Dan Snow's History Hit - Pandemics through History

Episode Date: May 5, 2020

I have hooked up with the Timeline Channel on youtube to do History Hit Live three times a week. Sometimes I'll share the audio as a podcast on this feed. My chat with Clifford Williamson, lecturer at Bath Spa University and specialising in the History of Public Health, was fascinating. We talked about the widespread pandemics of the last 150 years and what we can learn from them when we look at the current COVID-19 outbreak. He also had some suggestions about what may change as a result of the crisis we are going through.Subscribe to History Hit and you'll get access to hundreds of history documentaries, as well as every single episode of this podcast from the beginning (400 extra episodes). We're running live podcasts on Zoom, we've got weekly quizzes where you can win prizes, and exclusive subscriber only articles. It's the ultimate history package. Just go to historyhit.tv to subscribe. We have got an offer available at the moment. If you use the code 'Pod3' on sign up, you get 30 days free, then your first three months access will be just £1/euro/dollar - it's £5.99 a month after.

Hi there everybody, welcome to Dan Snow's History Hit. Thanks everyone who's donated and taken part in our little heritage fundraiser. We're looking to raise money for museums, heritage sites, archives all around the world that are suffering from terrible loss of revenue at the moment. Go to historyhit.com slash heritage to donate and take the heritage challenge where you read out a letter, a diary, a primary source. take the heritage challenge where you read out a letter a diary a primary source there's been some great ones so far uh hashtag save our heritage check them out uh and then nominate people to do it but the main thing is it'd be great if you're good night thank you very much in this episode of downstairs history here we've got clifford williamson he's a lecturer at bath spa university he came on to directly talk about how pandemics throughout history have changed society. There's a lot of hot takes at the moment about how the Black Death ended feudalism,

which is one that medieval historians, it kind of makes their head fall off. It's like if you ask a physicist if mass is constant in all dimensions. I don't understand why that does make physicists explode, but I do understand why medieval historians find the concept of feudalism and its ending by the Black Death in the 14th century deeply problematic. So this is a podcast to help us think about actually what the effects of these pandemics have been throughout history, how our world may change as a result of what we're experiencing at the moment. You can go watch

some beautiful TV if you want. History Hit TV, keep you busy during the pandemic. It's like a Netflix for history. Lots of documentaries on there, lots of audio. Just go to historyhit.tv. We've had a deal on to get people through the lockdown. It looks like it might be extended. So we've got an even better deal now. If you use the code POD3, P-O-D-3,

this offer will be available for the next few days. You'll get a month for free. And then your first three months, just one pound, euro or dollar. So this is now four months for just three pound, euros or dollars in all. I mean, which is going to take us to the end of the lockdown, I think, I hope. So please, please head over to History Hit TV and use the code POD3. In the meantime, everyone, enjoy Clifford Williamson.

Enjoy Clifford Williams. Cliff, thank you very much for coming on this History Hit Live. Let's get started. First of all, how do we judge what a pandemic is looking back through history? How should we define them? They have an academic and medical definition, which is the mass outbreak, simultaneous outbreaks of a single infectious disease strain across a significant geographical part of the globe. And are they regular occurrences? They are more regular and more

experienced more by you know what are regarded as underdeveloped countries but for the experience of the United Kingdom they used to be fairly commonplace until we get into the second half of the 20th century where the so-called therapeutic revolution takes place and there's greater vaccination and treatment of infectious diseases. So there's a historical memory of them as far as people here in the UK are concerned and in the developed world,

but they are a far more frequent occurrence in underdeveloped and less developed parts of the world. When did people start realising there was something called a pandemic? I mean, is it, you know, you look at the plague in ancient Athens where it was under siege by the Spartans. When did people start going, no, there is something that's happening in a global sense? Well, as the world itself joins up, as there's a greater consciousness

that there's other parts of the globe, certainly from my point of view, it starts with the first of the great bubonic plague outbreaks, which is during classical times in the Roman Empire. The consciousness of this is something which is affecting an entire imperial structure. It very much brings the idea of the interrelatedness of disease and the transmission of disease to the institutional

and imperial centre. Cliff, cholera is something that gets talked about a lot in the early modern period. Tell me about some of the extraordinary cholera pandemics that break out, say, in the early 19th century? Well there's a wave of them really going from 1830 through to the last significant one which doesn't really affect the UK is in the 1890s but the majority of them take place 1830s, middle of the 1840s, early 1850s and then there's a last substantive outbreak in the 1860s. So it is a periodic visitation of infectious disease, a very unique, distinctive and deadly infectious disease, which pockmarks, quite literally, Victorian society.

