Humanity has always feared illness, and sought remedies for the body's discomfort and dysfunction. In this book, author Susan Wise Bauer traces the progression of our understanding of disease, and the evolution of treatments, cures, and prevention.
For illustrative purposes, Bauer includes comparisons of paleolithic sufferers with modern patients, which adds a whimsical element to a serious subject.
For example:
➽ Late fall, 4,000 years ago: Last night you had bad dreams, and were sweating, restless, hot and wretched. This morning, your mouth is dry, your teeth are chattering, and swallowing is painful.
You get an asu (healer) to treat you with herbs and barks and salts stirred into beer to drink; and powdered snakeskins and river clay kneaded into fats to massage your aching limbs.
Because of the nightmares you also need the ashipu (priest), to determine which demons have invaded you and what you did to invite punishment (such as insufficient offerings to the gods). The ashipu will then instruct you to make amends, and perform an incantation to purify you.
➽ Late fall, 2020: You wake up sick, think about who might have infected you during the past week, and hope you don't have Covid.
*****
I'll provide a brief look at the book's contents, but keep in mind Bauer's coverage is MUCH MORE extensive, with NUMEROUS examples.
Over thousands of years, beliefs about the causes of disease have changed: from angry deities, to unbalanced humors (elements that make up the body), to miasmas (bad air), to germs. Naturally, prevention and treatment of illness changed accordingly.
Prehistoric humans had few problems with infectious disease because hunter-gatherer populations were sparse, and transmission from person to person, or by way of the environment, was limited.
When humanity formed settlements, however, and communities became more tightly packed, bacteria prospered in the growing heaps of feces and food scraps; hookworms, roundworms, and other intestinal parasites infected children who played in the dirt; water reservoirs for crops bred mosquitoes, and nurtured parasites that caused amoebic dysentery, dengue fever, schistosomiasis, and so on.
Animals also became a problem. Rodents and birds that nested around homes shed viruses, fungi, and bacteria; and domesticated animals - dogs, sheep, goats, cattle, pigs, horses, chickens, camels, etc. - 'shared' their diseases.
➽ Deities
We now understand why people get sick, but thousands of years ago, sickness was a mystery. Diagnostic methods, therefore, relied on various kinds of 'magic.' For instance, one method of diagnosis was 'extaspicy' - the ritual sacrifice of an animal, and the examination of its insides for messages from the gods.
Extaspicy
Other diagnostic tools included reading marks on oracle bones, and interpreting cracks on turtle shells. The answer was always that the sufferer had sinned, offended the gods, and had to make amends to be cured.
➽ Humors
Greek philosophers believed four elements made up the body: flesh, blood, bones, and breath. In the same way, four elements made up the universe: fire, water, earth, and air. In the body, the elements were represented by fluids, or humors, that moved through the tissues and determined health and illness. The humors were yellow bile, blood, phlegm, and black bile.
When the fluids were in equilibrium, people were healthy; when the fluids were unbalanced, people became ill. So, for example, too much phlegm in the head was thought to block the proper flow of air and cause seizures (epilepsy).
The physician's role was to determine the reason for the imbalance (such as cold weather and winds), and to provide suggestions for a remedy (such as resting near a warm fire).
The idea that unbalanced humors cause disease evolved into the Hippocratic model, which lasted for 30 generations. Bauer writes, "For Hippocrates and his followers, the body is naturally healthy. The humors WANT to be in proper proportion. But they are constantly pushed and pulled at by their surroundings, and since each body responds slightly differently to airs, and waters, and places, each body can easily get out of whack in a slightly different way."
The Hippocratic physician diagnosed the surroundings and experiences of the patient (food and drink; humidity and dryness; cold and heat; noise and quiet; and so on), diagnosed the imbalance, and sought to right it. As an illustration, if you got stomach pains, you might be advised to change your diet.
Bauer goes on to an extensive discussion of Hippocratic medicine, and the manner in which it was amended by Galen - who included human anatomy in the diagnoses of illness.
The author also discusses HORRIBLY DEADLY epidemics and pandemics, such as bubonic plague, which broke out repeatedly over the centuries.
The bubonic plague was horrific and deadly
When plague diseases didn't respond to Hippocratic and Galenic methods, people scapegoated those considered 'different' than themselves, especially Jews, who were hunted down and murdered.
