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2. Epidemic Disease, History, and the State

Published onApr 16, 2020
2. Epidemic Disease, History, and the State

The history of life, like that of humanity, flows through a channel confined by the edicts of nature. . .

—William Rosen

Times of plague are always those in which the bestial and diabolical side of human nature gains the upper hand.

—Barthold Georg Neibuhr

“Salus populi suprema lex esto,” Cicero advised his patrons among the ruling elites of Rome. Translated, this approximates “The welfare of the people shall be the supreme law.”1 Thus, the health and well-being of the population forms the very foundation of prosperity, of political stability, and indeed of the power of disparate societies relative to one another. If the welfare of the people is paramount, then those pathogenic forces that would undermine human well-being should be regarded as distinct threats to the cohesion, material interests and power of the state.

Over the span of recorded human history, the proliferation of infectious disease has acted as a stressor, generating significant and profound destabilization of societies and polities. Historians and anthropologists have increasingly recognized disease as a variable that has affected historical outcomes, in some cases considerably.2 Only belatedly have such connections between the natural and social sciences been revisited by political theorists.3 However, republican and Classical Realist theories of international politics have contained the seeds of such knowledge since the earliest writings in that disciplinary genre.

This chapter reviews the role of disease in the destabilization of societies, economies, and sovereign states from ancient Athens to the modern era (1914 AD). Pathogens are an ancient phenomenon. (Poliomyelitis virus was found in a Neolithic skeleton from Cissbury, Sussex, England.) Further, the bacterium that induces tuberculosis first appears in textual references in the Egyptian Ebers medical papyrus and in the Rig Veda, both dated to circa 1500 BC. Paleopathological evidence culled from human remains suggests that the pathogen existed in Italy during the fourth millennium BC. The pestilence, chronicled in the works of Hippocrates and Avicenna, flourished on a continental scale during the reign of Edward the Confessor in England (1003-1066 AD).4 Treponema bacteria, some of which induce syphilis, have been discovered in human remains in Siberia and dated to 1000 BC, and syphilis is evident in the skeletal remains of the Americas predating the arrival of Columbus. Material evidence of syphilis does not appear in Europe until 1500 AD, which supports the hypothesis that it was transported to the Old World via the Columbian Exchange.5

Each pathogen, with its unique niche in the human ecology, generates a constellation of diverse effects on affected countries. Thus, this chapter analyzes the effect of individual pathogens on state-society interactions over the historical record. The historical record compiled here indicates that contagion may foment significant socio-political instability, and I conclude from the balance of evidence that infectious diseases have historically represented a significant threat to the cohesion, the interests, the power, and thus the security of the state.

The pursuit of interdisciplinary (or consilient6) thought represents the epistemological basis of this volume, and therefore I eschew the “silo mentality” or fragmentation of knowledge arising from acute disciplinary specialization in the modern era. The political historian John Gaddis argues vociferously against this “Balkanization” of the disciplines: “. . . we have been known, from time to time, to construct the intellectual equivalent of fortified trenches from which we fire artillery back and forth, dodging shrapnel even as we sink ever more deeply into mutual incomprehension.”7 Further, Gaddis argues that history and political science share a common intellectual ancestry, and he bemoans the “narcissism of minor differences” that, over the past century, has driven the disciplines apart. The political scientist Harvey Mansfield echoes this view: “My profession needs to open its eyes and admit to its curriculum the help of literature and history. It should be unafraid to risk considering what is ignored by science and may lack the approval of science.”8

The effects of epidemic disease on societies, economies, and polities throughout history may inform our understanding of the effects of contagion on modern peoples. Thus, historical precedents form the basis of our postulates regarding the effects of contagion on modern statesociety interactions. Therefore, it is reasonable to assume that the significant work of historians, over the centuries, might provide political scientists with a wealth of qualitative observations from which to derive certain hypotheses regarding the effects of infectious disease on structures of governance. Such historical luminaries as Procopius,9 Galen,10 and Hippocrates11 recorded their direct observations regarding the destructive influence of contagion on prosperity and socio-political stability. One of the earliest records of the destabilizing effect of contagion comes from the Athenian general and historian Thucydides, who noted the highly destructive effects of the “plague” on Athenian social stability and power in his account of the Peloponnesian War.12 Subsequently, another father of republican thought (and subsequently Realist theory)—the Italian provocateur Niccolo Machiavelli—chronicled the sociopolitical and economic disruptions he witnessed during the plague’s visitation to Florence in 1527. “Our pitiful Florence,” Machiavelli wrote acridly,

now looks like nothing but a town which has been stormed by the infidels and then forsaken. One part of the inhabitants . . . have retired to the distant country houses; one part is dead, and yet another part is dying. Thus the present is torment, the future menace, so we contend with death and only live in fear and trembling. The clean fine streets which formerly teemed with rich and noble citizens are now stinking and dirty. . . . Shops and inns are closed, at the factories work has ceased, the law courts are empty, the laws are trampled on. The squares, the market places of which the citizens used frequently to assemble, have now been converted into graves and into the resort of a wicked rabble.13

Modern conceptualizations that link the emergence and proliferation of pathogens to the destabilization of a polity can be found in the works of the historians William McNeill, Alfred Crosby, Hans Zinsser, Sheldon Watts, and Michael Oldstone. It is curious that the pernicious effects of epidemics on states and societies should be well established in the domain of history and yet be paid little attention in the domain of political science. This lacuna in the latter discipline may be attributable to the nascent nature of political science, emerging as it did during the twentieth century, when outbreaks of contagion were increasingly constrained by the development of antibiotics.

The medical historian Hans Zinsser argues that negative externalities associated with contagion were not measured merely through mortality, but that they instilled profound disorganization into the affected polity in question.14 The visitation of contagion on a population generated significant levels of trepidation, often inspiring the mass flight of individuals from affected regions. Zinsser notes the pernicious affects of such fear on the affected polity: “Panic bred social and moral disorganization; farms were abandoned, and there was shortage of food; famine led to displacement of populations, to revolution, to civil war, and, in some instances, to fanatical religious movements which contributed to profound spiritual and political transformations.”15 The historical evidence provided below reinforces many of the theoretical postulates I have provided in the preceding chapter, and it provides us a referent point to assess the degree to which the relations between contagion and the statesocieties dynamic have persisted into the modern era.