And is that a product of these new super cities that are building in Victorian Britain at the time, or had cholera been around since the beginning of time? There had been various types of choleraic diseases floating around for many, many centuries. However, what seems to have been the catalyst for the Victorian versions of the late Williamite, early Victorian experiences, is a collision of empire and industrialisation and urbanisation. These three things collide roughly at the same time, development of trade links across the world, but also the early explosion of

the urban environments, the mega cities of Victoria and Britain, London being one of the major examples, but all the other industrial cities experience the first cholera outbreak almost simultaneously. So it is a feature, it could be described as an indicator of industrialisation and urbanisation, that you get these types of diseases prevalent. And cholera is waterborne, isn't it? Yes, it is. I mean, of course, it takes a little bit of time before there is the scientific evidence

when John Snow produces his famous Maps of London. But he was one of the first people to identify its waterborne characteristics. And this is controversial, of course, because the dominant theories in relation to disease is still very much built on the miasma theory and other ideas of an evil foul air polluting, rather than something which was microscopic in the water and that was passed from person to person through ingesting it. Did people try quarantining and other things to overcome cholera? Did they just accept it and how was Jon Snow able to influence that behaviour and that response?

Well historically quarantine was the de facto and default system for dealing with infectious diseases. You basically just hold people up or you expelled them and kept them in a controlled environment. Many parts of the, many of the cities of the UK had their own lazarettos, as they were referred to. They had their own quarantine area, which they sent plague victims to during the great plagues of the 17th century and before. So it was not uncommon to have quarantining.

However, it's not very efficacious once the disease is present in the community. All you're doing is locking it in and presenting it to a much wider potential victim pool. So what had to be done was isolating the source of it, which of course is the famous Broad Street pump in central London, isolating the supply itself, offering alternative water supplies and you know basically literally overnight transforming the status of this particular disease in the city. And it's remarkable its simplicity if you consider the centuries in which people have worried and wondered about what is the transmission of disease to lay down this important foundation

about the microscopic nature of infection. We've had cholera, the other 19th century disease everyone hears a lot about, they often talk about in the same sentence, is typhoid. Now, how is that different from cholera and when does it appear well it's it's it's not dissimilar in some respects and it has got uh it's a person-to-person transmission through well it's basically through body waste primarily and so therefore it's a manifestation of sanitation and the availability of public water supplies uh so it is something which has got some of a similar epidemiology to it, although its impact on the body is in some respects there are parallels, but it is also distinctive in the way in which it operates as an infection. It will cause the collapse of the digestive system and the waste systems of your body,

which makes it all the more notable. Was it a particularly bad outbreak in the mid-19th century? It was, again, something which was permanently part of the landscape of infectious diseases. This is the era of infectious diseases. This is the era in which there's a multiplicity of different types of infections, which, based on specific conditions, would appear appear every so often but would never die out and they were manifestations

of you know very simple phenomena and the most simple one is the lack of adequate clean water supplies both in terms for drinking and for using for the disposing of human waste at the same time. So they are present and they would be more prevalent at times and in places where the living conditions, the physical conditions and the social conditions are at their weakest. And how does society respond? How do they take on the challenge of typhoid? Well, initially quite slowly, because, of course, there are competing views about how to deal with them. And also, in some respects, it's an expensive way to deal with them. Gaining access to a clean water supply, gaining access to a significant sewage system,

is a major investment at a time when the national state is not providing these things and it's dependent upon local authorities. And this is the era of so-called municipal socialism, providing these resources. My own home city of Glasgow, for instance, was in the lead to this when it identified a new supply of clean water at Loch Catron, which they brought into the city by the latter part of the 19th century. Also, there were pieces of permissive legislation, police acts that were known, which allowed for the construction of internal water supplies, particularly internal

