How Pandemics Change History

In his new book, “Epidemics and Society: From the Black Death to the Present,” Frank M. Snowden, a professor emeritus of history and the history of medicine at Yale, examines the ways in which disease outbreaks have shaped politics, crushed revolutions, and entrenched racial and economic discrimination. Epidemics have also altered the societies they have spread through, affecting personal relationships, the work of artists and intellectuals, and the man-made and natural environments. Gigantic in scope, stretching across centuries and continents, Snowden’s account seeks to explain, too, the ways in which social structures have allowed diseases to flourish. “Epidemic diseases are not random events that afflict societies capriciously and without warning,” he writes. “On the contrary, every society produces its own specific vulnerabilities. To study them is to understand that society’s structure, its standard of living, and its political priorities.”

I spoke by phone with Snowden last Friday, as reports on the spread of COVID-19 tanked markets around the world, and governments engaged in varying degrees of preparation for even worse to come. During our conversation, which has been edited for length and clarity, we discussed the politics of restricting travel during epidemics, how inhumane responses to sickness have upended governments, and the ways that artists have dealt with mass death.

I want to start with a big question, which is: What, broadly speaking, are the major ways in which epidemics have shaped the modern world?
One way of approaching this is to examine how I got interested in the topic, which was a realization—I think a double one. Epidemics are a category of disease that seem to hold up the mirror to human beings as to who we really are. That is to say, they obviously have everything to do with our relationship to our mortality, to death, to our lives. They also reflect our relationships with the environment—the built environment that we create and the natural environment that responds. They show the moral relationships that we have toward each other as people, and we’re seeing that today.
That’s one of the great messages that the World Health Organization keeps discussing. The main part of preparedness to face these events is that we need as human beings to realize that we’re all in this together, that what affects one person anywhere affects everyone everywhere, that we are therefore inevitably part of a species, and we need to think in that way rather than about divisions of race and ethnicity, economic status, and all the rest of it.
I had done some preliminary reading and thought this was an issue that raises really deep philosophical, religious, and moral issues. And I think epidemics have shaped history in part because they’ve led human beings inevitably to think about those big questions. The outbreak of the plague, for example, raised the whole question of man’s relationship to God. How could it be that an event of this kind could occur with a wise, all-knowing and omniscient divinity? Who would allow children to be tortured, in anguish, in vast numbers? It had an enormous effect on the economy. Bubonic plague killed half the population of full continents and, therefore, had a tremendous effect on the coming of the industrial revolution, on slavery and serfdom. Epidemics also, as we’re seeing now, have tremendous effects on social and political stability. They’ve determined the outcomes of wars, and they also are likely to be part of the start of wars sometimes. So, I think we can say that there’s not a major area of human life that epidemic diseases haven’t touched profoundly.

Were you trying to make a point about how the way we respond to these things is often a function of our racial or ethnic or religious views rather than our general humanity, and that the response has shown the flaws of human beings in some way? Or were you making a different point?
I think I was trying to make two points. I think the causal chain works in both directions. Diseases do not afflict societies in random and chaotic ways. They’re ordered events, because microbes selectively expand and diffuse themselves to explore ecological niches that human beings have created. Those niches very much show who we are—whether, for example, in the industrial revolution, we actually cared what happened to workers and the poor and the condition that the most vulnerable people lived in.
Cholera and tuberculosis in today’s world move along the fault lines created by poverty and inequality and the way in which, as a people, we seem to be prepared to accept that as somehow right and proper, or at least inevitable. But it’s also true that the way that we respond very much depends on our values, our commitments, and our sense of being part of the human race and not smaller units. When Bruce Aylward, who led the W.H.O. mission to China, came back to Geneva at the end of it and was asked a question very similar to the one you posed, he said that the major thing that needs to happen, if we are to be prepared now and in the future, is there has to be an absolutely fundamental change in our mind-set. We have to think that we have to work together as a human species to be organized to care for one another, to realize that the health of the most vulnerable people among us is a determining factor for the health of all of us, and, if we aren’t prepared to do that, we’ll never, ever be prepared to confront these devastating challenges to our humanity.

Well, that’s a very bleak thought, if I may say so, because I think it’s unlikely we are going to experience that change of mind-set.
[Laughs] I didn’t want to suggest that I’m a great optimist in this matter, but I do agree it’s what needs to happen. There’s also a dark side to humanity and that is part of the interest of this. What choice will we make? How will we go when we’re faced with this? I don’t think it’s predetermined, and a great human moral drama is being played out in front of us.

The idea of a connection between how we respond to these things and the prevalence of them is almost Biblical.
I would entirely agree with that. It really is a matter that exists at that level and is that big a part of our sense of moral imperative. I think that’s a huge part of the history of epidemic diseases.

Before this gets too dark, let me ask you a lighter question—
Yeah, I’m sorry to have such interests. My daughters protest.