Let us now briefly examine a selection of specific pathogens and their deleterious economic, social, and political effects on polities, from ancient times to the early twentieth century.


The word “typhus” is derived from the Greek typhos, which means “hazy” or “smoky” (referring to the victim’s mental state). The illness, caused by bacteria of the Rickettsia class, was an ancient bane of both cities and armies, exploding throughout dense human populations courtesy of its ubiquitous vectors: the louse, the flea, and the rat.16 As I have already noted, Thucydides, in his classic account of the travails experienced during the Peloponnesian War, chronicled the debilitating effect of the “plague of Athens” (i.e., typhus) on Athenian society.17 The contagion emerged out of Ethiopia and struck Athens in 430 BC, returning in 429 BC to take the life of the Athenian leader Pericles and thus to erode the political cohesion of the polity. Medical historians, notably David Durack, have concluded that clinical manifestations of typhus are most representative of the contagion that ravaged Athens.18 However, recent forensic epidemiological investigations by the Greek dental physician Manolis Papagrigorakis19 suggest that the contagion that struck Athens may have been typhoid fever rather than typhus.20 The debate continues, but it is quite possible that both pathogens existed in the same population at the same time.

While the exact nature of the pathogen is debated, historians have fashioned a consensus that the “plague” generated profoundly destabilizing effects on Athenian social cohesion, governance, and power during the protracted conflict with Sparta and her allies. As Thucydides noted, the epidemic that coursed through Athens generated a significant disruption of social norms, undermined the observation of existing laws, and ultimately had a markedly deleterious effect on governance:

The bodies of the dying were heaped one on top of the other, and half-dead creatures could be seen staggering about in the streets or flocking around the fountains in their desire for water. For the catastrophe was so overwhelming that men, not knowing what would next happen to them, became indifferent to every rule of religion or law. Athens owed to the plague the beginnings of a state of unprecedented lawlessness. Seeing how quick and abrupt were the changes of fortune . . . people now began openly to venture on acts of self-indulgence which before then they used to keep in the dark. As for what is called honor, no one showed himself willing to abide by its laws, so doubtful was it whether one would survive to enjoy the name for it. No fear of god nor law of man had a restraining influence. As for the gods, it seemed to be the same thing whether one worshipped them or not, when one saw the good and the bad dying indiscriminately. As for offences against human law, no one expected to live long enough to be brought to trial and punished.21

According to estimates by the historian James Longrigg, the waves of contagion killed approximately one-third of the population of Athens, and during the second outbreak of contagion 4,400 hoplites (heavily armed foot soldiers) died, out of a total of 13,000, while 300 of 1,000 cavalry were killed from the pathogen in question.22 The historian A. W. Gomme, who analyzed Athenian accounts of the contagion, determined that the epidemic resulted in the destruction of roughly one-third of Athens’ land-based military forces.23 William McNeill and Hans Zinsser argue that the contagion fundamentally undermined Athenian power, and speculate that it may have altered the historical outcome of the conflict.24 Longrigg concurs:

Thucydides has realized the important role played by the impact of the plague in Athens’ ultimate defeat. Not only did the plague have a serious adverse effect upon Athenian military man-power; but it also, Thucydides believes, adversely affected, both directly and indirectly, Athenian leadership and policy during the war. Pericles, it seems, died of the plague and, it appears Alcibiades was later impeached under legislation introduced during and as a result of the plague. Thucydides has recognized . . . the importance of medical factors in the history of warfare.25

The consequent demographic collapse of the armed forces, the crippling of Athenian political elites, and the debilitation and demoralization of a significant proportion of the survivors certainly diminished Athens’ capacity to project power (martial and ideological) against Sparta and her allies.26

Plague (Yersinia pestis)

McNeill argues that the destruction of the Byzantine Roman empire in the sixth century AD was wrought by the “plague of Justinian,” arguably the first visitation of Yersinia pestis to Europe.27 The Plague acted as a stressor or a solvent on the machinery of empire, resulting in the attenuated erosion of societal and state cohesion, prosperity, and power during the sixth century AD. This emergent pathogen was one of the first negative consequences of the early phases of “globalization,” as trade and migration along the Silk Road saw the dissemination of Yersinia pestis from its natural reservoirs in Central Asia to Europe and East Asia.28 Consequently, the contagion resulted in massive mortality among immunologically naive populations throughout the Mediterranean region.29 The demographer Josiah Russell has argued that all the available data indicate that before the arrival of the contagion the populations of the Byzantine Roman Empire and the Persian Empire were robust and enjoying a rapid rate of increase.30 According to the historian William Rosen, this particular manifestation of contagion claimed the lives of circa 25 million people in and around the Mediterranean basin. Rosen concurs with Russell that it “depopulated entire cities; and depressed birth rates for generations precisely at the time that Justinian’s armies had returned the entire Western Mediterranean to imperial control.”31

Procopius wrote that he witnessed the Plague-induced destruction of 10,000 persons per day at Constantinople, where the illness raged for approximately four months.32 He also noted the profound psychological effects of the illness on norms of behavior and social cohesion. “And after the plague had ceased, there was so much depravity and general licentiousness, that it seemed as though the disease had left only the most wicked.”33 Gibbon’s account of the disruptive effects of the contagion accords with Procopius’ observations:

I only find that, during three months, five and at length ten thousand persons died each day at Constantinople; and many cities of the east were left vacant, and that in several districts of Italy the harvest and the vintage withered on the ground. The triple scourges of war, pestilence and famine afflicted the subjects of Justinian; and his reign is disgraced by a visible decrease of the human species which has never been regained in some of the fairest countries of the globe.34

