Outbreak! Plagues That Changed History

Outbreak
is a book of science and history. Any errors are my responsibility.

Still, no book is created alone. I am grateful to the many people who helped with this one. Marion Weber helped me design the handsome dummy I used to pitch this idea to Crown Books for Young Readers. The San Juan Library’s interlibrary loan program was my essential research tool. Paul Chadwick provided insightful critiques of my illustrations. Trudy Loucks, couturier at San Juan Community Theatre, provided me with the props and costumes I used to make these paintings. Daniel and Judy Finn, Fred and Xiao Fei Yockers, Marsha Rachlin, Elizabeth Pratt, Randy Hill, Ben White, Tom Holzhauser, Ladd Holroy, my wife Rebecca, my daughter Wynn, and my son Parks were my gracious models.

Dr. Amy Bloom of the Bureau of Global Health, Office of HIV/AIDS, Technical Leadership and Research Division of the U.S. Agency for International Development in Washington, D.C., offered me useful research advice. Dr. Robert Quick of the Foodborne and Diarrheal Diseases Branch of the Centers for Disease Control and Prevention (CDC) in Atlanta critiqued my chapter on cholera and informed me about the CDC’s Safe Water System. Dr. Susan Mahoney of Inter-Island Medical Center, San Juan Island, and Dr. Joseph Knight of Group Health, Seattle, read drafts of my manuscript. So did Sam Connery of Friday Harbor, who also supplied me with a voluminous array of articles, newspaper clippings, magazines, and books on infectious disease that were the basis for many chapters. They all provided valuable feedback. Kevin Brown, trust archivist and Alexander Fleming Laboratory Museum curator at St. Mary’s Hospital in London, provided important archival references for my painting of the discoverer of penicillin.

My astute editor at Crown, Michelle Frey, ensured that my manuscript for
Outbreak
was on track, on target, and on time. Her ideas were invaluable, including the title. Alison Kolani was the eagle-eyed copy editor who helped me keep my spelling and facts straight. Jason Zamajtuk designed the crisp, clean look of the book under the gentle supervision of Isabel Warren-Lynch, Crown’s art director.

Finally,
Outbreak
could not have been created without the members of my family, who were unfailingly supportive and helpful at every turn.

To all of you: thank you.

Cover

Title Page

Copyright

Dedication

Acknowledgments

Glossary

Sources

About the Author

You’re born pristine and alone, but it doesn’t last. With your first independent breath, your body becomes a cooperative venture with other creatures: a colony, a host. You become infected.

The creatures that invade your body are called
microbes
. Invisible to the eye, so small they have to be measured in millionths of a meter, these tiny organisms are mostly single-celled bacteria. They arrive via the air you breathe, the water you drink, the surfaces you touch, and the food you eat. They colonize your skin, your hair, your mouth, your eyes, your ears, and your intestines. By the time you’re an adult, you’ll be carrying around about two pounds of these creatures, mostly in your gut. In sheer numbers, they’ll make up 95 percent of all the cells in your body, about ten quadrillion in all.

This is a good thing. These microbes are
symbionts
. Our survival depends on cooperative coexistence with them. Symbionts exist with us in a mutually beneficial relationship. We give them protection and nourishment. They keep our bodily ecology in balance. Outside, symbionts keep our skin tidy, our eyelashes groomed, our armpits from rotting. Inside, symbionts help digest food, produce essential vitamins, and protect us from disease. We couldn’t stay healthy without them.

Many microbes are not symbionts. Some are free-living creatures like us. They putter around the soil, the forest floor, the oceans and streams, our kitchen countertops and toilets. Others inhabit environments too extreme for most other living things: polar wastes, volcanic vents, nuclear reactors, chemical soups. They live, reproduce, and die on their own, doing us no harm.

The majority of microbes, however, are neither helpful nor benign, neither symbiotic nor free-living. They are parasites. They live in us or on us at our expense. The original parasites were people and the term wasn’t an insult. In ancient Greece, parasites were religious workers who served at temple feasts (
parasite
means “beside food”). Over the centuries, however, the term changed to describe a professional dinner guest who flattered or amused the host. Eventually
parasite
came to mean any creature who takes without giving. In the case of microbial parasites,
we
are the feasts. Sometimes they only steal a little of our food or energy. Sometimes they alter our lifestyle to ensure their survival. Sometimes they make us get sick or die. Microbial parasites include both bacteria and more complex one-celled creatures called protozoans, plus multicelled worms and flukes. They also include viruses, vanishingly small creatures that are neither living nor dead. Viruses invade our bodies and replicate, using our cells as fuel and housing.

All these parasitic microbes are the unseen part of a much larger visible parasitic world that includes mosquitoes, ticks, leeches, and many kinds of worms. Parasitism, it turns out, is an astonishingly popular lifestyle. There are four times as many kinds of parasites on earth as free-livers. Most free-living organisms host several parasites. Many parasites host other parasites. And some of those parasites have parasites of their own. They divide and subdivide the delectable, concentrated food supply of their hosts into precisely defined real estate and fiercely defended turf.

Microbial parasites can change not just individuals but entire societies. If enough people live closely together and other conditions are right, an infectious microbe—a
pathogen
—can spread widely through a population. These are called
epidemics
and are as old as civilization. One famous Chinese catalog of epidemics lists some 304, starting in 243
B.C.
and ending in
A.D.
1911. Some epidemics race through populations like summer brush fires, consuming all they touch in a few months, then burning themselves out and disappearing until another season. Others move like glaciers, carving their way through a population over decades. If the disease is particularly successful, becoming continental or global in scope, it’s called a
pandemic
. If the pathogen settles in and becomes a permanent feature of a region, it is known as
endemic
.

But whether fast or slow, epidemic, pandemic, or
endemic, these infectious diseases can force enormous, sometimes cataclysmic changes on societies. They can reshuffle power, serve the greater good, or solidify the status of the ruling class. They can determine not just who lives and who dies, but who wins and who loses, who gets wealthy and who stays poor, which ideas become popular and which ones wither away. Without epidemics, ours would be a very different world indeed.

Outbreak
is the story of epidemics that have transformed human society. Of the thousands of epidemics that have occurred across human history, this book focuses on six of the most extraordinary: bubonic plague, smallpox, tuberculosis, cholera, yellow fever, and influenza. (Other epidemics, like AIDS, are supporting cast members.) Each chapter describes the origin of the pathogen, its spread, its treatment and cures, and its most influential outbreak. Many of these pathogens have been some of the most feared killers on the planet. Some still are. All have been crucial in changing the way we think and act.

Looking at how diseases have changed society tells us a lot about how science has evolved, too. Humanity’s understanding of the role of microbes in the spread of illness has been a slow, halting, convoluted journey of discovery. Along the way we’ve taken many wrong turns, traveled up many box canyons, been led down many blind alleys.