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RATS, LICE AND HISTORY
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RATS, LICE
AND
HISTORY
Being a Study in Biography, which, after Twelve Preliminary Chapters Indispensable for the Preparation of the Lay Reader, Deals With the Life History of TYPHUS FEVER
Also known, at various stages of its Adventurous Career, as Morbus pulicaris (Cardanus, 1545); Tabardiglio y puntos (De Toro, 1574); Pintas; Febris pur¬ purea epidemica (Coyttarus, 1578); Febris quam lenticulas vel puncticulas vocant (Fracastorius, 1546); Morbus hungaricus; La Pourpre ; Pipercorn; Febris petechialis vera; Febris maligna pestilens ; Febris putrida et maligna ; Typhus carcerorum; Jayl Fever; Fievre des hopitaux; Pestis bellica; Morbus castrensis ; Famine Fever; Irish Ague; Typhus exanthematicus ; Faulfieber; Hauptkrank- heit; Pestartige Braune; Exanthematisches Nervenjieber , and so forth, and so forth.
By HANS ZINSSER
BOSTON , Printed and Published for The Atlantic Monthly Press by Little, Brown, and Company
1 9 3 5
Copyright, 1935 ,
By Hans Zinsser
All rights reserved Published February, 1935
THE ATLANTIC MONTHLY PRESS BOOKS ARE PUBLISHED BY LITTLE, BROWN, AND COMPANY IN ASSOCIATION WITH THE ATLANTIC MONTHLY COMPANY
PRINTED IN THE UNITED STATES OF AMERICA
T his hook is dedicated in affectionate friendship to Charles Nicolle, scientist , novelist y and philosopher
PREFACE
These chapters — we hesitate to call so rambling a per¬ formance a book — were written at odd moments as a relaxation from studies of typhus fever in the laboratory and in the field. In following infectious diseases about the world, one ends by regarding them as biological individ¬ uals which have lived through centuries, spanning many generations of men and having existences which, in their developments and wanderings, can be treated biograph¬ ically. Typhus fever lends itself — more than most others
— to such treatment because of its extraordinary parasitic cycles in the insect and animal worlds, the salient facts of which have all been elucidated within the last ten years. In no other infection does the bacteriologist find so favor¬ able an opportunity for study of the evolution of a para¬ sitism. Moreover, in its tragic relationship to mankind this disease is second to none — not even to plague or to chol¬ era.
In the course of many years of preoccupation with in¬ fectious diseases, which has taken us alternately into the seats of biological warfare and into the laboratory, we have become increasingly impressed with the importance — almost entirely neglected by historians and sociologists
— of the influence of these calamities upon the fate of nations, indeed upon the rise and fall of civilizations.
viii PREFACE
The chapters which deal with this phase of our subject represent little more than preliminary notes. They may serve to stimulate future historians, who possess the learn¬ ing which we lack, to give these factors the attention which they merit and to interpolate their effects into the interpretations of the past history of mankind.
In no sense can we claim to have made any original contributions to the history of medicine. We have taken information where we could find it, and have freely used the works of such profound scholars as Schnurrer, Hecker, Ozanam, Haeser, Hirsch, Murchison, and others. In consulting ancient and mediaeval texts our meagre classical learning was reenforced by the charitable good nature of our colleagues Professors Gulick and Rand, of our friend Dr. Charles Lund, and by the enthusiastic interest of Mr. C. T. Murphy of the Harvard Classical Department. Conversation and correspondence with Professor Sigerist of Johns Hopkins, Professor Merriman of Harvard, Ma¬ jor Hume of the United States Army, and many others have brought us invaluable aid in critical places. We owe a particular debt of gratitude to our wise and kindly friend, Professor W. Morton Wheeler, who has been generous with advice and encouragement. Since this is, in no sense, a scientific treatise, we have left out references to recent work and, in order to neglect no one, have mentioned almost no names.
For our chapters and comments on matters of literary interest we make no apologies. Although we regard them as pertinent to the general scheme of our exposition, many will regard them as merely impertinent. But, in a way,
PREFACE ix
this book is a protest against the American attitude which tends to insist that a specialist should have no interests beyond his chosen field — unless it be golf, fishing, or contract bridge. A specialist — in our national view — should stick to his job like ua louse to a pig’s back.” We risk — because of this performance — being thought less of as a bacteriologist. It is worth the risk. But the day has twenty-four hours ; one can work but ten and sleep but eight.
We hold that one type of intelligent occupation should, in all but exceptional cases, increase the capacity for comprehension in general ; that it is an error to segre¬ gate the minds of men into rigid guild classifications; and that art and sciences have much in common and both may profit by mutual appraisal. The Europeans have long ap¬ preciated this. That our book has contributed in this re¬ spect we have not the temerity to assert. At any rate, we have written along as it has suited our fancy, and have been amused and rested in so doing.
H. Z.
December 3, 1934
CONTENTS
Preface ....... vii
I In the nature of an explanation and an
apology ...... 3
II Being a discussion of the relationship be¬ tween science and art . . . .15
III Beading up to the definition of bacteria and
other parasites y and digressing brief y into the question of the origin of life . . 34
IV On parasitism in generaly and on the neces¬
sity of considering the changing nature of infectious diseases in the historical study of epidemics . . . . .57
V Being a continuation of Chapter IV y but dealing more particularly with so-called new diseases and with some that have dis¬ appeared . . . . . .77
VI Diseases of the ancient world: a considera¬ tion of the epidemic diseases which afflicted the ancient world . . . . .105
VII A continuation of the consideration of dis¬ eases of the ancients y with particular at¬ tention to epidemics and the fall of Rome 128
VIII On the influence of epidemic diseases on po¬ litical and military history y and on the relative unimportance of generals . . 150
Xll
CONTENTS
IX On the louse : we are now ready to consider the environment which has helped to form the character of our subject . . .166
X More about the louse: the need for this chap¬ ter will be afferent to those who have entered Into the sflrit of this blografhy 179
XI Much about rats — a little about mice . 189
XII We are at last arriving at the folnt at which we can aff roach the subject of this blog¬ rafhy directly . . . . .212
XIII In which we consider the birth , childhood ,
and adolescence of tyfhus . . .229
XIV In which we follow the earliest efldemlc ex-
floits of our disease .... 240
XV Young manhood: the ferlod of early vigor
and wild oats ..... 265
XVI Affralsal of a contemforary and frosfects of future education and dlsclfllne
282
RATS, LICE AND HISTORY
CHAPTER I
In the nature of an explanation and an apology
i
This book, if it is ever written, and — if written — it finds a publisher, and — if published — anyone reads it, will be recognized with some difficulty as a biography. We are living in an age of biography. We can no longer say with Carlyle that a well-written life is as rare as a well-spent one. Our bookstalls are filled with stories of the great and near-great of all ages, and each month’s publishers’ lists announce a new crop. The biographical form of writing has largely displaced the novel, it has poached upon the territory that was once spoken of as criticism, it has gone into successful competition with the detective story and the erotic memoir, and it has even entered the realm of the psychopathic clinic. One wonders what has released this deluge.
There are many possible answers. It is not unlikely that, together with other phases of modern life, literature has gone “scientific.” As in science, a few men of origin¬ ality work out the formulas for discovery in a chosen sub¬ ject, and a mass of followers apply this formula to anal¬ ogous problems and achieve profitable results. In an age of meagre literary originality, it is a natural impulse for workers to endeavor to explain the genius of great masters. And for every novelist, poet, or inventor of any kind,
4 RATS, LICE AND HISTORY
we have a dozen interpreters, commentators, and critics.
Once biography was a serious business and the task of the scholar. When Plutarch wrote his Parallel Lives , his mind — as Mr. Clough rightly remarks — was running on the Aristotelian ethics and the Platonic theories which formed the religion of the educated men of his time. He dealt less with action, more with motives and the reaction of ability and character upon the circumstances of the great civilizations of Greece and of Rome. Scholarly biographies of later ages followed similar methods, even in such intensely personal records as BoswelPs Johns on , or the Conversations by which so dull an ass as Eckermann managed to write himself into permanent fame. The minor details of intimate life were, in the past, regarded as having consequence only as they had bearing on the states of mind that led to high achievement. It was rec¬ ognized that (<les 'petit esses de la vie privee peuvent fattier avec Phero'isme de la vie publique.” But they were utilized only when they were significant or amusing. But all this has changed. The new school sees the key to personality in the petitesses. Biography has become neurosis-conscious. Freud is a great man. But it is dan¬ gerous when a great man is too easily half-understood. The Freudian high explosives have been worked into firecrackers for the simple to burn their fingers. It has become easy to make a noise and a bad smell with materials compounded by the great discoverer for the blasting of tunnels. Biography is obviously the best playground for the dilettante of psychoanalysis. The older biographers lacked this knot-hole into the subconscious. They judged
RATS, LICE AND HISTORY 5
their heroes only by the conscious. The subconscious de¬ thrones the conscious. Great men are being reappraised by their endocrine balances rather than by their perform¬ ances. Poor Shelley! Poor Byron! Poor Wagner! Poor Chopin! Poor Heine! Poor Mark Twain! Poor Henry James! Poor Melville! Poor Dostoevski! Poor Tolstoy! And even poor Jesus! There are still a lot left — the surface is hardly scratched. But even before the great ones give out, the “damaged” ones make good reading: P. T. Barnum, Brigham Young — even unto A1 Capone and Pancho Villa.
In the present biography, we are forced by the nature of our subject to revert to the older methods. We will profit by no assistance from psychoanalysis. There will be no prenatal influences ; no CEdipus or mother complexes ; no early love affairs or later infidelities 5 no perversions, urges, or maladjustments ; no inhibitions by respectability, and no frustration by suppressed desires. We shall have no gossip to help us; no personal letters which there was no time to burn. We cannot count upon the reclame of a libel suit barely averted, or of scandals deftly hinted at. We have not even the comfort of preceding biographers and essayists whom we can copy, paraphrase, or refute. Indeed, we are quite stripped of the sauces, spices, and dressings by which biographers can usually make poets and scientists into quite ordinary and often objectionable people; by which they can divert attention from the work of a man to his petty or perhaps vicious habits; by which they can create a hero out of a successful commercial highbinder; by which they can smother public guilt by
6 RATS, LICE AND HISTORY
domestic virtue, or direct interest from the best and last¬ ing accomplishments of their subject to the utterly un¬ important private matters of which he was ashamed.
The habitue of biographies will ask himself how, with¬ out these indispensable accessories of the biographical tradesman, we can dare to enter this field. The answer is a simple one: the subject of our biography is a disease.
We shall try to write it in as untechnical a manner as is consistent with accuracy. It will of necessity be incomplete, for the life of our subject has been a long and turbulent one from which we can select only the high spots. Much of its daily domestic history has been as commonplace and repetitive as that of any human being, warrior, poet, or shopkeeper. Above all, our narrative is not “popular science.” If our story is, in places, dramatic, it will be the fault of the story — not our own. Nobody will be edu¬ cated by it. We have chosen to write the biography of our disease because we love it platonically — as Amy Lowell loved Keats — and have sought its acquaintance wher¬ ever we could find it. And in this growing intimacy we have become increasingly impressed with the influence that this and other infectious diseases, which span — in their protoplasmic continuities — the entire history of mankind, have had upon the fates of men.
In approaching our subject, however, we permit our¬ selves a number of digressions into which our undertaking inevitably forces us.
RATS, LICE AND HISTORY
7
2
Infectious disease is one of the great tragedies of liv¬ ing things — the struggle for existence between different forms of life. Man sees it from his own prejudiced point of view; but clams, oysters, insects, fish, flowers, tobacco, potatoes, tomatoes, fruit, shrubs, trees, have their own varieties of smallpox, measles, cancer, or tuberculosis. Incessantly, the pitiless war goes on, without quarter or armistice — a nationalism of species against species. Usu¬ ally, however, among the so-called “lower” forms of life, there is a solidarity of class relationship which prevents them from preying upon their own kind by that excess of ferocity which appears to prevail only among human beings, rats, and some of the more savage varieties of fish. There are, it must be admitted, isolated instances in the animal kingdom of a degree of ferocity within the same species not yet attained by man. Husband eating is an accepted custom with the spiders, and among the Ala- cran or Scorpions, it is quite de rigueur for the mother to devour the father and then, in her turn, to be eaten by her “kiddies.” When male members of the larger cat families — that is, mountain lions — waylay and eat their own children, this is not truly an evidence of ferocity. It is an indirect crime passionnel ; the result of an im¬ patient tenderness for the lioness who has become too ex¬ clusively the mother. The motive is love, and, as La Rochefoucauld has said, “Si on juge V amour par la plu- part de ses effets , il ressemble plus a la haine quya ly ami tie ”
8 RATS, LICE AND HISTORY
Nature seems to have intended that her creatures feed upon one another. At any rate, she has so designed her cycles that the only forms of life that are parasitic directly upon Mother Earth herself are a proportion of the vege¬ table kingdom that dig their roots into the sod for its nitrogenous juices and spread their broad chlorophyllic leaves to the sun and air. But these — unless too un¬ palatable or poisonous — are devoured by the beasts and by man 5 and the latter, in their turn, by other beasts and by bacteria. In the Garden of Eden perhaps things may have been so ordered that this mutual devouring was postponed until death, by the natural course of old age, had returned each creature’s store of nutriment to the general stock. Chemically, this might have been possible, and life maintained. But in the imperfect development of cohabitation on a crowded planet, the habit of eating one another — dead and alive — has become a general custom, instinctively and dispassionately indulged in. There is probably as little conscious cruelty in the lion that devours a missionary as there is in the kind-hearted old gentleman who dines upon a chicken pie, or in the staphylococcus that is raising a boil on the old gentleman’s neck. Broadly speaking, the lion is parasitic on the mission¬ ary, as the old gentleman is on the chicken pie, and the staphylococcus on the old gentleman. We shall not en¬ large upon this, because it would lead us into that excess of technicality which we wish to avoid.
The important point is that infectious disease is merely a disagreeable instance of a widely prevalent tendency of all living creatures to save themselves the bother of
RATS, LICE AND HISTORY 9
building, by their own efforts, the things they require. Whenever they find it possible to take advantage of the constructive labors of others, this is the direction of the least resistance. The plant does the work with its roots and its green leaves. The cow eats the plant. Man eats both of them; and bacteria (or investment bankers) eat the man. Complete elucidation would require elaborate technical discussions, but the principle is clear. Life on earth is an endless chain of parasitism which would soon lead to the complete annihilation of all living beings unless the incorruptible workers of the vegetable king¬ dom constantly renewed the supply of suitable nitrogen and carbon compounds which other living things can filch. It is a topic that might lend itself to endless trite moralizing. In the last analysis, man may be defined as a parasite on a vegetable.
That form of parasitism which we call infection is as old as animal and vegetable life. In a later chapter we may have occasion to consider its origin; to this we have some clue from the new diseases which appear to be constantly developing as we begin to conquer the old ones. But our chief purpose in writing the biography of one of these diseases is to impress the fact that we are dealing with a phase of man’s history on earth which has received too little attention from poets, artists, and historians. Swords and lances, arrows, machine guns, and even high explosives have had far less power over the fates of the nations than the typhus louse, the plague flea, and the yellow-fever mosquito. Civilizations have re¬ treated from the plasmodium of malaria, and armies
10 RATS, LICE AND HISTORY
have crumbled into rabbles under the onslaught of cholera spirilla, or of dysentery and typhoid bacilli. Huge areas have been devastated by the trypanosome that travels on the wings of the tsetse fly, and generations have been harassed by the syphilis of a courtier. War and conquest and that herd existence which is an accompaniment of what we call civilization have merely set the stage for these more powerful agents of human tragedy.
3
Having written the preceding paragraphs, we read them over and came to the conclusion that there was little in them that mattered very much. We were, perhaps, a little severe in discussing modern biographers. One is lured into discussions of this kind by one’s irritations. One can disagree with many of the opinions expressed by Goethe in Eckermann, or by Renan, or Sainte-Beuve, or by Babbitt, or by Whitehead, — when one understands what he is talking about, — and come away with the satisfaction of having been stimulated to oppose views by the importance of those one disagreed with. But one is merely irritated by the complacency with which the sciences and the arts are dealt with e superiore loco by the younger school of American biographical critics, who sit between intelligence and beauty, — like Voltaire between Madame de Stael and a flirtatious Marquise, — “with¬ out possessing either.” One wishes to exclaim, with a simi¬ larly irritated Frenchman: “Save us, dear Lord, from the connaisseurs qui n’ont pas de connaissance and from the amateurs qui n'ont pas d'amour!” A part of our first
RATS, LICE AND HISTORY 11*
chapter, therefore, is nothing more than a growl. Yet it still serves to introduce our subject ; and we are further inclined to retain it for the following reasons. We are engaged in an occupation which philosophers, mathe¬ maticians, physicists, physical chemists, biochemists, and even physiologists (who may in many cases have been less valuable to science than one of Pawlow’s dogs) do not acknowledge as a science ; and which poets, novelists, critics, biographers, dramatists, painters, sculptors, and even journalists categorically exclude from the arts. We are in a position, therefore, to look both ways with the clarity begotten of humility. But, in discussing our ideas with representatives of the various callings named above, we encountered a common misconception — perhaps the only opinion on which there was agreement — to the effect that men were impelled to enter the career of in¬ vestigating infectious diseases from a noble desire to serve mankind, to save life, and to relieve suffering.
A friend of ours is a professional writer. By this, we mean a person who makes his living by writing in the same way that a bricklayer makes his by laying bricks, or a plumber supports himself by sweating joints. Writing, of course, like speech, is a method of expressing ideas or telling tales. It is also a means of conveying to others emotions, conceptions, or original comprehensions which might instruct, amuse, delight, or elevate. This kind of writing used to be called art. And once — when only the intelligent could read — writing also needed to be in¬ telligent and artistic.
In our day, however, all kinds of people can read:
12 RATS, LICE AND HISTORY
college professors and scrubwomen, doctors and lawyers, bartenders, ministers of the gospel and trained nurses. They all have the same ideal of the happy ending of a dull day — a comfortable couch, a bed lamp, and some¬ thing to read. And there must, in consequence, be writers to supply this need — literature for the intelligent as for the moron — a book for every brain, like a motor car for every purse.
The particular writer of whom we speak has been un¬ usually successful in alternately supplying both markets
— now satisfying the reasonably intelligent, and again luring a fat check with stories about the poor boy and the boss’s daughter. In the latter mood, he has scented the rich possibilities of exploiting the sensationalisms of science
— a source of revenue so successfully tapped by a num¬ ber of his literary contemporaries. But never having had any close association with workers in the field of infectious diseases, he shared this misconception of the noble motives which impelled these queer people. And not quite under¬ standing how anyone could be impelled by noble motives, he asked us: “How do bacteriologists get that way?” We answered his question more or less in the following man¬ ner.
A great deal of sentimental bosh has been written about this totally erroneous assumption. When a bacteriologist dies — as other people do — of incidental dissipation, accident, or old age, devotion and self-sacrifice are the themes of the minister’s eulogy. Let him succumb in the course of his work, — as an engineer falls down a hole, or a lawyer gets shot by a client, — he is consecrated as a
RATS, LICE AND HISTORY 13
martyr. Novelists use him as they formerly did cavalry officers, Polish patriots, or aviators. If an epidemiologist on a plague study talked and behaved in the manner of the hero of Arrowsmith , he would not only be useless, but he would be regarded as something of a yellow ass and a nuisance by his associates. And de Kruif is far too in¬ telligent a man not to have known, when he wrote his thriller on Men against Death , that raucous laughter would be its reception in the laboratories and in the field where the work he describes is being done.
