Without smallpox, the course of history would be drastically different. Native Americans would have been much more capable of preserving themselves and their lands, slaves would not have been as necessary in the Americas, the Revolutionary War would have gone differently, and European colonial settlements as a whole would have taken on a different appearance.

Surely, Native Americans were devastated by use of firearms and other weapons, but disease was likewise destructive to the Amerindians. Having never experienced diseases such as smallpox, their bodies had not yet developed a method of dealing with the disease when it arrived along with the Europeans in the 1400s and beyond. Hence, their numbers dwindled as Europeans presence spread further and further westward. As Amerindians died in large numbers and their communities perished, Europeans became aware that they would require labor from other peoples, since Amerindians could not withstand the diseases and conditions.

Thus, Europeans looked towards the Africans in what became the slave trade. Having experienced tropical conditions as well as diseases such as smallpox, they were better able to withstand the diseases brought over to the new world on European ships (smallpox ppt, slide 17). Herein, Africans’ ability to effectively deal with disease actually hurt them in the long run, as they became the chosen ones for some of the most atrocious, inexcusable treatment in mankind’s history.

Smallpox would continue to be a problem as the Revolutionary War approached, as well. General George Washington, suspecting that the British would eventually use the disease as a weapon, wanted his Continental Army to be inoculated (slides 95 and 96). Its devastating effects on the troops even hindered the United States from capturing Canada in 1776 (slide 96).

Each of these effects describe periods temporally distant from each other. The introduction of smallpox to the Americas did not occur until very late in the 1400s and early 1500s. The ensuing use of Africans began soon thereafter, but did not reach its climax until centuries later. Additionally, the Revolutionary War did not begin until 1775. Thus, it is clear that smallpox had effects in the Americas and Africa lasting centuries. Such long-lasting, enduring effects are hard to ignore; without this disease, it is clear that history would have looked drastically different. Just as one cannot study European history without considering the role of religion, one cannot study American history (as well as the history of many other countries) without considering the role of disease.

The bacterium Yersinia pestis (Y. pestis) was responsible for the Justinian Plague, Black Death, and the Modern/Bubonic Plague (Plague History PPT, slide 3). The plague-causing bacterium is carried by fleas, who carry the bacterium to rats. When the rat dies, if no other rats are readily available, the flea finds a human to which it transmits the infection via biting and vomiting (slides 4 and 9).

Societal factors contributed to the virulence of these plagues. For example, the increased crowding of people throughout time led to the increased ability for air borne transmission; the plagues were much more fatal when pneumonic than septicemic (slide 12). Additionally, expanding trade networks linked cultures together like never before, further enabling the spread of the disease from country to country (slide 34). With ~100 million Eurasian deaths, there were also mounds of rotting cadavers due to the inability to bury such a large number of bodies (slide 38).

Fear over the highly lethal outbreaks led to an equally sized outbreak of blame. Such blame was largely targeted towards the Jews, who were occasionally massacred (slide 40). In a more practical attempt to control the transmission of plague, however, quarantine was introduced in 1377; 40 days was chosen for a number of reasons, to include biblical explanations, Hippocratic theories, and mathematical justifications (slide 43). Networks of spies were also introduced in order to provide an intelligence surveillance system (slide 44). Plague hospitals were also developed, wherein the sick were isolated and confined (slide 45). Western cultures more-so blamed poor sanitation for the plague, and thus isolated victims as well as their contacts, burned clothing and cadavers, and even fumigated houses/slums (slide 60). In Hawaii, any buildings suspected of containing a source of the disease was to be burned by order of the Board of Health (slide 61). Immigrants lost personal freedom, having been forced into quarantine and even forced to receive experimental vaccines (slide 68).

Today, more is known about plague transmission, to include its tendency to be spread from one non-human species to another, before it is in turn transmitted to humans. Additionally, it is likewise known that these transmission from one species to another are more common in cooler summers that follow wet winters (Plague Today, slide 12). Moreover, transmission in the U.S. is commonly through flea bites, contact with contaminated fluid or tissue, and infectious droplets (slides 17-19). Household pets (dogs, cats, etc.) can also serve as middle-men in the transmission from urban/rural species to humans (slides 13, 17, and 20).

