The Age-Old Fight for Better Health

JOANNE lived in New York, and she had tuberculosis (TB). But her disease was not a typical TB case. She had a mutant strain that is resistant to practically all drugs and that kills half of its victims. Joanne, however, did not seek treatment regularly, and she had already caused at least one TB outbreak. ‘She should be locked up,’ said her frustrated doctor.

TB is a very old killer. Literally millions of people have suffered and died from TB. Evidence of the disease has been found in mummies from ancient Egypt and Peru. Today, resurgent strains of TB kill some two million people every year.

Carlitos, lying on a small cot in an African hut, had beads of perspiration on his forehead. Malaria had made him too weak even to cry. His anxious parents had no money for medicine, and there was no clinic nearby where they could get medical attention for their young child. The fever did not relent, and within 48 hours he was dead.

Malaria kills nearly one million children like Carlitos every year. In East African villages, the average child is bitten by malaria-carrying mosquitoes between 50 and 80 times a month. These mosquitoes are spreading to new areas, and antimalarial drugs have become less effective. Every year, an estimated 300 million people suffer from acute malaria.

Kenneth, a 30-year-old man living in San Francisco, California, first went to his doctor in 1980. He complained of diarrhea and tiredness. A year later he was dead. Despite expert medical attention, his body just wasted away, and he finally succumbed to pneumonia.

Two years later and 10,000 miles [16,000 km] from San Francisco, a young woman in northern Tanzania began to suffer from similar symptoms. In a few weeks, she could no longer walk, and soon thereafter she died. The villagers dubbed the strange sickness Juliana’s disease because a man selling cloth decorated with the name Juliana had apparently infected her and other local women.

Both Kenneth and the Tanzanian woman had the same disease: AIDS. At the beginning of the 1980’s, just when it seemed that medical science had tamed the most dangerous microbes, this new infectious disease arose to haunt humanity. Within two decades the AIDS death toll began to rival that of the plague that swept across Eurasia in the 14th century​—a plague that Europe never forgot.

The Black Death

The outbreak of the plague called the Black Death can be traced to 1347, when a ship  from the Crimea berthed in Messina, on the island of Sicily. Apart from its regular cargo, the ship also carried the plague. * Soon the Black Death spread throughout Italy.

The following year Agnolo di Tura, of Siena, Italy, described the horror in his hometown: ‘The mortality in Siena began in May. It was a cruel and horrible thing. The victims died almost immediately. They died by the hundreds, both day and night.’ He added: ‘I buried my five children with my own hands, and so did many others likewise. Nobody wept no matter what his loss because almost everyone expected death. So many died that all believed it was the end of the world.’

Within four years, say some historians, the plague spread throughout Europe and about a third of the population lost their life​—perhaps between 20 million and 30 million people. Even remote Iceland was decimated. It is said that in the Far East, the population of China slumped from 123 million at the beginning of the 13th century to 65 million during the 14th century, apparently as a result of the plague and the accompanying famine.

 No previous epidemic, war, or famine had ever caused such widespread suffering. “It was a disaster without equal in human history,” notes the book Man and Microbes. “Somewhere between one-quarter and one-half of the people in Europe, North Africa, and parts of Asia perished.”

The Americas escaped the ravages of the Black Death, thanks to their isolation from the rest of the world. But oceangoing ships soon brought that isolation to an end. In the 16th century, a wave of epidemics that proved even more lethal than the plague ravaged the New World.

Smallpox Conquers the Americas

When Columbus arrived in the West Indies in 1492, he described the native people as being of ‘pleasing appearance with fine features and medium height with muscular bodies.’ Their healthy appearance, however, belied their vulnerability to the diseases of the Old World.

In 1518 an outbreak of smallpox erupted on the island of Hispaniola. Native Americans had never been exposed to smallpox before, and the effect was catastrophic. A Spanish eyewitness estimated that only a thousand people on the island survived. The epidemic soon spread to Mexico and Peru, with similar consequences.