As a matter of fact, men go into this branch of work from a number of motives, the last of which is a self- conscious desire to do good. The point is that it remains one of the few sporting propositions left for individuals who feel the need of a certain amount of excitement. In¬ fectious disease is one of the few genuine adventures left in the world. The dragons are all dead, and the lance grows rusty in the chimney corner. Wars are exercises in ballistics, chemical ingenuity, administration, hard physical labor, and long-distance mass murder. Ships have wireless equipment. Our own continent is a stage route of gas stations, and the Indians own oil wells. Africa is a play¬ ground for animal photographers or museum adminis¬ trators and their wives, who go there partly to have their pictures taken with one foot on a dead lion or elephant and disgusted-looking black boys carrying boxes of cham¬ pagne and biscuits on their patient heads. Flying is ad¬ venturous enough, but little more than a kind of acrobatics for garage mechanics, like automobile racing. But how¬ ever secure and well-regulated civilized life may become,
14 RATS, LICE AND HISTORY
bacteria, Protozoa, viruses, infected fleas, lice, ticks, mos¬ quitoes, and bedbugs will always lurk in the shadows ready to pounce when neglect, poverty, famine, or war lets down the defenses. And even in normal times they prey on the weak, the very young and the very old, living along with us, in mysterious obscurity waiting their op¬ portunities. About the only genuine sporting proposition that remains unimpaired by the relentless domestication of a once free-living human species is the war against these ferocious little fellow creatures, which lurk in the dark corners and stalk us in the bodies of rats, mice, and all kinds of domestic animals 3 which fly and crawl with the insects, and waylay us in our food and drink and even in our love.
CHAPTER II
Being a discussion of the relationship between science and art — a subject that has nothing to do with typhus fever , but was forced upon us by the literary gentleman spoken of
in the last chapter
i
This chapter will be received with contemptuous shrugs by the professionally literary. There is a prejudice in America that specialists should not trespass beyond their own paddocks, however interestedly they may look over the rails. But literary critics are constantly telling us that science is this or that — “science should not be exalted out of its place,” and so on; and since we cannot possibly know less about literature than most of these gentlemen know about science, we venture to proceed, hoping that Messrs. Edmund Wilson, Van Wyck Brooks, Mumford, Max Eastman, and others who were the “Younger School,” until they grew middle-aged, will skip this part of our book.
The biologist is in a peculiarly difficult position. He cannot isolate individual reactions and study them one by one, as the chemist often can. He is deprived of the math¬ ematical forecasts by which the physicist can so frequently guide his experimental efforts. Nature sets the conditions under which the biologist works, and he must accept her terms or give up the task altogether.
16 RATS, LICE AND HISTORY
He knows that physicochemical analysis will never give the final clue to life processes ; yet he recognizes that “vitalism” and “neovitalism” are little more than a sort of amorphous theology born of a sense of the helplessness of mere “mechanism.” 1 So the patient biologist plods along, piling up his empirical observations as honestly as he can — getting what satisfaction he may from the fact that he is helping, by infinite increments, to reduce the scope of vitalistic vagueness to narrower and narrower limits. As Bergson puts it: “A very small element of a curve is near being a straight line; and the smaller it is, the nearer. . . . So, likewise, Vitality’ is tangent, at any and every point, to physical and chemical forces. . . . In reality [however], life is no more made up of physico¬ chemical elements than a curve is composed of straight lines.” The biologist is constantly differentiating the curve of vitality, quite aware that mankind can approach, but never reach, the “limiting value” of complete compre¬ hension. Moreover, he knows — whenever he attacks a problem — that before he can advance toward his objec¬ tive, he must first recede into analysis of the individual elements that compose the complex systems with which he is occupied.
Such difficulties engender a habit of mind that has ham¬ pered us in the present undertaking. We approached the writing of the biography of typhus fever with the care-
1 And, indeed, ultimately they both encounter the same inevitable perplexity, since, as Paley rightly asserts, mechanism presupposes God as the mechanician. This is the difficulty faced by all the recent astro¬ nomical and physicist school of ponderers.
RATS, LICE AND HISTORY 17
less confidence which always accompanies the first concep¬ tion of an experimental objective. We were first deflected into contemplation of the general methods of biographical writing; then arose the question why men occupied them¬ selves with the study of disease. We thought we were through with preliminaries, when our literary friend dropped in again, and proceeded to scatter salt upon our enthusiasm.
“How,” he said, “can a person who has spent his life cultivating bacteria ; inoculating guinea pigs, rabbits, mice, horses, and monkeys; posting about the dirty corners of the world in the study of epidemics; catching rats in foreign cellars; disinfecting, delousing, fumigating; look¬ ing at rashes, down throats and into other apertures of man and animals; breeding lice, bedbugs, fleas, and ticks; examining sputum, blood, urine, stools, milk, water, and sewage — how,” he repeated, “can such a person, who is not quite a scientist and nothing of an artist, presume to undertake a task which no one not an artist could success¬ fully accomplish? You might be right about the keyhole biographers and the pasteurized Rabelaisian school of Freudian critics, but is that any worse than the literary- scientific spinster movement? Do you want to be like Dr. Collins of New York, cthe-Doctor-looks-at-this, the- Doctor-looks-at-that? business? ”
“But! ” we replied —
“Look at all the rest of the middle-aged scientists who have made fools of themselves dabbling with art. Read the Atlantic Monthly .”
18 RATS, LICE AND HISTORY
“Good Lord/7 I said, “one need n’t stop being a bac¬ teriologist just because one takes an intelligent interest in other things. Here in America we seem to expect a specialist to become a sort of Taylorized factory worker. Why should a man look at the world through only one knot-hole?”
“Oh, look through a dozen or climb up and look over the fence if you like. But keep still about things you ’re not trained to handle. Biography is a job for an artist. Stick your head out of your laboratory window and watch the world go by. But if you want to write, pull it in again and write for the Journal of Experimental Medicine . You ’ll only end, if you keep this up, by losing what little reputation you ’ve got.”
“But,” we demurred, “is a man to be denied an in¬ telligent appreciation of art just because he knows some¬ thing about a science? Is literature to be appraised only by those who have time to read after breakfast? What ’s the essential difference between art and science anyway?”
“That ’s a difficult question,” he said. “Goethe might have answered it, but he did n’t think it was worth while. The late war between humanists and antihumanists might have brought an answer — only both sides were so angry at each other and so ignorant of science that they neglected the main issue. Babbitt, with his vast erudition, might have found a reply if he had lived. Toward the end, the small fry were keeping him too busy with his heels. Any¬ way, neither you nor I know enough to deal with it.”
Our friend’s opinions on matters of this sort have always carried much weight with us, and, in this case, they im-
RATS, LICE AND HISTORY 19
pelled us to delay embarking upon our project — which, as he said, transcended our scientific training — until we had given thought to the essential differences, if there were any, between science and art.
We approached the problem modestly by examining the opinions of others, and found that men far wiser than ourselves had failed to agree. Eddington and Jeans in¬ cline to limit science to the “metrical or mathematical descriptions of phenomena,” a conception which would exclude even the biological branches of learning. But having ascended to these cold heights by laborious upward paths of reason, they sit down in their metaphysical tobog¬ gans and swish back into the warm and comfortable vales of theology. Dingle attempts a more liberal view, defin¬ ing science as a method of “dealing rationally with ex¬ periences which have a certain quality ; namely, that they are common to all normal people.” This is dreadful English, but — once parsed — it means, conversely, that the territory of art is that of experiences which are “pe¬ culiar to the individual, or perhaps shared by a limited number of others.” This opinion is much like the pre- Darwinian method of classifying animals by their super¬ ficial similarities, which made the whale a fish and the bat a bird. Whitehead penetrates more deeply beneath the mere morphology of the problem into its comparative anatomy and physiology. He includes, in the category of science, the biological branches and geology, and, more than that, he regards naturalistic art (Leonardo) as closely akin to science. Indeed, he finds in great literatures — for instance, in the “scientific imagination” of ^Eschylus,
20 RATS, LICE AND HISTORY
Sophocles, and Euripides, in their visions of Fate “urging a tragic incident to its inevitable issue” — the same princi¬ ple of “Order” which is the “vision possessed by science.” If Aristotle could return to us long enough to familiarize himself with modern scientific thought, we venture to say he would come pretty close to agreeing with White- head. Incidentally, what a kick Aristotle would get out of Harvard!
That any sharp separation between science and art is impossible was also in the mind of Havelock Ellis, when he wrote the following passage: “To press through, to reveal, to possess, to direct and to ennoble, that is the task and the longing alike of the lover and the natural discoverer 5 so that every Ross or Franklin is a Werther of the Pole, and whoever is in love is a Mungo Park of the spirit.” We should have taken more pleasure in this quotation had Mr. Park’s Christian name been other than “Mungo.” But, as it stands, it expresses the burden of the thought that was developing in our mind.
2
To most of the modern literary critics — probably be¬ cause of their almost incredible ignorance of scientific thought — the so-called scientist is a “mere rationalist,” and science is held, in respect to art, as photography is to painting. This separation on the basis of precision is utterly untenable. Science is not a whit more photographic than is art. Measurements and formulations are, even in the so-called exact — the physical — sciences, not much more than reasonably accurate approximations. Scientific
RATS, LICE AND HISTORY 21
method is again and again forced to employ abstract con¬ ceptions, irrational numbers like \/~2 and \'r3y the line without breadth, the point without volume, zero, the negative quantity, or the idea of infinity. And scientific thought continually sets sail from ports of hypothesis and fiction,2 advance bases of the exploring intellect. Matter becomes molecules, molecules become atoms ; atoms, ions; ions, electrons; and these, in turn, become uncompre¬ hended sources of energy — not more clear as seizable reality than the poet’s conception of the “soul,” which he knows only from its “energy” — the yearnings, delights, and sorrows which he feels. The history of science is full of examples of what, in art, would be spoken of as inspira¬ tion, but for which Whitehead’s definition, “speculative reason,” seems much more appropriate.
It is only too painfully obvious, moreover, that neither the scientist nor the artist is ever a “creator.” The word “creative,” so incessantly misused by our younger critical schools, is a fiction of that optimism about human achieve¬ ment which — it has been said — thrives most vigorously in lunatic asylums. Nature, as Goethe puts it, runs its course by such eternal and necessary principles that even the gods themselves cannot alter them. The most that the scientist and the artist accomplish is new understanding of things that have always been. They “create” a clearer perception. They are both, in this sense, observers, the obvious difference being that the scientist impersonally describes the external world, whereas the artist expresses
2 This has been clearly set forth in Hans Vaihinger’s Die Philosofhie des Als Ob.
22 RATS, LICE AND HISTORY
the effects which external things exert upon his own mind and heart. In both cases, the more generally applicable the observations, the greater is the science or art.3
Would it not be fair to say that an achievement of observation becomes science or art according to the degree to which its comprehension calls upon perception by the reason or by the emotions, respectively? The capacities of intelligence form a sort of spectrum which extends from what we may call an infra-emotional to an ultra¬ reason range. At the infra-emotional extreme lie the per¬ ceptions set in motion by music and by lyrical poetry. At the opposite end — that of pure reason — is placed the perceptional capacity for mathematics. Between the two there is a wide range of overlapping where art is scientific and science artistic. Literature in the sense of prose may be taken to hold a middle ground, shading on the left into epic and narrative poetry, and on the right through psychology, biology, and so forth, toward mathematics.
“What happens when you go off the deep end of either side?” asked my friend.
3 I. A. Richards expresses this function of the artist as an observer of the “facts” of human emotions in a precise manner when he says, “In the arts we find the record, in the only form in which these things can be recorded, of the experiences which have seemed worth having to the most sensitive and discriminating persons.” In this sense Leonardo, Shakespeare, Cervantes, Goethe, Dostoevski, and countless other artists were as truly accurate observers in the field of human experiences as were Newton and Pascal in the field of the external world.
Andre Gide means the same thing when he says, “Everything has always existed in man . . . and what new times uncover in him has always slumbered there. . . . How many hidden heroes await only the example of a hero in a book, only a spark of life given off by his life in order to love, only a word from him in order to speak.”
RATS, LICE AND HISTORY 23
“Well, beyond the 10~~10 range experience seems to show that the end organs give out and the physicist joins the church; whereas on the other side, as I should judge from Joyce, Gertrude Stein, and their imitators, the spinal cord begins to horn in on the brain. In either case it ceases to be science or art.”
3
I continued the discussion with my friend at our next meeting,
“On that basis,” he said, “it should be easy to classify any performance by a sort of intellectual spectroscopic analysis.”
“With the older forms it was usually easy to fit them into their proper places in the spectrum. Critics like Cole¬ ridge or Sainte-Beuve needed to concern themselves only with style, beauty of diction, clarity of thought, intensity, sincerity, depth, and the qualities of taste and sensitive¬ ness which, while vague and subtle, were still within the scope of the underanged mind. Art could be judged by any informed and intelligent critic without recourse to border¬ line psychiatry. The corner was turned by the French symbolists — who followed Baudelaire, Rimbaud, Ver¬ laine, Mallarme, Laforgue. On occasion these great men came close to the jumping-off place of uncomprehen¬ sibility. But in the main they achieved a great beauty by the very dusk and mist through which their thoughts, sufferings, and joys were mysteriously, grotesquely, vaguely, but still effectively perceived. One cannot, with Lasserre, deny them their just places merely because they
24 RATS, LICE AND HISTORY
applied their superb gifts to tristesse and laideur. We make no plea for a return to Tennysonism or the Longfellow era, but had Sainte-Beuve been required to pass judg¬ ment on certain passages of T. S. Eliot, the later Joyce, or Gertrude Stein, he would surely have gone into con¬ sultation with Charcot or Bernheim, a dilemma which our modern critics seem to admit — in their judgments of modern work — by their habitual appeal to Sigmund Freud. It is, of course, difficult, even in medical practice, to survey sharply the line between sanity and border¬ line derangements. But when the critic of a work of art needs psychiatric training, this fact alone would serve to throw suspicion on the artistic value of his subject. The real difficulty of applying our kind of spectroscopic analysis to much of the modern stuff lies in the fact that a good deal of it lacks the rationality of science without possessing the emotional appeal of art.
“Let us examine some of it. Take T. S. Eliot — who, in his prose, shows great clarity of thought and to whom no one will deny talent, originality, and, on occasion, great beauty. But in much of his poetry he plays, as has been aptly remarked, a guessing game with readers, whom he seems to appraise, apparently with some reason, as imbe¬ ciles. ‘Guess which memory picture of my obviously one¬ sided erudition I am alluding to? See note 6 ad Then he drops suddenly, after a few lines of majestic verse, into completely irrelevant babble.
“In the room the women go to and fro Talking of Michael Angelo.
RATS, LICE AND HISTORY 25
One is tempted to add, ‘Eenie, meenie, minie, mod Or this: —
“Madame Sosostris, famous clairvoyante,
Had a bad cold, nevertheless
Is known to be the wisest woman in Europe
With a wicked pack of cards.
“Why ‘nevertheless’? Was she wise because she had a bad cold? Or this (one has the choice of innumerable pas¬ sages) : —
“Now Albert’s coming back, make yourself a bit smart.
He ’ll want to know what you done with that money he gave you To get yourself some teeth.
“Is that poetry? It sounds like trivial prose. It certainly is n’t science.”
“Of course it ’s not fair to take things out of their con¬ texts like that. The thing as a whole symbolizes the Waste Land of modern disillusionment. Of course it ’s hard for a scientist to understand.”
“It ’s not whether a thing is hard to understand. It ’s whether, once understood, it makes any sense. Every now and then my monkeys get loose in the laboratory and achieve brilliant and bizarre effects by smashing bottles of colored liquids against microscopes and Bunsen burners. The result is a stimulating chaos of lights, sounds, and excitements. But when they get through there ’s nothing left but disorder and litter that has to be swept up before orderly scientific work can be resumed. You can do the same thing with the workshops of art. What I don’t under-
26 RATS, LICE AND HISTORY
stand is why a man of such obvious power will do that sort of thing.”
“I suppose you will say the same thing about Baude¬ laire?” he said.
“Oh, dear, it ’s the old stuff that these people derive themselves from Baudelaire and Rimbaud and Laforgue. But those men were making discoveries. Baudelaire was an organic chemist. He synthetized extraordinarily re¬ pulsive but new compounds. But incoherence and a bad smell don’t make a Baudelaire.”
“Well, let’s try another ; perhaps you recognize this one?
“Nearly all of it to be as a wife has a cow. All of it to be as a wife has a cow, all of it to be as a wife has a cow, a love story. As to be all of it as to be a wife as a wife has a cow, a love story, all of it as to be all of it as a wife all of it as to be as a wife has a cow a love story. . . .
or
“A meal is mutton mutton why is lamb cheaper, it is cheaper because so little is more.”
“That ’s Gertrude Stein,” I said, “but listen to this one: —
“Balloons — colored balloons — my colored balloons — Who busted my balloons? Bolony balloons; they have punctured my categorical imperative.”
“I don’t seem to remember that in her writings,” he replied.
“No, that is n’t Gertrude Stein. That ’s Alice Gray, whom I knew in the McLean Hospital. She was fifty, but she imagined she was a baby. Listen to another: —
RATS, LICE AND HISTORY 27
“Pease porridge hot, pease porridge cold,
Pease porridge in the pot . .
“You ’re only trying to be funny,” he interrupted me. “As a matter of fact, Gertrude Stein can write quite sen¬ sibly when she wants to.”
“Why doesn’t she?” I asked.
“She ’s practising automatic writing.” 4
“Then it ’s science.”
“Oh, no — she is creating an impression by an alter¬ nation of conscious and subconscious explosions.”
“Then it ’s art — in the sense of fireworks.”
“But she ’s had an immense influence on younger writers,” he said.
“So have Mrs. Eddy and P. T. Barnum,” I replied. “Without Baudelaire there might not have been a Rim¬ baud or a Verlaine. Without Buffalo Bill, P. T. Barnum, or Mrs. Eddy, there might have been no Gertrude Stein, and Joyce might have continued to write distinguished prose.”
“Speaking of Joyce,” he said, “have you tried ‘Tam and Shem’ or whatever their names are? Listen!
“Eins within a space and a weary wide space it wast, are wohned a Mookse. The onesomeness wast all to lonely, archunsitlike, broady oval and a Mookse he would a walking go (My hood! cries Antony Romeo). So one grand summer evening after a great morning and his good supper of gammon and spittish, having flabelled his eyes, pilleoled his nostrils, vacticanated his ears . .
“Stop!” I cried. “I got a licking for that sort of thing when I was a little boy.”
4 See B. F. Skinner in the Atlantic Monthly for January 1934.
28 RATS, LICE AND HISTORY
“Is it science or art?” he asked.
“Neither, of course,” I said. “But what puzzles me still is why they do it. It would be too easy to dismiss the matter by assuming that they were mildly crazy. More¬ over, the ability of the ones we have mentioned to return, at will, to the rational state excludes this.”
“You forget,” he said, “the idea of Poesie Pure — the less it means, the better ; the approximation of poetry to music of Walter Pater and of Moore.”
“The relationship of poetry to music has also come in for a great deal of learned twaddle. Valery says the poet is merely a sort of musician. Wyndham Lewis calls it ‘critical mysticism.’ They speak a lot (Bremond) about the ‘summons from within,’ the ‘weight of immortality upon the heart,’ poetry which ‘goes further than the word which expresses it,’ and so forth. Sometimes the critic goes much farther in his mysticism than the poets he writes about.”
Incidentally it is a curious phenomenon that some of the great scientists when they become critics, and are caught in efforts to explain their own aesthetic reactions to poetry, become almost as mystical as the literary analysts. Occasionally a man’s authority is so great — in most particulars rightly so — that to criticize him is, in the eyes of the learned world, like spelling God with a small g. I refer to Whitehead, and in disagreeing with him I feel much like a Neanderthal man attacking a mastodon with a bean-shooter. When he discusses the application of Clerk Maxwell’s equation to the interior of the atom, he has me on my back. But when he begins
RATS, LICE AND HISTORY 29
to attribute reference to some form of Kantian, Berke- ieyan, or Platonic idealism to Shelley in his poem on Mont Blanc, or derives Wordsworth’s nature worship from a Criticism of science,” he merely reveals his own in¬ ability to take his foot off the brake of reason and coast freely with the emotions.
