J. N. Hays. The Burdens of Disease: Epidemics and Human Response in Western History. Rutgers, 2003.

During the coronavirus epidemic of 2020, I decided to pull this book off my shelf and read it. I’m glad I did, since it approaches the history of epidemics and disease in Western civilization from a historical and social perspective, explaining how society reacted to such epidemics as the Black Death, leprosy, typhus, cholera, tuberculosis, smallpox, polio, the flu epidemic of 1918, and AIDS. Hays traces the history of how physicians, governments, religion and common people responded to these epidemics. In particular, he gives a history of the development of modern medical science.
Although the book was written long before the international crisis of COVID-19, many lessons in his book will be of interest to readers today. He sees epidemic as a social issue, not just a medical issue, because it affects all of society.
Religious views toward disease have often been a factor. During the bubonic plague (Black Death) of the late Middle Ages, people often thought God was punishing them, and groups of “flagellants” even drew their own blood to atone for sins, assuming the role of Jesus’ sacrifice. Diseases like syphilis and AIDS were especially associated with sexual sin, but also tuberculosis (formerly called “consumption”) and polio were associated with the immorality in filthy slums, until the presence of these diseases among the rich and famous reframed attitudes. Hays tends to be negative toward religious faith, saying the scientific revolution “undercut traditional Christian orthodoxy” (p. 88), although he does not explain how, and later admits that the devout Christian scientist, Isaac Newton, appealed to “the very first Cause, which certainly is not mechanical” (p. 99). On the other hand, Hays also points out the limitations of science, holding in the mirror of irony the bold claims of scientists in 1872 that “men will master the forces of Nature” (p. 213) and in 1955 a news writer’s claim that “man one day may be armed with vaccine shields against every infectious ill that besets him” (p. 240).
Hays shows how disease was used and abused by the powerful, particularly governments, sometimes to protect, and sometimes to control. Italian city-states often quarantined people during the bubonic plague in an attempt to stop the spread of disease, much to the chagrin of businessmen and churches not allowed to meet or trade. Governments cleaned up slums, installed sanitary running water and garbage collection, and required vaccinations, all with a view to better health. However, democracies that valued personal freedoms struggled with this approach, as cities like Hamburg, Germany about 1900 were reluctant to impose vaccinations against the liberties of its people, until the city saw evidence of its effectiveness. City officials in San Francisco denied the existence of plague in Chinatown in 1900, calling it a “scare” and made it a felony to tell the news (p. 183). Governments fighting in World War I suppressed the news stories of the flu epidemic of 1918-19, so as not to divert attention from the war effort, thus it was nicknamed “Spanish flu” because Spain, a non-combatant in the war, reported on it freely. The darkest story of disease was the use of eugenics and euthanasia by Nazi Germany, which considered Jews “diseased” and also exterminated “the tubercular, the homeless, those unwilling or unable to work, and criminals of many sorts” (p. 287). Perhaps the most sinister destruction was the elimination of most of the Native American population by diseases that were brought by Europeans to the New World.
Socially, Hays discusses how social isolation protected people from epidemics in the Middle Ages, when people rarely travelled outside their own villages, and the Black Death only occured after cities arose in Europe and trade developed from nation to nation. He notes that major advances in transportation such as steamships and railroads provided opportunities for plagues to spread rapidly as travel from continent to continent was reduced to days, not giving viruses time to die before they spread to new victims.
Social changes also occurred for the better to prevent disease, as it became socially accepted to take baths, wash hands frequently, drink pastuerized milk, and it became socially unacceptable to spit or sneeze in public, or smoke tobacco in public. One wonders what social changes may occur after our current epidemic, but that is likely the subject of another book.