The Rest Is History - 146. Disease vs. the rise of civilisation

Episode Date: February 3, 2022

The way we die has been utterly transformed. There have been around 10,000 generations of human beings, but only in the last 3 or 4 have infectious diseases not been an expected and accepted cause of death. What drove the most deadly infectious diseases? Was technological progress and globalisation one of the key causes for its spread over the course of history? Tom and Dominic are joined by Professor Kyle Harper from the University of Oklahoma to discuss the fascinating history of disease and how shifts in the way we die have changed our world completely. Producer: Dom Johnson Exec Producer: Tony Pastor Join The Rest Is History Club for ad-free listening to the full archive, weekly bonus episodes, live streamed shows and access to an exclusive chatroom community. *The Rest Is History Live Tour 2023*: Tom and Dominic are back on tour this autumn! See them live in London, New Zealand, and Australia! Buy your tickets here: restishistorypod.com Twitter:  @TheRestHistory @holland_tom @dcsandbrook Learn more about your ad choices. Visit podcastchoices.com/adchoices

Thank you for listening to The Rest Is History. For weekly bonus episodes, ad-free listening, early access to series, and membership of our much-loved chat community, go to therestishistory.com and join the club. That is therestishistory.com. Toward the end of the 19th century, in the United States and Britain, a great threshold was crossed for the first time in the history of our species. Non-infectious causes of death, cancer, cardiovascular disorders and other chronic and degenerative diseases accounted for a greater portion of total mortality than did infectious diseases. By 1915, an American social reformer could observe that a generation ago we would only

vainly mourn the deaths of children from disease. Today we know that every dying child accuses the community. The knowledge is available for keeping alive and well so nearly all that we may justly be said to sin in the light of the new day when we let any die. By mid-century, dying of infectious disease had become anomalous, virtually scandalous in the developed world. That is from Plagues Upon the Earth, Disease and the Course of Human History, a brilliant new book by Carl Harper, who is a professor of classics at the University of Oklahoma and wrote a fantastic book, The Fate of Rome, in which he looks at how disease impacted on the fall of the Roman Empire. Kyle is with us. Kyle, this book plagues upon the earth. I mean,

it's on a vast scale. We go from Homo erectus, the earliest ancestors of of homo sapiens right the way up to covid um and that passage that i read it's a kind of reminder to us how unusual it is that actually we're not all dying of of infectious diseases and presumably you wrote this book against the backdrop of of covid yes yes and no to your last question. And hi, thanks for inviting me to be here. I'm thrilled. And the book is sort of is a COVID book and isn't a COVID book. So I started it in 2017 when it was going to be a kind of, you know, project that I spent several years thinking about and then writing and a little bit of a abstruse academic topic, the history of infectious disease, that would have as its kind of finale a warning that the patterns of history should be another

reason why we should obviously expect that there'll be a new pandemic. So it wasn't born as a COVID book, but it came to completion certainly under the shadow of COVID, which was pretty bizarre, pretty surreal to end up with a book that was far more urgent and resonant than I ever imagined when I started writing it. So you have this incredible passage where you say that, you know, there have basically been, it's extraordinary to think about it, actually, there have been 10,000 generations of human beings basically and for all but the last three or four the big killer was infectious i mean infectious disease was your biggest fear and that we and our parents and grandparents are completely anomalous in the

course of human history in that we have until covid COVID actually, which confronted us, forced us to sort of stare into the abyss that once confronted our predecessors, we were kind of insulated from that. So in some ways, can you genuinely divide human history, do you think, into a before and after in that way? I think it's one of the most fundamental transformations in human existence. The way we died, the way we die has so fundamentally changed. This is sometimes called the mortality transition. And it happens first in the UK and US and Western Europe, and then increasingly across the entire globe. And it's still incomplete. Of course, even in the societies today with the lowest life expectancy, life expectancy at birth has nearly tripled. So there has have to have six children on average, just to replace the population. The fact that you don't have to go