Now, when Shelley writes about the cloud or about Mont Blanc, he is not thinking of the “elusive endless change of things,” nor is he consciously refusing “to accept the abstract materialism of science.” He is ex¬ pressing in magnificent images the thoughts and emotions that are aroused in him by the nature he views j and no amount of philosophical analysis can give the reader Shelley’s full effect. The sheer beauty of the shifting thoughts and feelings, and the musical beauty, — not only musical in sound, but in the harmony of images as well, — must arouse in the reader the same reaction, trans¬ mitted from the poet, which nature aroused in the poet himself. It is the old question that Shelley himself an¬ swered by saying: “To analyze a work of art into its elements is as useless as throwing a violet into a crucible.” Of course, poetry approaches music, but unlike music it has the power of concreteness in thought and imagery. The greatest poetry is communication and is clear. It may, through pure lyricism, progress sanely to the symbolism of Mallarme and his contemporaries, growing less and less intellectually clear — more and more dependent upon imagery and suggestion. When it goes beyond that, it may come to the deep end where it tries to be purely saxophonic, as in the “jug, jug, jug” or the “bam boo
30 RATS, LICE AND HISTORY
bim bam tree” gibberish in certain passages of Mr. Eliot. Baudelaire had this in mind when in UArt Romantique he said that “there are subjects which belong to paint¬ ing, others to music, others to literature,” and aEst-ce far une fatalite des decadences qu'auj our dy hut chaque art manifeste Penvie d'emfieter sur Part voisin ?” 5 When a work of literature, even if it is written in short, capital¬ ized lines, becomes utterly incomprehensible to the sane and sensitive, it has gone off the deep end.
Why, we must ask ourselves, have individuals of un¬ questionably great powers chosen to play with their minds like captive monkeys with their genitalia? It would be merely tragic had they not created a sort of “holy-roller” school of followers among the permanent intellectual un¬ dergraduates. Wyndham Lewis comes close to a definition when he calls it the “idiot child” cult — the child over¬ shadowed by the imbecile. As we have said, Skinner thinks, in the Stein case, it is conscious experimentation with “automatic writing.”
One could also postulate: —
( 1 ) That they are consciously pulling the legs of the
6 It is pertinent, in this connection, to ask oneself what would have been the result if D. H. Lawrence had been a professional instead of an occasional painter. A painted Lady Chatterley — the most exquisite technique notwithstanding — would surely have been so completely out of drawing, with the lower parts so much larger than the upper, as to have been hardly recognizable as a human figure. The picture could not have been hung, even in a speak-easy.
In this matter of disproportionate emphasis on those phases of a subject which correspond to the writer’s own neuroses, literature can “get away” with a great deal that would be impossible in architecture, sculpture, painting, or even music.
RATS, LICE AND HISTORY 31
large neo-intellectual public either for fun or for profit.
(2) That they are suffering from a well-recognized form of exhibitionism — the craving for sensational notice, whether approval or attack. This is the mild derange¬ ment that probably explains mediums. It is the impulse that, in a less pronounced form, leads people to write to the newspaper, to lend their names to cigarette advertise¬ ments, or to say in print that they buffered from fits” until they had taken one bottle of Neuropop.
(3) That they are seriously carrying on psychological experiments with themselves — in which case, they ought to do it in decent privacy, as though they were taking drugs.
Or (4) that it is barely possible they are yielding to the uncontrollable impulse to expose their own diseases, just as the physically sick like to tell about their operations or their chronic colitis.
If they were commonplace people this exercise would attract only sympathetic attention. These are formidable machines and one wishes the insulation had not burnt off the power lines.6
However one looks at it, it appears to the medically informed that these people are substituting the spinal cord for the brain, or at any rate are moving down from the frontal lobes towards the basal ganglia.
6 One could of course multiply examples with “cummins,” Ezra Pound, and so forth. We distinctly exclude Hart Crane, whom we had occasion to know when we were working on typhus in Mexico. He was a man of great talent, appealing and tragic, for he was vetry sick in spirit.
32 RATS, LICE AND HISTORY
“You ’ve talked a great deal/’ said my friend, abut in
the end it comes down to a definition of beauty — does n’t it?”
“Well, give me one,” I replied.
Here ’s the latest one,” he said. “Beauty is the mutual adaptation of the several factors in an occasion of experi¬ ence. Thus in its primary sense, beauty is a quality which finds its exemplification in actual occasions. Or, put it conversely, it is a quality in which such occasions can severally participate.”
Hail to thee, blithe spirit, ” I replied. “Bird thou never wert.”
Well, let ’s go on,” he replied. aIn order to under¬ stand this definition of beauty, it is necessary to keep in mind three doctrines' which belong to the metaphysical system in teims of which the world is being interpreted in these chapters. These three doctrines, respectively, have regard to mutual relations (#) between the objective content of a prehension and the subjective form of that prehension, and (b) between the subjective form of vari¬ ous prehensions in the same occasion, and (c) between the subjective form of a prehension and the spontaneity in¬ volved in the subjective aim of the prehending occasion. ”
“Stop,” I said. “Is that by Gertrude Stein?”
“No,” he replied, “it ’s by Whitehead.”
“Well, I ’ll be damned,” I said. “I think I Ve decided that it s perfectly safe for me to go ahead with my biog¬ raphy of typhus.”
Indeed, I reflected when my friend had departed, whenever I think about these things for any length of
RATS, LICE AND HISTORY 33
time I feel grateful for good honest diseases like typhus, syphilis, and a few others. You always know where you have them. And if you begin indulging in “whimso- whamso” while you are engaged with them they are sure to make a fool of you by putting you on your back. You either leave them alone or approach them with cautious competence. Think what might happen to our modern critics if the great dead whom they inexpertly dissect could infect them with psychic boils and carbuncles ; or if Mr. Joyce’s preoccupation with the intestinal functions, or if Mr. Eliot’s shadow boxing with passion, or if the lubricities and sexual neuropathies of our too modern writers could subtly invade the brains where they were engendered with locomotor ataxia or paresis. Indeed, for all I know, perhaps they can. And there is no arsphenamin for the psychic treponema.
Typhus is far less perilous.
CHAPTER III
Leading up to the definition of bacteria and other parasites y and digressing briefy into the question of the origin of life
— a discussion without which the reader would be quite
unprepared for what is to follow
i
In the history of the immense universe, that of our little planet is an isolated and probably unimportant episode. On some older island in the immeasurable spaces, some other evolution may have produced beings so much wiser than ourselves that they can comprehend the origin of life. For there is no just reason to believe that we — transitional creatures in the upward progress of evolution
— have reached the highest possibilities. The tragedy of man is that he has developed an intelligence eager to un¬ cover mysteries, but not strong enough to penetrate them. With minds but slightly evolved beyond those of our animal relations, we are tortured with precocious desires to pose questions which we are sometimes capable of ask¬ ing, but rarely are able to answer. We have learned to dream of conquests of the forces about us 5 we investigate matter and the energy that moves it, the order that con¬ trols the worlds and the sun and the stars; we train our minds inward upon themselves, and discover emotions, ethical desires, and moral impulses — love, justice, pity
RATS, LICE AND HISTORY 35
— that have no obvious relation to mere animal existence. The more we discover, the greater is our hopelessness of knowing origins and purposes. The more our ingenuity reveals the orderliness of the nature about us and within us, the greater grows our awe and wonder at the majestic harmony which we can perceive more clearly with each new achievement of art or of science, but which — in ulti¬ mate causes or in goal — eludes us. To feel this awe and to wish to fit into the harmony of natural things, with a vision of the whole, is apparently a definite phenomenon of human psychology ; it is the force that has engendered religions, just as the instinct to understand the material environment has produced science, and the impulse to express aesthetic reactions has produced art. It is obvious that religion begins where philosophy takes off from the solid shore of the exact sciences into speculative waters, the shallows of which are metaphysics. It is not entirely sensible in modern times, however, to speak of conflicts between religion and science which, to truly civilized people, have not existed for a long time. When perturbed ministers, like the Reverend Dr. Fosdick, passionately deny such a conflict, they are pounding the table and asserting that the earth is round. They desire to preserve the beneficent social and moral influences of an organized church in a world not yet ready for a purely ethical code. And when distinguished minds, like Millikan and others, take wing from the ultimate peaks of exact science into the stratosphere of an old-fashioned heaven, they illus¬ trate the biological truth that the mind of man possesses ethical desires which the most highly developed knowledge
36 RATS, LICE AND HISTORY
of science cannot satisfy — obviously, never will satisfy.
It is not entirely a matter of accident that astronomers, physicists, and mathematicians are more prone than the biologist to fall into the lap of Mother Church or at least into that of one of her barren metaphysical sisters. The biologist, in his work, is always confronted with the mystery of life. He learns a reverence for it which, com¬ pounded of wonder and awe, keeps him modest and will¬ ing to admit without despair that here is something quite amazing, worthy of continuous study, but, for the time being, beyond his capacities to comprehend. The sagacious physicists to whom I have alluded scamper back to God. But they think they have reached a new understanding and have discovered a new and modern Jehovah, when as a matter of fact all they have done is perhaps to take away his beard and express his thunder in ergs. In their hearts and minds he still remains the same old “Almighty.” What might eventually be attained is what, for a time, the Greeks achieved when the philosophy of Plato was the religion of educated people, and what, in the form of Confucianism, existed to some extent in China.
This, however, is too much to hope for in our present overpopulated world, for as fast as ministers like Dr. Fosdick throw overboard their ballast of mysticism in order to cross the shoals into a quiet harbor of reason, Millikan and other physicist-metaphysicians fish it out again to steady them in making the high seas of specula¬ tion. The prospect is hopeless unless someone can appear who will be as rigid as was Christ in differentiating be¬ tween issues of the spiritual and the material, and who at
RATS, LICE AND HISTORY 37
the same time possesses a thorough familiarity with the possibilities and limitations of modern science.
The scientist who achieves intellectual and emotional maturity without losing his investigative vitality and courage — that is, without metaphysical surrender — can come to rest in philosophical tranquillity with the recogni¬ tion that science, however highly developed, may never answer the ultimate questions ; but that there may be happiness in contemplating nature’s orderly coordinations, and peace in modest fellowship with the rational and humane spirits who, throughout the brutalities of history, have held to the purpose of reason. Complete compre¬ hension could add very little.
Bergson suggests that on another planet life might have been evolved by systems entirely different from our own. The element characteristic of substances that supply energy might have been other than carbon, and the ele¬ ment characteristic of living matter might have been other than nitrogen, leading to living bodies radically different from our own in chemistry, anatomy, and physiology. This may perhaps be true; but to believe it would require as¬ sumptions to which earthly observations give no clue. The origin of life, so far as we can analyze it on earth, is made possible by the unique properties of the com¬ bining powers of three elements,1 and the infinite diversity of the phases and systems made possible by the properties of water. By these relations, says Henderson, “the path¬ way from the simple compounds of the atmosphere to the complex organic bodies is a direct one.”
1 Lawrence J. Henderson, The Order of Nature .
38 RATS, LICE AND HISTORY
Out of these combinations and dissociations, in con¬ tact with the other elements in the infinitely variable conditions of pressure and concentrations, with the radiant energy drawn from the sun, — somewhere, at some time, life was begotten. In that transition between the dead organic combination and the similar one that is alive lies the great, incomprehensible mystery. What came before we can reasonably trace; what came after is at least open to inquiry in the records of existing living forms. In that leap from the dead to the living lies the mysterious break of continuity which defies our understanding. Between the chemically definable protein molecule and the living bacterial cell there is a gap of understanding far greater than that between the first living cell and man.
It is not easy to define life. An enzyme that could ex¬ pend energy and build up new energy for that which it expends, in automatically regulated cycles, would be alive though soluble and not organized in cellular form. There are invisible agents, parasitic upon plants and animals, which we know only by their activities. The ultra- microscopic virus agents, the mosaic disease which infects tobacco and potato plants, those which cause foot-and- mouth disease, rabies, yellow fever, infantile paralysis, smallpox, and many other destructive maladies, thrive in the living cells of higher beings and reproduce themselves m infinite generations, remaining true to type in habits of specific parasitism. Yet they are so small that they do not interfere with the waves of visible light,2 but are surely
2 Ultrafiltration measurements give them magnitudes raneine from 20 to 200 millionths of a centimetre.
RATS, LICE AND HISTORY 39
large enough to contain a hundred or more of the smallest protein molecules. It is probable that some of the largest ones have been seen as just visible dots under the highest magnifications; but many of them have never been seen. It is assumed that they are living things, cellularly or¬ ganized, but we are not sure of this; and the thought is at least reasonable that some of them are transitional things between true enzymes and formed cell-individuals. The evolutional transition from the dead organic com¬ plex to the cell may well have been a gradual one of infinitely small steps which may yet be uncovered. Modern observations of the bacteriophage phenomenon have at least given us the material for hopeful inquiry.
Did life originate spontaneously by such progressively complex associations of matter through enzymes — un¬ formed, regulated intermediaries, capable of building up and expending energy? Or did it come to our earth from elsewhere, — cosmically, — in which case it would have had to possess the capacity of resisting, without destruc¬ tion, exposure to temperatures ranging from absolute zero to incandescence. We cannot deny these possibilities, but we have no clue to either. We are beginning to know that all the processes which take place in living beings are governed — though with more complexity — by the same physicochemical laws which govern the reactions in dead chemical systems. Yet this purely mechanistic understanding is insufficient for the final answer, and vitalism is reborn again and again to bridge the gap.
With us, in the same modern world in which we culti¬ vate what we call art and science, our almost ultimate
40 RATS, LICE AND HISTORY
ancestors, the Protozoa and bacteria, have survived. The bacteria particularly (nearest of recognizable cells to the stem of living things) are still more important than we. Omnipresent in infinite varieties, they perform fermen¬ tations and putrefactions by which they release the car¬ bon and nitrogen held in the dead bodies of plants and
animals which would — without bacteria and yeasts _
remain locked up forever in useless combinations, removed forever as further sources of energy and synthesis. Inces¬ santly busy in swamp and field, these minute benefactors release the frozen elements and return them to the com¬ mon stock, so that they may pass through other cycles as parts of other living bodies. Some of them correct the excessive enthusiasms of their too thorough brethren, which break down nitrogenous substances to free nitrogen. In the soil and in the root tubercles of clover, peas, and other legumes, bacteria are busy fixing nitrogen into com¬ plexes ready for revitalization. Without the bacteria to maintain the continuities of the cycles of carbon and ni¬ trogen between plants and animals, all life would even¬ tually cease, plants would have no nitrates and no carbon dioxide with which to grow, cows would have no clover to eat, men would have no beef and vegetables. Without them, the physical world would become a storehouse of well-preserved dead specimens of its past flora and fauna as useless for the nourishment of the bodies of pos¬ terity as ugly and stupid thinking, petrified in books, is useless for the nourishment of its spirit.
RATS, LICE AND HISTORY
41
2
Among the adages and proverbs which tend to become the philosophy of the thoughtless, one of the most dan¬ gerous is: “Seeing is believing.” For thousands of years, wise men believed that the earth was flat and that the sun moved around the earth — because they could see with their own eyes that these things were so. It was, in part, this same faith in pure observation which delayed for so many centuries a sensible approach to the problem of the origin of life. Maggots were engendered from de¬ caying horseflesh, lice and fleas from human perspiration; a horsehair in a bucket of water became a threadworm. These things could be observed and, therefore, were true. Even the successful production of the homunculus (avQpuirapiov) was announced by the alchemist Zosimos in 300 a.d. with the same confidence and nearly as much authority as some of our modern biologists announce the transformation of ultra-microscopic viruses into bacteria on similar tenuous evidence.
In spite of the immense literature of error which we shall presently consider, the ancient mediaeval specula¬ tors were less dangerous to understanding than are their modern representatives. False doctrines became less widely known then, for few people could read and there was little personal gain in notoriety; the public had not begun to become science-conscious and intellectual, and scientific questions were appraised by the intelligent and instructed minority instead of being immediately submitted to the intellectual proletariat. Also, if we feel astonishment at
42 RATS, LICE AND HISTORY
the relatively slight progress that has been made in the solution of the question concerning the origin of life in the course of the many thousand years during which man has pondered it, we must remember that the view of the Greeks in 300 b.c. was a sounder one than any attained until very modern times, when the Greek method of thought was reenforced by the development of biochem¬ ical and biophysical methods after a century of a biological clearing of underbrush.
It is interesting to speculate what the Greeks might have achieved in another three or four hundred years of development if the empire building of the Romans, and the evolution of a Christian Europe out of barbarism, had not interrupted them. The one thing the Greeks lacked for the rapid acquisition of the necessary fundamen¬ tals of chemistry and physics was an experimental method¬ ology. And this, it would seem, must have inevitably developed out of their geometry — as, indeed, it had already begun to do with Archimedes and a few others. It was the influence of mathematical thought which, in later centuries, gave rise to the method of the experimen¬ tal isolation of individual phenomena or their fractions. The Greeks were certainly closer to this in 300 b.c. than the Europeans were until 1500 a.d.
The world being as large as it is, it is probably neces¬ sary every now and then to mark time culturally for a thousand years or so. And this is what seems to have happened in the single cycle of which we have histori¬ cal knowledge. The Roman genius for organization and the influence of a supernaturally enforced — and there-
RATS, LICE AND HISTORY 43
fore more easily comprehensible — system of Christianity were necessary to bring the hordes of sans-culottes of the European forests slowly to the point where, in two thou¬ sand years, they might continue where the Greeks left off. As a matter of fact, while European civilization, from 1600 on, went far beyond the Greeks in scientific discov¬ ery, it is debatable whether in spiritual and moral devel¬ opment we have yet attained the standards of the Platonic philosophy, which was free from any scaffoldings of doctrine or supernatural buttresses. And in spite of all progress, our school-teachers have substituted “household economy” and “sexual hygiene” for classical history and philology, and the civilized world still continues to sup¬ port a sort of dole system in the Protestant clergy. Just how badly the cultural spirit of the world has been dam¬ aged by the late war, it is too early to say. At the present writing, it certainly looks as though Fascism in Italy, however successful economically, had brought scientific and artistic production almost to a standstill; Russia’s science and art have so far been little more than feeble instruments of propaganda; and the present state of the lovely structure of scientific idealism of the Germany of the 1890’s brings tears to the eyes.
3
It is significant of our helplessness that the views we hold to-day regarding the origin of life are closer to its revelation only in direct proportion to the refinement of method which science has developed. Our forefathers based their opinions on the testimony of their five senses.
44 RATS, LICE AND HISTORY
We base our own on the additional reenforcements of chemical analysis, microscopic evidence, the potentiometer, and the thermodynamic laws. In the wake of Pasteur, Darwin, Emil Fischer, Willard Gibbs, and countless others, we are differentiating the problem. One of the great beauties of the scientific occupation is the pride of being a private in the great army of differentiators — the generals of which are never dead to their followers. Every objective gained, every trench dug, every citadel conquered, is a permanent advance in organizing the new territory for the coming of the next integrator. Some day he may arrive and make a dead complex live. He may be the son of an English lord, of a Czechoslovakian peas¬ ant, of a Russian Jew, of a French barber, or — most unlikely — of an American broker. Thus is science the great democratic adventure. But when he comes, he will be hailed as King.
The great mystery of life will be revealed as a physico¬ chemical process. But we know already that it is — though we have not succeeded in imitating it. And when we do, we shall be — philosophically — just about where we are now.
Its quest is a sort of forlorn hope of human endeavor, indulged in by the intelligent impractical of every age. But it is a strange fact that the impractical among man¬ kind are remembered. Why? Because of that quality which more than any other lends dignity to life: the in¬ stinct for happiness in understanding, — whether it be by intellectual or emotional perception, — which is the most incomprehensible of the attributes of mankind, and i which neither the brutalities of individual nor the bru-
RATS, LICE AND HISTORY 45
talities of national competition have ever succeeded in annihilating.
Among the impractical quests of man, none has been more alluring than that concerning the origin of life.3
In ancient China, insects were produced from wet bam¬ boo in sultry weather.