According to Russell, the initial wave of plague (541-544 AD) reduced the population around the Mediterranean (European and otherwise) by 20-25 percent over a three-year period.35 The contagion also served to induce the collapse of agricultural productivity, as pronounced demographic contraction induced severe labor shortages. John of Ephesus noted that “in every field from Syria to Thrace the harvest lacked a harvester.”36

This scenario was replicated in non-European lands. The demographers Ronald Findlay and Mats Lundahl write: “It is a fact (although some historians still refuse to recognize it) that all around the Mediterranean, the cities, as they had existed in antiquity, contracted and then practically disappeared.”37 The historian Michael Dols argues that epidemic disease often destabilized existing socio-political and economic equilibria, but that it also contained catalytic potential for the transformation of state-society relations following periods of exceptional turbulence:

. . . the pandemic and its recurrent epidemics were the solvents of classical Mediterranean civilization and were largely responsible for the formation of new political, social, and economic patterns . . . political power gradually shifted to the peoples of northern Europe, who were relatively unaffected by the epidemics, and, conversely, plague greatly weakened the Byzantine empire. Justinian’s plans for re-establishing the Roman Empire were wrecked, and the diminished Byzantine armies were unable to defend the extensive frontiers. Hence, there was the successful resurgence of barbarian invasions. . . .38

McNeill, Zinsser, and Rosen support this conceptualization of the Fall of Byzantium, concurring that the stresses generated on both state and society overwhelmed the Empire’s adaptive capacity, its ability to defend itself, and its ability to project martial power against its rivals, and led to the polity’s gradual dissolution.39

The negative effects of contagion on governance and power projection were consequential, and they were hardly confined to the Mediterranean region. Indeed, it appears that East Asian societies suffered similarly destabilizing effects when the contagion reached them centuries later. McNeill argues that, in the wake of a military revolt in 755 AD, the dissolution of central political authority in China was temporally synchronous with the waves of bubonic plague that visited the region.40

The Black Death: 1348

Beginning in 1348, Yersinia pestis (in its various bubonic, pneumonic, and septicemic manifestations) again visited Europe and the Middle East. The waves of contagion that became known as the Black Death swept across the entire region and again diminished the now immunologically naive population.41 The spread of disease was accompanied by profound fear and anxiety, giving rise to a host of odd (and often destructive) responses by affected populations. The geographer Harold Foster has ranked the appearance of the Black Death in Europe as the second-worst catastrophe in human history, superseded only by World War II in absolute destructive capacity.42 Estimates of contagion-induced mortality in affected populations range from 5 percent to 50 percent.43 However, the consensus figure is that 30-45 percent of Europe’s population was destroyed by the contagion.44

The epidemic generated moral, socio-political, and economic disintegration. It also generated mass flight from urban centers to safer rural areas, leading to the depopulation of urban areas. Paul Slack argues that contagion-induced flight from affected areas constitutes a fundamental historical axiom of societal responses but that it carried negative consequences for societal cohesion, and for effective governance, “since it took people away from charitable, neighborly, or political duties.”45 Manifestations of the contagion in Egypt resulted in a different dynamic as the rapid depopulation of rural (agrarian) areas led to famine, which consequently intensified the depopulation of the cities.46 Sheldon Watts further describes the effects of plague on other regions of Egypt: “. . . at Luxor, of the 24,000 feddans of arable land under crops before 1347, only 1,000 were still being cultivated in 1389.”47 Thus was Cairo rapidly emptied and impoverished by the Black Death.48

Emulating the earlier destabilization of Byzantium, Dols argues, the Black Death effectively eroded the cohesion, prosperity, and power of the Mamluk Empire, leading to its dissolution. Dols argues that declines in agricultural productivity diminished the flows of revenues to the Mamluk elites, and consequently to the central government’s investment in irrigation and other rural infrastructure, leading to the disintegration of the empire.49 The historian David Ayalon argued that the aggregate effect of waves of plague in Egypt was severe deterioration of the Mamluk armies, and a corresponding decline of Mamluk military power through-out the late fourteenth century, which led directly to the Ottoman conquest of Egypt.50

Thus, the Black Death exhibited the capacity to generate pernicious effects on regional economies, as the destruction of the population eroded the existing base of human capital, and thereby diminished economic productivity.51 Moreover, the Black Death disrupted wage and price patterns, generating economic contraction, which in turn exacerbated conflict between classes in prosperous regions such as Flanders and northern Italy.52 In addition, manifestations of plague disrupted trade flows, and ultimately shifted regional balances of economic power from the affected city-states to unaffected regions:

While Venice was closed down and its plague-dead leadership was being replenished from youthful entries in its Golden Book. . . . Dutch and English entrepreneurs moved into its traditional marketing territories around the Adriatic and Eastern Mediterranean. Once in possession they stayed. Shorn of its major markets and burdened with leaders suffering from sclerosis (young in body but old in mind), Venice soon found itself only a regional power with no economic clout. From this it was but a short step to becoming a museum city.53

The negative effects of the Black Death on social cohesion and on governance were also pronounced. The medical historian Johannes Nohl argues that conditions of privation, as directly fostered by the contagion, resulted in a terrible degradation of morality and social stability during this era of European history.54 During the affliction of Paris 1468, the French surgeon Ambroise Pare observed that the state’s capacity for effective governance was dramatically eroded by the contagion: “The worst of all is that the rich, the higher town officials and all persons vested with official authority, flee among the first at the outbreak of the plague. . . . General anarchy and confusion then set in and that is the worst evil by which the commonwealth can be assailed.”55 As in the case of cholera, the perceived legitimacy of government institutions was compromised by the contagion, as relations between classes deteriorated and the peasantry actively resisted the proclamations of government officials.56

