life. Which is why the ways in which people visit their doctors is very culturaly significant. Take this account of a female patient visiting her doctor in the medieval Levant. To sort out an inconvenient predicament, she goes to the famous clinician al-Razi and announces her symptoms: she speaks “confusedly”, laughs excessively and appears red in the face. Doctor al-Razi diagnoses her with malinkhuliya, or melancholy.

According to the theory of humorism, melancholy was an illness caused by an excess of black bile. To remedy to that illness, he recommends bloodletting to his patient, as well as an epithyme decoction. She will have to have her blood let at the median cubital vein to get better.

This account of Islamic Medieval medicine paints a common scene of medical habits in the Middle-Ages. In fact, it encompasses several of the famous (or infamous) obsolete medical practices of the time. For one, the clinician uses the theory of humors to diagnose his patient.

Humorism is the belief that illnesses appear when the human bodies secretes too much, or not enough, of one of our four bodily fluids, the humors. It also associates these fluids to our emotions, making a connection between certain temperaments (e.g. becoming sad, getting in a fit of rage) to our physical health. The four humors, blood, yellow bile, black bile and phlegm, all have their own purposes and an effects on the emotional disposition.

Explaining illness with humoralism

Representation of the four humours in tarot.
Representation of the four humours in tarot.

According to humoralism, blood, connected to the heart or the liver, is hot and moist and makes you sanguine. A sanguine personality consists in a friendly, upbeat disposition with risk-taking tendecies.

Yellow bile, connected to the gallbladder, is warm and dry, making you choleric. A choleric personality consists in having an ambitious mindset, but also short-tempered and violent.

Black bile, connected to the spleen, is cold and dry and makes you melancholic. A melancholic personality evokes a more thoughful, or even anxious mindset, prone to depression.

And finally, phlegm, connected to the brain an the lungs, is cold and moist and makes you phlegmatic. A phlegmatic personality is either considered sympathetic and easy-going, or low-spirited.

The interpretation of these personalities depends on the current epoch or school of thought. It remained a very prominent medical system for a long time in Europe and in the Islamic world.

How medieval plagues redefined society

During the Middle Ages, Asia and Europe hosted a slew of really destructive plagues. But how come they happened so frequently in European and Asian cities, while occuring very rarely in other places, like in the Americas? Actually, this has a lot to do with the density of their cities, as well as their lack of proper hygiene management.

To make things simple, medieval densely populated cities made the best environment for diseases to fester. For, they combined three qualities that eventually led to the proliferation of ravaging ailments. First, they had too many people in too little space. Second, the struggled to separate drinkable water from sullen water. And finally, they had too many domesticated animals living alongside humans.

Animal domestication was a great tool for economic prosperity that came at a great price: animal-borne illnesses. The more cattle came in contact with humans, the more the likelihood of an animal infecting a human with a new illness increased. This extremely rare and freaky occurence of nature succeeded in creating all the worst diseases the world has seen. Namely, smallpox, typhus, influenza, mumps, tuberculosis, cholera, measles, and last but not least, the bubonic plague, also known as the Black Death. Saddly, many believe that this is also how the Covid-19 epidemics started.

The Black Death

Representation of a European plague doctor.
Representation of a European plague doctor.

Long-beaked plague doctors, macabre danses, overwhelmed morgues… Although old of a few centuries, the bubonic plague still haunts western culture with its somber imagery. The Black Death arrived in Europe in the late 1340s. Medically known as the bubonic plague, it managed to wipe one third of the world population off the face of the Earth.

By itself, the bubonic plague destroyed the British federal system, forced England and France to temporarily interrupt their wars and lead to Vikings abandoning their exploration of North America. Without a doubt, one could say that the Black Death completely transformed England and left a strong scar on the country.

The Black Death also generated a revival of fanaticism in Europe. Perhaps to rationalize the crisis and assert a certain level of control on this terrible phenomenon, Europeans started looking for scapegoats. Thus, various groups of people became targeted. Jewish people in particular, but also Romanis, foreigners, lepers and beggers. In France and Italy, jewish communities had to bear the constant threat of imminent attacks. Many decided to flee to Poland in front of the brutality of the massacres.

The bubonic plague somehow caused a cultural and spiritual reset in Europe. Confronted by their mortality and the vulnerability of humanity, Europeans saw their mindset evolve. Italy saw an increase in piety. While French people embraced the ephemeral nature of life through their arts.

A "danse macabre", a dance of death represented in the bible of King Charles VII.
A “danse macabre”, a dance of death represented in the bible of King Charles VII.
Credits: ©Snark/photos12/AFP

Cholera and rethinking the way illness affects our infrastructure

Cholera made its way to England at the onset of the 19th century. The first epidemic started in Asia, but died out in the Caucuses in 1823. When a second epidemic started in Russia, London could no longer avoid a cholera epidemic, as it was egged on by one very smelly culprit: the river Thames. Along with assaulting Londoners daily with its pungent smell, the Thames brought upon some of the most destructive water-borne diseases.

Due to a poor sanitarization system, London failed to separate the waste-contaminated water from the water used daily by its inhabitants. So much so that citizens, allied with the sarcastic wit of the press, started condemning the city’s refusal to undertake serious restoration works on the piping systems.