The ancient Indians (the Laws of Manu) divided the animal kingdom into the egg-born and the “sweat-pro¬ duced,” or flies, beetles, worms, and so forth.
Out of the mud of the Nile, by the heat of the sun, were engendered frogs, toads, snakes, and mice — for could one not see them oozing out of it in the warm months?
The sacred, coprophagous scarabseus was mysteriously fashioned out of balls of dung, and bees sprang from the putrefying cadavers of cattle.
Thales, one of the seven wise men of Greece (an old woman made fun of him because, when he walked out to gaze up at the stars, he fell into a ditch ; and his mother kept him from marrying, because when he was young she said, “It is too soon,” and when he grew old she said, “There is not time enough left”), thought that water was the source of all living things and that life arose in the warm mud and ooze of the floor of the oceans. He was followed in the same thoughts by Anaximander and Xenophanes. Rain water was added by Anaxagoras, which carried down fertile seeds from the infinite spaces. There seems to have been a general agreement on mud.
That new creatures were born from the union of their
3 An extraordinarily complete and learned compilation of the subject, from which we have freely quoted, has been published by von Lippmann.
46 RATS, LICE AND HISTORY
similar ancestors was not denied. But, in addition, new ones were being constantly added from the synthesis of sun-warmed organic matter.
Parmenides, Empedocles, and Diogenes of Apollonia favored mud and moist earth as the sources whence life sprang.
Democritus, Epicurus, and their recorder, Lucretius, started something new. Everything on earth has life. The earth is the mother who, in her youth, gave birth to all living things — performing miracles of fecundity which gave origin to plants and animals and even to man. But as she grew old much of her power was lost, and only trivial things like insects, reptiles, and other inferior be¬ ings were begotten from decaying organic matter, with the help of warm rain and sunlight.
Plato was reasonably agnostic in these matters, as was Socrates, though the latter invented “Entelechia,” the power of the spirit, which, infused into matter, gave it life.
Archelaus believed that the putrefying spinal cords of animals and man were transformed into snakes.
Diodorus, about 30 b.c., revives the old louse story — its origin from human skin and perspiration ; and he again asserts that mice were produced from the mud of the Nile, for he could see them slipping out — perfectly formed in front, but unfinished behind.
Vergil seems to have believed the old story about the origin of bees from the dead bodies of steers. It is astonish¬ ing, in this connection, that Homer — in the Nineteenth Book of the Iliad — lets Achilles speak of the danger of
RATS, LICE AND HISTORY 47
flies slipping into the open wounds of Patroklos and there producing maggots — perhaps the earliest exact observa¬ tion in this matter.4
Ovid has the same ideas as Vergil, only he thinks that wasps come from the dead bodies of horses and beetles from those of asses.
With the influence of Christianity, there was of course a considerable change in some of the views. Gregory of Nyssa, in the fourth century, sticks to the Bible and states that the beasts and the plants were suddenly born from the earth by God’s will 3 whereas Augustine was troubled by his logical mind to the extent of wondering whether, if the earth retained its power to bring forth animals by spontaneous generation even after the flood, the Ark would have been unnecessary 3 and he could not harmonize his belief in the goodness of God with the divine produc¬ tion of disagreeable things like mice.
All through the Middle Ages, the same type of rea¬ soning persisted. There was a little less naivete in some of the theories, but many others were more fantastic than anything antiquity was able to produce. The great physi¬ cian Avicenna believed that intestinal parasites were all produced from putrefying materials and moisture, and he completely accepted the origin of animals from properly combined elements. Lippmann credits him with the state¬ ment that, as the result of a thunderclap, an incomplete calf dropped to earth from the sky.
4 “But I have grievous fear lest, meantime, on the gashed wounds of Menoitios’ valiant son, flies light and breed worms therein and defile his corpse — for the life is slain out of him — and so all his flesh shall rot.” (Lang, Leaf, and Myers’ translation.)
48 RATS, LICE AND HISTORY
Even the great Albertus Magnus, in his description De AnimalibuSy adheres to the old ideas that many of the lower animals spring from the materials on and in which they were found, — worms from rotting wood and refuse ; bees and beetles from decaying fruits and leaves, — and he seems even to have believed the story about the trans¬ formation of a horsehair into a spindle worm — a sup¬ position which is still prevalent among a good many intel¬ ligent people. The pious William of Auvergne, Bishop of Paris, was quite willing to believe that worms and frogs were produced in this way, but questioned the matter in connection with horses.
A remarkable tale that kept cropping up again and again until relatively modern times was the belief in the origin of wild ducks and geese from barnacles. These birds came and disappeared and were never seen to breed, so that their origin became the subject of much speculation. One of the stories traced to Saxo Grammaticus was to the effect that the little geese came out of shells which grew on trees in the Orkney Islands. The tale persisted until the latter part of the sixteenth century, when a Dutch sailor penetrated to the Arctic Ocean, where he observed and reported the nesting and breeding of the birds.
Similar to this tale of the barnacle geese is the story of de Mandeville, who, in his Travelsy speaks of a tree which bore huge, melon-formed fruit of which he him¬ self had eaten, and in which, when it was opened, he discovered a lamb. When the fruit ripens and falls, the lamb’s legs become attached to the ground, and it eats all the grass within its range. De Mandeville is now
RATS, LICE AND HISTORY 49
known to have been one of the most talented liars of his¬ tory. The descriptions of travelers who began to penetrate, in the late Middle Ages and early modern times, into all corners of the earth are responsible for innumerable stories of the same kind. The story of the vegetable lamb was not completely exploded until Linne, in the eight¬ eenth century, examined specimens of the various plants that were supposed to blossom as lambs.
The ideas of Paracelsus were, in regard to the origin of life, not materially different from those of his contem¬ poraries. However, the cfrvais of Hippocrates was as¬ sociated with the Christian belief in the soul in explaining the manner in which God infused life into some of his creatures.
Bacon was a firm believer in spontaneous generation, and Harvey, in 1651, must be regarded as the first who clearly opposed the older views with his famous Omnia ex Ovo.
Kepler, wise as he was, believed that plants could grow out of the earth without ancestors, and fish could be produced by spontaneous generation in salt water, just as comets could arise in the skies.6
There is practically no attempt through all this period on the part of the most powerful intellects to approach the problem by experimental methods, until the last half of the seventeenth century. In this period, a Tuscan physician, Francesco Redi, published experiments on the
6 It is to Kepler’s credit, however, that — although one of the most eminent physicists of all time — he never wrote a book on God and the Universe.
50 RATS, LICE AND HISTORY
development of insects, in which he showed that rotting materials are nothing more than the convenient nest for the depositing of eggs. He also asserted that various skin diseases are produced by parasites, and not the other way round; and Swammerdam comes to the same conclusion by the convictions of piety, since he held it impossible that flies, in which there has been expended so much wisdom and art on the part of Almighty God, could have arisen by chance from refuse. The honors are with Redi, though the conclusions are the same.
Leibnitz, in 1714, expresses the conviction that spon¬ taneous generation is impossible, and that neither plants nor animals could have originated from a chaos of putre¬ faction. Leibnitz was frankly agnostic in other expressions on this problem.
Descartes, who was familiar with the work of Leeuwen¬ hoek and of all other important naturalists of his time, gave little thought to the origin of living things, but speculatively hit the nail on the head by taking for granted that there may be a world of minute living things from which life of other kinds can develop by a sort of evolu¬ tion.
Between the end of the eighteenth century and the be¬ ginning of the nineteenth, an accumulation of accurate observations began to limit the field of speculation, and, indeed, in surveying the history of the thoughts of men upon this problem, it is quite apparent that here — as in all sciences — there has been an inverse ratio between speculation, on the one hand, and the accumulation of observations on the other. The discovery of the methods
RATS, LICE AND HISTORY 51
of reproduction in fungi and mosses in 1729 by the Flor¬ entine, Micheli, and Spallanzani’s experiments on insects, led to an increasing conviction that no such thing as spontaneous generation could take place. Lippmann men¬ tions the amusing fact that one of the important observa¬ tions on this subject was made in 1804 by a chef in a Paris kitchen, Appert by name, who preserved foodstuffs by heating them and putting them into hermetically sealed pots — an observation which was in line with a similar one made by Scheele on the preservation of vinegar by boiling and sealing in vessels. There were throwbacks, like Needham, but the modern era had begun and the ex¬ perimental method was soon to take charge of the de¬ velopment of biological thought.
4
With the gradual development of experimental method, those who were curious about the phenomenon of life became, by the very precision of their observations, more modest in regard to speculation. Modern biology was born when scholars began to concentrate their complete attention upon the study of the manner in which life existed, and limited speculation entirely to the construc¬ tion of trellises along which new experimentation might grow. The final demonstration, by Pasteur, that alleged observations of spontaneous generation were attributable to experimental error marked the ending of biological medievalism. But long before this, chemistry, emerging from alchemy and physics, turning from the firmaments to the minor affairs of this earth, had started biology on
52 RATS, LICE AND HISTORY
its modern career. Thus, biology began as it will end —
as applied chemistry and physics.
It will be of profit, in maintaining this thesis, to set forth, in the bare bone, the structure of biology as it has come down to our time. The reader of imagination will remember with sympathetic admiration the unnamed mul¬ titude of patient toilers, the unknown soldiers of the great struggle toward the truth, who helped to forge the tools for the hands of genius.
Everyone who thinks about these matters can construct a table of significant achievements for himself, and no two will be alike. But since this book is written more for our own amusement than for anyone who may possibly buy it, we set down in chronological order those conquests of understanding which seem to us to have most directly contributed to the modern views of the mechanism of living things. We give them without explanations, since those to whom such matters are unfamiliar may look them up in any up-to-date history of science.
1774. Priestley recognizes that “spoilt” air (spoilt by mice) was made “good” by the presence of green plants. In 1780, Ingenhousz shows that this action was due to the presence of green plants which acted only under the in¬ fluence of light j in the same year Senebier demonstrates the change to be one from carbon dioxide to oxygen, and in 1804 de Saussure proves the quantitative nature of the conversion.
1784. Lavoisier demonstrates the indestructibility of matter. Quantitative chemistry begins ; respiration is rec¬ ognized as akin to combustion.
RATS, LICE AND HISTORY 53
1812. Kirchhoff finds that starch can be converted into glucose by dilute sulphuric acid, without being itself changed. This may be regarded as the first clue to the undei standing of catalytic processes, leading to Berzelius’s conception of a “new force,” in which he saw a powerful factor in the explanation of the chemical processes of the living body.
1821. Cuvier lays the foundation of paleontology.
1824. Synthesis of an organic compound (urea) by Wohler.
1828. Discovery of the mammalian ovum by von Baer. The birth of modern embryology and the first great for¬ ward step in this direction since Harvey.
1838-1839. Schleiden demonstrates the cell struc¬ ture of plants, and Schwann the cell structure of animals.
1838. Cagniard de la Tour proves that fermentation is dependent on yeast cells.
1838. Von Mohl describes protoplasm.
1840. Max Schultze conceives of it as the “physical basis of life.”
1842. Mayer suggests the first ideas concerning the conservation of energy, later developed in an orderly manner by von Helmholtz in 1847 ( Abhandlung ilber die Erhaltung der Krajt), the eventual consequences of which were the thermodynamic laws.
1842. Birth of biochemistry with Liebig’s volume, Die Thierchemie> and so forth, on the application of chemical methods to animal tissues ; also containing the important conception of animal heat as combustion.
1857. Claude Bernard lays the foundation of modern
54 RATS, LICE AND HISTORY
physiology, and discovers the production of glycogen by the liver. The beginning of the application of biochemical and physiological methods to the living animal.
1859. Darwin and Wallace advance the ideas of or¬ ganic evolution, bringing in their train the energetic de¬ velopment of comparative anatomy, embryology, and ra¬ tional systematology.
1860. Final refutation of the experiments on sponta¬ neous generation by Pasteur.
1861. Recognition of differences in the laws of behavior of the so-called “crystalloids” and matter in particles larger than molecules. The birth of colloidal chemistry by the studies of Graham.
1862. Pasteur defines the dependence of fermentation and putrefaction upon living organisms.
1865. MendePs work on the crossbreeding of sweet peas. This work, which would probably have materially modified Darwin’s original hypotheses, was completely buried in a local scientific journal until 1900, when it was discovered, confirmed, and extended by de Vries and others. It was the foundation of the science of ge¬ netics.
1867. Traube’s work on semi-permeable membranes.
1877. Discovery of osmosis by Pfeffer.
1880-1900. Development of modern bacteriology and immunology, with the growth of technique for the study of life in its simplest available form.
1885. The correlation of osmotic pressures with their chemical and physical properties of solutions, by Van’t Hoff.
RATS, LICE AND HISTORY 55
1885. Rubner applies quantitative methods to the study of the heat value of food materials.
1887. Beginning of the syntheses of organic matter by Emil Fischer — glucose, fructose, and finally polypeptide, which is one of the higher cleavage products of protein. With the era of Fischer begins the true structural knowl¬ edge of the proteins.
1888. Elucidation of the carbon-nitrogen cycle by Hell- riegel and Wilfarth.
1889. First discovery of an ultra-virus (mosaic disease of plants), by Beijerinck.
1893. First discovery of ultra-virus causing disease in animals (foot and mouth disease), by Loffler and Frosch.
1900. Beginning of knowledge of the effect of radiant energy (X-ray, ultra-violet) on life processes.
1902. Sutton first pointed out that chromosome segre¬ gation furnished the mechanism by which Mendelian laws could be explained.
1904. Discovery of hormones or physiological messen¬ gers ; internal secretions defined by Bayliss and Starling.
1910. The significant beginning of the application of physicochemical methods to protein and to living tissues; acid base equilibrium; hydrogen ion concentrations; mem¬ brane potentials; Donan’s equilibrium; oxidation reduc¬ tion phenomena; surface phenomena and electrophysics of cells and fluids of living complexes. Those responsible: Sorensen, Loeb, Henderson, Clark, and many others.
1912. Vitamins discovered by Hopkins and Funk.
1915. Discovery of the bacteriophage phenomenon by Twort and d’Herelle, with the suggestion of the pos-
56 RATS, LICE AND HISTORY
sibility that they may be intermediate substances between the enzyme and the formed cell, having the power of reproduction only in the presence of specific living cells, upon which they act. Whether these substances are alive or dead is at present almost an academic question.
1925. Discovery of the relationship between radiant energy and the accessory food factors ; the activation of fats to vitamin functions by radiation with ultra-violet light. Based on experiments of Steenboek and of Hess.
1930. The crystallization of enzymes, the credit for which goes to Northrop.
All this may seem remote from the story of typhus fever ; but only to those who are impatient for the sen¬ sational events in a turbulent narrative. Without the de¬ velopments here recorded, we should now know little about the true nature of the subject of our biography.
CHAPTER IV
On 'parasitism in general , and on the necessity of consider¬ ing the changing nature of infectious diseases in the his¬ torical study of epidemics ; with a brief consideration of syphilis as an illustration of this contention. T hese matters have direct bearing on our biography , since we must pro¬ ceed as though we were writing of a man for readers
ignorant of the race of men
i
Nothing in the world of living things is permanently fixed. Evolution is continuous, though its progress is so slow that the changes it produces can be perceived only in the determinable relationship of existing forms, and in their paleontological and embryological histories. Though the processes which determine evolutionary change do not appear as simple to-day as they seemed when the Origin of Species was published, it would occur to no biologist to assume that any living form is perma¬ nently stabilized. On purely biological grounds, there¬ fore, it is entirely logical to suppose that infectious dis¬ eases are constantly changing, new ones are in the process of developing, and old ones being modified or disap¬ pearing.
Parasitism originated in dim primordial antiquity as a consequence of habitual contacts between different living things. It did not develop suddenly, but evolved gradu- ally, as one form adapted itself, step by step, to the en-
58 RATS, LICE AND HISTORY
vironmental conditions found in or upon another. Para¬ sitism, in its origin, means a breaking down of that opposition which, normally, every living cell complex offers to invasion by another living entity. The simplest illustration of this (for want of a better name, we may call it “vital resistance”) is the well-known one of the frogs’ eggs. They develop and remain free from invasion in a pond which is swarming with bacteria and Protozoa. A frost kills them overnight, and within a few hours their substances have become culture media for innumer¬ able microorganisms. It is conceivable — and, indeed, could be supported by experimental evidence — that a diminution of this “vital resistance” — which is, in itself, a complex phenomenon — may let down the bars suf¬ ficiently to permit invaders to gain a preliminary foothold, even though the host does not succumb to the injury which rendered him susceptible. And once begun, the further evolution of parasitism can proceed in an almost unlimited variety of directions.
Parasitism represents that phase of evolutionary change which lends itself most easily to analysis. There are few parasites which cannot be traced with considerable clear¬ ness to some free-living ancestral stock, either still existent or available in fossil form. From this point of view, the study of parasitic adaptation is one of the most important buttresses of evolutionary theory. Each instance represents a miniature system in which the host is the world by which the parasite is moulded. The parasitism which is infec¬ tious disease involves the invasion of more or less complex plants or animals by simpler, in most cases, unicellular,
RATS, LICE AND HISTORY 59
beings — like the bacteria, the Protozoa, the Rickettsia, and the curious, still undefinable agents of which we speak as “ultramicroscopic” or “filterable” viruses. Though ac¬ tually complex in function and metabolism, these sup¬ posedly simple things display an amazing biologic and chemical flexibility 5 and since, in them, generations suc¬ ceed each other with great speed (at least two every hour, under suitable circumstances), the phenomena of infection constitute an accelerated evolution extraordi¬ narily favorable for the observation of adaptive changes. It would be surprising, therefore, if new forms of para¬ sitism — that is, infection — did not constantly arise, and if, among existing forms, modifications in the mutual adjustment of parasites and hosts had not taken place within the centuries of which we have record.
As a matter of fact, the evidence of modern bacteriology lends much likelihood to the view that epidemic diseases are constantly changing; not, perhaps, with sufficient speed to confuse the diagnostic problems of any particular period, but still rapidly enough to encourage the consid¬ eration of this factor in the study of epidemic history. To be sure, it has not — so far — been possible in the laboratory to convert a pure saprophyte 1 into an habitual parasite. But it is relatively easy to induce fatal infection with an organism of ordinarily low parasitic powers by reducing the resistance of an individual host. This has been repeatedly done since the time of Pasteur. More¬ over, recent advances concerning what is technically spoken of as “bacterial dissociation” have developed simple
1 If the reader does not understand this word, it is too bad.
60 RATS, LICE AND HISTORY
methods by which a majority of the highly infectious bac¬ teria can be deprived of their virulence and then reversed to their fully pathogenic conditions. Such changes in both directions occur in the bodies of infected animals, can be produced at will in test-tube experiments, and can be correlated with morphological and chemical changes in the bacteria themselves. The subject is one of the most important fields of contemporary investigation, and the results achieved have profoundly modified conceptions of infection. To pursue it further would obviously lead us into technical discussions, more suitable for a text¬ book of bacteriology. The matter is mentioned in the pres¬ ent connection merely to support our contention that the historical study of infectious disease must, hereafter, take into account the fact that parasitic adaptations are not static, and that extraordinarily slight changes in mutual adjustment between parasite and host may profoundly alter clinical and epidemiological manifestations.
There is a wide range of delicate gradations between saprophytism and parasitism, and the biological and chem¬ ical properties along which adaptation changes progress are — to some degree — dependent upon whether an organism that causes disease in man and animals has re¬ tained the capacities for life in nature, whether it passes through intermediate hosts, or whether it is so closely adapted to an individual host that it cannot exist apart from him, and perishes when the host dies, unless trans¬ mitted to another.