Within the broader European context, the plague generated significant inter-ethnic hostility, exacerbating tensions between European gentiles and the resident Jewish and Roma populations.57 Plague was also responsible for exacerbating pre-existing inter-ethnic tensions, manifesting in the scapegoating and often torture of minorities. Exceptional violence was directed by panicked Christian populations against Jewish minorities throughout Europe during this period. Anti-Jewish pogroms were carried out throughout Europe, and with a particular intensity in France and Germany, largely as a result of the dissemination of conspiracy theories that the Jews were poisoning the wells of Christian communities. The fact that Jews too died of plague did nothing to dissuade many from adopting such outlandish theories and engaging in violence against the now vilified minority.58 The Black Death, Slack argues, “provoked extreme religious reactions, including a revival of eschatological prophecies. . . . The Christian notions of original sin and divine chastisement therefore predisposed men to action: to search out the targets of epidemics, often to find scapegoats, but also to identify the physical as well as the moral sources of disease—unruly public assemblies, vagrants and beggars, disorderly slums.”59

One of the first cases of plague inspired the pogroms that occurred in May 1348 in Provence.60 Pogroms then occurred across Europe for decades, and draconian legislation, such as that enacted in Strasbourg in 1348, ensured the continued persecution of Jews.61 However, this pales in comparison to the atrocities committed at Basle. “The diabolical scheme,” Nohl writes, “was then conceived of imprisoning all Jews in a wooden shed on an island in the Rhine, outside the town, and then setting the shed on fire. . . . These atrocities were perpetrated exclusively on the tempestuous urging of the populace. . . .”62

The xenophobia and targeting of minorities during times of plague was not relegated solely to the targeting of Jews and Roma. In Spain in 1630 the French were designated as the “poisoners,” and they were subsequently targeted as convenient scapegoats. “In consequence of this,” Nohl writes, “all Frenchmen . . . became . . . unpopular. . . . Ultimately a royal edict was issued that all Frenchmen in Spain had to be registered.”63 The plague also gave rise to unusual behaviors and disruptive groups, such as the Flagellants, who beat themselves to stave off the wrath of the divine for their prior sins and who sought to undermine the authority of the Roman Catholic Church.64

During Britain’s occupation and colonization of the Indian subcontinent, the recrudescence of Yersinia pestis also exacerbated ethnic tensions between the British overseers and their indigenous subjects and induced societal destabilization65:

People found themselves pitted against each other in the panic far more than they were gathered into large social solidarities. Social tension, competition and antagonisms were heightened not only between but also within classes. The fragile façade of social order was cracked open and whole towns and villages appeared to be on the edge of chaos. In virtually every town, the outbreak of plague paralyzed trade and put its inhabitants to flight. At anarchy’s edge, the panic created fresh opportunities for profit and power for those with the temerity and ruthlessness to seize them. The evacuation of towns and villages . . . was accompanied by an increased incidence, and fear, of crime.66

The cumulative impact of waves of plague generated profound changes in relations between the state and society in Europe. The proliferation of contagion certainly generated significant lawlessness, inter-ethnic violence, and changes in accepted norms of behavior. In addition, it often undermined the capacity of governmental institutions to provide services to the people, damaging the state’s legitimacy. Such sclerotic effects of the plague resulted in declining economic productivity, diminishing tax revenues available to the state, which in turn resulted in further weakening of armies and police forces. The force of the plague even undermined the cohesion of institutions of higher learning, such as Oxford University.67 The societal disarray that accompanied visitations of la peste often generated correspondingly draconian reactions by the state against the people in order to maintain order, eventually causing erosion of governmental legitimacy and a shift in power toward the state and away from the society it claimed to protect.

Perhaps the most notable outcome of the waves of plague was the creation of an ideology of coercion that concentrated power in the hands of the state in order to control the people. In this manner, epidemic diseases have often generated a shift in power away from the people and toward the apparatus of coercion, often resulting in oppression of the people in order to guarantee order. The quarantinist ideology, also known as contagionism, often mandated harsh laws that tended to inflame tensions between state and society. The period of the Black Death gave rise to the first structures of public health governance, notably in the Italian city-states of Venice and Florence and subsequently in Milan (where public health commissions were constituted in 1348). Public health commissions gradually evolved into permanent institutions that monitored public health,68 setting a precedent that would be emulated by other city-states over the centuries. The practice of the quarantine of maritime vessels originated in Venice on March 20, 1348, continuing a tradition (dating from 1000 AD) of guarding the health of the people in order to protect the interests of both society and state.69 The term “quarantine” (which refers to a 40-day period of sequestration) is derived from the Italian quarantenaria. Measures of quarantine to control the flows of infected goods and the isolation of the sick, developed by Bernabo Visconti, Duke of Milan, were first put into practice in Mantua and Raguso in 1374. The practice subsequently spread throughout Italy and then to the French port of Marseilles, which began to quarantine goods and travelers in 1383.70

During the late 1300s, the city of Firenze (Florence) followed the contagionist model of pathogenic containment, now well established in the north of Italy. According to the dictates of the ascendant Florentine Board of Health, during an outbreak of plague it became standard practice for military forces to ensure order in the towns of the region, and those who sought to slip through the military cordon sanitaire were routinely executed. Furthermore, the health administrators in Firenze made it necessary for people to carry “health passports” (declaring they were free of plague) to travel from one town to another.71 Such coercion in the name of order was popular among the city-states of Italy, and from 1578 on this new authoritarianism was adopted in England. As Watts notes, “in England in 1604 anyone thought to have the plague who was found out on the streets could legally be hanged.”72

In seventeenth-century Tuscany such draconian public health laws entailed sending individuals off to “pesthouses,” locking entire families up in their homes, burning infected goods, shutting down markets, and suspending trade, which in turn fostered unemployment.73 In 1679, Spain, adopting the Florentine model, imposed harsh controls on population movements, employing martial force to control migration between infected and disease-free zones.74 The Habsburg regime instituted draconian restrictions on population movements throughout Central Europe in 1739 when it created “plague-control zones” in which military forces were under orders to fire on unauthorized travelers. Such cordons sanitaires covered the majority of Slavonia and Croatia, Transylvania, and various regions to the south of the Danube.75