Are there certain epidemics where the response has shown something inspiring about humanity?
Oh, I certainly think that. I think when I said it shows a mirror to ourselves, it doesn’t show just the dark side of humanity. It also shows the heroic side. A really good example is Doctors Without Borders in the Ebola crisis, and the way in which they put their lives and their futures knowingly, directly on the line for no self-interest whatsoever and no reward, but purely because they were committed to defending the lives and health of the weakest people in the world. And Doctors Without Borders is doing that every day in many parts of the world, and they’re even now in China confronting this.

I believe that this is something that also does bring out the highest qualities. Indeed, novels are also written about these major events. It affects our literature and our culture. I’m thinking of the great plague novel, which is “The Betrothed,” by the Italian novelist Alessandro Manzoni. He talks about the archbishop of Milan, Cardinal Borromeo, who went into the pest houses and was willing to lay down his life to look after the poorest and most unwell people in his flock.

What about in terms of world leaders or regimes responding positively, or positive political changes arising after an epidemic?
Absolutely. I’m thinking about the end of chattel slavery in the New World. That and the success of the Haitian rebellion and Toussaint Louverture was determined, above all, by yellow fever. When Napoleon sent the great armada to restore slavery in Haiti, the slave rebellion succeeded because the slaves from Africa had immunity that white Europeans who were in Napoleon’s army didn’t have. It led to Haitian independence. Also, if one thinks from the American point of view, this was what led to Napoleon’s decision to abandon projecting French power in the New World and therefore to agree, with Thomas Jefferson, in 1803, to the Louisiana Purchase, which doubled the size of the United States.

To flip it around, how often has the existence of these diseases gone hand in hand with political oppression or been used as an excuse for political oppression?
I think it has always been also seen as part of political oppression. I’m persuaded that the nineteenth century was a terrible time, not only of rebellion but also of political oppression. For example, the slaughter of people after the 1848 revolution in France, in Paris in particular, or after the Paris Commune. Part of the reason that this was so violent and sanguinary was that people who were in command saw that the working classes were dangerous politically, but they were also very dangerous medically. They had the very possibility of unleashing disasters on the full of society. I think that was really a part of this metaphor of the dangerous classes, and I think that led to, say, the inhumanity of the slaughter of 1871 after the Paris Commune had been put down.

What have you made of China’s response to this current coronavirus?
That’s a really interesting question to ask, and it’s one that I think we’re going to need to think about long and hard, because it has a number of aspects to it that are really complicated. The first thing is the strong-arm methods introduced by the Chinese on January 23rd, when they introduced cordon sanitaire, which is a wholesale quarantine by cordoning off with soldiers and policemen whole geographical areas and communities. In this case, in Wuhan, a city of some eleven million, and then the Hubei Province, which has almost sixty million people, they decided to impose a lockdown.
That is something which harkens back to plague measures and that has been repeated over and over, including in the Ebola epidemic. The problem with the cordon sanitaire is that it’s clumsy. It’s a sledgehammer. It arrives too late and it breaks down that fundamental element of public health, which is information. That is to say that, threatened with the lockdown, people don’t coöperate with authorities. Authorities therefore no longer know what’s going on and people take flight, which spreads the epidemic. I was very startled to see that this was the response of the Chinese government at the outset. It differs from the norms of public health, which have developed since the plague years, which stress case findings of individuals, then tracing and isolation.

So I was horrified and expected the worst. It turns out, I believe, that the regime slowly began to change course. One sees that, as time went on, the Chinese were very diligent about collecting records, trying to elicit the coöperation of the population, in a sense to repair the damage of the early days. I think it’s a story of more than one response. It wasn’t all bad, and not all good.

I don’t quite go along with the response of the W.H.O., which praised this as wonderful public health. That makes me fearful. Is that to say that other regimes and other countries where there are strongmen ought to impose lockdowns, as was tried with Ebola in West Africa, where it didn’t work? That terrifies me. I don’t think that’s the lesson. I think it’s the more nuanced approach, that probably it wasn’t working so well in China, and, indeed, Xi Jinping is willing to say, unlike the World Health Organization, oddly enough, that there were mistakes that were made and that they’d had to change course, and that they need to learn from those mistakes. I think that’s what China was able to do.

That’s interesting, because earlier you were saying that the World Health Organization, or at least members of it, was calling on people to find their common humanity, but at the same time you’re saying they’re also willing to praise a response that was, at least initially, somewhat inhumane.
Yes. I’m not justifying it, but I can say I can understand it, because it would be terrible to alienate the largest member of the World Health Assembly and to alienate a country that’s in the midst of this extraordinary crisis. So I can understand why it happened. At the same time, there’s been a great deal of stress on total honesty, producing evidence, communication, data-based, factual, scientific approaches to public health, and that is not what happened at the early stages of the Chinese response. It did come into play later on.