The last condition is the one in which noticeable modi¬ fications can be most reasonably expected within the short
RATS, LICE AND HISTORY 61
period of human records. In such cases, there is an un¬ interrupted transmission from host to host, the parasite is never subjected to environments other than those to which it is most perfectly adapted, and, in consequence, evolution may progress in a single direction — toward a more perfect mutual tolerance between invader and invaded. It is conceivable that, when such parasitism first begins, the host’s reactions are violent, and either the invader or the host succumbs, according to complex criteria which vary for individual cases. As adaptation becomes more perfect, reaction is less energetic, and dis¬ ease becomes less severe and more chronic ; finally, a stage may be reached in which mutual adjustment is so nearly perfect that the host may show no signs of injury whatever. This condition exists, for example, in certain trypanosome infections of rats, in the spirochetosis and sarcosporidial infections of mice, and in a large variety of other conditions of animals and plants. In these, the in¬ fected animal shows practically no signs of discomfort or pathological change in reaction to the parasite. The principles have been thoroughly discussed by Theobald Smith. In animal populations, the first impact of a new virus is upon individuals of all ages. The survival of some of them is a matter of chance, depending on genetic differences or the accidental overlapping of immunity derived from other — possibly related — diseases. The extinction of many species of animals in past ages is best explained by freshly introduced parasites. Subsequent im¬ pacts are against the very young, and this tends to elim¬ inate the weak variants and leads to a population gradually
62 RATS, LICE AND HISTORY
growing more resistant to that particular form of infec¬ tious agent.
In man, a condition which illustrates these principles is syphilis. There is little doubt that when syphilis first appeared in epidemic form, at the beginning of the six¬ teenth century, it was a far more virulent, acute, and fatal condition than it is now. Uninterrupted transmis¬ sion from one human being to another, without intervals of extraneous existence in the course of almost five hun¬ dred years, has led to gradual mutual tolerance, one of the consequences of which has been an increasing mild¬ ness of the disease. If mankind could be kept as thor¬ oughly syphilized in the future as it has been in the past, another thousand years might produce a condition not unlike the present spirochetosis of mice, in which a peri¬ toneal puncture of almost any bon vivant would reveal the presence of a treponema pallidum infection of which the host is all but unconscious. Arsphenamin has probably ruined this prospect.2
In those forms of parasitism in which the invading or¬ ganism, in spite of its capacity for infection, has at the same time retained saprophytic properties, it is less easy to determine changes within the periods of historical record. Anthrax and lockjaw — deadly to man and ani-
2 This might be a loss to civilization: it has often been claimed that since so many brilliant men have had syphilis, much of the world’s greatest achievement was evidently formulated in brains stimulated by the cerebral irritation of an early general paresis. We omit reference to specific instances of this among our contemporaries only to avoid, for our publishers, the vulgar embarrassment of libel suits. Modern treat¬ ment, and the agilities of expert testimony, render legal proof of such contentions hopelessly difficult.
RATS, LICE AND HISTORY 63
mals — can, in spore form, be preserved for years in soil without loss of pathogenicity, so that — reinoculated by accident — they can again cause fatal disease. Typhoid and dysentery bacilli, cholera spirilla, the streptococci and staphylococci which cause surgical infections, and many other microorganisms can survive for longer or shorter periods separated from the host ; and the circum¬ stances under which this is possible, the length of time of survival, and the alterations which take place in them during such periods, are all of them of the greatest im¬ portance to the student of epidemics. Yet even in such in¬ fections by half-parasites — if the infection is widely disseminated — the factors discussed above become active, and successive generations tend to develop increased resistance. For human infections, many examples of this could be cited — one of the most illustrative that of tu¬ berculosis, in which the high susceptibility of aboriginal peoples as compared with resistance of the thoroughly tuberculized populations of European origin is a well- known fact.
The idea that we may logically expect modifications in the clinical and epidemiological manifestations of dis¬ ease within the short period of human history is espe¬ cially encouraged by study of the so-called “filterable virus” agents. Not an inconsiderable number of the more important epidemic diseases are caused by these mysterious “somethings” - — for example, smallpox, chicken pox, measles, mumps, infantile paralysis, encephalitis, yellow fever, dengue fever, rabies, and influenza, to say noth¬ ing of a large number of the most important afflictions
64 RATS, LICE AND HISTORY
of the animal kingdom. Here, as in bacterial disease, there is a lively interchange of parasites between man and the animal world. Indeed, since we can neither see these infectious agents nor cultivate them, except in the pres¬ ence of living tissues, the only opportunity we have of subjecting any of them to systematic study is by finding some animal in which disease can be produced. As a con¬ sequence of such study, it has appeared that these agents, even more than bacteria, are of an extraordinary biological plasticity, and can often be modified by simple labora¬ tory manipulation. The transformation of smallpox virus into vaccinia by passage through cattle is far more pro¬ found a change than the alteration which differentiates the plague of Athens from smallpox as we know it to¬ day. The mere passage of the virus through another species has — in this case — so altered it that it will no longer cause more than a negligible local reaction in man 3 but, nevertheless, it retains the fundamental bio¬ logical properties by which it immunizes him. In the same way, the passage of rabies virus through rabbits rapidly increases its virulence for these animals, slightly diminishing it at the same time for monkeys and man. Yellow- fever virus, injected into the brains of mice, ceases to produce typical yellow fever, but causes a form of encephalitis which, thereafter, can be carried in series from mouse to mouse. Carried back to monkeys, even though passed through mosquitoes, it retains its affinity for the nervous system. As a matter of fact, a large num¬ ber of these viruses, including that of herpes, which causes cold sores, vaccinia virus, and many others, can, by ap-
RATS, LICE AND HISTORY 65
propriate manipulation, be adapted to what is spoken of as “neurotropism” — that is, so changed that they will selectively invade the nervous system and cause encephalitis.
What we speak of as “new” disease, therefore, need not be conceived as the acquisition — de fiovo — of forms of parasitism that have not previously existed. While this process is probably continuing, it is too gradual and slow to be traceable from an established disease to its ultimate origin. There remain two chief sources of new diseases within historic periods: namely, the modifications of para¬ sitisms already existing in man by gradual adaptative changes in their mutual relations; and the invasion of man by parasites, well established within the animal king¬ dom, by new contacts with types of animals and insects to which mankind was not previously exposed. That there are many diseases already existing in nature which man has not hitherto acquired only because of lack of oppor¬ tunity is quite obvious from the recent experience with the psittacosis of birds and a disease of sheep spoken of as “louping ill.” In both of these conditions, although isolated human cases had been observed, laboratory as¬ sociation promptly demonstrated an extreme infectious¬ ness to investigators. The Australian X disease — a po¬ liomyelitis-like condition — was probably contracted by man from sheep, and tularaemia — a disease not recog¬ nized before 1904, and at present spreading through the United States — is acquired from a number of animal sources.
One of the most interesting phenomena of infectious
66 RATS, LICE AND HISTORY
parasitism is the interchange of infectious agents between insects and the world of higher animals. This is a large field, which we have no intention of discussing except in so far as it concerns the subject of our biography — typhus fever. Entirely apart from the medical and sani¬ tary aspects of the typhus-fever problem, the circum¬ stances of its transmission are of extraordinary biological interest, because they give us — more than any other disease cycle — the opportunity of studying the evolu¬ tion of a parasitism which has taken different channels in various parts of the world, adapting itself to the diver¬ gent circumstances of local insect and rodent distribu¬ tion. Typhus fever is one of the Rickettsia diseases which form a closely related group. The minute, bacillus-like organisms which cause these conditions (Rickettsiae — named after Ricketts, an American who died while in¬ vestigating typhus in Mexico) are closely related to a number of similar and harmless microorganisms which are habitually found in the bodies of many insects. It is, for this reason, not unlikely that the original parasitism of these organisms was acquired by insects, and from them was passed on to some of the lower animals (rodents) and so to man. These conditions are discussed at some length in a later chapter.
2
When circumstances are such that an infection can saturate almost the entire population of crowded regions, the result is what the Germans call T)urchseuchung. The accidentally less susceptible survive, and through gener-
RATS, LICE AND HISTORY 67
ations a gradual alteration of the relationship between parasite and host becomes established. The more thor¬ ough the saturation, the more apparent the results. The simplest demonstration of such changes is the rapidity of spread and the virulence of a disease when it is first introduced into the reservoir of an aboriginal — that is, entirely susceptible — population. When measles first came to the Fiji Islands in 1875, as a result of the visit of the King of the Fijis and his son to Sydney in New South Wales, it caused the death of 40,000 people in a popula¬ tion of about 150,000. Another example is the terrific violence of smallpox when first introduced among the Mexican Indians by a Negro from the ship of Narvaez. The virulence of tuberculosis for Negroes, Eskimos, and American Indians living in contact with whites is another case in point. Any number of illustrations of this kind might be cited. But even among crowded, thoroughly in¬ fected populations, diseases have changed within relatively short periods. Scarlet fever has become definitely milder throughout Western Europe, England, and America since about 1880. The same is true of measles and diphtheria, as regards both incidence and mortality. The change began well before modern preventive methods had exerted any noticeable influence. Perhaps it is not an accident, however, that, in the case of diphtheria, — in the control of which modern bacteriological methods have been most effective since the late nineties, thus creating interference with normal evolution, — we are just beginning to observe the return of excessively toxic and deadly cases, reported in increasing numbers from Central Europe. It is not at
68 RATS, LICE AND HISTORY
all unlikely that the successful control of an epidemic disease through several generations may interfere with the more permanently effective, though far more cruel, proc¬ esses by which nature gradually immunizes a race.
Syphilis best exemplifies the alterations which may take place in a disease within a short period, if the popula¬ tion is once thoroughly “saturated.” The problems con¬ nected with it are so interesting that they seem worth a few paragraphs. Before the last decade of the fifteenth century, there are few reliable records of syphilis in Europe. The subject has been greatly disputed, and many passages — especially in ancient Hindu manuscripts — have been interpreted as signifying that venereal sores similar to those characteristic of syphilis were known in the ancient world. There are, however, forms of non¬ syphilitic venereal sores, the so-called “soft chancres” or “chancroids,” which cannot be distinguished from true syphilis on the basis of extant descriptions ; and no phy¬ sicians whose writings have come down to us from ancient or mediaeval literature describe any disease characterized by the sequence of genital sores, followed by skin erup¬ tions and the various secondary and tertiary lesions, which were obvious enough to the physicians of the Renaissance as consecutive stages of one and the same original cause.
Medical historians have cited many observations which they regarded as indicating the ancient existence of syph¬ ilis 5 but most of these, on close scrutiny, turn out to be unconvincing. Talmudic references are not sufficiently pre¬ cise to permit conclusions, and such allusions as those of Celsus, in the Sixth Book of his Medicina , the regulations
RATS, LICE AND HISTORY 69
for prostitutes issued by the Countess of Avignon in 1 347, and similar ones, do not constitute reliable evidence. Ozanam quotes two sonnets from a Florentine poet — one entitled “De Matrona,” the other “Ad Priapum” — which he accepts as definite proof that syphilis existed in 1480, when the poems were written. Careful transla¬ tion of these sonnets, with particular scrutiny of the ex¬ pressions in them which are diagnostically significant, leads to the conclusion that they are merely very nasty poems, with no precise reference to the disease.
It is not, of course, possible to exclude with certainty the ancient existence of a form of syphilis milder than that which swept over Europe in the early sixteenth cen¬ tury, and Haeser — who does not subscribe to the opin¬ ion of the American origin — believes that syphilis may have been prevalent to a limited degree and in a less virulent form since ancient times. Sexual immorality was widespread and quite shameless at many periods of an¬ tiquity, in Rome, in the Middle Ages, in connection with the great epidemics, and — a strange and common contradiction between idealism and license — during the period of the Crusades. Gonorrhoea undoubtedly was com¬ mon all over the known world from most ancient times,3 and was accurately described as the “running sore” in England, and under the names of clap and chaudepisse in France. There are unmistakable descriptions of chan¬ croids and phagedenic ulcers, which sometimes extended
3 aNo stewholder to keep a woman that hath the perilous infirmity of Burning” (Beckit, P hiloso'phical Transactions , xxxi, 47, fourteenth century, cited from Haeser).
70 RATS, LICE AND HISTORY
widely and destroyed the genitalia, and in these diseases — as now — there were swellings of the inguinal gland and the bubo. There are few descriptions, however, in which it is possible to trace the relationship of a venereal infection to secondary and tertiary consequences in other parts of the body. This Haeser is inclined to believe is due to the unwillingness of doctors and patients to attribute venereal origin to conditions occurring several weeks after infection and, similarly, he believes that the later and usually mild manifestations may have been overlooked, or described in unrecognizable form. There are a few accounts cited by him which lend weight to his views. One, taken from Littre, refers to the observa¬ tions of the French physician de Berry (thirteenth cen¬ tury), who described a condition venereally acquired which, beginning in the genitalia, spread to the entire body: “ Nam virga infcitur , et aliquando alter at to turn corpus?' Another case is that of Nicolas, Bishop of Posen, who died in 1382, as a result of “morbus cancri ” on the genitals, followed by ulcers of the tongue and pharynx. A similar case is that of King Ladislas of Poland, and of Wenzel of Bohemia.4
It is thus quite impossible to assert with confidence that syphilis did not exist in pre-Columbian Europe. But if it did, it must have been relatively rare, and certainly so much less virulent than the later malady that the epi-
4 Wan er Faulen fegan An dcr stat da sick dy man V or Sc ham ungern schcn lant.
— Steyersche Reimchronik (cited from Haeser)
RATS, LICE AND HISTORY 71
demic of 1500 marked the beginning of a new phase in the parasitism of the treponema pallidum.
The American origin of syphilis forms the basis of a theory that has become widely prevalent, and although it cannot be proved beyond question that America was the source from which the disease reached Europe, it is more than likely that it existed in the Western Hemisphere and that early explorers may have been infected by inter¬ course with coastal Indians. In this connection, much has been made of lesions on bones found in the graves of the mound builders of Ohio and other regions — notably, New Mexico, Peru, Central America, and Mexico. Pro¬ fessor Herbert U. Williams, who has recently sifted the evidence, with attention both to the antiquity of examined bones and to the trustworthiness of pathological examina¬ tions, believes that there is unmistakable evidence of syphilis in many of these lesions.5 Williams has also re¬ viewed some of the early Spanish literature bearing on the same question. In the Life of Christopher Columbus , by his son, Ferdinand, there are included passages from the writings of a hermit of the order of Saint Jerome, — Pane, by name, — written at the time of the second voy¬ age of Columbus. The passage quoted by Williams reads as follows: —
They say that Guagagiona being in the land where he had gone, saw a woman whom he had left on the sea, from whom
5 R must always be remembered that some of the lesions observed in the Western Hemisphere and attributed to syphilis may have been due to a disease which is more than a cousin, rather a half brother of syphilis — namely, yaws.
72 RATS, LICE AND HISTORY
he had great pleasure, and immediately he sought to cleanse him¬ self, on account of being plagued with the disease that we call French; and afterwards he betook himself into Guanara, which signifies a place by itself, where he recovered from his ulcers.
Oviedo y Valdes says, among other things, that the dis¬ ease of Buas (probably syphilis) tormented the first Chris¬ tian settlers in the West Indies, and adds: “Many times in Italy I did laugh, hearing the Italians say the French Disease, and the French calling it the Disease of Naples; and in truth both would have hit on the right name if they had called it the Disease from the Indies.” He also speaks of a knight, Don Pedro Margarite, who had been on the second voyage, as suffering from the affliction, and regards him as probably one of the infectious foci from which it spread at court. He says that it “was something new, the physicians did not understand.” Similar evidence comes from Las Casas, Sahagun, and de Isla. From the manuscript of the last named writer, Williams quotes a paragraph not represented in the printed editions, — left out for unknown reasons, — which is of exceptional importance. “As has been found by very long and well- proved experience, and as this island was discovered and found by the Admiral Dom Cristoual Colon at present holding intercourse and communication with the Indies. As it is of its very nature contagious, they got it easily: and presently it was seen in the Armada itself, in a pilot of Palos who was called Pincon and others whom the aforesaid malady kept attacking. And as it is a secret disease never seen . . .” and so forth.
Whether syphilis originated in Europe or came to it
RATS, LICE AND HISTORY 73
from America will probably never be decided. The the¬ ory of American origin, however well-founded in other respects, meets with an almost unanswerable objection in the shortness of the period which elapsed between the return of Columbus and the syphilis epidemic which broke out in Naples in 1495. Moreover, Julien, a French naval surgeon, has recorded that syphilis was more common among the coastal tribes who were in contact with Euro¬ peans than among the Indians of the interior, even in the early days of exploration of the Western Hemisphere. It is not at all unlikely that a mild form of syphilis oc¬ curred all over the world, including China (according to Dudgeon) and Japan (according to Scheube), long before the fifteenth century. This is the view favored by Haeser, Hirsch, and other learned scholars.
While, thus, there remain legitimate differences of opinion concerning the problem of origin, there is no doubt whatever that syphilis flared up in a sudden, intense, and widespread manner shortly after the time when Charles VIII of France led his army through the South of Italy against Naples. The city wTas taken by the French in February 1495, and the disease promptly appeared among the troops and the burghers. As the army dis¬ persed, deserters, camp followers, and demobilized sol¬ diers spread the infection far and wide, and, because of the malignancy and disgusting character of the malady, it was the custom of the day to blame it upon the enemy. Thus it was at first known variously as the “French dis¬ ease” or the “Neapolitan disease.” Benvenuto said he had “the French affliction.”
74 RATS, LICE AND HISTORY
The infection as it occurred in Naples was to all in¬ tents and purposes a new disease in representing a com¬ pletely altered relationship between parasite and host, with consequent profound changes of symptoms. Some¬ thing must have happened at that time, apart from war and promiscuity, — both of which had been present to an equal degree many times before, — which converted a relatively benign infection into a highly virulent one. The history of the subsequent fifty years strikingly illus¬ trates the rapidity with which adaptive changes may take place. It is probable that in all parasitisms these alterations of mutual adjustment begin with considerable velocity, the curve flattening out progressively with the increasing number of passages of the parasite through the same species of host.6
But when the disease first broke out in Naples in the army of Charles VIII, it possessed a violence that is un¬ observed in syphilis to-day. According to Scharfenberg, it was a feverless disease characterized by pustular and ve¬ sicular eruptions with extensive ulceration. Though the first ulcerations usually appeared on the genitals, this was not always the case. Primary contact infections oc¬ curred on many other parts of the skin, and the disease was often transferred from mothers to children in ordinary association. The ulcerations which often resulted from the eruptions covered the body from the head to the
6 Fantastic theories as to the origin of syphilis were held in early days. Van Helmont, Ozanam tells us, believed that it was started by the intercourse of a man with a mare that had glanders. Linder thought that it started by a similar relationship with a monkey, and Manard thought it came from marriage with a leper.
RATS, LICE AND HISTORY 75
knees. Crusts formed, and the sick presented so dreadful an appearance that their companions abandoned them and even the lepers avoided them. Extensive losses of tissue in the nose, throat, and mouth followed the skin mani¬ festations, and in the train of these came painful swellings of the bones, often involving the skull. The disease it¬ self, or secondary infection, caused many deaths. In sur¬ vivors, emaciation and exhaustion lasted for many years. Fracastorius says that some of the ulcers traveled, like those that are called “phagedenic,” and extended even into the bones themselves, where “gummositates” or gummata as large as eggs developed on the limbs and, when opened, contained white, sticky mucus.
Within a little more than fifty years, the disease had already changed. Fracastorius’s De Contagione was pub¬ lished in 1546, sixteen years after his syphilis poem.7 His description of the disease, its methods of transmission and course, is so complete and precise that we cannot question the accuracy of his observations concerning the changes that had taken place between his own time and the epi¬ demic of 1495. The passage in the Second Book of De Contagione reads as follows: —
I use the past tense in describing these symptoms, because though the contagion is still flourishing to-day, it seems to have
7 The renowned poem of Fracastorius was written in 1 530, and in it the disease was given its modern name — that, namely, of the shep¬ herd Syphilus. The poem was finished in its earlier form in 1 525, and presented to the Sainte-Beuve of his time, Bembo. Within the next five years it was rewritten and enlarged, and a third book was added, which deals chiefly with the treatment of syphilis with guaiac. However, in both the earlier and the later versions, Fracastorius indicates in an allegorical manner that mercury is the best remedy.