The successive waves of bubonic plague that swept Europe from the fourteenth century through the early seventeenth century acted as a profound stressor on the feudal system. The rich and the poor, the pious and the heretic, all died in similar fashion, and so a fundamental axiom of epidemic disease became visible: the de-legitimization of existing hierarchies and structures of authority. In this case, the plague generated significant doubts about divine power, and therefore about the legitimacy of the Roman Catholic Church. Therefore, the successive waves of contagion and death gradually de-legitimized the pre-existing structures of religious authority throughout feudal societies in Europe.76 This diseaseinduced mass destabilization and the de-legitimization of the Church contributed to the Protestant Reformation and thereby helped to fashion the tinderbox of pan-European conflagration known as the Thirty Years’ War.77

Notwithstanding the minor outbreak of plague that occurred in Surat, India in 1994, the last significant outbreak of “plague” would seem to have occurred throughout India from 1896 to 1914. The historian Chandavarkar notes that the epidemic generated exceptional levels of affect (fear and panic), the social destabilization in turn resulting in the intervention of the state, which provoked “fierce resistance, riots, occasionally mob attacks on Europeans and even the assassination of British officials.”78 The epidemic, and the fear and social chaos it generated, compelled the British government to institute draconian measures and controls, including mass quarantine and the burning of personal property, and to construct a surveillance system replete with checkpoints and detention camps.79 The British response was based on their perceptions that the emergence of plague in India constituted a direct threat to the material interests (i.e. prosperity), the power, and even the security of the Empire. Chandavarkar explains the “imperial consequences” of the plague as follows: “An international embargo on Indian shipping not only threatened to close an important market and source of raw materials for Britain but also disturb the intricate system for the multilateral settlement of its balance of payments, in which India played a large and vital part. If (the plague) spread through the subcontinent it might devastate India’s social order and economic base, flatten the pivot of empire and undermine the foundation of Britain’s influence between the Yellow and the Red Seas.”80

Smallpox (Variola major)

The earliest empirical evidence of smallpox (the disease generated by the virus Variola major) dates from the preserved physical attributes of several Egyptian mummies. The most notable cadaver in this respect is that of Ramses V, who died in 1157 BC.81 The disease would seem to have been subsequently transmitted to India circa 1150 BC, and thereafter to China in 1122 BC. The historian Jonathan Tucker suggests that smallpox played a significant role in the destruction of the army of Alexander the Great during his expedition to India, and that Marcus Aurelius succumbed to the contagion during the Antonine plague in 180 AD.82

The “Plague” of Antonius (165-180 AD), which appears to have been induced by Variola, had negative effects on the socio-economic stability and governance of Rome. The epidemic appears to have begun in the Roman army of Verus, which was conquering cities throughout Asia Minor in 165 AD. As the Roman forces returned to southern Europe, they distributed the contagion throughout the lands they traversed, eventually bringing it to Rome, whereupon Verus fell to the contagion in 169 AD. The historian Donald Hopkins argues that the illness claimed between 3.5 million and 7 million lives and “must have weakened the Empire.”83 Doubtless the contagion functioned as a significant stressor to erode the power of Rome. “There can be little room for doubt,” Zinsser concludes, “that a calamity of this kind, lasting for over a decade, during a political period rendered critical by internal strife and constant war against encircling hostile barbarians, must have had a profound effect on the maintenance of the Roman power. Military campaigns were stopped, cities depopulated, agriculture all but destroyed, and commerce paralyzed.”84

Smallpox generated further political discord by disrupting lines of succession throughout the ranks of European nobility. For example, in northern Italy, the Duke of Mantua and his only son succumbed to smallpox in December 1612. Abruptly ending the male line of succession of the Gonzaga family, this led directly to the War of the Mantuan Succession between Austria and France.85

In 1700 AD the pox raged in Britain, killing Queen Anne’s only son, destroying the English royal house of Stuart,86 and generating a constitutional crisis that ended in the Act of Settlement, which explicitly prohibited Catholics from occupying the throne and thereby opened the door to the Hanovers. The pox also disrupted the Habsburg dynasty, killing Emperor Joseph I in April 1711 and depriving the family of the Spanish succession. “Because Joseph I died without a son,” Hopkins notes, “he was succeeded by his only surviving brother Charles VI. . . . By accepting the Austrian inheritance, Charles was forced to abandon the Spanish throne to the Bourbon claimant Philip V. Austria’s erstwhile allies . . . now changed sides to support Philip V. . . .”87 Various crowned heads of Europe fell to the pox, including Queen Mary II of England in 1694, Joseph I of Germany, King Louis I of Spain in 1724, Tsar Peter II of Russia in 1730, Queen Ulrika Eleanor of Sweden in 1741, King Louis XV of France in 1774, and William II of Orange.88

As I have already noted, early forms of globalization (conquest and trade) served as highly efficient vectors for the global spread of contagion, including Variola. The dissemination of pathogens throughout the Americas by European forces generated significant morbidity and mortality among indigenous peoples, and the consequent demographic implosion effectively undermined pre-existing structures of authority throughout Amerindian societies. This, in turn, facilitated the rapid conquest of the Americas and the extension of European empire.

The first reports of the pox in the Americas come from the island of Hispaniola, where the disease erupted in epidemic form, destroying about half of the population. From there the disease passed to Cuba and subsequently to Mexico, courtesy of an infected African slave in the party of the conquistador Panfilo de Narvaez, who was sent to meet with the party of Hernando Cortes.89 Smallpox, the most virulent of the various pathogens imported by the Europeans, ravaged Amerindian societies to such an extent that when European forces pushed into the interior they often found villages filled with cadavers and devoid of survivors. This may partially account for the considerable military success that European forces enjoyed throughout their missions of conquest and subjugation. Crosby argues that smallpox was the pivotal variable providing for the socio-political destabilization of Amerindian societies, and their subsequent conquest by European forces.