through the experience of losing half to a third of your children. The fact that you can invest and send kids to school for 20 years to become Roman historians or something requires a kind of stability and predictability. So it's changed our ideas around pain and suffering and predictability. There's, there's nothing that this doesn't change. It changes everything. It allows the empowerment of women. And so it's easy for us to take it for granted. It's amazing. It really is only three or four generations ago. But, but how quickly we've come to build into all of our expectations about life that we shouldn't die of smallpox or tuberculosis or

plague or something. Because, Carl, I mean, when you, obviously, the past two years, interest in the history of disease and the relationship of humans to disease has just gone through the roof. But really, before that, there was a sense that disease is something that you can kind of park, that it's a distinct area of human history, separate from everything else, history of medicine, history of disease, whatever. But the argument of your book, basically, is that humanity's relationship to pathogens, to organisms that essentially can kill us. It's the history of everything. It's the history, I mean, you say the history of migration, the power of poverty and prosperity of progress and its unintended consequence. And that this is a history that goes back way, way before the

emergence of Homo sapiens, that it goes back to our kind of ancestral ape ancestors. Right. And I mean, I try to look at human beings and human history the way that a biologist would, and particularly the way a disease ecologist would, because really, if you sort of lose our human arrogance and remember that we're organisms that are part of the web of life or part of nature, like any other living being. If you look at us objectively from the outside, we are very weird. And we usually think of our uniqueness in terms of our big brains and all of the good things. But, you know, if you're a chimp looking at us, our closest relative is the chimp. You might say, my goodness, that ape has so many infectious diseases. That is the germiest creature. I need

to stay away. And one of the really important ways in which we are weird, just speaking objectively, looking at us the way a biologist would, is that we have a huge number of pathogens that cause disease in us. So much more than other apes. Much more than other apes. And not only that, but we have a lot of them that are really, they're obsessed with us like a, like a creepy stalker. They really only care about us. A lot of pathogens in nature can't be too picky because you have to be able to infect different hosts, but a lot of pathogens, you know, think measles, smallpox, really, really have a narrow host range or exclusively can infect humans.

That's very weird. And then it's very weird how virulent many of our diseases are. In nature, pathogens are always evolving constantly and more or less virulent strains emerge. But there are some kind of limits on the ability of pathogens to become so virulent that they kill their host so quickly that they can't survive. And so apes and a lot of animals have some really, really nasty pathogens. But we've just got a lot of really, really virulent diseases. So looking at ourselves objectively, we're weird. And one of the really important ways is the human disease pool. Why is that so broad?

Is that to do with what becomes our history? The one word answer is history. Chimps 100,000 years ago had the same diseases that they have today, mutandis mutandis. There's always evolution. But chimps 100,000 years ago lived and died in pretty much the same way because they had the same biology and the same technology. Whereas humans 100,000 years ago did not have the same diseases. All of these diseases that I've already mentioned, measles, smallpox, tuberculosis, plague, malaria, are products of the recent past and the reason why we have the diseases we have is because of history in the sense of the the ongoing technological development that that

our species has has led so we live completely different lifestyles we get our food differently we live in different habitats um we live yeah so that in a social organization. One of the key to begin with is that we migrate and we occupy kind of ecological niches that our distant ancestors didn't. Yeah. Most primates are pretty stuck where they are because they evolve and adapt to their environment. They get food from, forest they live in. Chimps are very good at finding bugs to eat and fruit and occasionally a little monkey. But they're so hardwired to live in that ecological surrounding that that's it. I mean, a chimp population can't pick up and say, well, maybe we should go live in the savannah, or let's, let's check out the, the Arctic tundra and see if there's some food up there. Whereas humans are one of our most distinctive characteristics is that our, our intelligence and social capacities and technology