76 RATS, LICE AND HISTORY
changed its character since those earliest periods of its appear¬ ance. I mean that, within the last twenty years or so, fewer pustules began to appear, but more gummata; whereas the con¬ trary had been the case in the earlier years. . . . Moreover, in the course of time, within about six years of the present genera¬ tion, another great change has taken place. I mean that pustules are now observed in few cases, and hardly any pains — or much less severe — but many gummata.
CHAPTER V
Being a continuation of Chapter IV, but dealing more 'particularly with so-called new diseases and with some
that have disappeared
i
It is obvious that when one searches the ancient and medieval literature for the existence of maladies in which differential diagnosis is difficult even to-day, one is likely to make many mistakes. Accurate descriptions are rare and, even when details of symptoms and courses are as accurate as those to be found in Hippocrates, there is a total lack of the laboratory evidence which is often in¬ dispensable for certainty. The problem is particularly confusing in connection with epidemic infections of the nervous system, many of which are generally regarded as new diseases at the present time. We are inclined to believe that a few only of these conditions are new in the sense that a virus is involved which had never in¬ fected man before. It seems more than likely that in many cases the diseases are new in that they represent a pre¬ viously unknown biological relationship between parasite and host. What we have said in the preceding chapter about the changes which can be experimentally produced in some of the filterable virus infections bears upon this point.
We have no reliable evidence of the existence of in-
78 RATS, LICE AND HISTORY
fantile paralysis in epidemic form before 1840, and it seems likely that if a disease of such striking character¬ istics had existed in epidemic form it would have found its way into the seventeenth- and eighteenth-century litera¬ ture. In regard to encephalitis ( vulgo dictuy sleeping sick¬ ness), it is equally difficult to find reliable evidence of its existence before the eighteenth century. In 1712, Biermer studied an epidemic in Tubingen which was popularly known as “sleeping sickness,” because it was accompanied by somnolence and brain symptoms. The “ coma somnolen- tum” observed by le Pecque de la Cloture in 1769 was similar and, like the disease of 1917, was associated with influenza. Ozanam mentions a condition of like nature occurring in Germany in the last decade of the eighteenth century, in Lyons in 1800, and in Milan in 1802. After this time no reliable evidence of any disease of this kind can be found until 1917. In that year, synchronous with the first considerable outbreak of influenza, a group of encephalitis cases occurred in Vienna. Soon after that others appeared in France, Great Britain, and Algeria ; then during the latter half of 1918 cases were seen in North America, and by May 1919 had been reported from twenty states — the largest number from Illinois, New York, Louisiana, and Tennessee. To all intents and purposes, this was a new disease to our generation, and up to the present time the virus of this form (lethargic encephalitis) has never been successfully transferred to animals. In 1924 a clinically similar and much more severe malady appeared in Japan, and while it differed only in severity from that reported previously, successful
RATS, LICE AND HISTORY 79
transfer of the virus of the Japanese disease to rabbits marked it as a new and different type. During the sum¬ mer of 1932, an outbreak of encephalitis occurred in Cincinnati and in certain parts of Ohio and Illinois, which cannot at present be classified, but in the summer of 1933 again a similar disease started in the neighborhood of St. Louis, attacking over a thousand people within several months, killing 20 per cent of them. And the virus of this disease, unlike any of the others, could be transferred to mice. It appears, therefore, as though, within the course of less than twenty years, at least three new types of severe virus infections of the central nervous system had appeared among us.
Vaccination has been practised on millions of people since the time of Jenner, and never before the present generation has the practice of vaccination been associated with any kind of nervous disorder. Within the last twenty years, however, a severe type of post-vaccinal encephalitis has occurred in a few regions of the world, and since we know, by experimental manipulation, that vaccinia virus can be made “neurotropic” in animals, it is not impossible, though not yet certain, that in these few cases peculiar circumstances have permitted an invasion of the central nervous system by the vaccinia virus. This condition de¬ velops in such a disappearingly small percentage of the vaccinated that it has practically no importance and certainly is not an argument against the practice of vac¬ cination. On the other hand, it appears to be a new disease and for that reason is cited in this place. Indeed, under circumstances which we do not understand, a large number
80 RATS, LICE AND HISTORY
of the filterable virus infections may create disturbances in the central nervous system. Thus encephalitis can oc¬ cur in the train of measles, smallpox, German measles, and influenza, and the laboratory infections which have resulted from investigations of the parrot disease, psittaco¬ sis, and the disease called “louping ill,” have in both in¬ stances taken the form of encephalitis-like conditions.
In searching the literature for ancestral forms of infec¬ tious diseases of the nervous system, one cannot overlook a curious chapter of human affliction — namely, that dealing with the dancing manias spoken of in mediaeval accounts variously as “St. John’s dance,” “St. Vitus’s dance,” and “Tarantism.” These strange seizures, though not unheard of in earlier times, became common during and im¬ mediately after the dreadful miseries of the Black Death. For the most part, the dancing manias present none of the characteristics which we associate with epidemic in¬ fectious diseases of the nervous system. They seem, rather, like mass hysterias, brought on by terror and despair, in populations oppressed, famished, and wretched to a degree almost unimaginable to-day. To the miseries of constant war, political and social disintegration, there was added the dreadful affliction of inescapable, mysterious, and deadly disease. Mankind stood helpless as though trapped in a world of terror and peril against which there was no defense. God and the devil were living conceptions to the men of those days who cowered under afflictions which they believed imposed by supernatural forces. For those who broke down under the strain there was no road of escape except to the inward refuge of mental derange-
RATS, LICE AND HISTORY 81
ment which, under the circumstances of the times, took the direction of religious fanaticism. In the earlier days of the Black Death mass aberrations became apparent in the sect of the flagellants, who joined in brotherhoods and wandered by thousands from city to city. Later, for a time, it took the form of persecution of the Jews, who were held guilty of the spread of disease. The criminal proceedings instituted against the Jews of Chillon were followed by a degree of barbarism throughout Central Europe that can only be regarded as a part of the mass insanity of which the dancing manias were a manifesta¬ tion. These manias are, in many respects, analogues of some of the political and economic crowd hysterias which have upset the balance of the civilized world in modern times. In some parts of Europe the World War was followed by famine, disease, and hopelessness not in¬ comparable to the conditions which prevailed in the Mid¬ dle Ages. For obvious reasons, in the reactions of our own day, economic and political hysterias are substituted for the religious ones of earlier times. Jew baiting alone seems common to both.
Although it is likely that the overwhelming majority of these outbreaks were purely functional nervous de¬ rangements, a certain number of them may have repre¬ sented early traceable beginnings of the group of epidemic infectious diseases of the nervous system, in which we now include infantile paralysis and the various forms of en¬ cephalitis.
In 1027, in the German village of Kolbig, there was an outbreak among peasants which began with maniacal
82 RATS, LICE AND HISTORY
quarreling, dancing, and hilariousness, but went on to stupor and in many cases to death, and, in the survivors, left behind permanent tremors, possibly not unlike the “Parkinsonian syndrome” which follows encephalitis lethargica. Hecker has given a detailed account of most of the reliable historical records. In Erfurt, in 1237, over one hundred children were taken with a dancing and raving disease which, again, in many cases led to death and permanent tremors in the survivors. The most severe dancing mania began in 1374, in the wake of the Black Death, at first at Aix-la-Chapelle, soon in the Netherlands, at Liege, Utrecht, Tongres, and Cologne. Men, women, and children lost all control, joined hands, and danced in the streets for hours until complete ex¬ haustion caused them to fall to the ground. They shrieked, saw visions, and called upon God. The movement spread widely, and undoubtedly the numbers of the truly afflicted were enhanced by multitudes of the easily excited, in a manner not unlike that observed in modern camp meet¬ ings and evangelistic gatherings. Yet there must have been a physical disease in many of the cases, because throughout the accounts there is frequent reference to abdominal swelling and pain, for which the dancers bound their bellies with bandages. Many suffered from nausea, vomiting, and prolonged stupor. The condition was sufficiently widespread and important to warrant a long dissertation by Paracelsus, who tried to classify the malady into three subdivisions by a system not of suf¬ ficient modern importance to warrant review.
The tarantism of Italy, supposed by many of its
RATS, LICE AND HISTORY 83
chroniclers to have been caused by the bite of the tarantula, belongs to the same category. It probably had little rela¬ tionship to spider bite. The descriptions left behind by Perotte, in the middle of the fifteenth century, and by Matthiolo and Ferdinando in the sixteenth and seven¬ teenth centuries, are quite clear in indicating that many of the cases of tarantism represented a nervous disease of probably infectious origin. Some of them have much re¬ semblance with hydrophobia. Melancholy and depression, followed by maniacal excitement and motor activity, ended in death, or less fatally in semiconsciousness, with alternating laughter and weeping. Ferdinando’s descrip¬ tions add sleeplessness, swollen abdomens, diarrhoea, vomiting, gradual loss of strength, and jaundice. By the middle of the seventeenth century, the disease as an epidemic menace had practically disappeared. Schenck von Graffenberg, writing in 1643, says that St. Vitus’s dance attacked chiefly sedentary people — tailors and artisans. When it came upon them, they rushed about aimlessly, and many dashed out their brains or drowned themselves. In others, renewed at¬ tacks followed periods of exhaustion. Many never recov¬ ered completely.
Hecker’s account, which is the source of most of the facts here cited, includes extensive abstracts of the medi¬ aeval literature which indicate that, in the dancing manias, many things were involved. In great part, no doubt, the outbreaks were hysterical reactions of a terror-stricken and wretched population, which had broken down under the stress of almost incredible hardship and danger. But
84 RATS, LICE AND HISTORY
it seems likely that associated with these were nervous diseases of infectious origin which followed the great epidemics of plague, smallpox, and so forth, in the same manner in which neurotropic virus diseases have followed the widespread and severe epidemics which accompanied the last war.
2
Diseases new to the population of any given part of the world in many cases were “new” merely in their territorial extension, as the result of established com¬ munication by discovery or conquest. Yellow fever and dengue fever — transmitted to man by the same species of mosquito ( TEdes csgypti) — - may well have existed for ages in the West Indies and the continent of South America. But no reliable account of the former exists in Western medical history until Dutertre described the out¬ breaks at Guadeloupe and St. Kitts in 1635, and Moseley reported the epidemic on Jamaica in 1655. Since that time, the disease has appeared in many parts of the world — though not all — where the responsible mosquito ex¬ ists or can survive. With smallpox, as Audouard makes clear, it was probably widely distributed by the slave trade, and, in view of the discovery of yellow-fever foci in West Africa, we shall probably never know whether it came to the Americas from there or vice versa. A serious modern problem is that arising from the automobile and aeroplane traffic now developing across the Sahara be¬ tween Mediterranean North Africa, where the appropri¬ ate mosquitoes are plentiful, but which is not yet infected,
RATS, LICE AND HISTORY 85
; and the West African coast, where the fever is firmly i established.
As far as dengue fever (breakbone fever) is concerned, | there is no information of any corresponding epidemic i malady until the last twenty years of the eighteenth ; century. Then, according to the researches of Hirsch, it appeared in many places in rapid succession: 1779 in ; Cairo 5 1780 in Batavia (reported by Boylon); in the same year in Philadelphia (described by Rush) ; 1784 in I Spain. From 1824 to 1827, the first great epidemics were reported from India and from the West Indies and the ! Caribbean coast, respectively. Since that time, it has been prevalent, in varying intensity, in most of the tropical and ; subtropical regions of the world. It is not at all impossible : that dengue is not in any sense a new disease of the eighteenth century, but was present much earlier, though l unrecognized and wrongly regarded by early Spanish 1 writers as a mild form of yellow fever.
In the so-called “new” disease called tularsemia, we i have a problem of a different sort. Can man acquire a novel ; type of infection, so late in the history of a crowded planet as the twentieth century, by contact with infectious agents i long established in insects and wild animals? In 1911 a curious plaguelike infection in ground squirrels was i found by McCoy and Chapin. After a great deal of dif¬ ficulty, they managed to isolate a bacillus roughly similar ; to the plague bacillus, but still quite easily distinguished I from it by appropriate methods. It was not until 1914 1 that the first proved infection of man was reported. Francis names the disease “tularaemia” because the ground squir-
86 RATS, LICE AND HISTORY
rel in which the disease was first observed had come from Tulare County, California. On becoming thoroughly familiar with the symptoms in man, he discovered that cases had been reported in 1 907 from Arizona and in 1 9 1 1 from Utah. Since that time, the disease has been found in every state except Maine, Vermont, and Connecticut. In nature, it is an infection of the ground squirrels of the Rocky Mountain states ; of wild rabbits and hares ; of wild rats in Los Angeles; wild mice in California ; quail, sage hens, and grouse in Minnesota; sheep in Idaho; wild rabbits in Japan, Norway, and Canada; water rats in Rus¬ sia; sage hens and grouse and wild ducks in California and Montana. Many animals that are not naturally infected are experimentally susceptible. Man acquires the disease by direct contact with the infected animal tissue — es¬ pecially hunters, butchers, and all who handle, skin, and dress infected animals. The infection passes through small wounds in the skin and may be rubbed into the eye with an infected hand. Almost all investigators of tularemia have acquired it. Among animals, the disease is trans¬ mitted by blood-sucking insects, chiefly ticks and flies. It may be transmitted to man by the horsefly and the bite of the wood tick. In ticks, the disease may be hereditary, so that it is not necessary for a tick to bite an infected animal in order to become dangerous to man. Thus we have another disease of animals which may have caused human infections in small numbers for a long time, and has probably existed in animals for centuries, but which did not become a menace to man until the beginning of the twentieth century.
RATS, LICE AND HISTORY 87
In the case of the so-called “abortus” type of undulant fever — closely related to Malta fever — it is more than likely that failure of recognition before the present era is due to nothing more than the inevitable diagnostic in¬ accuracy of former times. Fevers of clinical similarity were known to Hippocrates, and Malta fever itself was de¬ scribed in the early eighteenth century as a diagnostic differentiation of familiar fevers, probably of ancient existence, from similar conditions like malaria and the true enteric fevers. But it was not until very recently (1918) that the similarity of the Brucella melitensisy the baccilli which cause abortion in cattle (Bang’s bacillus), and a bacillus found in swine was recognized. And it was not until 1922 that bacteriological methods enabled in¬ vestigators to determine that the milk of infected cattle and the handling of hogs or their fresh meat may produce a disease not unlike that transmitted in the Mediterranean basin with the milk of goats. Since then, these diseases have become public-health problems on our continent and in many parts of Europe. But they are probably new only in the sense that we have been able to “cut out” a new subdivision from an ancient disease group by refined diagnosis.
3
We have seen that the appraisal of the appearance of a so-called “new” disease is fraught with many pitfalls — largely the uncertainty of historic data and the rela¬ tively primitive diagnostic methods of earlier days. Never¬ theless, even our very superficial discussion of these
88 RATS, LICE AND HISTORY
problems may have supported our thesis that infectious diseases are not static conditions, but depend upon a con¬ stantly changing relationship between parasite and in¬ vaded species, which is bound to result in modifications both of clinical and of epidemiological manifestations. The principle is illustrated with considerably more pre¬ cision by a survey of infections which, once widely prev¬ alent, were well described, and which have either be¬ come modified or have actually disappeared regionally or altogether. In such instances we possess premises for rea¬ soning of considerable accuracy.
An interesting example of this is the vanishing of bu¬ bonic and pneumonic plague from Western Europe.1 The Black Death, which was mainly bubonic plague, is one of the major calamities of history, not excluding wars, earth¬ quakes, floods, barbarian invasions, the Crusades, and the last war. It is estimated by Hecker that about one quarter of the entire population of Europe was destroyed by the disease — that is, at least 25,000,000. It carried in its wake moral, religious, and political disintegration. This epi¬ demic is an excellent example of the biological phenomena which accompany the process of what the Germans call T)urchseuchungy which, as we have said, means thorough saturation of a population with an infection. There were, of course, — as we shall mention elsewhere, — formidable plague epidemics in Europe before the fourteenth century, but these — as far as we can tell from the records — did not reach Central and Northern areas within the centuries
1 The history of plague has been ably recorded by many historians. One of the most detailed accounts is that of Sticker.
RATS, LICE AND HISTORY 89
i immediately preceding the Black Death. Resistance to in- i fectious disease, an acquired characteristic, is not hereditary i — except in the evolutionary sense of the selective sur¬ vival of the more resistant. And such increase of resistance by natural selection is not noticeably active, unless the infection continues uninterruptedly throughout centuries and is of such an order that a majority of the infected ! survive. The Black Death, spreading in Europe, there¬ fore, found an entirely susceptible population, which ac- ' counts for its terrific ravages. When its first sweep across the Continent was exhausted for want of victims, it re¬ mained endemic, smouldering until relighted by the ac- i cumulation of new fuel; and thus it broke out again in 1361, 1371, and 1382. These successive calamities, cover¬ ing only thirty-four years, illustrate the manner in which i an epidemic disease can become progressively less fatal, when it occurs repeatedly in populations that have been thoroughly saturated in immediately preceding years. Statistics are of course incomplete, but the records left I behind by Chalin de Vinario, whom we cite from Haeser, are particularly instructive in this regard. In 1348, two thirds of the population were afflicted, and almost all died; in 1361, half the population contracted the disease,
! and very few survived; in 1371, only one tenth were sick,
! and many survived; while in 1382, only one twentieth of the population became sick, and almost all of these sur¬ vived. Had the disease continued, constantly present, and attacking a large proportion of the new generations as they appeared, it might gradually have assumed an en- i demic, sporadic form, with relatively low mortality. As it
90 RATS, LICE AND HISTORY
is, plague appeared throughout the fifteenth century in Europe, but relatively localized and in incomparably milder form, gradually diminishing until it again broke out in the last European pandemic from 1663 to 1668, reached London in 1664, and was so vividly described by Defoe and — in some of its episodes — by Pepys.
There was an outbreak in Turkey in 1 66 1 , which spread first to the coast of Greece and the Greek Islands, then traveled rapidly westward and, more slowly, in an east¬ ward direction. In 1663, it reached Amsterdam, where it killed 10,000 out of a total population of less than 200,000. In the following year it gained velocity, killing about 24,000 in Amsterdam, spread to Brussels and Flan¬ ders, and thence to London. In the first week of Decem¬ ber, 1 664, two Frenchmen died in a house in Drury Lane. No other cases occurred for six weeks. On the twentieth of February, 1665, there was another case; then a pause until April. By the middle of May, the epidemic was in full swing. It is reported by Pepys: —
This day (June 7th, 1665), much against my will, I did in Drury Lane see two or three houses marked with a red cross upon the doors and “Lord have mercy upon us” writ there; which was a sad sight to me, being the first of the kind that, to my remembrance, I ever saw. It put me into an ill conception of myself and my smell, so that I was forced to buy some roll- tobacco to smell and to chaw, which took away my apprehension.
King Charles, rejoicing in the victory over the Dutch fleet, saw more and more houses marked with the terrifying cross, and removed the court from town. Two thirds of the inhabitants fled London, carrying the disease first to
RATS, LICE AND HISTORY 91
other cities along the Thames, and finally throughout England.
The epidemic remained several years in Flanders, passed thence to Westphalia, down the Rhine, into Nor¬ mandy, Switzerland, and Austria, which it reached in 1668. Throughout the remainder of the seventeenth century, trailers of the disease continued, and lasted well into the eighteenth century. There were localized epi¬ demics in Hungary, Silesia, Prussia, the Baltic Provinces, and Scandinavia. In 1711, 215,000 people died of the disease in Brandenburg ; 300,000 in Austria. Another wave spread from Marseilles across Provence in 1720 and 1721. After that, the disease, in severe but localized outbreaks, continued through the second half of the eighteenth century, but was gradually pushed eastward, so that the considerable epidemic which occurred in Russia and the Balkans between 1770 and 1772 failed to make headway in a westerly direction. Russia and the Caucasus con¬ tinued to suffer up to 1820, but since that time no great plague epidemic has swept beyond Russia, and no wide¬ spread outbreaks have occurred anywhere in what is spoken of as the Western World.