The disease exterminated a large fraction of the Aztecs and cleared a path for the Spaniards to the heart of Tenochtitlan and to the founding of New Spain. Racing ahead of the conquistadores, it soon appeared in Peru, killing a large proportion of the subjects of the Inca, the Inca king, and the successor he had chosen. Civil war and chaos followed, and then Francisco Pizzaro arrived. The miraculous triumphs of that conquistador, and of Cortes, whom he so successfully emulated, are in large part the triumphs of the virus of smallpox.90

Estimates of the Amerindian population immediately before the arrival of the Europeans (in 1492) vary considerably. Russell Thornton has estimated the original population to have been circa 72 million in 1492, which was subsequently diminished by disease and war to a nadir of 600,000 in 1800.91 Using the data of Henry Dobyns,92 McNeil estimates that Amerindian societies declined from circa 28 million in 1520 to 3 million by 1568 and to approximately 1.6 million by 1620.93 McNeill details the consequences of such demographic disaster: “Overall, the disaster to Amerindian populations assumed a scale that is hard for us to imagine. . . . Ratios of 20 : 1 or even 25 : 1 between pre-Columbian populations and the bottoming out (point). . . . Behind such cold statistics lurks enormous and repeated human anguish, as whole societies fell apart, values crumbled, and old ways of life lost all shred of meaning.”94 According to the historians James Lockhart and Serge Gruzinski, the Nahuatl population of Mexico Valley, which in 1518 supported an indigenous population of 25.2 million, had been reduced to 1.1 million by 1605.95 The viral waves appear to be synchronous with political destabilization as the Aztec state imploded in 1521, the timing of which corresponds to the first waves of the virus.

The pox began to afflict the Inca in 1524, similarly resulting in the demographic collapse of the Andean population. The decline was evidently catastrophic, as the population base withered by 93 percent in the period 1524-1630.96 The “pox” also resulted in the death of the Inca leader Huayna Capac, killed his heirs, disrupted succession, and ultimately facilitated Pizarro’s conquests.97 Such catastrophic and rapid declines in the population of a society generate profound psychological and social destabilization, and destroy the skill and knowledge base. Clearly, European military victories throughout the Americas were greatly facilitated by the pathogenic destruction of the antecedent populations and by the resultant collapse of their military power, erosion of elite legitimacy, and implosion of their structures of governance.98 The pox also would seem to have influenced the outcome of the American Revolutionary War, during which the thirteen colonies of the nascent United States fought to secede from British rule. In this case the contagion was directly facilitated by the conditions of the war, but it also burned through the ranks of the forces on both sides and often incapacitated entire divisions. According to the historian Elizabeth Fenn, the destructive effects of the pox were exhibited during the campaign against Canada, wherein the American general Benedict Arnold watched as his forces were cut down by the pox during the siege of Quebec City in November of 1775.99 As a result of the Canadian debacle, infectious disease became recognized as a significant threat to the integrity and efficacy of the US military, and thus perceived as a direct threat to national security.


A water-borne illness induced by the bacterium Vibrio cholerae, cholera is now principally a disease of the indigent throughout the developing countries—a disease attributable to the lack of clean water and adequate sanitary infrastructure. Historically, however, cholera exhibited significant negative effects on prosperity and governance in the core states of Europe (particularly in regard to the evolution of health governance at the level of the state). It is thought to have caused the death of such philosophical and artistic luminaries as Hegel, Clausewitz,100 and Tchaikovsky.101 During the nineteenth century, cholera generated 130,000 deaths in the United Kingdom, while India lost approximately 25 million people to Vibrio.102 Significant problems in the analysis of the historic impact of cholera emanate from the mortality data, as many who perished would have not been registered as victims of cholera, owing to the stigmatization of dying a “dog’s death.”103 Further, until the German biologist Robert Koch identified the pathogen in 1884, there was no empirical means of accurate diagnosis. Thus, certain individuals who appeared to succumb to cholera may have in fact died of illnesses displaying similar symptoms (such as dysentery).104

The historian Richard Evans has argued that the novelty of the pathogen and its Eastern origins produced psychological trauma among afflicted European populations and undermined their assumptions of biological superiority. “All this,” Evans writes, “made (cholera) into an object of peculiar terror and revulsion to the contemporary imagination, and further contributed to the shock effect it had on nineteenth-century society.”105 As the pathogen proliferated throughout Europe, the disease was viewed by the lower classes as a deliberate attempt by malign elites to poison them, fulfilling the Malthusian dictates of a draconian form of population control. As cholera swept across France in 1832, the historian Francois Delaporte notes, “the poor all over Europe shared the same fears and identified the same enemy, for the simple reason that cholera struck the poor first. People could not understand how a disease that attacked only the lower classes could be anything but intentional.”106 The uncertainty surrounding both the origins and vectors of transmission of cholera generated profound fear and anxiety, induced the perception and construction of elites as enemies, exacerbated mistrust between classes, and thereby augmented the potential for conflict between social factions. Such tensions often exploded into overt civil violence. Delaporte explains the “construction” of such a deliberate threat by the impassioned (and fearful) working class as a draconian solution to the problem of masses of poor, uneducated, and unproductive people.107 The psychological demonization of “the other,” and consequent manifestations of social tensions in the form of inter-class violence, often bedeviled European societies. The historian Frank Snowden shares these conclusions. “As at Naples in 1884,” he writes, “cholera epidemics gave rise in many countries to serious social tensions, leading to riots, mass flight, and assaults on doctors and officials.”108

Evans characterizes cholera’s march across Europe during the 1830s as “marked by a string of riots and disturbances in almost every country it affected. Riots, massacres and the destruction of property took place across Russia, swept through the Hapsburg Empire, broke out in Königsberg, Stettin and Memel in 1831 and spread to Britain the next year.”109 Fear of contagion (and the poisoning hypothesis) led to pathos, to scapegoating of “the other,” and to intra-state violence. According to Roderick McGrew, “the hysteria focused on particular scapegoats. The most popular villains were Polish agents and foreigners in general, though both physicians and government officials were also included. By midsummer a mass phobia had set in which affected the educated and the illiterate alike. . . . For the masses a spirit of evil had entered the land, and no one was immune. The poison scare played a part in the Petersburg cholera revolt, in the risings in the Novogorod military colonies, in the riots which occurred in Staraia Russia. . . .”110