lets us change the, the natural ecology in ways that benefit us, lets us exploit radically different environments. So we are a cosmopolitan ape. And that very fact exposes us to a huge range of potential diseases that is sort of what gets the ball rolling in terms of creating a unique and distinct human disease pool. You mentioned our use of fire in your book as one of the sort of things that, you know, crucial technological, I suppose you would say, innovation. How does that shape our relationship with disease? Yeah, it's, I mean, it's in some ways, it's the kind of technology. Humans are not the only animal that uses technology. Chimps use sticks to dig up ants and so on. So technology is not uniquely human, but human ancestors before Homo erectus had tools, very, very simple, primitive tools. But fire is sort of the

revolutionary technology. It puts a power in our hands that is unlike anything else in nature. It makes us the only animal that consumes energy through both metabolism and combustion. It lets us migrate. So it's what gives us the power to live in environments where otherwise it would be too cold or where otherwise the flora would be too dense. We can just burn it down.

It keeps predators away from us. It lets us build other technologies like ultimately metallurgy. So fire is sort of the technology that in many ways sets the history of human technology on a different path. So it's the technology. And in that sense, I would say technology is one of the great driving forces of human history. And it's certainly one of the great driving forces that lets us change the environments we live in. And when we do that, nature will respond. Microbes are pervasive. They're everywhere. They're always evolving. They evolve fast. I mean, COVID-19 has been the best sort of public education project for understanding the evolution of, in this case,

viruses. Evolution is constant and fast. That's how we end up with these new variants. And so anytime humans change the environment, when we move to a new ecosystem, we're burning it down, we're extracting food, and we're also exposing ourselves to new pathogens driving their evolution. And fire is really what gets all of that going. Carl, have you played a computer game called Civilization? I know, but I know it, yeah. Well, you know, the way you begin with hunter-gatherers and then you progress to spaceships going to Alpha Centauri. And it's done as a sequence of sequence of amazing technological cultural leaps or whatever. But reading your book, I thought the history of humanity could

just as readily be described as the expansion of diseases that can prey on us. So if we begin with hunter-gatherers, this idea that they are living in harmony with nature is not entirely true. In fact, they are going into habitats that are generating all kinds of new diseases, of which I think malaria is the most lethal. I mean, I'm sorry that I have to pile on the hunter gatherers because they, you know, they had a real moment in the 60s and 70s when it was quite popular to say that hunter-gatherers had it figured out. They, you know, they didn't have private property. They were kind of open about their sexuality. They moved around a lot. They ate a very healthy- And had a high aspirin.

They're basically hippies. Yeah. Sort of, you know, bohemian paleo diet, healthy, living in harmony with nature. So that's a bit of a caricature, but there really is this sort of story that will never go away. And one of the reasons it won't go away is because there's some truth to it, that agriculture is this huge catastrophic fall from grace. And we can come back to the ways that's true and not true. But hunter-gatherer societies, we've come to really understand, were a lot more varied. There was inequality. There was ecological violence, as well as violence against humans. There was war. And our species has sort of expansionist tendencies. And another way in which we can sort of pile on the hunter-gatherers is they were not living in a kind of disease-free paradise. Now, that said, there were clearly

some limits because hunter-gatherer societies tended to be small. They didn't have the energy technologies to build cities or to build really, really big, dense populations. And they moved around a lot, which isn't always a bad idea if you're trying to avoid germs to move away from your waste. But hunter-gatherers, if we, again, look at them like a biologist, they have lots of germs. And there's a lot of reasons why it's hard to know what Pleistocene people's lifestyles were like and what germs they had. But there are ways to get at that question. And most of them leave us with the answer that human hunter-gatherers already had a lot of infectious diseases and the burden of infectious diseases is already quite high. And in some cases, one of the really revolutionary things that's happening is that genetics is

