People have been reacting poorly to epidemics for as long as there have been epidemics. In the Middle Ages, fear and ignorance drove many living in the path of bubonic plague to behave cruelly and irrationally, worsening an already unmitigated disaster.
There was much to be irrational about, as bubonic plague was a horrific disease. Once rats with plague-carrying fleas died, the fleas would seek other sources of food, including humans. As the fleas fed on their human hosts, they would leave plague bacteria, called Yersinia pestis, on the skin. After an incubation period of up to a week, a black blister would appear at the feeding site followed by high fever, nausea, and vomiting.
From the skin, Y. pestis invaded the lymphatic system and the lymph nodes, causing them to painfully swell and appear as “buboes” that might eventually erupt. All of the bodily secretions of plague victims smelled horribly, as if they had started to decompose before death. The exponentially dividing bacteria eventually spread to the blood, causing septicemia and the development of petechiae (purple spots beneath the skin), multiple organ failure and death.
Naturally, a populace terrified by the horrific loss of life surrounding them as they grasped for a sense of control often looked for a supernatural explanation, or someone or something to blame. Astrological explanations were popular when outbreaks were coincident with the appearance of a comet or planet (especially Mercury) in retrograde.
Believers in astrology also thought that some metals and precious stones like rubies and diamonds could serve as talismans to ward off disease. Lucky numbers provided others a sense of safety; the number four was popular as it was associated with many known groupings, such as the four humors, the four temperaments, the four winds, seasons, etc.
As Christianity was well-established in Europe by the Middle Ages, Jews were often the preferred target of blame. The domestic and spiritual separation of Jews from the majority Christian population made them the usual suspects when plague-driven mobs needed a scapegoat.
As Joshua Loomis explains in Epidemics: The Impact of Germs and Their Power Over Humanity, in the fourteenth century tens of thousands of Jews were accused of poisoning “wells, rivers, and lakes throughout Europe in an effort to kill Christians. Many were arrested and subjected to various forms of torture in order to force confession of their crimes.” Once “proven” guilty by forced confession, they were either given the choice of conversion or death, or given no choice at all and simply burned at the stake.
In addition to targeting Jews, people that lived during plague epidemics often believed that that being stricken with the plague was a sign of God’s wrath against sinful behavior. Prostitutes, foreigners, religious dissenters, and witches—anyone who could be labeled as ‘other’—were attacked, cast out, stoned, lynched or burned. Those lucky enough to survive the Black Death were forced into compliance and silence, lest they also become targets of hysterical mobs.
To appease the wrath of God, one group of especially pious individuals called the Flagellants marched throughout Europe in the fourteenth and fifteenth centuries. Their vow of piety included a promise to not bathe, change clothes, or talk with members of the opposite sex during their journeys. As indisputable proof of their piety, as they marched they “whipped their own backs with leather thongs tipped with iron until their blood flowed, all the while chanting penitential verses, “ Frank Snowden writes in Epidemics and Society: From the Black Death to the Present. “Some marchers bore heavy wooden crosses in memory of Christ; others beat their fellows as well as themselves, and many knelt periodically in public humiliation.”
Wherever the Flagellants traveled, persecution of ‘undesirables’ also increased, as mobs were often inspired by their presence. Unfortunately, their movements also may have helped spread the plague throughout Europe, and rather fortunately, the Flagellant movement died out by the end of the fifteenth century.
One of the first places where quarantine strategies to combat plague were enacted was Venice in the fifteenth century. Venice was a trading powerhouse city-state during that time, with ships arriving from all corners of the known world, some of them inevitably transporting plague-carrying rats. Although authorities in Venice were hoping to prevent miasma spreading from contaminated ships to their city, some of their mitigation strategies were inadvertently effective.
Venetians were the first to quarantine ships, cargo, and passengers for forty days while the ships and cargo were scrubbed and fumigated. In reality, this time period exceed the incubation period of Y. pestis and likely allowed all plague-carrying rats and fleas to die off. As a result of this limited success, quarantining became a normal procedure in many other European ports.