The following century, when the Pilgrim settlers arrived in the area of Massachusetts in North America, they discovered that smallpox had practically cleared the land of inhabitants. “The natives, they are near all dead of the smallpox,” wrote Pilgrim leader John Winthrop.

Other epidemics followed smallpox. According to one source, by a century after Columbus’ arrival, imported diseases had wiped out 90 percent of the population of the New World. The population of Mexico had shrunk from 30 million to 3 million, that of Peru from 8 million to one million. Native Americans, of course, were not the only victims of smallpox. “Over the course of human history, smallpox claimed hundreds of millions of lives, far more than plague . . . and all the wars of the twentieth century combined,” notes the book Scourge​—The Once and Future Threat of Smallpox.

The War Has Not Yet Been Won

Nowadays, the horrific epidemics of plague and smallpox may seem like catastrophes long since consigned to the pages of history. During the 20th century, mankind won many battles in the war against infectious diseases, especially in industrialized countries. Doctors  discovered the causes of most diseases, and they also found ways to cure them. (See the box below.) New vaccines and antibiotics seemed like magic bullets capable of exterminating even the most stubborn disease.

However, as Dr. Richard Krause, former director of the U.S. National Institute of Allergy and Infectious Diseases, points out, “plagues are as certain as death and taxes.” TB and malaria have not gone away. And the recent AIDS pandemic has provided a grim reminder that pestilence still stalks the globe. “Infectious diseases remain the world’s leading cause of death; they will remain so for a long time to come,” states the book Man and Microbes.

Some doctors fear that despite remarkable progress in fighting disease, the gains of the last few decades may only be temporary. “The danger posed by infectious diseases has not gone away​—it’s worsening,” warns epidemiologist Robert Shope. The following article will explain why.


^ par. 10 The plague took several forms, including bubonic plague and pneumonic plague. Fleas, carried mainly by rats, spread the bubonic form, and droplets sprayed from infected persons most often spread the pneumonic form.

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Within two decades the AIDS death toll began to rival that of the plague that swept across Eurasia in the 14th century

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Knowledge Versus Superstition

In the 14th century, when the Black Death threatened the pope’s household in Avignon, his doctor informed him that the conjunction of three planets​—Saturn, Jupiter, and Mars—​in the sign of Aquarius was the principal cause of the plague.

Some four centuries later, George Washington went to bed with a sore throat. Three eminent doctors treated the infection by draining some two quarts [2 L] of blood from his veins. Within a few hours, the patient was dead. Bloodletting was standard medical practice for 2,500 years​—from the time of Hippocrates until the mid-19th century.

Although superstition and tradition delayed medical progress, dedicated doctors worked hard to discover the causes of infectious diseases and remedies for them. Below are a few of the significant breakthroughs they made.

Smallpox. In 1798, Edward Jenner successfully developed a vaccine for smallpox. During the 20th century, vaccines have proved effective in preventing other diseases, such as polio, yellow fever, measles, and rubella.

Tuberculosis. In 1882, Robert Koch identified tuberculosis bacteria and developed a test for the disease. Some 60 years later, streptomycin, an effective antibiotic for treating tuberculosis, was discovered. This drug also proved useful for treating bubonic plague.

Malaria. From the 17th century onward, quinine​—obtained from the bark of the cinchona tree—​saved the lives of millions of malaria sufferers. In 1897, Ronald Ross identified Anopheles mosquitoes as the carriers of the disease, and mosquito control was later promoted to reduce mortality in tropical countries.


Zodiac chart (above) and bloodletting

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Both: Biblioteca Histórica “Marqués de Valdecilla”

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Today, resurgent strains of tuberculosis kill some two million people every year

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X ray: New Jersey Medical School–National Tuberculosis Center; man: Photo: WHO/Thierry Falise

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A German engraving, dating from about 1500, depicts a doctor wearing a mask to protect against the Black Death. The beak contained perfume

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The bacteria that caused the bubonic plague

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© Gary Gaugler/Visuals Unlimited