toilets, to counteract the spread of the disease in what were known as private middens. How many people are we talking about that are suffering in these particular, I know to counteract the spread of the disease in what were known as private middens. How many people are we talking about that are suffering in these particular... I know you say it's there all the time, but in these spikes, how many people might it affect? You're talking about short, sharp outbreaks periodically in which, depending upon where they break out, you're talking about thousands of people contracting within a few months of each other, upon where they break out, you're talking about thousands of people contracting within

a few months of each other, with often a lethality, a mortality of over 50 to 60%. So you're talking hundreds and thousands at various times through the era, declining steadily as we get towards the end of the 19th century as these new innovations in public water supplies and public sewage supplies are actually acting as really effective countermeasures so although it doesn't seem large numbers in comparative terms it's their perpetual and their permanent place and the way in which they can disrupt that becomes most problematic for them. And so the key thing there was it was not a vaccine or anything it was just getting fresh clean water into people and getting rid of everyone's poo and whey. Well basically a

very simple I mean and it took a long time for people for the penny to drop that that was one of the most efficient mechanisms to do so. There was competing theories about the transmission of disease. There were disputes about the resourcing of it. There were complications, particularly when it came to water supplies, because there's two different interests at heart within the water supply. There are those in industry, for instance, who want different types of water so that they can use it for the cleansing and for their industrial practices and there are those that need it for a clean water supply so there's multiple issues going on when we are dealing with the whole question of gaining access

to these what are seen you know simple mechanisms to counteract disease although the biggest issue to deal with and this will be the ultimate one is to change the social conditions that people lived in in a much larger sense than just simple water supply so so you're suggesting i guess that the rich people were able to swerve it and got their nice clean source of water but people stuck in the east end of london or whatever that's you know they're a huge disadvantage well it's a perennial feature of the history of infectious diseases. It is those with the least means that are the ones that are most affected. Although it's important to realise that these diseases are equal opportunity killers. As we're discovering with the current

pandemic, when there is no efficient and organised system to deal with it, it will affect people significantly. In some respects, one of the reasons why there are changes is because it is affecting the richer people. And so therefore they've got a vested interest to help those who are the most commonly affected by it. So there's an interesting game of politics being played when it comes to the access to these resources.

It's self-interest in some respects, as well as efficient sanitary practice. Land a Viking longship on island shores, scramble over the dunes of ancient Egypt and avoid the Poisoner's Cup in Renaissance Florence. Each week on Echoes of History, we uncover the epic stories that inspire Assassin's Creed. We're stepping into feudal Japan in our special series, Chasing Shadows, where samurai warlords and shinobi spies teach us the tactics and skills needed not only to survive, but to conquer. Whether you're preparing for Assassin's Creed Shadows or fascinated by history and great stories, listen to Echoes of History, a Ubisoft podcast brought to you by History Hits.

There are new episodes every week. Cliff, the next album is one I thought was consigned to the Middle Ages. The Plague. The Plague was back at the end of the 19th century. Absolutely. I mean, it's regarded as the third great visitation of the bubonic plague, starting in the early 1890s in China and gradually making its way across the world to Europe by the start of the 20th century.

Yeah, I mean, in the United Kingdom's case, it hadn't seen significant presence of the bubonic plague since the 1660s, since the Great Fire of London and all that sort of things. It was a remarkable surprise. And you see that phrase being used a lot in the literature of the time, saying, where the hell did this come from? Again, it's meant to be a relic of the medieval experience not something that modernity has any folk memory of.

And it was the same plague that we've become familiar with the buboes and did they have equally high mortality? Well it depended where you were and again this is something which is evidence of the different states of sanitation development and social conditions. Where it breaks out in places like China and India, its lethality is gigantic. It is taking away more than 50% of the people infected by it. For instance, in Bombay, the victims number in the hundreds of thousands by the time it is burnt out. And bubonic plague is a permanent feature of the Indian subcontinent throughout the period, but not to this extent.