Individuals forced to quarantine were often taken to Lazarettos, or pesthouses, which were considered death houses where bodies were thrown into mass graves or burned on funeral pyres. Pesthouses were often surrounded by a pall of smoke and a dreadful stench of burning bodies. City inspectors searched houses and condemned exposed individuals to the death houses, causing terror and hostility among Venetians.
Some inspectors threatened healthy people with confinement if they didn’t pay bribes, and assaulted others and stole their possessions. These abuses were tolerated by authorities, as they themselves were often tempted to send their inspectors to harass and punish their enemies, increasing their control over a largely cowed populace.
Medieval physicians during the time of the Black Death often donned Plague Doctor attire, a “protective” suit consisting of a wide-brimmed hat, a mask with a bird-like beak containing aromatic herbs protecting the wearer from dangerous odors, and a rod to prod patients without directly contacting them. Some Plague Doctors also carried a brazier of burning coal to purify the miasmatic air surrounding them. If an examined individual was deemed to be stricken, he would be carried off to die in a pesthouse, as most Medieval medical treatments provided no help.
By the eighteenth century, plague epidemics began to wane in Europe, and in addition to a cooling climate, a major factor in this recession may have been the arrival of the brown rat via trading ships from the East. The large brown rat quickly replaced the smaller black rat throughout Europe, and this displacement is remarkable for plague epidemiology because the brown rat was much more wary of people than the black rat, which was more comfortable around humans and sometimes even kept as family pets. The natural social distancing of brown rat behavior likely changed the ecology of plague transmission, as places where the brown rat completely displaced the black rat saw the most significant decreases in future plague epidemics. In contrast, wherever the black rat remained, as in India, plague outbreaks continued until the end of the nineteenth century.
Yet antiplague measures forced on the Indian population by British colonial authorities were neither understood nor appreciated, and often resulted in violent protests and large scale evacuations. Many residents of crowded cities such as Bombay (now Mumbai) were driven out not by fear of the disease, but by the heavy-handed measures dictated by the British, resulting in increased spread of the plague to other cities.
The clear disparities in plague outcomes between the Indian population and the British colonials, rather than being seen as a result in differences in standards of living, were instead seen by many colonials as confirmation of their racial superiority and provided support for continued policies of segregation, by keeping the natives safely at arms-length. However, compulsive measures were abandoned by the British when the Indian Plague Commission of 1898 concluded that stringent and coercive government policies had completely and utterly failed, both in their attempts to contain the disease and by also causing tremendous and costly collateral damage.
Even though harsh mitigation measures were largely ineffective in response to the plague, many have continued to believe their utility, especially government officials unable to resist the enormous temptation to claim similar powers during epidemics or other crises, as Frank Snowden writes:
When new, virulent, and poorly understood epidemic diseases emerged, such as cholera and HIV/AIDS, the first reaction was to turn to the same defenses that appeared to have worked so effectively against plague. It was unfortunate that antiplague measures, however successfully deployed against bubonic plague, proved to be useless or even counterproductive when used against infections with profoundly different modes of transmission. In this manner the plague regulations established a style of public health that remained a permanent temptation, partly because they were thought to have worked in the past and because, in a time of uncertainty and fear, they provided the reassuring sense of being able to do something. In addition, they conferred upon authorities the legitimating appearance of acting resolutely, knowledgeably, and in accord with precedent.
The “reassuring sense of being able to do something” might also be called “pandemic theater”, or the “Appearance of Safety”. Snowden then concludes:
Plague restrictions also cast a long shadow over political history. They marked a vast extension of state power into spheres of human life that had never before been subject to political authority. One reason for the temptation in later periods to resort to plague regulations was precisely that they provided justification for the extension of power, whether invoked against plague or, later, against cholera and other disease. They justified control over the economy and movement of people; they authorized surveillance and forcible detention; and they sanctioned the invasion of homes and the extinction of civil liberties.
In other words, we can see the long arm of history reaching from the times of the Black Death to modern epidemics, where coercion and state control are accepted by a terrified public and conveniently deemed by a power-hungry elite to be the only acceptable way to combat natural disasters, even at the risk of tremendous and unnecessary collateral damage. The disastrous response of many countries to the COVID-19 pandemic is merely the latest reminder that increased power during times of crisis will always tempt leaders, and that this temptation must not be left unchallenged by free people.