The most recent resurgence of plague was in Madagascar after 2009, where there are 300-600 cases per year. This is largely the result of political upheaval and financial cutting of basic government services. This has led to millions of people in poverty, the closure of hundreds of health clinics, lack of funding for clean water and infrastructure, poor hygiene, and the accumulation of trash in the streets (which in turn led to increased numbers of rats) (slide 29). Additionally, although plague victims are to be buried immediately near a city hospital, many families in Madagascar unbury their loved ones to bury them in their villages. Other families also decide not to bring their loved ones to hospitals at all in order to keep them from being buried by health care officials. Moreover, the lack of health care facilities has led to the rise in traditional healers, who use hand mirrors which allow the healers to receive advice from ancestors. Such traditional healers have at times used spit as treatment for their patients (slide 31). Also, villages typically keep their animals (cattle, chickens, etc.) and crops in their homes, which gives rise to rats and fleas (slide 32).

Throughout history, it has become quite clear that human behavior and decisions impact the rise and spread of disease. Harmful cultural traditions, inept necessary funding, poor sanitation, lack of education, and pseudoscience (e.g., anti-vaccinationists) continue to harm the well-being and safety of communities and the world at large. Failure to pay attention to past events, such as historic plagues, as well as the present, such as in Madagascar, bars us from important, useful information.

Diseases have not remained the same throughout time – new strands have emerged, diseases have exited and then returned, and even entirely new diseases have emerged for the first time. This plays an important, ongoing role for researchers and health care workers alike to find, quickly but correctly, proper diagnosis and treatment. Without such continued monitoring, infectious diseases can spread to an extent that may become hard to manage by the time health care workers catch on to the presence of an emerging or re-emerging disease.

Clearly, it would be easier for us all if diseases did remain the same throughout history; vaccines would be more effective, science would have more time/resources to place on modern issues rather than trying to accurately predict the future, etc. However, with the diverse world we live in, combined with the ability of viruses, bacteria. fungi, and bacteria to change and mutate, it is not entirely surprising that this is not the case. Earth consists of many different environments: dry, tropical, hot, cold, forests, marine, etc. There are also many different species, each coming with its own capacity to host viruses, bacteria, etc.: chimpanzee, chicken, bird, cow, lizard, pig, rabbit, and the list goes on. Zoonotic diseases, or diseases that begin in these animal species before ‘spilling over’ to humans, account for some of the worst historic as well as modern diseases: Herpes, Nipah, Rabies, etc. (Killer Viruses PPT and film notes).

With the nature already considered, that is not to leave humans, socially and culturally, off the hook. Outbreaks can be exacerbated drastically by human behavior and decision-making (or lack thereof). For instance, the presence of ‘anti-vaccinationists’ poses a threat to everyone else, involved with the crowd or not. Believing there are risks of vaccination that outweigh the benefits, anti-vaccinationists choose to avoid vaccinations, thus increasing their chance of contracting a given disease.

Additionally, an ‘outbreak culture’ has been seen to emerge after outbreaks, “driven by multiple factors, from political motivation and life-threatening fear to personal gain and isolation. Behaviors as a result of outbreak culture can lead to confusion, collusion, and culpability amid an already chaotic situation” (outbreak culture article). This has hindered response efforts towards AIDS in the 1980s, SARS in 2002, the avian flu in 2006, and Zika. As for Ebola, in 2015, nearly all Ebola responders who were surveyed “mentioned that political and interpersonal challenges at times slowed their responses. Many said they feared the politics more than the virus. More than a quarter reported either witnessing, hearing about, or falling victim to illegal or unethical tactics while responding to the outbreak” (outbreak culture article).

Moreover, the increased globalization likewise poses a serious risk for increased transmission. Compared to the 1970s, modern planes now hold nearly 10 times more passengers (Is America Ready for the Next Pandemic article), with many of them coming from and going to different areas. This leads to the rapid spread of what could have once been a local infection to a multi-area infection. On a grand scale, this could be one of the biggest factors underlying a potential pandemic. Thus, regardless of how prepared we may believe ourselves to be, there are numerous factors that could hinder our ability to effectively manage a pandemic, should one arise. In fact, as The Atlantic writes in an article, The Next Plague Is Coming. Is America Ready?, “Yet just 10 years ago, the virus that the world is most prepared for caught almost everyone off guard. In the early 2000s, the CDC was focused mostly on Asia, where H5N1—the type of flu deemed most likely to cause the next pandemic—was running wild among poultry and waterfowl. But while experts fretted about H5N1 in birds in the East, new strains of H1N1 were evolving within pigs in the West. One of those swine strains jumped into humans in Mexico, launching outbreaks there and in the U.S. in early 2009.”

