Source of book:
borrowed from the library
I should
mention at the outset that this book has some overlap with other books I have
read. Sweetness and Power
by Sidney Mintz is about the rise of the sugar industry, and its
connection to slavery and disease. The Ghost Map by
Steven Johnson is about the cholera epidemic that led to the
creation of the London sewers. And finally, The Mosquito by
Timothy Winegard is all about malaria and yellow fever, the most
deadly of mosquito-borne plagues.
This is not to
say that Pathogenesis is just a duplication. Rather, so many things are
connected that any book that addresses one subject is bound to bleed over into
other related fields. Pathogenesis takes a more sweeping look at the
great pandemics that affected human history, rather than focusing on a single
one. It makes largely the same argument as The Mosquito that pathogens
have had a greater impact on human history than they are usually given credit
for - and that they in fact determined history far more than the “great men” or
even technology.
To give an idea
of the scope of the book, it starts with Paleolithic plagues - the diseases
that effected hominid evolution and interbreeding at the origin of our species.
It moves on to Neolithic plagues, ancient plagues, Medieval plagues, colonial
plagues, revolutionary plagues, industrial plagues, and finally the modern
plagues of poverty. Yeah, that’s quite a scope, and makes for a fascinating
book.
As with most
non-fiction I read, attempting even a summary is impossible, and would at best
be a pale imitation of the book itself. As I always do, I encourage readers of
my blog to put this book on their list and read it for themselves.
The book starts
off with a discussion of microbes themselves, and how they were essential to
the rise of higher life forms. It is a great summary of current knowledge about
biological evolution and the history of life on our planet. I decided to quote
the opening at length, though, because it is quite a tour-de-force.
According to Sigmund Freud, there have
been three great revolutions in Western science and each of these dealt a blow
to humans’ belief in their special status - or what he referred to as our
“naive self-love.” The first, which began with Copernicus, was the revelation
that the earth is not the center of the universe but just one of several
planets revolving around the sun. After this setback, we could still console
ourselves with the Book of Genesis’ claim that God created humans in his
own image and gave us dominion over the land, sea and animals - albeit in a
location that was astronomically peripheral. Then Charles Darwin came along and
pointed out that humans are just another species of animal and that we share a
relatively recent common ancestor with apes. The third great scientific
revolution, according to Freud, was his own discovery of the unconscious. The
realization that we aren’t even in control of our thought processes was, he
argued, the “most irritating insult” to “the human mania of greatness.”
Freud’s suggestion that psychoanalysis
is more significant than the Copernican or Darwinian revolutions seems a
little, well, egotistic. But his general point - that the more humans learn
about the world, the more insignificant we realize we are - is insightful. For
example, advanced telescopes have revealed that earth is an infinitesimally
small rock rotating around an unremarkable star in a galaxy of at least 100
billion stars, which itself is just one of many billions of galaxies in the
universe. In addition to this, there have been other scientific revolutions
that have further undermined our species’ high opinion of itself. To my mind,
the most important of these is the discovery of a world as vast as outer space,
and yet so tiny that it is invisible to the naked eye: the realm of bacteria,
viruses, and other microbes.
The discussion
of the Tree of Life - the branches of life forms - is also interesting. All
higher forms are eukaryotes, but eukaryotes form less than 0.001 percent of all
species on earth. That’s pretty wild. Also crazy is that by total weight,
bacteria are 35 times that of all the animals on the planet.
And that is
before you even get to viruses, which may or may not be alive. And they
outnumber even bacteria. A liter of seawater contains over 100 billion virus
particles. That’s insane. Fortunately, only a couple hundred viruses are
capable of infecting humans. Most infect bacteria and keep their numbers under
control.
It is just
mentioned in passing, but the book also references the fact that many of our
functional genes came from viral infections somewhere in our evolutionary
history. For example, the ability to form memories requires a gene that was
inherited from a retrovirus infection around 400 million years ago - that’s a
long while back, about twice as old as the dinosaurs.
Another
retrovirus infection enabled mammals to gestate live young. The placenta is a
unique interface, like nothing else in our bodies. But the genes responsible
are almost identical to the one retroviruses use to attach to cells - another
interface. Without this gene, we would be laying eggs.
