By Dieter Buse
The COVID-19 pandemic might be a new one for human civilization, but it is certainly not the first time a disease has swept through society, leaving death and misery in its wake.
Over the centuries, society has learned valuable lessons about fighting pandemics, lessons that still inform how we manage disease outbreaks today.
So what important lessons has humanity learned? Here are three gleaned from three major outbreaks: cholera in Europe in the 19th century; plague in Europe in the Middle Ages, and; the flu epidemic (so-called Spanish Flu, but perhaps more accurately called Kansas Flu, if we’re going to continue to be reductive) of the early 20th century.
Scourge of cholera
As a social historian, I made senior students read Richard Evans, Death in Hamburg: Society and Politics in the Cholera Era 1830-1910. The book provides a detailed account about why a supposedly modern city had nearly 10,000 people die from cholera during six weeks in 1892.
Hamburg was then known, as was its sister city Bremen, for building the most modern and largest ocean-going ships in the world. Both cities transported emigrants from central and eastern Europe to much of the world.
In trade of items such as coffee, sugar, cotton, rice and timber, they were among the world’s foremost trans-shipping centres. Yet, Bremen had only six deaths from cholera in the same year.
London, and many other cities had repeated outbreaks of cholera from the 1830s through the1850s. London had about 7,000 deaths during its last major outbreak in 1857. After that, London rebuilt its sewer and water systems, as did Bremen in the 1870s.
Evans summarized why the cholera crisis became a catastrophe in Hamburg.
First was the overcrowding, poverty and malnutrition. Hamburg’s slum areas had 23 persons to a dwelling, Bremen eight.
So once a disease started, it spread very quickly in Hamburg. Second, there was the lack of a water filtration system. Third, and here is one lesson for the present, for fear of stopping trade and commerce, the Hamburg authorities tried to deny, conceal and delay. Bremen leaders, by contrast, accepted the new science of bacteriology and isolated or quarantined immediately. To stop the disease entering the city, they set up control points by medical authorities at the cities’ boundaries.
Thus, a short answer to the different cholera experiences lies in the Hamburg slum landlords refusing to pay the taxes required to put an effective sewer and water system in place. Unfiltered water taken from the Elbe River passed directly into the water supply.
Further, when the original outbreak occurred, city officials refused to acknowledge the seriousness of the crisis and they delayed quarantining the ill. Even in Canada cholera was a recurring problem if water became contaminated, with the most fatal case being in Montreal in 1832. The type of bacillus involved was not clarified until an outbreak in Hong Kong in 1894.
In Montreal, the authorities acted similar to in Hamburg: too late and too lax. That’s a lesson.
The great, unending plague
If we go back to the great plague of the 14th century, it still has lessons for disease crises. I do not mean the odd-shaped masks used to ward off bad airs, or the supposed cure of having a billy goat in your main room to fight the disease by smell. Instead, I mean the fact that the pestilence kept recurring and that it impacted more on the poor than the rich.
The first two years, 1347 to 1349 (known as the Plague Years when it started in Italy but spread to nearly all of Europe), may have killed off a third of Europe’s population. However, the disease kept returning. For example, England had sporadic outbreaks throughout the 14th to 16th centuries.
Its worst wave was in the 1660s. In 1665, England had its last main outbreak with the following death toll: May: 43; June: 6,137; July: 17,036, and; August: 31,159. At least 15 per cent of the population died.
In Vienna during 1679 alone 76,000 died. France had some of its worst but last outbreaks in the 1720s.
When my daughter and I were hiking in southern France, we saw at the little village of Carbriole d’Avignon the remnants of the mur de pest (wall against plague) from 1732, built to defend Marseille from travelers thought likely to bear the disease. Marseilles saw about 100,000 victims in the 1720s.
The plague had been in Roman Europe during the 6th century and seems to have cycled back six or seven centuries later. Diseases based in viruses, as the great historian William McNeill pointed out in Plagues and Peoples, take a long time to run their course and perhaps longer for an immunity to be built up in the populace.
The lesson from the great plague is patience and vigilance: diseases return.
The so-called Spanish flu
The flu epidemic that hit Europe toward the end of the First World War has been misnamed the Spanish flu. It was given that name because information about it first came from Spain, a neutral country with less censorship than the warring states.
The disease possibly came from China, but probably from Kansas. American troops going to fight in Europe during 1917 definitely had it and spread it as they went through the ports of France. For example, Etaples had more than 100,000 soldiers from the Allies pass through in a year. That port also had crowded hospitals and was one of the main places through which the injured went to England. The disease spread quickly and catastrophically as troops were demobilized.
The main lesson of this pandemic was that stopping quarantine too soon meant a recurrence and in many places that recurrence operated with a greater vengeance than the first phase. That seems not to have been the case locally.
The flu epidemic came suddenly to Sudbury. During late 1917 and early 1918 focus was on a smallpox outbreak. City council discussions about compulsory vaccination, demanded by the medical health officer, continued during September 1918.
When the flu came to Canada, the Sudbury authorities insisted that all was fine locally even if other centres were already affected. Then, suddenly on 9 October, 1918, the Sudbury Star reported “Spanish Flu Invades Sudbury.”
Schools and public places were closed. By 19 October, the paper asserted “Influenza worse than Hun [German] bullets.” By 30 October, the paper stated there were 998 cases. Eventually more than sixty died.
On 11 November, the ban on public meetings was lifted. However, new cases appeared with some 30 dying in mid-December at the Burwash prison farm where many socalled “aliens” were imprisoned.
In all the above cases, there were other aspects that I have not detailed but from which we could learn: in many instances the rich fled; the poor suffered most; those serving in the medical or public health systems were gravely overworked, and; it became commonplace to blame “foreigners” as the source and cause of the spread.
In all cases, the denial of a disease’s significance, the lateness in taking action, the slowness to pin down who has it make it worse.
There’s a lesson in that, too.
Dr. Dieter K. Buse is Professor Emeritus, History, Laurentian University. He has published many studies on modern European history and more recently on our region, including Come on Over: Northeastern Ontario (co-authored with Graeme S. Mount) and the two volume work, Untold: Northeastern Ontario’s Military Past vol. 1: 1662-World War I and vol. 2: World War II-Peacekeeping (available from Latitude 46, Sudbury).