To move back in time a bit, are there broad themes in how artists have reacted to epidemics?
I think one of the things I’ve learned about epidemics is that each disease, as I see it, is like a person. Each one is an individual and different from any other. They aren’t just interchangeable causes of death. It depends on the nature of each individual, and how societies and artists react to them. It depends on how many people they kill, if they kill people in excruciating ways, if they kill children and the young, or if they leave orphans behind, or if they are familiar diseases or if they have come from outside.

In the case of plague, it stirs the problems of mortality and sudden death. Artists responded to this, particularly on the Continent. In Catholic countries, the main thrust was to see this as a reminder that this life is temporary and provisional. One sees a great attention to themes of suddenness of death, that is, the danse macabre, where everyone is swept away. Of course, the use of the hourglass, of bones, of vanitatem. You know, “Vanity of vanities, all is vanity, saith the Preacher.” There’s this enormous sense of that, and a sense also of a worship for plague saints, who were widely depicted. One can see this going across Europe—the cult of religiosity, the themes of sudden death, repentance, and getting your affairs and your soul in order before the plague might suddenly cut you off. It had a transformative effect on the iconography of European art.

You can see this even into the twentieth century with that wonderful film by Ingmar Bergman, “The Seventh Seal,” where the plague is a metaphor for what Bergman was worried about in 1957, which is nuclear war. One can see that it has all the things that I’ve been talking about with regard to the plague, including the danse macabre with which the film ends. You’d see paintings of the Grim Reaper coming, and it really is an example of the persistence of this artistic response to death.
Other diseases provoke different responses. One could talk about tuberculosis, and how different it was in the Romantic period, in the nineteenth century. That’s really an odd one, because, to me, tuberculosis is one of the most gruesome and painful ways to die, where, in the end, you asphyxiate, and yet, on the other hand, you’ll have it glorified with operatic heroines on the stage who are perceived as beautiful. Or “Uncle Tom’s Cabin,” which is not only about slavery. It’s also about tuberculosis.

Why was tuberculosis glorified?
I want to say something I hope will make you smile, but I would like to be able to give you a definitive answer to that. Human beings are funny creatures, aren’t they? Not all of the things that are done are easy to understand, but, with regard to plague, it was a disease that affected everyone. I think that’s critical. It was the end of the world, the final reckoning, the final apocalypse. With tuberculosis, on the other hand, people thought something that wasn’t true. They thought—and the medical doctrines of the early nineteenth century taught them this—that it was a disease of the élite, of the artist, of the beautiful, of the refined, and that it made people much more beautiful, so that fashion tried to turn women into tubercular creatures. You see Toulouse-Lautrec painting an anorexic-looking woman who’s putting rice powder on her face so that she’ll look pale like the tuberculosis people. The Pre-Raphaelites actually married their models, who were tuberculosis patients. Victor Hugo was told by his friends that he had one great fault as a writer, which was that he wasn’t tuberculous, and therefore he wouldn’t be as great a writer as he would have been otherwise.
There was an American thinker and writer about culture, Arthur C. Jacobson, who had the idea that America, at the end of the nineteenth century, as tuberculosis was beginning to recede, was going to face a crisis for the arts, the sciences, and culture, because there wouldn’t be geniuses anymore the way there had been in the time of tuberculosis.

That’s amazing.
I’m not a Luddite regarding science, but sciences sometimes have an undertow, and this is one of the undertows of the germ theory of disease. The germ theory actually helped to stigmatize the poor. TB, it insisted, was overwhelmingly not a disease of the beautiful classes but of the ugly classes who were filthy and poor. There, the whole interpretation changes. If you look at André Gide’s “The Immoralist,” in the early twentieth century, he regards his own case of tuberculosis as the most despicable, disgusting thing that could ever happen. The idea of a beautiful disease has disappeared forever, and tuberculosis is never that again.

Let’s end here: we may be seeing a response to an epidemic that combines tragedy and farce, as we saw a couple of days ago, where a bunch of health officials got up at the White House and decided to praise President Trump as well as talk about what was happening. Do you have any amusing stories from history of mad kings or crazy rulers dealing poorly or perhaps tragicomically with epidemics?
Well, yes. I’m not sure it’s exactly funny, but I think the reaction of Napoleon to the diseases that were destroying his rule were tragic and grotesque in a black-humor kind of way, where he doesn’t value the lives of his soldiers. He’s therefore able to talk about the coming of yellow fever in the West Indies as a personal insult.

I think that this is something that we might see yet again. It’s something that maybe you can laugh at. Maybe history is best seen as comedy in retrospect, but I don’t think what’s about to happen this next year with regard to this particular epidemic in the United States is going to be fun at all. To have officials in the White House saying, “Oh, it’s nothing more than the common cold, we’ve got it under control,” when they have nothing under control, as far as I can see, and they’ve put people in charge who don’t even believe in science.

Epidemics and solipsism are the two things that human nature can’t conquer.
I’m with you on that one.