The Greatest Benefit to Mankind. Roy Porter

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СКАЧАТЬ with civilization and commerce, colonization has contributed to the dissemination of infections. The Spanish conquest of America has already been mentioned; the nineteenth-century scramble for Africa also caused massive disturbance of indigenous populations and environmental disruption, unleashing terrible epidemics of sleeping sickness and other maladies. Europeans exported tuberculosis to the ‘Dark Continent’, especially once native labourers were jammed into mining compounds and the slums of Johannesburg. In the gold, diamond and copper producing regions of Africa, the operations of mining companies like De Beers and Union Minière de Haute Katanga brought family disruption and prostitution. Capitalism worsened the incidence of infectious and deficiency diseases for those induced or forced to abandon tribal ways and traditional economies – something which medical missionaries were pointing out from early in the twentieth century.

      While in the period after Columbus’s voyage, advances in agriculture, plant-breeding and crop exchange between the New and Old Worlds in some ways improved food supply, for those newly dependent upon a single staple crop the consequence could be one of the classic deficiency diseases: scurvy, beriberi or kwashiorkor (from a Ghanaian word meaning a disease suffered by a child displaced from the breast). Those heavily reliant on maize in Mesoamerica and later, after it was brought back by the conquistadores, in the Mediterranean, frequently fell victim to pellagra, caused by niacin deficiency and characterized by diarrhoea, dermatitis, dementia and death. Another product of vitamin B₁ (thiamine) deficiency is beriberi, associated with Asian rice cultures.

      The Third World, however, has had no monopoly on dearth and deficiency diseases. The subjugation of Ireland by the English, complete around 1700, left an impoverished native peasantry ‘living in Filth and Nastiness upon Butter-milk and Potatoes, without a Shoe or stocking to their Feet’, as Jonathan Swift observed. Peasants survived through cultivating the potato, a New World import and another instance of how the Old World banked upon gains from the New. A wonderful source of nutrition, rich in vitamins B₁ B₂ and C as well as a host of essential minerals, potatoes kept the poor alive and well-nourished, but when in 1727 the oat crop failed, the poor ate their winter potatoes early and then starved. The subsequent famine led Swift to make his ironic ‘modest proposal’ as to how to handle the island’s surplus population better in future:

      a young healthy Child, well nursed is, at a Year old, a most delicious, nourishing and wholesome Food; whether Stewed, Roasted, Baked, or Boiled; and, I make no doubt, that it will equally serve in a Fricassee, or Ragout … I grant this Food will be somewhat dear, and therefore very proper for Landlords.

      With Ireland’s population zooming, disaster was always a risk. From a base of two million potato-eating peasants in 1700, the nation multiplied to five million by 1800 and to close on nine million by 1845. The potato island had become one of the world’s most densely populated places. When the oat and potato crops failed, starving peasants became prey to various disorders, notably typhus, predictably called ‘Irish fever’ by the landlords. During the Great Famine of 1845–7, typhus worked its way through the island; scurvy and dysentery also returned. Starving children aged so that they looked like old men. Around a million people may have died in the famine and in the next decades millions more emigrated. Only a small percentage of deaths were due directly to starvation; the overwhelming majority occurred from hunger-related disease: typhus, relapsing fevers and dysentery.

      The staple crops introduced by peasant agriculture and commercial farming thus proved mixed blessings, enabling larger numbers to survive but often with their immunological stamina compromised. There may have been a similar trade-off respecting the impact of the industrial Revolution, first in Europe, then globally. While facilitating population growth and greater (if unequally distributed) prosperity, industrialization spread insanitary living conditions, workplace illnesses and ‘new diseases’ like rickets. And even prosperity has had its price, as Cheyne suggested. Cancer, obesity, gallstones, coronary heart disease, hypertension, diabetes, emphysema, Alzheimer’s disease and many other chronic and degenerative conditions have grown rapidly among today’s wealthy nations. More are of course now living long enough to develop these conditions, but new lifestyles also play their part, with cigarettes, alcohol, fatty diets and narcotics, those hallmarks of life in the West, taking their toll. Up to one third of all premature deaths in the West are said to be tobacco-related; in this, as in so many other matters, parts of the Third World are catching up fast.

      And all the time ‘new’ diseases still make their appearance, either as evolutionary mutations or as ‘old’ diseases flushed out of their local environments (their very own Pandora’s box) and loosed upon the wider world as a result of environmental disturbance and economic change. The spread of AIDS, Ebola, Lassa and Marburg fevers may all be the result of the impact of the West on the ‘developing’ world – legacies of colonialism.

      Not long ago medicine’s triumph over disease was taken for granted. At the close of the Second World War a sequence of books appeared in Britain under the masthead of The Conquest Series’. These included The Conquest of Disease, The Conquest of Pain, The Conquest of Tuberculosis, The Conquest of Cancer, The Conquest of the Unknown and The Conquest of Brain Mysteries, and they celebrated ‘the many wonders of contemporary medical science today’. And this was before the further ‘wonder’ advances introduced after 1950, from tranquillizers to transplant surgery. A signal event was the world-wide eradication of smallpox in 1977.

      In spite of such advances, expectations of a conclusive victory over disease should always have seemed naive since that would fly in the face of a key axiom of Darwinian biology: ceaseless evolutionary adaptation. And that is something infectious disease accomplishes far better than humans, since it possesses the initiative. In such circumstances it is hardly surprising that medicine has proved feeble against AIDS, because the human immunodeficiency virus (HIV) mutates rapidly, frustrating the development of vaccines and antiviral drugs.

      The systematic impoverishment of much of the Third World, the disruption following the collapse of communism, and the rebirth of an underclass in the First World resulting from the free-market economic policies dominant since the 1980s, have all assisted the resurgence of disease. In March 1997 the chairman of the British Medical Association warned that Britain was slipping back into the nineteenth century in terms of public health. Despite dazzling medical advances, world health prospects at the close of the twentieth century seem much gloomier than half a century ago.

      The symbiosis of disease with society, the dialectic of challenge and adaptation, success and failure, sets the scene for the following discussion of medicine. From around 2000 BC, medical ideas and remedies were written down. That act of recording did not merely make early healing accessible to us; it transformed medicine itself. But there is more to medicine than the written record, and the remainder of this chapter addresses wider aspects of healing – customary beliefs about illness and the body, the self and society – and glances at medical beliefs and practices before and beyond the literate tradition.

      MAKING SENSE OF SICKNESS

      Though prehistoric hunting and gathering groups largely escaped epidemics, individuals got sick. Comparison with similar groups today, for instance the Kalahari bush people, suggests they would have managed their health collectively, without experts. A case of illness or debility directly affected the well-being of the band: a sick or lame person is a serious handicap to a group on the move; hence healing rituals or treatment would be a public matter rather than (as Western medicine has come to see them) private.

      Anthropologists sometimes posit two contrasting ‘sick roles’: one in which the sick person is treated as a child, fed and protected during illness or incapacity; the other in which the sufferer either leaves the group or is abandoned or, as with lepers in medieval Europe, ritually expelled, becoming culturally ‘dead’ before they are biologically dead. Hunter-gatherer bands were more likely to abandon their sick than to succour them.

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