Amid the current Covid-19 pandemic, it is more important than ever to talk about death and disease in a manner that is sensitive yet pragmatic. A way to understand the development of public health is to look to the past through archaeological material. However, dismissing the current pandemic as being ‘not as bad as the past’, can be a problematic approach. Yes, the 14th century Black Death killed 200 million people, but that doesn’t lessen the severity of our current health climate. On the other hand, we cannot directly compare the two, as to do so only creates an atmosphere of mass panic and hysteria. Comparing Covid-19 to a pandemic in a time of poor sanitation with little known effective medicines is dangerous and irresponsible. Both approaches have their dangers- so what should we do?
We should approach historical and archaeological material with both approaches in mind as to make sensible observations. For example, the British Society for the History of Medicine (BSHM) recently posted an article entitled ‘Can history help us in the Covid-19 epidemic?’ asking whether global health management of today can learn anything by examining the handling of the 1918 Spanish Flu pandemic. Whilst comparisons are made between both pandemics (i.e. lack of vaccine, slow implementation of social distancing), it is clear that the research of mortality rates of Spanish Flu were done to encourage quick intervention, not as a way to create panic amongst the general public. Epidemiologists are approached more and more on contributing to global health management, a responsibility with a lot of strings attached.
This post will look at four examples of archaeological material from four different pandemics/ epidemics (most were originally epidemics that became pandemics) with the hope of encouraging discussion on disease mortality without directly comparing them with Covid-19. Discussion of current public health concerns through observing archaeological material is important but should be done with an objective mind in assessing how relevant they are today.
- Bubonic Plague- ‘The Black Death’ (1346-53)
Death toll: 50 million worldwide
Mass burial ‘Plague Pit’, East Smithfield, London (1348).
Everyone has heard of the ‘Black Death’, the catastrophic tragedy that killed 60% of Europe’s population. The bubonic plague outbreak was linked to the bacterium Yersinia pestis (though recently this has been challenged) that spread through wild rodents. With rat infestation such a problem in the past its no wonder the disease spread with such ferocity. Once fleas killed off the rat colonies they would turn to humans as new hosts. Bubo sites would often form in groin, thigh, armpit or neck (Lymph node sites) and the bacteria could spread through the blood stream to the lungs causing cases of pneumonic plague. This was only in a small number of plague cases, but the bubonic infection would kill 80% of victims. Often symptoms would only develop 5 days after infection, and another 3-5 days after the victim would die.
In 1986 archaeologists discovered a large cemetery near the Tower of London in East Smithfield. The burial ground was confirmed to be an emergency cemetery to cope with the rising death toll, and over 24,000 people are thought to be buried at the site. Plague pits were all over Europe to dispose of victims of bubonic plague. These mass, anonymous graves can be viewed as pragmatic response to death- but what were the effects on the bereaved? Although the outbreak occurred at a time when mortality rate was high anyway, one cannot help but ponder how the population felt about their loved one buried or ‘stacked’ without the pomp associated with religious rites. The use of mass graves has been linked to infectious disease as a way to stop the spread of an epidemic- in this case however it was likely to confine the ‘smell’ which was more associated with sickness then the disease itself (i.e. Miasma Theory). Some probably went into the pits without identification, another worry for families in a time of desperation.
- Bubonic Plague (last wave in Britain)- ‘The Great Plague’ of London (1665-1666)
Death Toll: 100,000 in London
17th Century plague doctor mask
The plague outbreak of 1665, was the worst outbreak of the disease since it’s 14th century outbreak. It was the summer months that caused the outbreak to swell, with many of the wealthier classes fleeing the city. Much of the poor had to stay in London to prevent the spread of infection to other parts of England – all trade was halted from the city and Scotland even closed its border with England. Infected houses were watched over and the dead were searched for at night and buried in plague pits in the same manner as the 14th century outbreak. This era of the epidemic resulted in the further rise of plague doctors. Perhaps the most iconic image of this era is the plague doctor mask. This beak-like mask was used to protect the wearer against bad smells and prevent contagion, with a wooden cane used to probe victims to stop themselves touching the infected buboes. The nose of the masks was filled with substances such as cloves, rose petals and other pleasant-smelling herbs. Charles de L’Orne is credited with creating the iconic costume in 1619, it was usually made from goat leather. Although we still see the association with disease and miasma theory, it is clear the population were becoming more conscious of the isolation of the infected. Plague doctors also carried out autopsies on the dead and listed deaths on the public register. Treatment often included blood letting and the use of leeches.
- Broad Street Cholera Outbreak, London (1854)
Death Toll: 500 in 10 days on Broad Street, London
The Broad Street (now Broadwick Street) Pump
There were numerous outbreaks of cholera in London in the 19th century. The worst outbreak killed almost 15,000 people in 1849. Whilst cholera was a worldwide pandemic, the Broad Street outbreak is significant as we look at the investigatory work of Dr John Snow. Cholera effects the intestines and can cause death at quite a rapid pace, the first symptoms are vomiting and diarrhoea. According to the World Health Organisation, cholera still kills 100,000 people annually.
Miasma theory (Illness from bad air/smells) was still a prevalent theory surrounding disease outbreaks, until Snow was able to prove that this epidemic was a result of contaminated water. Snow studied the patterns of death and plotted their locations on a map, allowing him to conclude that water was the source of the outbreak. The Broad Street pump was very close to a cesspool and Snow removed the handle from the pump himself after community officials ignored his pleas to intervene. Although the original pump is no longer at the site, a replica one was placed there in the summer of 2018.
- Influenza Pandemic (‘Spanish Flu’), H1N1 (1918)
Death Toll: 50 million worldwide
Spanish flu face masks
Perhaps one of the deadliest pandemics of recent history, Spanish flu spread between 1918 and 1920. It is estimated that half a billion people were infected with the virus – this was about one third of the world’s population at the time. The mix of urbanisation without any known vaccine or antibiotics to prevent secondary infection, meant the virus was particularly lethal. There was quite a high mortality rate amongst the younger population, with those between the ages of 20 and 40 considered one of the most vulnerable groups, as well as those under the age of 5 and over the age of 65.
Health initiatives of the time became strict and limiting, with quarantining and social isolation becoming the norm. Images of the time are striking in their similarities to modern populations, as face masks become more of a fashion statement than sanitary necessity. Face masks worn by women of the time could stretch down like a veil – echoing the ‘trendy’ masks we see now. Hand washing and personal hygiene also became the prime advice given by health professionals. Perhaps it is the similarities in societal anxieties and healthcare advice that allows us to make links with outbreaks of the past, not similarities in the nature of the disease itself.
Antoine D. (2008). The archaeology of “plague”. Medical history. Supplement, (27), 101–114.https://www.mentalfloss.com/article/505090/doctors-didnt-actually-wear-beaked-masks-during-black-plague https://allthatsinteresting.com/plague-doctors