Thus, with all of this being said, to effectively react to a pandemic, it would require rapid detection, diagnosis, treatment, research, wise human behavior (i.e., vaccines), and limited interactions between infected and uninfected individuals. Moreover, outbreak culture would have to be kept under control. To do so would require “a deliberate choice that is thoughtfully implemented, governed by core principles, and guided by realism, honesty, transparency, and accountability. It requires eliminating the middle-man and sometimes intentional barriers that impede the organization and collaboration needed to quell an outbreak” (outbreak culture article) – policy that is not currently in place.

Surely, maintaining a hunting and gathering lifestyle had its consequences – you did not get to return to your comfortable bed, located at the same place each time, to take lazy naps every day; you did not get to pet your luscious dog upon returning home from school; and you did not have the same stationary village to return to every day where you would play ding dong ditch. Rather, you had to be on the move all of the time, searching for water as well as food in the form of wild animals (Sedentary PPT, slide 9). Additionally, this on-the-move lifestyle made it difficult to rear children, thus limiting the number of children people typically had. However, such a lifestyle had its benefits. In regard to epidemics, such an on-the-move, spaced out, limited population society hindered the ability of infections to spread and plagues to develop.
Thus, when the agricultural revolution and domestication of animals set in, and people were thus able to remain sedentary/stationary, populations grew, and infections likewise were able to spread more rapidly. Domestic animals living with the villagers attracted numerous kinds of disease-carrying insects, and their feces did not help either. Moreover, people used the same water supply as the animals (Sedentary PPT, slide 21). The development of agriculture also led to many people consuming a limited diet focused on a single crop, which led to numerous infections (slide 20). All of these conditions led to the development of infections, but the widespread spread, and eventual development of plagues, was largely a result of the large, dense population that was continuing to grow. Such infections that required dense populations include smallpox, influenza, malaria, plague, etc. (slide 24).
Population density continues to be, and always will be, a factor that increases the development of infectious disease. However, factors that have only recently become problems include current technologies, human interventions, and societal issues. For example, climate change has led to considerable changes in human health as well as infectious diseases, specifically. Diseases transmissible from animals to humans can flourish when climates worsen animals’ ability to handle them (Globalization, Climate Change, and Human Health assignment). Moreover, climate change can aid mosquitos’ survival, thus leading to increased vulnerability to many diseases, to include Rift for example. With warming coastal waters has come increased coastal outbreaks of cholera (Globalization, Climate Change, and Human Health, p. 1340). Additionally, globalization through channels such as trade also increases transmission by increasing contact with foreign peoples and goods.
In regard to societal issues, incoming inequality and poor city infrastructure has led to a surge in incidences of disease, particularly among the poor (American Epidemic article). The less financially stable often have less access to quality health care, thus limiting their ability to detect and treat infections. Likewise, substance abuse has continued to rise in the United States over the years, as has the number of elderly, who are more vulnerable to disease. The crisis of anti-vaccination has also led to an increased spread of disease, as well.
Improper use of military technology has also sadly spread diseases around the globe (Diseases and Famine as Weapons of War article). In Yemen, for example, the bombing of water treatment facilities and medical facilities has led to the use of disease as a weapon, i.e. bioterrorism. Such activities are prohibited by numerous universal laws, including the Geneva Convention, but the behaviors still occur, nonetheless.
Thus, in all, numerous factors have played a role in the development and spread of plagues throughout history. Upon analyzing such factors, it is quickly apparent that many are controllable by society, at least to an extent. Simple sanitation, attention to climate change, and eradicating bioterrorism – a form of warfare that should not even be considered by governments, due not only to its illegality, but also its unethical nature – would lead to drastic changes in the spread of plagues.