Fearing massive disease-induced mortality and severe internal disruption, Czar Nicholas I adopted contagionist tactics, imposed a quarantine, and ordered that those infected be isolated. Such tactics failed to stem the spread of the pathogen and led to increasing social destabilization as the people reacted to the draconian measures of the state, with particularly serious riots in St. Petersburg in 1831.111

The British cholera epidemic of 1831 also incited riots, notably in Manchester. During the spring of that year, the public ascertained that the cadavers of cholera victims were being harvested by unscrupulous hospital authorities and sold to schools of anatomy. Furious citizens rose up in Manchester, among other cities, and demanded that their dead be treated with dignity.112 Such riots in Britain were chronicled by the historian Michael Durey, who counted thirty cholera-induced riots in the United Kingdom between February and November 1832.113 The appearance of cholera was also associated with the flight, or mass exodus, of citizens from affected regions, adding an additional dimension to the chaos that the illness generated. This phenomenon of contagion-induced refugees facilitated the expansion of the epidemic into naive populations.114

During this era, cholera infection also became associated with “immorality” (sex and drinking, specifically), providing the impetus for a legal crackdown by the state on such “unhealthy” habits.115 As cholerainduced mortality mounted in Britain, the elites decided that segregation of the poor into “union houses” (also known as poorhouses ) would be the most effective means of containing transmission. Parliament enacted the Poor Law Amendment Act of 1834, which entailed the creation of poorhouses based on parish. The conditions in these poorhouses were atrocious. According to Sheldon Watts, “the response of ordinary men and women was to dub the union poor-houses ‘bastilles’ and to keep clear of them. Within a generation, the idea that it was degrading, dishonorable, and depraved to allow oneself to be carted away to the poorhouse had become central to laboring people’s system of values. The alternative—starvation or suicide at home—was seen as preferable.”116 Thus, cholera worsened the social stratification of British society and intensified the antipathy of one class toward the other. And through the closure of markets and the stagnation of business, not to mention the debilitation and/or destruction of human capital, cholera was instrumental in eroding the economic prosperity of affected regions.117 After the international cholera control meetings held in Istanbul in 1866, trade was further constrained by London’s imposition of exceptionally strict quarantine regulations on foreign vessels harboring infected persons.118

The extreme contagionist measures undermined citizens’ perceptions of the legitimacy of state institutions and of certain elites associated with the state (namely physicians), and it promoted violence against ethnic groups who were seen as carriers.119 Thus, acute social tensions and manifestations of violence were rampant during the first waves of epidemic cholera to strike Europe. Advances in public health and biology (courtesy of John Snow and Robert Koch) reduced uncertainty about the nature and source of the pathogen and about its vectors of transmission, and thereby resulted in a corresponding decline in fear and violence.

Yellow Fever

Yellow fever (caused by an arbovirus of the family Flaviviridae that induces hemorrhagic fevers)120 has also had significant impacts on state-society relations, and at times on the trajectories of history. Such impacts range from a role in reinforcing the Jacobin coup and rebel government of former slaves in Haiti, to the Louisiana Purchase, to creating substantial problems of governance in the fledgling United States.

The breakdown in effective governance that resulted from the epidemic that struck Philadelphia in 1793 generated anxiety, panic, and even terror in the population. The contagion effectively closed down the federal government as Thomas Jefferson and George Washington fled the capital for the perceived safety of the countryside.121 Alexander Hamilton, stricken by the illness, commented that “undue panic” was “fast depopulating the city, and suspending business both public and private.”122 Washington noted that even the heads of departments in the federal government would not carry out their duties, having discovered “matters of private concernment which required them to be absent.”123 Again, profound levels of negative affect accompanied the arrival of the contagion. According to the historian J. H. Powell, “people sickened of the fever, and they sickened of fear. Panic spread from heart to heart, fear paralyzed the whole as spasms racked the stricken, panic was the vicious ally of disease.”124

The Philadelphia epidemic is an excellent example of the sclerotic (even paralytic) effects that contagion may induce within the institutions of the state. Indeed the epidemic of 1793 forced the early adjournment of Congress and the flight of legislators from the capitol, despite the apparent persistence of certain markets which remained open.125 The diseaseinduced chaos that ensued confounded the effective operation of the federal government: “Public papers were locked up in closed houses when the clerks left. Postmaster-General Pickering and Attorney-General Randolph were off on an Indian treaty; their departments quickly fell apart, and they found nothing but confusion when they returned. President Washington had no one to inform him or bring him reports, none to advise or confer with him. The federal government had evaporated.”126

Yellow fever was also associated with generating panic and the mass flight of individuals from affected areas. A classic example of such fearinduced exodus occurred during the New Orleans epidemic of May 1852, which caused more than 50,000 people to flee the city.127 The fever resulted in 9,000 deaths, representing about 10 percent of New Orleans’ citizens.128 Once again the disease produced a sclerotic effect within the city, resulting in shutdowns of commerce and of basic government services.129

The fever was also instrumental in generating dislocation and sociopolitical chaos in Memphis, Tennessee in 1872. As the epidemic approached, economic elites fled the city, leaving behind a skeleton crew of municipal government officials who had enormous difficulty providing basic services to the frightened citizens. “After Autumn frosts put an end to the slaughter,” Watts reports, “survivors met and petitioned that the bankrupt city find a new way to govern itself; the State obliged by canceling the city charter. While this was going on it was seriously suggested that the site of Memphis be abandoned, leveled to the ground and salted.”130

On State-Society Relations

The Galenic tradition, its environmentalist precepts being derivative of Hippocrates, worked to undermine the discovery of the principle of contagion by the medical community during the 1400s. As Watts notes, it was during the 1450s that the political elites or “magistrates” of the cities of northern Italy discovered that infectious disease was in fact contagious.131 The inability of medical “authorities” to contain disease, led to increasing disdain by the authorities (i.e., the state) for the Galenic132 medical community, and thus one observes the rise of draconian controls by the state to suppress disease transmission.133 Watts argues that centuries of persistent ineffectiveness of the medical community contributed to the widespread adoption of such hard-line positions by states in the sixteenth and seventeenth centuries:

The establishment of efficient quarantine control measures in port cities, of cordon sanitaire by armed troops and of information networks to warn of the approach of disease danger was all achieved by those European civil authorities who purposely ignored or overrode the objections of the medical doctors. By creating and enforcing the Ideology of Order in time of plague, princes considerably strengthened their hold over their subject populations. Quarantine procedures coincided with the gradual disappearance of plague from Western Europe: it last appeared in 1721.134

During periods of contagion, the historical record contains numerous instances of sovereign governments imposing significant (often draconian) controls on the behavior of the population, and on those who would enter the territory of the state. Such use of quarantine and martial law was termed “contagionist” and was typically associated with regimes that were held to be politically conservative. At the domestic level of analysis, then, the ascendancy of contagion worked to shift power away from civil society and toward the state. Contagionist thought was first articulated by Girolamo Fracastoro in his three-volume work De contagione, contagiosis morbis et eorum curatione (1546). Fracastoro argued that infectious agents generated human disease, and that epidemics were the resulting outcomes.135 Containment measures enacted under the contagionist paradigm included military cordons of national boundaries, the identification and isolation of infected individuals, and the disinfection of trade goods and migrants. Despite its victories (depending on the pathogen in question) in containing the spread of epidemic disease, the paradigm is also historically associated with the intensification of political repression, as executed by the state against society in order to maintain the ideology of order, so popular with Central and Eastern European states of the time. Jean-Jacques Rousseau fell victim to the practices of quarantine and was detained at Genoa in 1743. His captivity, hunger, and frustration are detailed in his Confessions.136 Given that contagionist philosophy emanated from the political elites of the time (primarily because of the persistent inadequacies of the Galenic community’s response), it may correctly be seen as an effective implementation of social ingenuity in order to compensate for a lack of technical ingenuity.137

It is not my purpose here to re-open this age-old dispute between the contagionists and the environmental sanitationists,138 but rather to discuss the impacts of epidemic disease on state and society, and the relationship between the two. The inherent peril associated with contagionism was that it held the potential for significant abuses of power by an unchecked bureaucracy, and that various manifestations of such abuses of society had in fact occurred over the centuries. For example, in Britain various waves of epidemic disease had resulted in the establishment of draconian policies of containment by the sovereign, including mandatory quarantines, lazarettos, the establishment of cordons and the execution of violators.139 The popularity of contagionist thought spread beyond its European origins to become profoundly influential in Ottoman lands. Such externalization of contagionist thought became evident in 1840 when the Egyptian pasha Muhammad ‘Ali, who ruled Egypt at the behest of the Ottoman Sultan, dismissed the opinions of his Galenic medical advisor. Based on contagionist successes in containing bubonic plague, Ali established the Florentine model of cordons and quarantine which effectively contained the pathogen in 1844.140

Despite the efficacy of contagionism in the containment of certain pathogens, the state’s zeal in enforcing quarantinist measures often resulted in tensions between protection of the public good and the rights of the individual. Often such methods resulted in the erosion of the public’s perceptions of the legitimacy of the state, and generated resistance (including violent riots) against the government.141 Over the centuries, one can observe that the targets of popular aggression in times of epidemic shifted from minority groups toward the state and toward physicians who were seen to be allied with the government.142 Evans notes the dynamics of such relations during the cholera years in Central Europe:

The coincidence of inexplicable outbreaks of mass mortality with the sudden appearance on the scene of government officials, troops, and medical officers readily aroused popular suspicion. It was not cholera by itself so much as the actions taken by the state against it which sparked off popular unrest. In Hungary, after over 1,000 cholera deaths between June and September 1831, castles were sacked and nobles massacred in an outburst of popular fury against those believed responsible for the deaths. In Russia military officers—themselves usually noble—bore the brunt of a good deal of popular hostility, as peasants attacked cordons sanitaires and murdered those who were trying to set them up.143

Those Prussian authorities who sought to contain epidemic disease using contagionist models often invoked national security concerns as a justification for their actions, and those who sought to evade the authorities were judged unpatriotic and even guilty of sedition.144 But even as the state sought to protect its material interests from the destabilizing effects of disease, contagionist measures employed to stem the spread of disease subsequently imposed significant costs on the state as restrictions on markets and trade resulted in declining tax revenues.145

The balance of evidence as derived from the historical record suggests several preliminary conclusions regarding the validity of the postulates presented in the introduction. First, epidemic disease may generate widespread debilitation and/or significant levels of mortality within the population, which in turn often resulted in direct effects including the contraction of the economy and the depletion of state power. Further negative externalities emanated from the psychological “construction” of the epidemics by both state and society, often resulting in extreme societal tensions that occasionally took the form of riots and outright insurrection against the state. This “construction” of epidemics also generated societal instability through the stigmatization and persecution of the ill, manifestations of violence directed toward ethnic minorities and classes (elites), and the reinforcement of socio-economic inequities. Thus, visitations of infectious disease often presented the affected country with complex web of threats, both direct and indirect, that directly compromised the state’s material interests and its base of power, and indirectly threatened the stability of the polity in its entirety. Second, in the domain of political science, there is increasing debate over whether health should be politicized, indeed “securitized.” In recent years the debate has become sterile as those who recognize the potential threat that epidemics present to national security (what I shall refer to as the Florentine school)146 and their ideological opposition (the Galenic school) talk past each other. This impasse is due largely to a lack of historical knowledge on the part of many of the protagonists on both sides, for, as we have seen, health has been associated with security concerns for centuries, indeed as far back as Thucydides. If we are to press ahead with improving our understanding of the links between health, prosperity, stability, and security, the Galenic school must acknowledge that issues of health have affected the calculus of power for sovereign countries, both internally and externally, for centuries. Finally, the Florentine School must recognize the perils arising from potential abuses of power by the sovereign state against its own citizens, in the name of maintaining order in the face of contagion, and must guard against such egregious abuses.

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