letting us know about a lot of things about the evolutionary history of our germs, including giving us a better and better sense of how old some of them are. And it's increasingly evident that while a lot of our pathogens are very, very young, Some are sort of in the middle. They're not like just timeless. They don't go back to, you know, millions of years, but they do go back to the Pleistocene, the period when humans emerge, Homo sapiens emerges and starts just expanding relentlessly everywhere we can. And this expansion and process of expansion of early humans clearly reverberates back on our health. And malaria is one of the big case studies because malaria is one of the great human diseases. There are different species of the parasite that causes

malaria. The worst one is actually probably younger, probably doesn't evolve until the Holocene, Plasmodium falciparum. But the most widespread form of malaria caused by Plasmodium vivax, which is a very severe disease, is a good example of what we now think is a late Pleistocene. So it's a late Ice Age hunter-gatherer disease that is spread by mosquitoes that really would have weighed heavily on human health even 10,000, 20,000 years ago. Kyle, let me ask you a very basic question, which you've answered a bit of it already. So I think in your book, you say that basically about half of all chimpanzee deaths are caused by infectious diseases, and about just under three quarters of hunter-gatherer deaths are caused by it, which is a big difference. Is that basically because hunter-gatherer deaths are caused by, which is a big difference. Is that basically because hunter-gatherers are just moving around much more? Is that the single biggest difference?

They're moving around more than chimpanzees are. Yeah. I mean, I'm using what I think is a very good meta study there. And there's been a lot of work trying to figure out what, you know, what do chimps die of? Of course, they don't have hospitals and governments, but human observers have looked at different chimp populations very extensively. And so we have a pretty good idea of the demography of chimpanzees and infectious diseases. I'd say this too, chimps have a lot of germs. If you compare them to other primates and other mammals, you know, everything back in our wing of the family tree. But just a bad bit of the family tree, right? We're the worst bit of a bad bit in general.

But hunter-gatherers, and again, this is based on a lot of different data points, and there's variability. But hunter-gatherers do, most of them, from what we know, die of infectious disease. And it wouldn't be the same infectious diseases that, say, you died of in early industrial Britain. It's probably not tuberculosis and smallpox, but they're dying of low-level respiratory diseases, of worms, which is very underrated as a burden on human health. And herpes. Of gastroenteric diseases. Of what's that? Herpes. Herpes. Herpes is really old. It's been around for millions of years.

So, and we have two, unlike most primates, we have two species of herpes virus. Spoilers. Well adapted to us. Okay. And so then just for fun, we have the agricultural revolution and we all start living in shit. Well, this is one of the interventions I'm trying to make that we can qualify and should the idea of a Neolithic revolution. It happens in two dozen places around the globe. It's not sudden, but it is still the biggest change in human lifestyles in pre-modern times. The ultimate transition from taking our food from wild

sources to making our food, to producing it with domesticated plants and animals. And people have talked about the importance of this change for human health and in some important ways, it changes diet, it changes patterns of labor, the stress on the human body. Um, but the, the sort of famous narratives or the big histories of disease have often sort of moved straight from the invention of agriculture to what are sometimes called the crowd diseases or the diseases of civilization, which are all respiratory diseases like measles and smallpox and so on. So I'm trying to intervene and say that story's not quite right. For one thing, it was developed at a time, I think, before radiocarbon and before we really knew how many thousands of years there were between the transition to agriculture and the rise of civilization and cities. But there's there's thousands of years in there before you really get large scale states and empires and cities in, say, Mesopotamia in the

fourth millennium BC. So that's what's going on in that stretch of time, to me, is you have this change in human lifestyle, change in the way the settlement structure, the way we live, that isn't yet big cities, but is sedentary. And this is a huge factor in disease ecology, because it means that you're constantly surrounded by your own waste, human waste. And animal waste. Humans have this really bad idea. Let's take normally mobile herds of very large body mammals that are also constantly moving away from their ways. Let's put them right in our house or yard and make sure that they don't go anywhere and that they're just all around us.

