Duel Without End
Mankind’s Battle With Microbes
Stig S Frøland
Reaktion Books 2022
Hb, 632pp, £25, ISBN 9781789145052
The World Health Organisation estimated in May 2022 that Covid-19 had directly or indirectly killed between 13 million and 17 million people. But, as this superb new book reminds us, mortality could have been much worse. Cocoliztli claimed almost 15 million lives as it swept across Mexico between 1545 and 1548. The Black Death killed almost 50 million Europeans, when, of course, the population was much smaller. About two to three per cent of people who develop Covid-19 die. Marburg virus kills up to 90 per cent of those infected.
Vaccines, drugs, better nutrition and hygiene, and improved medical care saved countless lives. Yet our scientific understanding of infection is surprisingly recent. In 1876, Robert Koch proved for the first time that bacteria caused human diseases. Koch also disproved the then widespread idea that there was only one bacterium, which transformed into various pathogens.
The “germ theory” took a while to catch on. Frøland, a leading Norwegian microbiologist, notes that opponents to the germ theory deliberately exposed themselves to infections, usually without developing disease. But microbiological Russian roulette could misfire. One experimenter survived an attempt to contract plague, but he died when he exposed himself to yellow fever.
Until about 150 years ago, we blamed gods. Many societies had gods to one of the most terrible infections: smallpox. In West Africa, Shapona could punish people with smallpox. Hindus have worshipped their goddess of smallpox, Shitala, for at least 2,000 years. During the Black Death, groups of people travelled around whipping themselves until they bled as penance. Some people, even today, regard infections as divine retribution.
Frøland shows how history sometimes turns on microscopic pivots. Some historians suggest that waterborne infections destroyed the Harappa culture, which thrived in the Indus valley between 3000 and 2000 BC. The
Harappan had well-developed water supply and waste disposal systems. But sewage possibly contaminated well water. During the American Civil War, typhoid fever, dysentery, pneumonia and malaria caused about two-thirds of the estimated 660,000 deaths among the military. Some outbreaks delayed or scuppered military operations. Some estimates suggest that infections lengthened the conflict by two years.
Despite the best efforts of forensic microbiology, the causes of some historical infections, such as the plague that swept through Athens in 430 BC killing about a quarter of the population, remain mysterious. Between AD 249 and 270 another epidemic caused by an unknown pathogen led some patients to bleed from their eyes, and probably killed two Roman emperors and 5,000 people in one day in Athens. Frøland adds that the cause of the English Sweating Sickness in the 16th century and Cocoliztli still remain enigmatic.
Frøland’s copiously illustrated book, while steeped in compelling historical detail, is topical, touching on Covid-19, biological warfare and terrorism. Meanwhile, antibiotic resistance keeps rising and new threats continue to emerge. As Frøland’s book (currently my book of the year by some margin) reminds us, it’s not a matter of if there will be another pandemic, but when. We’ll probably always remain in an arms race with pathogens. And it’s not one we’ll inevitably win.