Regarding
Paleolithic plagues, I just wanted to mention that there were multiple species
of hominids that evolved around the world. (Although the common ancestor came
from Africa.) For a number of years, these hominids interbred with Homo
sapiens, but then died out. The evidence is increasingly strong that it was
a series of plagues which caused this, rather than intentional genocide.
There are a lot
of fascinating and relatively unknown historical facts in the chapter on
Neolithic plagues. For example, the identity of the people who built
Stonehenge. (Spoiler: they were immigrants.) In addition to comparing
Stonehenge to the queen and fish-and-chips as British icons, the author notes
that none of these supposedly “English” icons were actually…English.
Immigrants from what is now Turkey built Stonehenge, the British monarchy is
actually from Germany, and battered cod was introduced to England by Jewish
refugees in the 16th century.
And it isn’t
just England. This is the history of humanity.
While the tale of Stonehenge is
specific to the small corner of the world that I inhabit, it illustrates a more
general phenomenon. Prehistory was punctuated by massive waves of migration
that resulted in a new population moving into a region and almost completely
wiping out the previous inhabitants. Nearly always, the migrants were
unwittingly aided by an invisible but devastating weapon of mass destruction:
infectious diseases to which they were to some extent immune but to which
original communities had little or no resistance.
Perhaps this
history is at the heart of our subconscious memories, and drives the lizard
brain part of ourselves in the direction of xenophobia. Of course, now the
world has changed, and this dynamic is no longer accurate. Few places on earth
are isolated, meaning that all of us have been exposed now to the same disease.
No one population can evolve defenses that others do not have, and no disease
is limited by geography to the extent that they used to be. And any modern
plague (see: Covid) can be rapidly spread around the globe without mass
migration. It isn’t the immigrants spreading the disease: it’s the
tourists.
Also
fascinating is the genetic history of Europeans. Just like “white” isn’t a
thing from a scientific point of view, but a social construct invented to
perpetuate social hierarchies, there is no “European” original. Three specific
waves of immigrants interbred.
The implications of this are momentous:
contemporary Europeans are neither genetically “pure” nor are they the region’s
indigenous people. Even white Europeans are mongrel immigrants.
Moving on to
ancient plagues, the book makes an argument that the waves of plague that
burned through the Roman empire in the 2nd and 3rd centuries was a significant
factor in the rise and spread of Christianity.
The Christian faith skyrocketed because
it provided a more appealing and assuring guide to life and death than paganism
during the devastating pandemics that struck the Roman Empire in the second and
third centuries CE…One major point of difference between the old and new faith
was the issue of what happens when we die. Jesus promised everlasting life in
paradise, whereas “pagans believed in an unattractive existence in the
underworld.”
Also going
along with this was the fact that early Christians believed caring for the sick
was a crucial part of their religious practice, which was a stark contrast to
the wealthy Romans who fled to the countryside.
I have been
thinking about this a lot lately. More than anything, the reason Christianity
is in decline in the West is that the version we have doesn’t even resemble the
original. It looks more like the entitled Romans leaving everyone else to
perish and suffer alone than a faith that cares for others. Like paganism then,
today’s pale imitation of Christianity is unsatisfying for our situation - it
brings no answers and no hope to the problems of our world, instead dishing out
blame and condemnation to those who are the oppressed and marginalized of our
time.
The chapter on
Medieval plagues covered mostly ideas I was familiar with - the depopulation of
Europe led to both the Protestant Reformation and the end of Feudalism (and
thus the rise of Capitalism in England) - it’s interesting stuff, of course,
and the author ties it all together well.
There is a
fascinating quote that opens the chapter on colonial plagues, by Alfred Crosby.
“European imperialists were egomaniacal
about themselves, their religions, and their customs, and they had short
tempers and long swords, but why were they so much more successful in the
Americas and the Pacific than in Asia or Africa?”
Why indeed? In
fact, it was because in the Americas and the Pacific, Europeans had the
advantage of microbes that gutted the indigenous populations. The same was not
true in Africa or Asia – in fact, the opposite was true: Europeans lacked
resistance to the local diseases. The more I explore of the Southwest, the more
obvious it is that the Americas were home to vast civilizations, with
population densities close to that of Europe at the time, plenty of technology
(if not quite at the level of weaponry - but bows are plenty effective), and
functional government.