So, as I say in the book, human settlements in the early Neolithic were up to that point in time, the single greatest accumulation of interspecies scat in all of nature. There's really nothing like a human settlement that brings together so much crap from so many different animals in such a concentration. And that has a huge effect on our health. The most underrated category of disease in most histories, big history of infectious disease is diarrheal disease and dysentery. And it's, to me, this is, this is a crime that all the respiratory diseases are these big, sexy, famous named diseases that everybody knows. Whooping cough, diphtheria, measles, smallpox, scarlet fever. Fine. The respiratory diseases are important. They're sexy. They get these, these names. Whereas the diarrheal diseases don't have a chance because you can barely even say you know shigellosis and paratyphoid fever

well they're very unglamorous aren't they they're unglamorous diseases but they they impose a huge burden on human health throughout the past they would have just been up there with particularly on children category on young particularly on children, right? And particularly in children, particularly in children, because there are lots of them and the human body will be exposed to them over time and develop some level of immunity. But it's children who are naive immunologically to these diseases. And then, of course, human children are filthy little creatures and their hygienic habits are extremely questionable. You've got four young children. I have a lot of them in my house. Speak from personal knowledge.

It's fingernails, isn't it? Isn't it fingernails? So one of my son was tiny. He scratched my eyeball and it immediately kind of massively swelled up and I went to the doctor and the doctor said, yeah, we see this like every day because kids' fingernails, kind of massively swelled up and i went to the doctor and the doctor said yeah we have that we see this like every day because kids fingernails they're just they don't even need to go outside

to somehow accumulate ginormous quantities of mud under their nails anyway this is they're filthy here's a question for you that might seem a very basic and dumb question so these people are are more sedentary they're living in kind of little settlements and they are surrounded by waste but obviously that waste you know attracts flies all these kinds of things and and now we would be horrified by it right we would be repelled by the stench and the sight and all these kinds of things how come it doesn't occur to people at the time that this is less than i know this is this is a great question and i think um you know i think it really challenges you as a historian to try and sympathetically think about

the the mindset of of people in the past and i i think that actually most of our ancestors um you know they weren't indifferent they they too know, your nose tells you when something stinks that it's dangerous. That's hardwired for good reason to tell us to avoid corpses and to avoid waste because putrefaction collects all these bacteria that are unpleasant. So there may be really interesting ways in which cultural frames can partly can partly remold the wiring of, of your sensory perception and your, your cultural processing of it. But I actually think, you know, the Romans, the early Neolithic people, they, they must have wanted to avoid some of these smells. And we know that, you know, as soon as people can, they're doing everything they can to get clean water and so on. But the, um, so

they weren't indifferent and I don't think we should imagine that, um, that they were, but I think they were overwhelmed and, um, the, the technology required to ensure, um, clean drinking water, um, is, is something we can't take for granted. And so I, I rather try to portray them as, as in many ways overwhelmed by the, that are at play, because they obviously they need their advantages, economic, social, cultural, spiritual advantages to living in cities. So there's a lot of forces at play here, but also the health threats and risks and challenges of living in dense settlements overwhelm them. And has it always been the case up until really the past, what, 1,500 years, 150 years, that cities can only grow if they're replenished by incomers because they kill? Yeah. I mean, I think in the big picture, all pre-modern cities are probably more or less giant demographic sinks. And that the only

way they can sustain their population, much less grow, is by constantly replenishing from the countryside, which tends to be less dense and therefore healthier. And there may be exceptions on the margins to some of this. And there are some places that have better environments than others. And some cities, the Japanese cities in the early modern times um are pretty pretty interesting in terms of their efforts to maintain clean and healthy environments but um but from the very well-documented western societies you know the london um the the death rate exceeds the birth rate until about 1800 um and so for london to maintain its size or grow if the death rate exceeds the birth rate until about 1800. And so for London to maintain its size or grow, if the death rate's higher than the birth rate,

your population's going down unless there's migration. Yeah. Okay, let's take a quick break there for some ads and we will see you in a minute. I'm Marina Hyde. And I'm Richard Osman. And together we host The Rest Is Entertainment. It's your weekly fix of entertainment news, reviews, splash of showbiz gossip and on our Q&A we pull back the curtain on

