Seldom in recent times has a new historical work drawn as much attention as PLAGUES AND PEOPLES, William H. McNeill’s account of the effects of disease on human history. Reviews included such comments as:
“A very remarkable and original book.… It is rewarding, immensely so, and well worth the effort.”
Washington Post
“PLAGUES AND PEOPLES, a glorious successor to THE RISE OF THE WEST, integrates ecology and demography with politics and culture on a vast scale. A brilliantly conceptualized and challenging scholarly achievement.”
Kirkus Reviews
“The volume provides fascinating reading and emphasizes a perspective on events that is not often found in the treatment of history. The reader, once started, will find it difficult to lay the book down.… The book can be unhesitatingly recommended.”
Tampa Tribune-Times
“Far-reaching … certain to provoke wide debate … original and exciting.”
Publishers Weekly
“A brilliant book.”
Cleveland Press
“In PLAGUES AND PEOPLES, a fascinating exercise in historical speculation, William H. McNeill argues convincingly for the extraordinary impact of disease on human history.”
The Progressive
“The scholarship the author displays in this study is dazzling.… PLAGUES AND PEOPLES is a very skillful work.… It will fascinate and intrigue us.”
Ithaca Journal
“A brilliant and challenging thesis supported by fascinating examples.”
New Tork Magazine
“This is an important, original, and well-researched work.”
Library Journal
“Irresistible.”
Boston Sunday Herald
“University of Chicago professor William H. McNeill in his PLAGUES AND PEOPLES describes, with an impressive accumulation of evidence, the frequent and decisive role that disease has played in man’s historical development.”
Baton Rouge Sunday Advocate
“[An] intriguing new interpretation of world history.”
San Francisco Examiner
“He does a commendable job in providing a surprising amount of the details of even sometimes overlooked epidemics and plagues.”
Chicago Daily News
“This amazingly detailed book … certainly offers an insight into the disasters of nature which have swept the world’s population at one time or another.”
Natchez Democrat
“A novel study by a noted historian.… With expert reinterpretation of past events, supported by scientific detail, McNeill makes a strong case.”
American Library Association Booklist
“Enlightening.… PLAGUES AND PEOPLES definitely is recommended reading.”
Grand Rapids Press
“McNeill ably and in extremely scholarly fashion offers an impressive accumulation of evidence to demonstrate the central role of pestilence in human affairs and the extent to which it has changed the course of human history.”
Jackson Clarion-Ledger/Daily News
ANCHOR BOOKS EDITIONS, 1977, 1989, 1998
Copyright © 1976 by William H. McNeill
Preface copyright © 1998 by William H. McNeill
All rights reserved under International and Pan-American Copyright Conventions. Published in the United States by Anchor Books, a division of Random House, Inc., New York, and simultaneously in Canada by Random House of Canada Limited, Toronto. Originally published in hardcover in the United States by Doubleday in 1977. The Anchor Books edition is published by arrangement with Doubleday, a division of Random House, Inc.
Anchor Books and colophon are registered trademarks of Random House, Inc.
The map, “The Spread of the Black Death in Europe,” is reprinted by permission of the Annales: Economies, Sociétés, Civilisations and appeared in the Annales, 17, in the article “Autour de la Peste Noire: Famines et Epidémies dans l’Histoire du XIVe Siècle,” by Elizabeth Carpentier (1962, pp. 1062–92).
Library of Congress Cataloging-in-Publication Data
McNeill, William H.
Plagues and peoples / William H McNeill,
p. cm.
Reprint. Originally published: Garden City, N.Y.:
Anchor Press, 1976.
1. Epidemics—History. 2. Civilization—History.
I. Title.
RA649.M3 1989 89–27689
614.4’9—dc20
eISBN: 978-0-307-77366-1
www.anchorbooks.com
v3.1
Contents
Cover
Title Page
Copyright
Acknowledgments
Preface
Introduction
Chapter I Man the Hunter
Chapter II Breakthrough to History
Chapter III Confluence of the Civilized Disease Pools of Eurasia: 500 B.C. to A.D. 1200
Chapter IV The Impact of the Mongol Empire on Shifting Disease Balances, 1200–1500
Chapter V Transoceanic Exchanges, 1500–1700
Chapter VI The Ecological Impact of Medical Science and Organization Since 1700
Appendix
Notes
About the Author
Acknowledgments
T
his book was composed in the spring and sum mer of 1974 and corrected in the spring of 1975. In between, a rough draft was circulated to the following readers for their expert criticism: Alexandre Bennigsen, James Bowman, Francis Black, John Z. Bowers, Jerome Bylebyl, L. Warwick Coppleson, Alfred W. Crosby, Jr., Philip Curtin, Allen Debus, Robert Fogel, Ping-ti Ho, Laverne Kuhnke, Charles Leslie, George LeRoy, Stuart Ragland, Donald Rowley, Olaf K. Skinsnes, H. Burr Steinbach, John Woods. The manuscript also benefited from a panel discussion at a meeting of the American Association for the History of Medicine, May 1975, at which Saul Jarcho, Barbara G. Rosenkrantz, John Duffy, and Guenter B. Risse commented on what they had read. Subsequently, in the autumn of 1975, Barbara Dodwell read Chapter IV and Hugh Scogin worked over Chinese data for me; between them they led me to adjust the way I understand the propagation of the Black Death. Fortunately it proved possible to insinuate appropriate adjustments into the text at the last minute.