So why did they
lose to a handful of Europeans?
A modern-day equivalent might be a
right-wing U.S. militia or band of English football hooligans making their way
to Moscow, kidnapping and killing Vladimir Putin, seizing Russia’s oil and gas
reserves and then declaring the territory a colony, which their descendants go
on to dominate for centuries. The Spanish conquests were so remarkable that
they have proved hard to explain without resorting to miracles (the
pre-eminence of the Christian God) or racism (the innate superiority of
Europeans.) And although both explanations are clearly flawed, they still,
consciously or subconsciously, shape the way that many people understand the
creation of modern Latin America.
The author goes
on to push back at Jared Diamond’s book, Guns, Germs and Steel for
giving far too much credit to the first and last of those factors. As part of
his argument, the author notes that the book dates to the 1990s, before the US
had its ass handed to it in Afghanistan - and there is no doubt that our
weaponry is even more of an advantage than the muskets and horses of the
Spaniards. And, our GDP advantage is far more overwhelming as well. After 20
years of occupation (such as it was), the Taliban went right back into power
after our withdrawal. So, guns and steel aren’t that decisive, are they?
Instead, it was
the germs. Nothing like most of your population dead or gravely ill to make a
war go badly.
The chapter on
revolutionary plagues doesn’t just discuss the American revolution and the role
that malaria played in that conflict; it also takes a detailed look at Haiti.
In the author’s view, the successful rebellion of Haitian slaves changed the
course of the slave trade. Sure, Wilberforce and others advocated for its
abolition, but without Haiti, we might still be a slave nation.
It isn’t a coincidence that Britain
banned the Atlantic slave trade in 1807, three years after Haiti declared
independence. At the time, this move wasn’t seen as a first step toward the
abolition of slavery; rather it was an attempt to preserve the institution. The
British hoped that banning the trade in human beings would cut off the cheap
supply of African labor and force plantation owners to take better care of
“their property,” thereby reducing the risk of rebellions spreading from Haiti
to other colonies in the region. This strategy failed…The story of Haiti serves
as a vital corrective to the self-congratulatory narrative that I was taught at
school, which emphasized the role of William Wilberforce, the enlightened white
savior. Enslaved Africans played a crucial role in winning their own freedom by
making the risk of another Haiti too much for the British government to
bear.
Oh, and germs?
Well, the fact that the French troops sent to Haiti succumbed in large numbers
to Malaria, to which they had no resistance, was decisive. The Haitian
revolutionaries knew this, and kept drawing the soldiers to the swamps, and let
the bugs do the rest.
Moving forward
to the Industrial Revolution, when populations began to move to the cities in
response to changing job availability in rural areas, new diseases began to
decimate them. These were caused less by mosquitoes and fleas, and more by shit
getting mixed in with the water. What is frustrating in retrospect is that it
took so long for the necessary infrastructure to be built. The lessons from
that era seem ominous for today’s America, for the same reasons.
It was not lack of technology or money
that stopped society from dealing with the deadly unsanitary conditions in
working-class neighborhoods of provincial towns and cities; rather it was the
absence of political will. Providing sanitation and clean water to the masses
is an enormously expensive undertaking, but one that delivers huge long-term
economic and non-economic benefits. Such projects are not viable for private
companies motivated by short-term returns on investment, so the problem of
sanitation can’t be solved by the invisible hand of the market. Instead, it is
imperative that the state steps in, at the very least to coordinate.
Unfortunately, local and national governments in the nineteenth century were
beholden to the parochial interests of small business owners who voted for
politicians promising to keep taxes low, and in spite of recurrent cholera
outbreaks local leaders refused to invest in preventative health
infrastructure. In the second half of the nineteenth century the political
context changed once again, moving in a direction that made sanitary reform not
only possible but desirable for municipal authorities to undertake.
Today’s right
wing is absolutely allergic to government that benefits everyone - to them,
government is to protect the rich from the wrath of the poor. And so, we have
let our infrastructure crumble so as to keep the taxes of the obscenely wealthy
low. And don’t even think of expanding our health infrastructure through, say,
universal health care or environmental regulation.