entertainment and we tell you how it all works. We have just launched our Members Club. If you want ad-free listening, bonus episodes and early access to live tickets, head to therestisentertainment.com. That's therestisentertainment.com. dot com. Hello, welcome back to The Rest Is History. We are still here with Kyle Harper from the University of Oklahoma, and he is telling us about the history of disease. So, Kyle, you talked about how the advent of the Roman Empire, perhaps counterintuitively to a lot of our listeners, meant that people were shorter because they're fighting off disease, they've got diarrhea when they're young because they're living in cities. Is that true generally, would you say, through

most of human history for people who live in cities and large settlements, that they are shorter or smaller than they would otherwise have been if they had stayed in the fields or whatever? Yeah. I mean, big picture, I think that is the pattern, that they'd stayed in the fields or whatever yeah i mean a big picture i think that is that is the pattern that um that they're they're skeletons insofar as skeletons reflect health in different ways uh the skeletons tend to be shorter and and generally more stressed from urban environments than the rural environments we know that's true all over the roman empire but it's true going back further in time and coming up more recently down to, down to the modern times.

So Tom, you know why I asked Carl that question? Because you often give me grief in this podcast about not living in London. And now I've been proved completely and utterly right. No, I'm sorry. I'm sorry. Around 1900.

Yeah. It all changes, Dominic. Get with the, get with the speed. It flips. Somewhere in the 20th century, you're,

the deep continuities of human history prove me right, Tom. No, the Metropolitan League get better health than the peasants, I'm afraid, are left behind. That's the lesson of history, Dominic, and you can't argue with it. But of course, the most famous plague pandemic is in the 14th century the black death how do you think that the impact of that of the black death compares to the justinianic plague or to any other um pandemic experience before that before the black death yeah i mean one of the one of the things i really wanted to do in writing a history of disease is to to broaden the the canvas and make sure that we're we're not just focusing on the big sexy diseases,

whether it's kind of these lesser known diarrheal diseases or worm diseases or particularly tropical diseases that sometimes European or American historians don't pay very much attention to because they're maybe not the sort of local history diseases. But even so, so I comment this from a perspective where not inclined to put plague at the top of the pyramid of wildly crazy, insanely deadly diseases, but it's there. I mean, I still just am struck and looking at the whole swath of the history of infectious disease and how hard it really is to wrap your mind around bubonic plague. So

the plague caused by the bacterial disease Yersinia pestis. It's hard to understand how something could exist that causes so much disease and so much death so quickly on such scales. What is the current thinking on how much death it does cause? In the Black Death, we're, so I'm a Roman historian who's perennially jealous of scholars working in the late Middle Ages and early modern periods, because you still have pre-industrial societies, but you have more of a documentary record and, you know, in places like Italy, you, you have really rich record from civic, um, uh, governments and in England as well. And then increasingly from church records. So we actually have more of a basis than we do in the

Roman empire. And there's been a ton of work on the black death and it doesn't, you know, there's not like a sort of quotient that it hits everywhere it goes. I mean, there's one amazing, I use this one manor record from the South of England in the book that has been studied where you have this amazing list of people, workers on these villages from 1347 and 1349. It's just like this granular look at the arrival of the plague. And there are little like hamlets or something where it's killing nobody. Hamlets was killing everybody. So we're talking about an average of a spread, but the work on the Black Death, you know, that used to be canonically that it killed a third to a half, which I always think is kind of funny because it's sort of like just got ingrained. And there's all this history work that just says third to half, third to half, third to half. And, you know, that's not bad, but it's still pretty big spread.

And anywhere there's like a ton of detailed evidence, it really is more like half. And it's usually these overtimes. Historians like to be critical and these big claims get kind of broken up. But actually what's weird about the study of the Black Death is that hasn't, in a lot of ways, really happened. I mean, there was definitely variability. But if anything, the older estimates tend to be on the lower end of what we think. So over really large areas, it's killing half the population. And the thing is, we sort of take the Black Death for granted.