This disappearance of epidemic plague from Europe presents one of the unsolved mysteries of epidemiology. The disease has been introduced into various parts of Europe and America again and again during interven¬ ing years, but has never shown any tendency to spread in epidemic form. In 1 899, isolated cases occurred in Trieste, Hamburg, Glasgow, Marseilles, and Naples — in most cases demonstrably the result of the landing of passengers
92 RATS, LICE AND HISTORY
and sailors from ships arriving from plague foci. Similar small group infections have occurred in a number of the South American harbors. Adding considerably to the mystery of the situation are such instances as the infections that occurred in Sydney, Australia, in 1903. In January, a dock laborer died of plague ; and on February 14, dead rats were found on the quays. Another laborer came down with plague on the fifteenth of February, after traceable contact with rats; another on February 26. Within the next few weeks, the keeper of a hotel close to the harbor was found to have plague, and by the end of June isolated cases occurred in the suburbs of the city. Comparable conditions existed in Melbourne in April of the same year, with scattered cases. In Adelaide the same thing happened, and plague-infected rats were found, both in the suburbs and in the city itself. Still no epidemic oc¬ curred. In 1900, the disease was carried to New York, again without serious results. The existence of plague among the Chinese in San Francisco was discovered in 1900; and cases in different parts of California, widely scattered, occurred from then on until the end of the first decade of the twentieth century. As late as 1907, twenty-four Chinese of San Francisco came down with plague, with thirteen deaths, and a few cases were found in Oakland and Berkeley. In the same way, harbors of England and the larger cities of Central Europe have occasionally had plague cases, and plague rats have been discovered in one of the large European capitals as lately as 1923. Yet no epidemics have resulted.
RATS, LICE AND HISTORY 93
The first thought that occurs in explanation is that the population of Europe has acquired considerable resistance. That this is not the case is apparent from the susceptibil¬ ity of Europeans living in India and other plague centres of the East. We cannot, moreover, attribute the change to any success in the destruction of rats. As for fleas, any¬ one who has not traveled too luxuriously in Central and Southern Europe during the flea month — September — knows well that there is no dearth of fleas. When all is said and done, we have no satisfactory explanation for the disappearance of plague epidemics from the Western countries, and we must assume that in spite of the in¬ fectiousness of the plague bacillus, the plentifulness of rats, their occasional infection with plague, and their in¬ variable infestation with fleas, the evolution of an epi¬ demic requires a delicate adjustment of many conditions which have, fortunately, failed to eventuate in Western Europe and America during the last century. The most reasonable clue lies in the increased domestication of rats. Plague epidemics in man are usually preceded by wide¬ spread epizootics among rats 5 and under the conditions of housing, food storage, cellar construction, and such, that have gradually developed in civilized countries, rats do not migrate through cities and villages as they formerly did. The exemption of many may be directly dependent upon the greater domestication of rats, which remain contentedly at home, and, as a consequence of this, plague foci among them remain restricted to individual families and colonies.
94 RATS, LICE AND HISTORY
Closely bound up with the biology of plague is that of leprosy. This disease, well known in ancient times, in¬ creased immensely in mediaeval Europe. It is assumed that it was widely distributed in Europe by the returning Crusaders, although there are indications that it was present to some extent in France in the sixth century. By the end of the eleventh century, institutions for the segre¬ gation of lepers — leprosaria — were common, the first one founded in 1067 in Spain by Ruy Diaz de Bivar, commonly known as El Cid. Under the auspices of the church, similar institutions grew in number and size, so that by the time of Louis VIII, Haeser tells us, there were as many as nineteen leprosaria in the diocese of Troyes alone.
The story of leprosy is a chapter as extensive as that of plague, and would require a volume in itself. The point of interest in our present discussion is that after the middle of the fifteenth century leprosy began to decline, and leprosaria gradually became unnecessary. By the middle of the sixteenth century, only a few centres of the disease remained. In the seventeenth century, it had practically disappeared. Medical histories have attributed this decline to all kinds of vague conceptions, based upon assumptions of improved sanitary conditions, and so forth, but none of these are adequate. The most likely solution of the prob¬ lem was suggested to us in conversation by Professor Sigerist, who connects the disappearance of leprosy with the immense mortality that occurred at the time of the Black Death and its secondary waves. When the plague struck Europe, with its dreadful destruction of human
RATS, LICE AND HISTORY 95
life, immense numbers — perhaps the majority — of lepers had been segregated in institutions, which thus represented a concentration of relatively susceptible and weak groups. It is not impossible, as Dr. Sigerist sug¬ gests, that most of the lepers of Europe were wiped out by the plague, and that the few who survived were too scattered and represented too meagre a spark to revive the disease. This seems especially likely in view of the relative noncontagiousness of leprosy, the manner of transmission of which we do not yet understand, but about which we know that prolonged and intimate contact alone gives rise to new cases.
4
The so-called “English sweating sickness” is probably the most important of those severe plagues that tormented mankind in brief and terrifying visitations and then com¬ pletely and inexplicably vanished. The “sweat” came on with tempestuous speed, and disappeared as suddenly as it came. There is no mention of a similar fever before 1485 or after 1552.
After the battle of Bosworth, in which Henry VII gained the ascendancy in England, there broke out in the ranks of the conquering army a disease that completely put a stop to the procession of the victorious troops. With disbanded soldiers, it was carried into London. The speed of spread can be estimated from the fact that the sick¬ ness reached its height in London by September 21, the battle of Bosworth having been fought on August 22. It spread over England rapidly from east to west, carried
96 RATS, LICE AND HISTORY
far and wide by the men scattered from the army. In London it killed, within the first week, two Lord Mayors and six Aldermen. It attacked the young and robust, this being one of the points in which it was similar to the Picardy Sweat, of which we shall have something to say presently. The mortality of this English sweating sick¬ ness was such, according to Holinshed, that “scarce one amongst an hundred that sickened did escape with life 5 for all in maner as soone as the sweate tooke them or in a short time after yeelded up the ghost.” The Coronation of Henry was postponed. In Oxford, where Thomas Linacre — who later founded the College of Physicians — was then a student, it was so severe that professors and students fled the University, which was closed for six weeks. This first outbreak remained entirely in England, not even spreading to Scotland or Ireland.
The symptoms of the disease have been described by many writers, and, though minor differences occur, the accounts are in the main consistent. Particularly important is the description by John Kaye, whose famous pamphlet on The Sweate was published in 1552. The disease began without warning, usually at night or toward morning, with a chill and with tremors. Soon there was fever, and profound weakness. Accompanying this were cardiac pain and palpitation, in some cases vomiting, severe headache, and stupor, but rarely delirium. Although some writers make no mention of a rash, there are nevertheless de¬ scriptions which do so — especially that of Tyengius, whose accounts come to us from Forest, and who relates that, after the perspiration was over, there appeared on
RATS, LICE AND HISTORY 97
the limbs small vesicles awhich were not confluent but rendered the skin uneven.” The profuse sweating, which was the most noticeable characteristic, began soon after the onset of the fever. Death came with astonishing speed. It is stated that many cases died within a day, and some even within a few hours. A single attack did not immun¬ ize, since a number of people had two or three attacks in brief succession.
After a short and violent career, the disease completely disappeared, and we find no mention of it from 1486 until 1507.
The second epidemic was apparently much like the first, but there is not much reliable information available. It again started in the summer — this time in London
and, as Senf suggests, it is not improbable that it may have remained endemic in that city during the inter¬ epidemic quiescence.
In 1518, the disease appeared for the third time, and with enhanced severity. Again it spread over England, again sparing Scotland and Ireland. But this time it reached the Continent, advancing only to Calais, where — strangely enough — none but the English inhabitants are said to have contracted it. Again it killed many pa¬ tients within two or three hours, and it brought death to many important men in Oxford and Cambridge; in some towns from a third to a half of the population was wiped out.2
The sweating sickness seems to have gained energy be-
2 It is stated that in some places 80 to 90 per cent of the population died.
98 RATS, LICE AND HISTORY
tween epidemics, for the most severe outbreak was that of 1529.3 This started in May, again in London, and the terror it inspired was so great that society was disorgan¬ ized, agriculture stopped, and famine resulted. The disease swept across the sea to the Continent, where it was first reported in Hamburg, which it reached in July, probably with a ship returning from England. In the same month it spread across Eastern Germany to Liibeck and Bremen ; by August, it had reached Mecklenburg ; in September it came to Konigsberg and Danzig $ thence it traveled southeastward to Gottingen, where the mortality was so great that five to eight corpses had to be put into a single grave. A curious fact noted by many who described it at this time is the lateness with which the disease reached the Netherlands, — that is, four weeks later than its ap¬ pearance in Hamburg, — although active communication by sea was carried on equally between both places and England. In Marburg, the epidemic interrupted the Coun¬ cil of the Reformation. In Augsburg, 15,000 fell sick in the first five days. It reached Vienna during the siege of the city by the Sultan Soliman and, probably ravaging the Turkish army, may have had some effect on the raising of the siege. A little later, it entered Switzerland $ but it never crossed into France.
The fifth and last epidemic of the sweat occurred in 1551. Again it started in England, this time in Shrews¬ bury, in April, where 900 died in a few days. It spread
3 We are using the dates given by Haeser. Those of Hecker, and many others, differ by one year, owing to the discrepancies between the English and the Roman calendar.
RATS, LICE AND HISTORY 99
over the whole county, carried about — as Haeser puts it — “in the drift of poisonous clouds of fog.” A strange ob¬ servation made at this time, which corresponds to the previous limitation of the sickness to the English in¬ habitants of Calais, is the apparent exemption of foreign¬ ers in England. Yet the fifth epidemic seemed to follow Englishmen into other countries, so that many died in France and the Netherlands. This outbreak of 1551 is the one that John Kaye described in his famous pamphlet.
Only once after this date (we take our information fi om Senf) has a sickness resembling the English sweat occurred, unless we identify the disease — as many have done — with the Picardy Sweat. About two hundred and fifty years after the fifth epidemic, that is, in 1802, at Rottingen in Franconia, a similar but regionally limited malady appeared.
It is impossible to identify the sweating sickness with any epidemic disease now prevalent. Purely on the basis of synchronous occurrence, Schnurrer and others believe that it was a modified form of typhus, and it is true — as Senf points out — that it did not spread into any of the countries where typhus was prevalent at the time. How¬ ever, this opinion is not convincing. The sickness remains an entirely individual condition which could not — were it to reappear at present — be properly classified with any of the known infectious diseases. The suddenness of onset, the rapid death, were more violent than any of the dis¬ eases of our day, with the exception of occasional cases of meningitis or infantile paralysis. While speed and man¬ ner of spread remind us of influenza, the apparent absence
100 RATS, LICE AND HISTORY
of prominent catarrhal symptoms, the lack of a secondary pneumonia fatality, and the nonexistence of successive waves within a short period suffice to separate it from in¬ fluenza, as it now occurs. Its general characteristics would incline us to regard it as caused by a filterable virus of a variety at present unknown. It is a reasonable speculation that the sweat was due to a virus that had for centuries been prevalent on the Continent in milder form, and in England spread in an entirely susceptible community. This is the only basis on which one can hope to explain the reiterated observation that it was peculiar to the Eng¬ lish people, even when they were living in foreign parts. Knowing what we do about the wide general distribution throughout modern populations of the virus of infantile paralysis, with which a large proportion of the population has probably been infected without manifest disease be¬ fore adult life, it is not fantastic to assume that virus in¬ fections may eventually become so widely distributed that, in time, entire populations become immunized ; and, eventually, a disease which at first was epidemic and severe may become endemic, modified, milder, and finally — extinct. This sort of thing is certainly going on in diseases like measles, infantile paralysis, and in¬ fluenza, which — endemic with us — cause destructive and violent epidemics among primitive peoples when carried among them.
Another disease which seems to have come suddenly out of the blue and which, within less than two hundred years, has almost completely disappeared is the so-called “Suette des Picards.” There is some confusion regarding
RATS, LICE AND HISTORY 101
the relationship of this disease to the English sweating sickness, and to the so-called “military fevers.5’ Under the latter term, there were probably included a great many of the well-known eruptive fevers, such as measles, scarlet fever, chicken pox, and so forth. It is impossible to re¬ view the voluminous controversial literature dealing with these problems, but there are accurate records which show that a peculiar malady quite unlike any of the now prevalent exanthemata suddenly appeared in Normandy in 1718 and spread within a few years into Poitou, Bur¬ gundy, and other regions of Northern France. Opinions of the leading medical historians (Hirsch, Haeser, and Ozanam) are at variance concerning the existence of a similar disease in other parts of Europe before 1718. Haeser believes that foci existed before this date in Alsace and in Turin. But the descriptions of such outbreaks lack precision until 1718. Most students agree that, apart from localization, the Picardy Sweat can be differentiated from the English sweating sickness largely on the basis of the eruption and of the violent mental symptoms ac¬ companying the Picardy disease.
Several excellent descriptions regarding its manifesta¬ tions in different places and many years apart establish its character as a definite clinical entity. The first of these is the precise account by Dr. Belot of the outbreak of 1 7 1 8. And this corresponds almost exactly with that of Dr. Vandermonde, who reported the epidemic at Guise in 1759.
The onset was sudden, often with a chill, abdominal pain, and difficulty in breathing. There followed a severe
102 RATS, LICE AND HISTORY
headache, high fever and insomnia, and often great ex¬ citement. Profuse sweating began within twelve to twenty-four hours, usually accompanied by violent itch¬ ing. A rash, variously described as resembling measles ( rougeole ) or erysipelas (which probably means an even reddening something like the rash of scarlet fever), was noticed within the first forty-eight hours. Nosebleeds were frequent and violent. In fatal cases there was delirium, and often death was accompanied by convulsions. Many cases died within one or two days.
After 1718, many local epidemics occurred in France — at first at short intervals, later less frequently — up to the middle of the nineteenth century. In the latter part of this period there were similar outbreaks in Northern Italy and in Southern Germany. Altogether, according to Hirsch, 194 epidemics occurred in France between 1718 and 1804. Nothing is known of the mode of transmission, of the causes which led to outbreaks, or of the reasons for their decline. Boyer, writing in 1751, declared that the disease was not contagious, — that is, there was no evi¬ dence of transmission from one case to another, — and in this opinion most observers agree.
Unlike almost all other diseases of equal violence, the Picardy Sweat was always closely circumscribed in the in¬ dividual epidemics. Most of the outbreaks remained limited to individual villages or towns. In only a few in¬ stances did they extend beyond defined localities, though on one or two occasions widely separated districts of France were invaded. Individual epidemics rarely lasted more than a few months.
RATS, LICE AND HISTORY 103
It is impossible to form any trustworthy opinion con¬ cerning the nature of this disease. It does not fit into any of the categories of modern classification. While in some respects it resembles rapidly fatal scarlet fever, the ab¬ sence of any evidence of severe throat infection renders its identification as this improbable. It was surely not measles or smallpox. The only infection of which the fatal and most violent cases of Picardy Sweat remind us is the fulminating meningococcus infections which are occasionally seen during meningitis epidemics. In such in¬ fections — many of which were seen in camps during the late war — the sudden onset, profuse rash, sweating, high fever, and rapid death, often with delirium and convul¬ sions, present a clinical picture closely resembling de¬ scriptions of the severest cases of Picardy Sweat. Other similarities between the two are the lack of traceable re¬ lationship between cases (masked contagiousness) and the limitations of spread. However, the milder cases — which were apparently in the majority — have little resemblance to meningococcus infections. We can only conclude that we are here dealing with a disease which is either unique or which represents a now unknown form of a surviving disease, modified in the course of time. Typhus can be excluded with confidence because of the sudden onset with shaking chills and the rapidity with which the rash de¬ veloped (one to two days). The violent itching so fre¬ quently noticed is also uncharacteristic of typhus. More¬ over, the first Picardy epidemic occurred at a time when typhus in its present form had been well known for several centuries.
104 RATS, LICE AND HISTORY
A few isolated cases of a condition resembling the Picardy Sweat are occasionally reported by French physi¬ cians at the present time, but even if these are genuine, no outbreak — even of limited extent — has occurred since the seventies of the last century.
CHAPTER VI
Diseases of the ancient world: a consideration of the epidemic diseases which afflicted the ancient world y with attempts at making diagnoses which , if they are difficult to make at the distance of a thousand yearsy are equally difficult under the circumstances to disprove. T hough this may appear another unnecessary postponement of our biography y it represents our effort to determine the
antiquity of typhus fever
i
That bacterial diseases have attacked the higher forms of life since the very beginning is unquestionable.
There are, in the Vienna Museum, remains of pre¬ historic bears which show unmistakable signs of large ab¬ scesses of the teeth and jaws. Reasoner has collected from the paleontological literature a number of descriptions of conditions of bacterial origin occurring in prehistoric animal remains. He mentions the remains of a reptile, Dimetrodon, of the Permian Age (21,000,000 years ago), described by Gilmore, in which there was evidence of chronic osteomyelitis of the spine y also a Jurassic croco¬ dile (14,000,000 years ago), described by Auer, which presented signs of infection in the pelvis, with metastases in the femur, the sacral vertebras, and the palate. Signs of carious teeth, of possibly rheumatic swellings of the joints, have been found in numerous fossils by Renault, Moody, and others. Evidences of bone necrosis and subse-
106 RATS, LICE AND HISTORY
quent hyperostoses are not uncommon in fossil remains.
As far as primitive man is concerned, not much is kno wn — although Raymond described a case of spondy¬ litis deformans and one of arthritis of the knee in neolithic bones of France. There is, however, much doubt as to the antiquity of some of these fossils. The meagre paleonto¬ logical literature of man furnishes little direct informa¬ tion on this problem. There is, however, a good deal of evidence that bacteria became capable of producing in¬ fections millions of years ago, and there is no reason to doubt that man from the very beginning suffered from in¬ fectious disease j and at the time when mankind had reached the period of the earliest historical records, in¬ fectious diseases of many varieties already existed. And though diagnosis is often difficult, it is certain that epidemics were prevalent thousands of years before Christ.
The diagnostic determination of the various infectious diseases from ancient medical literature presents many difficulties because of the uncertainties involved in de¬ termining the meanings of descriptive words, unless these occur many times in different connections. Thus it is often impossible to gain any accurate impression of the nature of a skin eruption, since it is often difficult to know whether the word used should be properly translated as referring to raised surfaces, vesicles, pustules, or ulcers.
In Chinese literature, there is very little descriptive material accessible to the Western student from which opinions can be formed regarding the nature of the prev¬ alent diseases. It is not impossible that smallpox and
RATS, LICE AND HISTORY 107
some of the exanthemata originated in China and reached Europe across Persia and North Africa. However, opin¬ ions concerning this, as expressed by Wise and by Moore, rest upon very slim evidence. Moore, taking his informa¬ tion from the oldest available Chinese medical treatises, believes that smallpox was prevalent in China at the time of the Tsche-u dynasty, — a period between 1122 b.c. and 249 b.c., — and Smith, in an article in the Medical Times and Gazette for 1871, cites evidence that the dis¬ ease occurred during the dynasty of Han, about 200 b.c., and was imported from India.1
In the ancient Indian writings, the Ayur-Veda (date uncertain, but surely before 200 b.c., perhaps parts of it as old as 900 b.c.), and the writings of Susruta, there are accounts that may refer to tetanus and chorea. Fevers of various kinds were known — some of them quite surely malaria, some possibly inflammatory rheumatism and per¬ haps leprosy, known as “Kushta.” An intestinal disease, interpreted with reasonable accuracy as cholera, was well known. Haeser, who studied the translations of Wise, finds evidence also of catarrhal jaundice, of gonorrhoea, and possibly of tuberculosis. It is of particular interest that in Susruta’s writings there are descriptions of genital ul-
1 This information is largely taken from Hirsch. The origin of smallpox, however, is a much disputed problem, which has been a sub¬ ject of learned dissertations by Krause, Hahn, Werlhof, and many others. Haeser questions the validity of the evidence advanced for the existence of smallpox in ancient India and China, though he admits the possibility. He does not accept, as indicating smallpox, many of the descriptions so interpreted from the writings of Hippocrates. Unmistakably accurate descriptions of the disease are found in writings dating from and after 40 A.D.