It's the sheer scale and the overwhelming scale of the disease that emerges, that transforms it into a global pandemic. And we're really using these terms at the end of the 19th century because the world is getting its act together to create an international system to deal with disease control. Yeah, so what were the responses to this pandemic and how are they different to its medieval predecessor? Well, as I was saying, it is very much going to be built

around the first attempts at international coordinated countermeasures to stop the spread of the infection but also to deal with it uniformly in terms of what happens once it becomes present in any significant community. That notwithstanding however there are significant national divisions which open up at this time. Not least over finding a way to understand the epidemiology of the disease, because rival biochemists are looking for the source of the disease and the best way to counteract it and fight it. And so were governments on the bull? Were they able to take countermeasures to do the kinds of things we expect modern governments to do?

Well, it was more, strangely enough, it was more in local contexts that much of the effort took place because it was very much city to city, town to town, because much of the sovereignty over, for instance, ports didn't rest with the state, it rested with the local authority in various ways. And so therefore, this is again, very much part of the pre-national state approach. It is international rules which are applied at the local town and city and port level. Today, we talk about the pandemic has really, in the space of weeks, moved from one side of the globe to the other. How quickly would that outbreak have been travelling across these local areas? Well, the earliest manifestation of it is around 1894 to 1895. So we're talking less than six years.

And in fact, by the time it gets to the Indian subcontinent, it's less than two years before it is present in Europe and reaches the United Kingdom in August of 1900. How many people are we talking that died in this wave of the plague? Well, the plague itself, the actual terms of the pandemic is from 1894 to around 1950 and you're talking over 20 million, 20 to 30 million dead as a result of it globally as it burns itself out at the start of the 1950s. It's funny because you know you read in warded literature you don't read about the plague. I mean was this something that would have been on everybody's radar? Well they would have known it was coming. They would have known

it was coming and it would be something which again we've kind of talked about this the sheer novelty of it in some respects that not having seen this this infection in the west for such a long time and of course the folk memory of it was of its lethality of its of its physicality all those images of the sort of duck-billed physicians going from house to house and bodies you know deteriorating in place etc etc and so therefore there was a real fear of what the plague would actually mean in terms of its physicality and the way in which it was going to cause disruption because remember and I know you know this fine well when the plague hit in the 14th century, it brought Europe and much of the Near East to a grinding halt. So there was an anticipation that this was going to be similarly problematic.

However, it was a different time. We're at the end of the 19th century. We're at a time when there is a greater consciousness of the nature of disease and also the ability to counteract it and contain it and isolate it very efficiently. I'm sure the outbreak of the First World War didn't particularly help the international response then. Well, absolutely.

But that time, it really, once again, kind of receded back into its core areas and only sporadically broke out from it. By the time we get to the First World War, they're far more anxious about diseases such as typhus impacting the military more than anything else. And that's where the bulk of the effort on infectious diseases has moved on to by 1914. So it just sort of gradually disappeared? It gradually, it kind of burns itself out. Well, once it finds enough victims or it is deprived of victims,

it will run its course. But that's notwithstanding periodic outbreaks. There was an outbreak in Los Angeles in the 1920s. So there's the potential for it to take hold in communities relatively quickly. But as we get to the latter stages of it, the world has moved on in a lot of ways. There is an effective inoculation for it and there's effective treatment for it.

Cliff, you are one of the great authorities on this. Reviewing all that stuff we've just talked about, what are the key differences and what are some of the similarities of what we're experiencing now and these pandemics that have gone before? Well the first thing to say about it is that this is the first time in living memory that we have seen this type of pandemic in the west, in the northern hemisphere if you like and so therefore there is like and so therefore there's there's um there are problems in relation to that because our public health system has moved on from the uh the concentration on infectious diseases and in fact in some respects our public health system is probably more vulnerable now than it would have

been in 1900 to the outbreak of the bubonic plague because there was fever hospitals in 1900 there aren't fever hospitals these days we're going to have to rely upon the infrastructure of the National Health Service as it's currently constituted. Now, of course, there are significant differences in terms of the lethality of the current outbreaks that are taking place. We're talking 1% to 2% generally, although larger in other age groups and genders, of course, because this current coronavirus seems to have a disproportionate effect on men as opposed to women and also the elderly as opposed to the young. And that's a significant difference because historically infectious diseases disproportionately hit children