We're familiar with the iconography. But we don't really probably think enough about what that must have meant i mean one in every two people is killed if you've got 20 friends 10 of them are dead you've got four kids two of them are dead and the other two will probably die anyway something else it's mind boggling so this is the most cataclysmic event in human history? Yeah, I mean, I think that there used to be, now, this is a useful contrast, the Columbian Exchange, so the arrival of European explorers and conquerors in the New World following Christopher Columbus, there used to be the idea that these unleashed these sudden huge pandemics that also killed 50, 60, 70% of the

population. Obviously, I think the introduction of European and African diseases to the new world is hugely important and killed massive numbers of people. And you can't talk about European expansion and colonialism without the biology of infectious disease. But those numbers don't stand up. There were some really, really big pandemics. And over the course of a century, there may have been that level of population change. But none of the, say, 16th century pandemics that we can follow were quite the same magnitude as the Black Death. Now, I still think they're sort of in that tier of the most destructive disease events in history. But I would say that the plague

pandemics at their worst seem to just have a kind of scale and magnitude that we don't see in other events. And Carl, I mean, obviously, if you live in England, I guess also in America, the focus of the Black Death is Europe, particularly Latin Christendom. But there's a kind of a growing interest in the scale and the scope of the spread of the Black Death across Asia as well, isn't there? And there is research being done recently, suggesting that it actually spread the century before in the wake of the Mongols. Is that right? Yeah, there's all sorts of really interesting scholarship happening right now, partly driven by the ability to draw from genetics as a source for understanding the evolutionary history of these pathogens. And it's really reopened, really, the question of how big was the black death chronologically and spatially?

And certainly there's a lot going on in the evolutionary history of the bacterium about three generations before the black death. And this is interesting because it really, I think even deepens the overlap with the Mongol mongol expansion um and the the establishment of mongol empires in the the 13th century so um so that's a really interesting angle and then just i think we're we're living in a time where there's a lot more global history that doesn't sort of just start with you know england i mean england is sort of the very fringe of what's what's happening in the black death and it comes from central as. We always, even without the genetic evidence, the Arabic evidence, Arabic language evidence

for the Black Death is extraordinary. And we know as richly what happens in Egypt as we do from Western Europe. So it's a story that always should have been. But China, China is interesting, isn't it? Because there the evidence is more ambivalent. Yeah. And it's hard for me as a scholar because the language in East Asia are so inaccessible to me.

And there's a huge level of interest and a lot of debate going on now. And there's smart, informed people who seem to be on both sides of this. So it's very hard for kind of an outsider to really know are these attestations of pestilence in China in the 13th century, is that part of the Black Death or the big bubonic plague pandemic, or is it not? And I really am unconvinced that either side has the decisive win in this argument right now. But it's one of the things we are going to find out. It's exciting. We need to know. It's really cool to try and ask.

If it does get to China, then it widens the scope of this pandemic. If it doesn't, then we need to ask why wasn't it there. And for instance, in South Asia, too, I think we don't fully know. But I would say there the balance of the evidence still suggests that the Black Death doesn't get to India in the 14th century, and we don't really have a good explanation for that. But it was big and bad. It was big and bad where it was, for sure. Now, that is the end of today's episode, but tune in tomorrow when we'll have the next installment. Or, alternatively, you can always join the Rest Is History Club at restishistorypod.com

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That's restishistorypod.com. I'm Marina Hyde. And I'm Richard Osman. And together we host The Rest Is Entertainment. It's your weekly fix of entertainment news, reviews, splash of showbiz gossip. And on our Q&A, we pull back the curtain on entertainment and we tell you how it all works. We have just launched our Members Club. If you want ad-free listening, bonus episodes and early access to live tickets, head to therestisentertainment.com. That's therestisentertainment.com.