This episode illustrates how tentative many of the assertions and suggestions of this book are and must remain until epidemiologically informed researches have been undertaken in Chinese and other ancient records. Suggestions and corrections from the entire array of readers permitted improvement of the original version in numerous details and steered me away from some silly errors; but needless to say, I remain responsible for what appears below, including any and all residual errors.
A generous grant from the Josiah Macy, Jr., Foundation permitted time away from normal academic duties for the completion of this essay. I was assisted by Edward Tenner, Ph.D., who looked things up for me in European languages, and by Joseph Cha, Ph.D., who consulted Chinese and Japanese texts on my behalf and compiled the roster of Chinese epidemics that appears in the Appendix. Without their help the task would have taken longer and, in particular, my remarks about the Far East would have been far sketchier. Marnie Veghte twice typed the text with cheerful accuracy and admirable speed. Charles Priester of Anchor Press/Doubleday asked suitably pointed questions to provoke me to improve the original manuscript in important ways.
To all who thus assisted in bringing this book to birth, I am sincerely grateful.
WILLIAM H. MCNEILL
15 December 1975
Preface
R
eaders of a book about epidemic infections, like this one, are sure to wonder why it contains no mention of AIDS. The reason is simple. That disease was identified and named only in 1981–82, some six years after Plagu
es and Peoples was published. Since then, the AIDS epidemic has been a major driving force behind the continued interest in what this book has to say about earlier epidemics and human responses to them, and perhaps it is time to acknowledge that fact and say something about the disease that has attracted so much attention since it was first identified.
The climate of medical opinion has changed considerably since this book came out, for in 1976 many doctors believed that infectious diseases had lost their power to affect human lives seriously. Scientific medicine, they supposed, had finally won decisive victory over disease germs. Newly discovered antibiotics and relatively simple prophylactic and public health measures had at last made infections easy to prevent and cure. The World Health Organization actually succeeded in eliminating smallpox from the face of the earth in the same year this book was published, and optimists believed that other infections, like measles, might go the same way if sufficient medical effort were put into worldwide campaigns to isolate and cure each and every infection.
A glance at my concluding remarks on this page will show that I did not accept this view of what doctors had accomplished, and it is now clear that the elimination of smallpox in 1976 was the high point of the World Health Organization’s remarkably successful post-World War II campaign to reduce human deaths from infections. Thereafter, infectious organisms launched a counteroffensive. The appearance of AIDS was the first notable landmark of this process; and despite initial expectations, the subsequent identification of the HIV-1 virus that causes AIDS has not yet led to a cure.
Development of resistant strains of malaria, TB, and other familiar infections was a second, and in many ways more important, sign that twentieth-century victories over the parasitic microorganisms that feed upon our bodies was only an unusually dramatic and drastic disturbance of the age-old balance between human hosts and disease organisms. As the century comes to its close, it seems sure that infections are coming back, regaining some of their old importance for human life; and medical men have begun to recognize how their increasingly powerful interventions had the unexpected effect of accelerating the biological evolution of disease germs, making them impervious to one after another form of chemical attack.
For a long time, I felt that the remarks on this page about how the age-old balance between host and parasite remained a permanent feature of human (and of all multi-celled forms of) life were sufficient to explain the appearance of AIDS and the emergence of resistant strains of older infections. In fact, I still do, and so have not altered anything in these pages. A second reason for saying nothing explicitly about AIDS was that accurate information about its origins and spread was impossible to find. This is still the case, but alternate theories have emerged with the passage of time, and some statistics about the scale of the epidemic worldwide and within the United States are now available. Let me therefore offer a few brief observations on the AIDS epidemic and how it appears to conform to familiar ecological and sociological patterns.
First, origins. When AIDS was newly discovered in the 1980s and doctors were still expecting to come up with a quick and easy cure for the HIV-1 infection, a related virus was discovered to exist among a species of African monkeys. This suggested that the human form of the infection might have arisen recently, when the virus shifted its parasitism from monkeys to humans. Routes of transmission, from Africa to Haiti and so to the United States, were swiftly inferred, offering a plausible account of how AIDS had arisen and spread.