1U8 RATS, LICE AND HISTORY
cerations which Haeser thinks may have been syphilitic.
About ancient Egyptian diseases, we have a good deal of information from the Papyrus Ebersy which was writ¬ ten during the reign of King Re-Ser-Ka, approximately 1700 years before Christ. The infectious diseases men¬ tioned were an erysipelas-like condition called “Hmaou,” which was treated largely with the feces of donkeys 3 in¬ testinal worms, and varieties of ophthalmia. Examinations made upon mummies by Sir Marc Ruffer, Dr. Eliot Smith, and Dr. Wood Jones revealed evidences of Pott’s disease, and in a mummy of the twentieth dynasty (about 1200 b.c.) there are spots on the skin which might have been smallpox. A similar eruption was found on the body and face of Rameses II. On Rameses V there was a triangular ulcer above Poupart’s ligament in the region of the inguinal glands, which might have been a plague bubo or a venereal sore (the disease of kings). In some of the older mummies, in which the abdominal viscera had not been removed, Ruffer observed large spleens which may indicate malaria.2
The diseases mentioned in the Old Testament are sum¬ marized by Garrison in his History of Medicine as in¬ cluding gonorrhoea, leprosy, or possibly psoriasis 3 in Sam¬ uel, enlarged inguinal glands are noted, indicating the probability of plague. In the Talmud, there is mention of conditions of the lung that might reasonably be re¬ garded as tuberculosis 3 of au abscess of the kidney, and of infections of the female genital organs.
2 For references to many of these observations, we are indebted to an interesting essay by Colonel Reasoner of the United States Army.
RATS, LICE AND HISTORY 109
Jehovah seems to have been pretty hard on the poor Philistines. In I Samuel iv, there is an account of a battle in which the Philistines overcame the Jews, slaying about 30,000 of them in what appears to have been a perfectly fair fight. The victory of the Philistines was facilitated by the fact that the Hebrew army ran away, and tried to hide in their tents. The conquerors then took the ark of God (I Samuel v) into the house of their own god, whose name was Dagon, and who was a sort of half fish, and consequently more or less helpless. The Hebrew God then smote Dagon, cutting off his hands and throwing him off his pedestal, so that his face was on the ground. This threw a terrible scare into the Philistines of Ashdod, so that they sent the ark to Gath. Thereupon, “the head of the Lord was against the city with a very great destruc¬ tion: and He smote the men of the city, both small and great, and they had emerods in their secret parts,” and athe hand of God was very heavy there. And the men that died not were smitten with the emerods.” This is the sort of thing, of course, which — throughout the ages — has led to what in modern terms we may speak of as “Nazi movements.” But the Lord only knows what an “emerod” was. Literally, it is a hemorrhoid — the etymological re¬ lationship of these two unpleasant words being obvious 5 but it is hardly likely that even the Philistines could have had a fatal epidemic of hemorrhoids. The words trans¬ lated as “emerods” are “ophalimf? and “teharim,” which mean swellings, or rounded eminences. According to our learned informant, the translation “emerods” depends on a comparison with Psalms lxxviii. 66, where God is
110 RATS, LICE AND HISTORY
said to have smitten his enemies “in the hinder parts.” This identification is very early, from Talmudic sources and in Aramaic translations. “Ophalim,” according to other translators, merely means an elevated, rounded place. Hastings, in his Dictionary of the Bible , does not believe that “emerods” were hemorrhoids, and connects this description with bubonic plague. Granting, therefore, that these words refer to swellings in the private parts, the controversy merely turns upon whether it was the hinder end or the front end which was affected. Al¬ though the material available is insufficient for diagnostic accuracy, rounded swellings in these regions, associated with epidemic spread and high mortality, are suspicious of plague.3
In the time of David, as a punishment for the forbidden census, there was a severe pestilence, which destroyed 70,000 by sudden death. Most of these people are sup¬ posed to have died in one day. No clue whatever to the nature of this malady is available.
Among the plagues of the ancient Hebrews mentioned by Josephus, there are none that are described with suf¬ ficient detail to justify even an intelligent diagnostic guess. Of the afflictions visited upon the Egyptians, one had to do with polluted water, which gave them great pains; in another an innumerable quantity of lice arose out of their bodies (since many of them died, a louse- borne disease like typhus may be suspected, though in view of the absence of historical data concerning typhus
8 Preuss, Medizin im Talmud , is the foremost authority on diseases of Biblical times.
RATS, LICE AND HISTORY 111
elsewhere at this period, this is most unlikely) -7 still an¬ other was a fatal epidemic of boils.
There is repeated evidence in Biblical history that the fair competition of other nations with the Jews was al¬ ways rendered a triumph for the Hebrews by the inter¬ ference of what, to the others, must have seemed a biased and relentless God. We wonder whether this does not lend a great deal of justice to the opinion of Houston Stewart Chamberlain, who explains anti-Semitism entirely on the basis of a clash between religions. Jewish teachings were widely spread in the ancient world, and if the atrocious vengeance of God on all who opposed the Jews — who apparently were no lilies in their relations with others — were believed, hatred and resentment would be easily understood.
2
Interpretation of the infectious diseases that occurred before the time of the Greeks is, in most instances, largely guesswork. From the Greeks, however, a great deal of ac¬ curate description has come down to us, which permits us to form intelligent opinions concerning the symptoms, clinical pictures, and often the epidemiology of the condi¬ tions that occurred among them. Although there is much medical information before Hippocrates, it has only oc¬ casional bearing on the epidemic diseases in which we are interested. Asclepius, a Thessalian king, son of Apollo, was largely a mythical figure, but that a certain amount of knowledge of infection was prevalent among his later followers is apparent from the isolated places in which
112 RATS, LICE AND HISTORY
his temples were built, and from the laws which — in Delos, for instance — prohibited the burying of dead bodies near the temple. Democritus mentions diseases that were probably epidemic, and 'Empedocles is supposed to have arrested — by the closure of a crevice in a mountain
— miasmas that came from a river. Democritus believed that the epidemic diseases which ravaged mankind were due to the destruction of heavenly bodies, the cinders of which dropped upon the earth. Alcmxon stopped a plague in Athens by the lighting of fires. There is, however, no material for ancient diagnostic opinion, even among the Greeks, until the time of Hippocrates.
Hippocrates was probably not the first great physician of antiquity. Indeed, it is likely that many skillful and sagacious medical men practised in ancient Egypt, where
— Herodotus tells us — physicians were even more highly specialized than they are to-day, since often they limited themselves to a single organ of the body. There were dentists, as well as internists and surgeons. Hippocrates, however, is the first great physician from whom we have records and writings which show an approach to medical problems entirely analogous to our own. Indeed, his de¬ scriptions of cases in the Efidemlon are so precise that diagnoses more accurate than the ones he made himself can be deduced from his clinical histories.
The Greeks suffered from a great variety of infectious diseases. Being an outdoor people, living in a good climate, with — at first — no formidable concentrations of popu¬ lation, the earlier outbreaks of contagious disease among them were not of sufficient extent to be noticed by histo-
RATS, LICE AND HISTORY 113
rians. The medical reader is struck by the absence of any serious descriptions of epidemics among the Greek armies of Homeric times, during the early struggles between the Spartans and the Athenians, and in the Persian wars. The armies were large, often rapidly mobilized, and they must have had disease ; but neither Herodotus nor others who deal with this period speak anywhere of the kind of wide¬ spread epidemic mortality which one is justified in ex¬ pecting. This is possibly due to the fact that any such oc¬ currences would then have been interpreted as the wrath of enraged deities, rather than as visitations of transmis¬ sible disease.
In the time about which Hippocrates writes, we find mention of epidemics of inflamed eyes at Thasos — very likely pink eye. There were diarrhoeas, with fever and tenesmus, watery stools, vomiting, and sweating — not improbably forms of bacillary dysentery. The continued fevers that occurred chiefly in the autumn and early winter were, in part, quite clearly due to malaria of the quartan, double tertian, and aestivo-autumnal varieties. There were prolonged fevers lasting twenty-four or more days, with — occasionally — late, nonsuppurating swellings of the parotid glands, which we can reasonably interpret as typhoid fever j others which, in view of their interrupted nature and the cult of the goat in ancient Greece, might well have been Malta fever. There is one description which unquestionably refers to an epidemic of mumps — a mild fever, without mortality, and with bilateral parotid swelling, dry cough, and occasional swellings of the testi¬ cles. Sore throats, with coughs, fever, and often with de-
114 RATS, LICE AND HISTORY
lirium, may have been either scarlet fever or diphtheria.
In the Epdemiony there are a considerable number of case histories, quite as thoroughly recorded, from day to day, as many of our modern ones, upon which diagnostic judgment can be based. In many instances, the observa¬ tions of Hippocrates are so precise that we can often sup¬ ply, from modern knowledge, the exact type of infection — not infrequently the microorganism that must have been responsible for the individual conditions. In regard to many nonsurgical conditions Hippocrates did quite as well, we surmise, as will be possible for the modern gen¬ eral practitioner or afamily medical adviser” who is so dear to the hearts of many of our reactionary contempora¬ ries, and who, by a return to medical muzzle-loading, is to emancipate our profession from all the newfangled laboratory doodads.4
Herophontos came down with an acute fever, with liquid and bile-colored movements, tenesmus, and abdominal tenderness. On the fifth day, he became delirious and be¬ gan to sweat, with continued liquid movements. On the ninth day, there was a crisis with severe perspiration, and a relapse seven days later. Herophontos must have had either acute bacillary dysentery, typhoid or paratyphoid fever, or cholera ; but, since his was an isolated case, it was probably not cholera.
The haemolytic streptococci were as formidable then as they are now. The wife of Philinus and the wife of Do- madeos unquestionably died of what we should now call puerperal sepsis.
4 See Frothingham.
RATS, LICE AND HISTORY 115
The wife of Epicrates developed a sore throat two days before childbirth, had a prolonged fever, which lasted without abatement for twenty-one days, and did not com¬ pletely subside for eighty days. She might have had typhoid fever, or a subacute streptococcus infection.
Criton, of Thasos, had a sudden pain in his big toe, fol¬ lowed by fever and delirium on the same night. The next day, his foot was red and oedematous, with little black spots, and his leg began to swell. He was dead in two days, and without doubt died of a virulent streptococcus in¬ fection, perhaps starting from an ingrown toenail.
A Clasomenian had what was unquestionably typhoid fever.
A pregnant woman, three months with child (the thir¬ teenth case in the First Book), suffered from a sudden pain in the back, rapidly followed by fever, headache, pain in the neck and right hand, and loss of speech. There was delirium on the fifth day, and paralysis of the right hand and arm. There is no statement as to residual paraly¬ sis after recovery on the fourteenth day, but the whole story sounds like acute anterior poliomyelitis, or possibly the encephalitis lethargica which we have thought to be a new disease.
An unnamed man died of a condition which was with¬ out much question an attack either of acute appendicitis or of cholecystitis. In the middle of the night, after a heavy meal, he was seized with sudden vomiting, fever, and pain in the right hypochondrium. The symptoms continued j the abdominal pain became general, and he died on the eleventh day. We favor acute appendicitis,
116 RATS, LICE AND HISTORY
because of the omission of any reference to jaundice. It is interesting to note the care with which physical examina¬ tions were made by Hippocrates. He states that on first observing this patient, he found no abdominal rigidity. This must have developed later, or we must assume that even Hippocrates may have made a mistake.
Among the remaining cases there are carbuncles, ery¬ sipelas, possible diphtheria, various forms of paralysis, and, not impossibly, cases of plague,5 since there are
5 If the cases described by Hippocrates were true plague, it is of course strange that there is no description of epidemic spread. That he knew plague in isolated cases seems likely from passages in his Afhorisms , cited by Littre, in which he says that fevers with buboes are all dangerous except those which last a very short time. The same author also cites a sentence from the Second Book of the Efidemion , which indicates a knowledge of true plague. Hippocrates was born at Cos, in the first year of the eighteenth Olympiad — that is, 460 b.c. The great plague of Athens occurred in 430 b.c., and if this had been an epidemic of bubonic plague, Hippocrates would have recognized it as such. As we shall see in another place, notwithstanding the opinion of Ozanam and some others, the Athenian plague cannot, in the light of the descriptions, be regarded as plague. There was also, during the life¬ time of Hippocrates, a severe contagious disease in Persia. Artaxerxes sent envoys to the great physician, offering him rich treasure if he would come to the aid of the stricken Persians. Although (it is so stated, but also contradicted) Hippocrates declined this mission from motives of patriotism, the nature of the Persian disease must have been thoroughly described to him. It is likely, therefore, that if plague in its typical manifestations had existed in Greece during the fifth century b.c., Hippocrates would have described it recognizably. The question has been thoroughly sifted by all the leading medical historians. If Greece was exempt from epidemics of plague at a time when it was prevalent elsewhere, this may have been due to the scarcity or possible absence of domesticated rats. In our chapter on the history of the rat, we discuss the information on which this surmise rests. However, there may have been other, more mysterious reasons. We are faced with a similar prob¬ lem in the absence of epidemic plague from modern England and
RATS, LICE AND HISTORY 117 descriptions of buboes of the thighs.0 There were pneu¬ monias and pleurisy, and protracted diseases of the lungs which resemble pulmonary tuberculosis. Rheumatic fever
does not seem to have been unknown, but the descriptions ; are vague.
Our primary purpose in examining the clinical histories i of Hippocrates was to find evidence of the early existence i of typhus fever. Ozanam and others have stated that Hip- ; pocrates described typhus fever, and the case that has i often been cited as evidence for such an assumption is that i of the second patient in the First Book of E'pidefniofi.
This individual, Silenus, ason of Eualcides, who lived near I the platform, was attacked by a fever as the result of I fatigue and excessive drinking and exercise. From the beginning, he had pain in the back, headache and pain in ! the neck.” For a number of days he had fever, with intestinal symptoms, feelings of pressure in the abdomen, insomnia, and delirium — all of which might be con- | sistent with a number of different types of infectious disease, but are quite consistent with the onset of typhus. On the seventh and eighth days, he had severe sweats, i and on the eighth day he developed an eruption of red, spherical spots which continued without suppuration. He
Western Europe. Isolated cases of plague have been observed in some of the larger European cities within the last twenty-five years, but not even local outbreaks have occurred. Plague epidemics have not been known in Western Europe since about 1721. In the nineteenth century there were practically none west of Russia, and yet rats infested with fleas ! are plentiful and ubiquitous.
Hippocrates seems to have employed a method of auscultation.
Laennec> the father of modern auscultation, says: “Iffocrate avait tente V auscultation immediate
118 RATS, LICE AND HISTORY
died on the eleventh day. The headache, the sweating, the delirium, and the eruption, the onset and length of the disease, are all as one would expect them to be in a severe case of typhus. The question of the diagnosis turns largely on the nature of the eruption, and this depends, of course, entirely upon the exact meaning attached to the words describing it. The significant expression is e^avOrjiiara pera idpcoros epvdpa apoyyvKa apLKpa oXov ” IovOol . The otov T ovQoi has been translated by Farr as meaning “like vesicles,” and by de Mercy as “ semblable aux varices Professor Gulick, who has been good enough to take an interest in our classical dilettantisms, advises as fol¬ lows: “I can find no other occurrence of the word "lovOos in Hippocrates, so that it is impossible to check up on his use of it. From Aristotle ( Hist . Animal. , V, 31), it is clear that T ovOoi (originally the root of a hair) could occur either with or without pus. In Problem . xxxvi, 3, he asks why they occur mostly on the face; and in xxxiv, 4, he says that ‘excrescences’ — literally, ‘hail,’ or knots on the tongue — are like ’ 'IovOol (exactly the expression in Hippocrates). Galen (xn, 824, ed. Kuhn) says that boils, like ’’lovdoiy come from the skin moistures (he calls them juices), and that they are either hard and crude, or in¬ flamed; in the latter case, fever subvenes; and he then gives several prescriptions for their treatment.” It is therefore pure conjecture to regard this as a case of typhus fever. Indeed we think this improbable, when it is con¬ sidered that no other similar ones are mentioned.
The tenth case in the series, the Clasomenian, whom Ozanam regards as definitely a case of typhus, appears —
RATS, LICE AND HISTORY 119
i on careful reading of the original — more like a severe typhoid fever. -
There is not, therefore, anywhere in Hippocrates a clinical description which can be definitely recognized as ; applying to typhus fever. The search is equally unsuccess- I ful if one investigates the writings of other classical au- ! thors who are supposed to have described the disease.
I Euryphon, a contemporary of Hippocrates, a physician of ; the Cnidian School, is often cited in support of the an- ; tiquity of typhus fever. Galen (xvn, 1, ed. Kuhn) says:
: aSuch fevers Euryphon names ‘livid’ (TroXias), and he writes as follows: ‘The fever becomes livid and attacks j the top of the head (/ Spey^ds ) in recurrent attacks; the head aches, a pain seizes the bowels, and the patient vomits bile; when this pain holds him, it is not possible : to see what ails him; the belly becomes dry and all the i skin livid, and the lips as if he had eaten black mulber¬ ries; the whites of the eyes become livid, and the patient looks as if he were being strangled; when he suffers this less, he suffers changes in his condition very often.’ ” This I again is obviously not typhus as we know it to-day, but the description might well serve as a vivid portrayal of ; a severe attack of cholera.
The oldest recorded epidemic often regarded as an out¬ break of typhus is the Athenian plague of the Pelopon¬ nesian Wars, which is described in the Second Book of the History of Thucydides.
In trying to make the diagnosis of epidemics from
120 RATS, LICE AND HISTORY
ancient descriptions, when the differentiation of simulta¬ neously occurring diseases was impossible, it is important to remember that in any great outbreak, while the large majority of cases may represent a single type of infection, there is usually a coincident increase of other forms of contagious diseases j for the circumstances which favor the spread of one infectious agent often create opportunities for the transmission of others. Very rarely is there a pure epidemic of a single malady. It is not unlikely that the description of Thucydides is confused by the fact that a number of diseases were epidemic in Athens at the time of the great plague. The conditions were ripe for it. Early in the summer of 430 b.c. large armies were camped in Attica. The country population swarmed into Athens, which became very much overcrowded. The disease seems to have started in Ethiopia (e£ kiOioirlas rijs virep klyvivTov ), thence traveled through Egypt and Libya, and at length reached the seaport of Pirasus. It spread rapidly. Patients were seized suddenly, out of a clear sky. The first symptoms were severe headache and redness of the eyes. These were followed by inflammation of the tongue and pharynx, accompanied by sneezing, hoarseness, and cough. Soon after this, there was acute intestinal involve¬ ment, with vomiting, diarrhoea, and excessive thirst. Delir¬ ium was common. The patients that perished usually died between the seventh and ninth days. Many of those who survived the acute stage suffered from extreme weakness and a continued diarrhoea that yielded to no treatment. At the height of the fever, the body became covered with reddish spots ( vwepvOpov , Tre\iTvdvy 4>\vkt aivais piKpais Kal
RATS, LICE AND HISTORY 121 eXKeaiv efrvdrjKos), some of which ulcerated.7 When one of the very severe cases recovered, convalescence was often accompanied by necrosis of the fingers, the toes,
: and the genitals. Some lost their eyesight. In many there was complete loss of memory. Those who recovered were i immune, so that they could nurse the sick without further ; danger. None of those who, not thoroughly immunized,
I had it for the second time died of it. Thucydides himself I had the disease. After subsiding for a while, when the i winter began, the disease reappeared and seriously dimin¬ ished the strength of the Athenian state.
The plague of Athens, whatever it may have been, had ; a profound effect upon historical events. It