Bauer notes that scapegoating never faded away, and continues into modern times. For example, in 1900, Chinese immigrants were blamed for epidemics of tuberculosis, syphilis, and other diseases; in 1916, Mexicans were blamed for outbreaks of typhus; and in 2018, Donald Trump spread the word that "poor, uneducated, foreign immigrants are a particular threat to White Americans", and he later called the Covid pandemic "the Chinese virus" or the "Kung flu."
Chinatown was destroyed during the epidemics of 1900
Mexicans were forced to take kerosene baths when crossing the border in 1916
➽ Relief (Drugs)
From early times, humans understood that beer, wine, and opium juice made them feel better, so the idea of using substances - like plants, herbs, and vegetables - to relieve symptoms is very old. Our ancestors had no idea how the remedies worked, and paired characteristics of plants with (supposed) cures. For instance, plants that split rock crevices were administered to break up kidney stones.
Over time, curative substances, and foods and drinks made from them, VERY SLOWLY evolved into drugs. Unfortunately, the proliferation of drugs also gave rise to quack remedies from hucksters, which persists in modern times (i.e. suggestions to use hydroxychloroquine and chloroquine for Covid).
Quack Medicines
➽ Human Anatomy
In ancient times, the human body was sacred, and healers would never open a body to diagnose illness, even after death. Over time, enterprising physicians overcame this superstition, did extensive autopsies, and wrote books about human anatomy. This was a big step forward in understanding illness and disease.
➽ Germ Theory
Historically, physicians had no knowledge of germs, but returning epidemics - like smallpox, plague and flu - demonstrated that humors couldn't be blamed, and that 'seeds of disease' spread the scourges. Though MANY people (including doctors) resisted this idea, what came to be known as germ theory slowly gave rise to inoculation and vaccination.
Sadly, failure to acknowledge that germs cause disease led to countless unnecessary deaths, since physicians who refused to wash their hands killed patients, especially when women got puerperal fever (an infection) after childbirth. [The arrogance here is mind-boggling; did the doctors also sit down to dinner with dirty hands that stunk from autopsies‽‽]
Childbirth was deadly in unsanitary conditions
➽ Cleanliness
Once humanity accepted the fact that germs cause disease, cleanliness became an issue. Bauer writes, "The first best response to sickness in the home was to examine the sinks, replace the drainage pipes, install traps to block the miasma [germs] from rising up from the cesspools beneath." Moreover, people eschewed furnishings that were difficult to clean, and assiduously scrubbed their homes.
Household cleaners and personal products changed as well, and in the late 1800s - early 1900s, items like Listerine and Vicks VapoRub, which had very strong odors, became popular. Bauer writes, "The American Medical Association found itself obliged to warn the public that too many health products were created 'to smell and to sell', rather than to actually kill germs." The author points out that the addiction to 'germ killers' continues in modern times, as demonstrated by our purchase of all kinds of soaps, disinfectants, and cleaning products.
Fear of germs also led to a 'throwaway culture', and we now use myriad disposable items, such as plastic cups, paper plates, paper towels, styrofoam containers, tissues, plastic wrap, plastic bottles, and on and on.
➽ Antibiotics and Vaccines
Sulfa drugs were the first antibiotics, followed by penicillin, which - since it killed almost all bacteria - was considered a wonder drug. Lamentably, bacteria mutate quickly, and many germs eventually became immune to penicillin.
Other, stronger antibiotics were developed, but bacteria inevitably become immune sooner or later. Thus, we can't count on antibiotics to rescue us from bacterial epidemics, and antibiotics DON'T WORK AT ALL on viruses and other pathogens.
Vaccines can help fill the void, since they stimulate a person's immune system to mount a defense against invasive germs. Bauer discusses the discovery and development of vaccines, and notes that, during the Covid pandemic, some people shunned the Covid vaccine because "they didn't understand the science." A portion of the population also defied government attempts at quarantine and lockdown, perhaps egged on by Donald Trump.
Bauer observes, "In early March, 2024, former president and then-candidate Donald Trump announced, at a campaign rally in Richmond, Virginia, 'I will not give one penny of federal money to any school that has a vaccine mandate." Nevertheless, vaccines are currently our best hope for protection against disease.
Bauer wraps up her narrative by noting that, sooner or later, another pandemic will arrive, and hopefully we'll be ready.
The book is interesting, informative, and understandable. Highly recommended.
Thanks to Netgalley, Susan Wise Bauer, and St. Martin's Press for an ARC of the book.
Rating: 4 stars