Allegory of death brought upon by the Thames during the Great Stink.
Allegory of death brought upon by the Thames during the Great Stink.

Even through the Victorian era, sewage was still discharged in the Thames, without much regards to the proliferation of bacteria it would cause. The Great Stink of 1858 finally forced the city to build massive and efficient sewer systems to improve the quality of the water. These constructions, led by engineer Joseph Balzaguette, is what made London the city it is today. Nowadays, infrastructure remains a huge issue in many developing countries. Proper infrastructure is required to avoid outbreaks of water-borne epidemics, but for many countries, the cost of construction and maintenance is too expensive.

Possession and hysteria: the strange treatment of female health in history

Hysteria and the obsession with female insanity

Did you know that if you are a woman, you have a little wretched creature wandering freely in your body, causing a plethora of illnesses and affecting your reason? As ludicrous as this proposition might sound, it perfectly sums up – with slight exageration – the beliefs of Hippocratics doctors of Ancient Greece. Indeed, a significant part of them believed that non-other than the uterus was an independant being, wandering aimlessly in the female body until, at last, the woman became pregnant.

They called this movement “hysterike pnix”, or “uterine suffocation”, which will lead to the controversial hysteria diagnosis. Many medieval clinicians believed that lack of sexual activity lead to hysteria. Symptoms of hysteria included the impairment of physical and/or mental functions. Doctors believed that women suffering from that illness needed to have sexual intercourse with a man and sometimes, even to get pregnant.

Cursed be the uterus…

Further than being associated with a state of uncontrollable frenzy, the uterus has also been linked to demonic possession. Therefore, treatments came in the form of prayers or exorcisms. Some sufferers would even be accused of witchcraft, and would therefore be prosecuted as such.

Thanks to the work of activists and scholars, hysteria shifted back to the status of medical condition in the sixteenth century. Clinicians started declaring it as a psychological condition which had no correlation to female sexual health.

Today, the medical world no longer uses the terminology of “hysteria” and has stopped linking female sexual health to psychological impairments. But unfortunately, the stigma inflicted on female patients for centuries has not completely faded away.

Drawing representing the arterial system of a pregnant woman in a Persian Manuscrupt.
Drawing representing the arterial system of a pregnant woman in a Persian Manuscrupt.
Credits: Copyright © 2009 Wellcome Library

The tendency to associate female hormones to insanity has translated itself into different medical prejudices against women. For one, many women suffer from the stereotype of being over-emotional, and get accused of exaggerating their symptoms and pain in medical consultations. Such prejudices has led to the underdiagnosis of illness such as endometriosis. It also transpires in the lack of research in female menstrual health, as well as medical violence against women in obstetrics and gynecology.

Disease, creator of the New World

When the colonization of America started, the Ancient World collided with the New World. But what did that mean for the indigenous population? Evidently, it announced the onset of a struggle between two distinct cultural identities. A struggle between two different ways of life, cosmogonies, histories… And yet, the most lethal difference between the New World and the Ancient World was not cultural or political, it was epidemiological.

Before the arrival of Europeans, America was a land mostly devoid of epidemic diseases. The reason for that is due to the different type of fauna that originally inhabited the land. Contrary to cows, sheep, chickens and pigs, indigenous animal species of America could not be easily domesticated. Bisons, bears, cougars and eagles simply behave in a way that makes their domestication extremely difficult. Hence the lack of livestock in such societies, which in turns reduced the likeliness of animals living in densely-populated areas and infecting humans with dangerous pathogens.

Indigenous Americans had no possibility to build immunity against these epidemics. Which means that when Europeans came in contact with Americans, the latter had no means, biological or otherwise, to fight the diseases. A similar phenomenon occurred in Australia and in North-America.

Representation of dying Aztec of Mexico after the introduction of smallpox by Spaniards.
Representation of dying Aztec of Mexico after the introduction of smallpox by Spaniards.
Credits: Private collection/Bridgeman Images

Now, imagine this happening to your community. You are living a relatively peaceful life amongst your people, worrying only about trivial inconveniences of life. When suddenly, a group of stranger arrive to your land. From that point on, you watch 90% of your people die of an unstoppable, painful, never-seen before disease. Such an experience would, undoubtedly, create an immense generational pain in a community, aggravated by the other atrocities that came with colonization.

Illness and epidemics: What about the present?

Illness confronts us to our vulnerability, our mortality. It reminds of why we humans are social creatures: to be strong as a community, we must care for each individual. However, like most things, illness can, and will be used as a tool of power. Whether it is used to obtain power, deflect responsibility, or increase inequality, some will not hesitate to use disease as a political weapon.

Epidemics also hold a lot of cultural and even political relevance when it comes to the evolution of human society. That, because epidemics create a state of crisis. A crisis creates a sense of vulnerability. And vulnerability triggers a desire for control. Hence, why humans, in all times, have reacted in odd or harmful ways during an epidemic?

Though we all expect for this current pandemic to subside and for life to get back to normal, it has become obvious that Covid-19 has changed society for good. And while we get used to this new normal, nothing can tell us what epidemiology plans for our future.

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