and were one of the major causes of infant mortality. So there's a significant difference in that. It's similar in that we've got to anticipate how we are going to respond to the relatively permanent presence of this infection and how we are going to organise around it as part of our everyday lives. At the moment, we're in the midst of this this lockdown that can't be sustained forever and also if it's going to be permanent there has to be a more efficient a more substantial system which is going to ensure that we don't return to this you know weird world that we're currently living in where we will never ever see people through

the computer screen. Cliff it's lovely seeing you through the computer screen, so I'm not complaining at all. Having looked at these other pandemics and the way they change the world, have you got any preliminary ideas on the sort of societal change, behavioural changes that this might lead to? A lot of people are asking, how is this going to change our everyday lives? Well, I think that anyone who studies the history of pandemics and infectious diseases come to the same idea. These outbreaks don't just affect people.

They don't just result in disease. They reveal so much about society. They reveal so much about the way in which we are currently organised and whether or not our society is fit for purpose to cope with the considerable vulnerabilities which are being exposed by it. The most significant, of course, is because we are now all indoors. The working population has changed quite considerably.

Now, people like myself who work in academia, indoors, the working population has changed quite considerably. Now, people like myself who work in academia, it's a relatively straightforward transition for us. It's a little bit difficult because we're not all that computer savvy. But for significant parts of the population, they are going to be workless, and they're therefore going to be economically vulnerable. And so therefore, there is a reflection upon whether or not our welfare and social care systems are fit for purpose to deal with just the general problems of modern poverty and modern living and I think that's going to be the most

revelatory part of it and how much that is therefore going to change the approach of government towards the idea of providing for those who are going through temporary periods of unemployment and difficulties. So as I say, this particular experience is going to be revelatory of where we currently stand. And secondly, it's going to be a test of political will about doing the things that need to be done to remedy it so that people are not left vulnerable. You know, I was speaking just earlier on to one of my PhD students who's renting his home at the moment. He's faced with the problems of potential eviction or the ramping up of his rents that he can't pay for. How is that

going to be accommodated? There are millions of people in rental accommodation at the moment who are faced with these vulnerabilities this is a real touchstone of where we're at how is this going to transform our attitude to those that are struggling and the collective responsibility which we have towards them. Can I ask you as a human as well as an expert how are you feeling are we Are you a little optimistic? Are you looking at these pandemics in the past? Where are we? What are we talking? Well, I'm optimistic in a lot of respects, because we have been here before. This is not a unique experience in human history. We have a lot of historical memory to draw upon. We have a lot of resilience to draw upon. We've seen that as the pandemic has emerged. There was obviously the panics at the start of it.

But, you know, if you go to the shops and we do that on our officially government approved exercise slash shopping trips, we see appropriately social distancing. We see people allowing the elderly and carers and NHS staff to get to the front of the queue when the shops open in the morning. We are seeing significant indicators of civic virtues and civic values coming to the fore. And I think that's something which is going to lay down a good template for when we get past this, about the future relationship we have with our neighbours, with our friends, with our co-workers, with those whose work at one point we regarded as low value, but who are now at the core and at the heart of ensuring that we are fed and we are clothed and we're able to get amenities. The other thing I suppose is as you mentioned it's not killing vast numbers of young people or kill kids which would be a perhaps seems callous but it would be give another whole element of into the tragedy wouldn't it? Well I mean it's something which is quite distinctive from previous experiences of infectious diseases and the infectious diseases which we see in other parts of the world, that is you know, if there's a saving grace in

all of this, we are not seeing the youngest generation being you know sort of mown down in the sort of biblical sense by these infections and that in itself will be important for the recovery process and future developments. I agree Cliff, that's a strong place to leave it. Thank you very much sir for coming on this episode of History Hit Live on Timeline. It's a pleasure, thank you. hi everyone it's me Dan Snow just a quick request it's so annoying and I hate it when other podcasts do this but now I'm doing it I hate myself please please go on to iTunes wherever you get your podcasts and give us a five-star rating and a review it really helps basically boosts up the chart which is good and then more people listen which is nice So if you could do that, I'd be very grateful.

I understand if you don't subscribe to my TV channel. I understand if you don't buy my calendar, but this is free. Come on, do me a favour. Thanks.