Contrary to the
doctrine of the right, private enterprise is not going to do that. Education,
health care, and more become privileges of the rich when left to the private
sector. Which is probably the point - particularly to re-segregate our nation
by race and socioeconomic status.
The author gets
into this a lot more in the final chapter, on plagues of poverty. His native
Britain has its own issues, as he points out, but the United States is at a
whole other level.
The US spends
twice as much per person on health care as the rest of the first world. Yet, we
have millions of uninsured people, tens of thousands of us die every year from
treatable disease due to lack of ability to afford care, and medical costs are
far and away the main cause of personal bankruptcy. And our life expectancy is
lower.
The system is so inefficient that if
the U.S. had a national health service like the UK’s, its health outcomes would
improve and it would save almost 2.5 trillion dollars every year. Deaton
and Case point out that the dysfunction in the U.S. healthcare system is, in
monetary terms, more of a handicap than the reparations that Germany had to pay
following the First World War.
Let that sink
in. We are shooting ourselves in the foot when it comes to healthcare. And why?
The answer both in the past and now is….racism. White Americans are willing to pay
twice as much for inferior care because people of color have it even worse.
Seriously. Any time I have tried talk about this with right wing family and
acquaintances, it sooner or later comes down to “I don’t want to pay for the
care of those lazy minorities.” Every. Single. Time.
You could even
see this during the early months of the Covid pandemic. Early on, people masked
up, they stayed home, and tried to pull together. Then, the news came out that
people of color and impoverished people were dying at higher rates, and you
could sense a change. After that, assholes harassed my wife the nurse for
wearing a mask, right wingers protested masks and demanded that they be allowed
to gather in large groups (even as the death tolls at churches and other
gatherings snowballed), and embraced anti-vaccine conspiracies. That’s the
American way: willing to die as long as black people suffer more. Good god, we
are terminally stupid.
In the
conclusion, the author notes that pandemics are not over. We will see them
again and again and again. Doing nothing didn’t work when humans thought the
gods caused plagues, and it won’t work against the next pandemic either.
So what should we do instead? As a
species, our best chance of surviving the threat posed by pathogens will come
from working collaboratively. The great improvement in health that high-income
countries experienced in the nineteenth and twentieth centuries was not a
result of better medicine - as William McNeill claimed - or even economic
growth per se. It was, rather, the consequence of political decisions to make
massive investments in drinking water, sanitation, housing and poverty
reduction. Just as cholera and other waterborne diseases forced cities to
undertake vast infrastructure projects, Covid-19 should encourage us to tackle
the causes of ill health. This might include ventilation in buildings and in
public transport. But in order to prepare society to be resistant to future
pandemics, it is crucial to address the more fundamental problems that make
some people more vulnerable to infectious diseases than others. Reducing stark
inequalities both within and between countries would be a very good start, as
would improving lack of access to basic health care across the world.
Although such changes might seem
unachievable in the current political climate, we should take inspiration from
the fact that, throughout history, pandemics have driven momentous political
and economic transformations. They shine a light on corrupt and incompetent
leaders, reveal and exacerbate pre-existing social divisions, and encourage
people to question the status quo. The Covid-19 pandemic has highlighted many
of the problems that blight modern society. It is now up to us to seize the
opportunity to address these iniquities and to build a happier and healthier
world.
This is indeed
the only way forward. I suspect that, for the American Right Wing, it will not
be until the next pandemic, when their refusal to take basic precautions for
the protection of themselves and others will lead to catastrophic casualties,
that they will finally consider change. Even if that change comes primarily in
the form of demographic turnover - the deaths of so many will inevitably change
things up a good bit.
I foresee that
when the next pandemic comes, the Right will be so entrenched in their anti-vax
conspiracies that they will refuse preventative treatment, instead poisoning
themselves with whatever the next Ivermectin turns out to be, and spread the
disease among themselves by arrogantly believing God will think them too
special to allow to be killed off.
Oh, and if they
succeed in ending government involvement in both healthcare and pandemic
response, well…
Dying of whiteness indeed.
This book is
quite fascinating, and a good read. It is thoroughly researched and documented,
and the author ties threads together well.