But there were difficulties with this theory. The virus that existed among monkeys in Africa had a relatively mild human equivalent in the form of HIV-2; but the lethal HIV-1 virus that causes AIDS was so different in details of its structure that recent derivation from the form of infection existing among a few African monkeys and humans seemed implausible. This led a distinguished medical historian, Mirko Grmek,* to propose in 1989 that AIDS was in fact a longstanding human infection, widely dispersed around the earth, but hidden from medical attention both by the diversity of symptoms sufferers developed and by the infrequency with which it occurred. According to Grmek, changes in medical science on the one hand and changes in human behavior on the other were what provoked the AIDS epidemic.
Assuredly, without techniques of molecular biology introduced within the past fifty years or less, the HIV-1 virus could not have been identified. Moreover, symptoms later associated with AIDS were observed as early as 1868, when the so called Kaposi’s skin cancer was diagnosed and named in Vienna. And beginning in the 1930s, doctors encountering strange infections sometimes stored tissue samples in hope that later advances in science might solve their puzzlement. In a few cases, analysis of such tissues has turned up evidence of HIV infection decades before AIDS was first recognized.
But the most persuasive evidence that HIV-1 is a longstanding human infection rests on the fact that slightly divergent strains of the virus exist among human populations in different parts of the earth, and now appear to be evolving toward a recombinant, global form as local strains intermingle and the most vigorous, viable viruses multiply themselves at the expense of less successful variants. It is even possible that the AIDS epidemic, as recognized in the 1980s, was itself provoked by recombination of older viral strains, producing what is now called HIV-1 from different ancestral forms of the virus. No one is sure; but a recent transfer from some African reservoir of HIV infection no longer seems necessary or even probable.
Whatever pathways HIV viruses may have followed in the deeper past, it seems certain that the sudden outburst of AIDS in the 1970s depended on changes in human behavior that favored transmission of the viruses from host to host. One such change was an increase in sexual promiscuity among homosexual men in the United States and elsewhere, partly as a result of gay liberation. A second factor was an increase in the intravenous injection of heroin and other mood-altering drugs beginning in the 1970s, when cheap plastic syringes first became available. As these practices became more common, it became far easier than before for HIV viruses to spread from host to host. The infection had previously remained rare because opportunities for direct entry into the bloodstream of a new host, which the virus required, were narrowly restricted. Presumably, only the fact that hosts lived a long time before lethal adventitious infections killed them had allowed the chain of HIV infection to continue, sporadically and precariously. But shared needles and sexual promiscuity among infected individuals abruptly widened chances for the virus to transfer from an infected individual to a new host; and it appears that the result was indeed spectacular.
For example, retrospective analysis of blood samples collected from gay men in San Francisco showed that in 1978 (before AIDS had been diagnosed) 4.8% of them were HIVpositive. A mere six years later, the figure was 73.1%.* By then, knowledge of how the infection is transmitted had hit home. Sexual practices in the homosexual community of San Francisco changed abruptly and infection rates among gay men ceased to grow, but only after blood samples showed that the majority of gay men in the city had become bearers of the disease. I have not seen comparable figures for intravenous drug takers, and they may persist in reckless behavior. After all, fear of dying of AIDS far in the future is unlikely to deter someone whose craving for a quick “fix” eclipses any and every long-range consideration.
But in American society at large, it seems clear that awareness of how AIDS is transmitted put a chill on sexual promiscuity and made intravenous drug-taking a lot less attractive than before. It therefore seems almost certain that the future incidence of the disease will reflect resulting behavioral changes. Only a few reckless individuals are likely to remain high risks, concentrating very likely at the social extremes—on the one hand, gilded youth who suppose themselves immune from sexual or any other sort of mischance; and on the one hand, poor, down-and-out drifters who do not know or care enough about themselves or others to take precautions against HIV infection. This was what happened to syphilis, and is probably also happening to AIDS in the United States and o
ther similar societies today. If so, the epidemic will be contained and never have any very noticeable demographic effect on society at large, just as was true of syphilis.
This may not be the case in some parts of sub-Saharan Africa where AIDS appears to be widespread among the general population. But reliable statistics do not exist; and blood samples collected from urban areas may exaggerate the prevalence of the infection. As elsewhere in the world, the disease appears to be new in Africa, and changes in sexual behavior associated with massive migration from the countryside into urban shantytowns presumably lie behind its propagation. These changes affect both men and women and are not associated with homosexuality. That makes the impact of AIDS different in Africa from what it has been in the United States. But it is too soon to be sure that the disease will not be contained by changes in human behavior on the one hand and by the global process of HIV-1 evolution on the other. So far at least, official population statistics from African countries do not show any demographic effect that is clearly attributable to AIDS. Population growth rates are diminishing, but remain higher than anywhere else in the world. Nothing remotely like the disease disasters of the deeper past has yet become evident, but the long gap between initial HIV-1 infection and death from AIDS means that no one can yet be sure how statistically important the AIDS epidemic in Africa will prove to be.
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