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EpidemicsHate and Compassion from the Plague of Athens to AIDS$

Samuel K. Cohn, Jr.

Print publication date: 2018

Print ISBN-13: 9780198819660

Published to Oxford Scholarship Online: May 2018

DOI: 10.1093/oso/9780198819660.001.0001

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(p.531) 24 Conclusion

Samuel K. Cohn, Jr.

Oxford University Press

Abstract and Keywords

The conclusion summarizes the findings of the book’s investigation of the hypothesis that epidemics which were mysterious and without known cures were the most likely to provoke hatred, blame, and violence towards ‘the other’ and the disease’s victims. These assumptions are based on a handful of examples, such as the Black Death, cholera riots of the 1830s, and the US experience of AIDS. In a brief survey of the book’s descriptions of epidemics across time, the conclusion highlights several key insights into their socio-psychological consequences, which are richer than the dominant hypothesis would lead us to expect. Epidemics could possess the power to negate class, race, ethnic, and religious differences by spurring compassion and self-sacrifice. Despite the laboratory revolution, collective violence provoked by disease appears overwhelmingly to have been a modern phenomenon but has never constituted the general rule.

Keywords:   pestilence, blame, violence, compassion, race, ethnicity, class conflict, physicians, nurses

This book challenges a dominant hypothesis in the study of epidemics across time: that mysterious diseases with no preventive measures or cures to hand were the ones to provoke ‘sinister connotations’, spurring hatred and blame towards ‘the other’ and victims of disease. If this were true, then why were such incidents so rare before the spread of cholera through Europe in the 1830s? As we have shown, these violent reactions hardly appeared in antiquity, and for the Middle Ages the Black Death has cast a long shadow that needs contesting. Recurrences of plague after 1348 into the sixteenth century did not rekindle the horrors of the Black Death, which pervaded social relations and brought about not only the burning of Jews but also the more diffused cruelty of abandoning loved ones in their moment of need. Even with resurging fears of plague spreaders in the sixteenth century, neither Jews nor other minorities were then the butts of prejudice and persecution; rather, insiders from solid artisans to bankers were the usual suspects. Moreover, those tried, tortured, and executed did not amount to thousands; nor were entire communities exterminated as in 1348–50. In the most studied case, the torture and execution of alleged plague carriers in Milan in 1630, only ten executions are recorded. The Black Death was a colossal exception, not the rule for a pre-‘laboratory-revolution’ past when almost all diseases were without cures to hand.

Should we then suppose that a socio-psychological immunity developed, with epidemics losing their capacity to terrorize and spark widespread violence after their first mysterious appearances? The answer was usually no. Sometimes we forget that cholera first struck parts of Europe in the early 1820s, not the 1830s, and first spread through Russia’s Volga basin without traces of social violence.1 But it returned there for the next five cholera waves with deadly socio-psychological effects, as in the 1890s, when crowds of 10,000 killed a governor, physicians, and soldiers and destroyed an important industrial town, present-day Donetsk. Such recurrences were not limited to authoritarian regimes that brutally enforced sanitary controls. In Italy, cholera’s social violence, instead of declining or disappearing with successive bouts of the disease, expanded geographically. With its first attack in 1836–7, riots were confined almost exclusively to Sicily. By its last major wave, 1910–11, riots had advanced through Puglia, Calabria, and Abruzzi, invading towns in the centre-north, such as seaside resorts north of Rome, and by some accounts, Venice. With the same fantasies and fears of the 1830s, crowds attacked town halls and (p.532) hospitals, killed doctors and mayors, and ‘liberated’ afflicted neighbours, whom they triumphantly carried on their shoulders back to their homes.

Cholera was not the only epidemic disease that failed to acquire immunity to attacks of blame and violence. While rioting accompanied the first spread of plague in Mumbai in 1896, social violence mounted with successive strikes of the disease and peaked with its largest, most deadly revolt in March 1898, joined by shopkeepers who closed their businesses and workers who went on strike. The same holds for plague in the Middle East, where social violence was not triggered by the first appearance of the disease but after four plague seasons had passed.

Smallpox’s trajectory of violence was more striking. If the Antonine pandemic of the 160s CE was smallpox, as historians now believe, it provoked no known cases of blame, persecution, or violence. Quite the opposite: tensions along Rome’s bellicose borders eased. Nor did the Middle Ages record any smallpox riots or persecution, and the same appears to have been the case when it arrived in the New World and later in colonial Latin America. Instead, sustained smallpox violence that blamed outsiders—the tramp, ‘Negro’, ‘Chinaman’, and ‘Bohemian’—came late in the day with the pandemic of 1881–2 in the US and mounted in frequency and cruelty into the twentieth century, that is, after it had become a familiar disease both epidemically and endemically, and after an effective means of prevention had been discovered.

Aggressors and Targets

Smallpox highlights a second theme running through this book. The violence spawned by various epidemic diseases was not all alike, nor was it what historians have supposed. People perceived as the ‘other’—ethnic and racial minorities, the outsider, the foreigner, the Jew—were not predominantly the victims. Rather, aggressors and their targets assumed different sides, depending on the epidemic. Although officials, intellectuals, and physicians may have decried the ignorance and filth of the labouring classes, seeing them as cholera’s cause, elites were the victims of this disease’s rage. As René Baehrel claimed sixty-six years ago, these were matters of class struggle, but one to which neither Marx nor Engels paid any heed. Across a wide range of political regimes from Czarist Russia to liberal Manchester, the poor and marginal—recent Irish Catholic immigrants in English, Scottish, and North American cities; Asiatic Sarts in Tashkent, impoverished women and children in Glasgow and Edinburgh, fig-growers and fishermen in Sicily and southern Italy—produced similar fantasies that accused elites of plotting to cull populations of the poor. Here, the ‘others’, instead of being the butts of blame, were the perpetrators, who attacked physicians, pharmacists, mayors, and police.

On first impression, plague riots, mostly in India in the years 1896 to 1902, may appear to have followed cholera’s suit. These riots, however, rarely divided communities. Instead, they unified castes and classes, bridging differences even between Hindus and Muslims in common cause against colonial and municipal (p.533) abuses, military searches, destruction to temples and homes, and disrespect for local customs. In contrast to the bulk of cholera riots, which show few signs of prior organization, planning, or leadership, plague riots usually began with open meetings, resolutions, newspaper editorials, and letters to colonial commissioners. Despite initial criticisms of violence or lower-class ‘superstitions’, intellectuals and indigenous elites often ended up supporting the demands of the lower classes against abuses, incompetence, and notions of plague control that dated back to the Middle Ages, but by 1898 had been discovered to be counterproductive.

Plague protest as a force for unity was not exclusive to the subcontinent. The national Public Health Service’s discriminatory quarantine on San Francisco’s Chinatown and coercive vaccination of the Chinese alone not only united the city’s Chinese community across class, it moved white merchants to support their Chinese neighbours with demonstrations, business closures, and legal actions in marked contrast to their earlier attitudes and actions during outbreaks of smallpox, tuberculosis, and syphilis. Similarly, Honolulu’s plague experience ultimately was a force for unity, despite white citizens’ initial fears and armed quarantine entrapment of Chinese, Japanese, and native Hawaiians, while their homes and businesses burnt to the ground. No class or ethnic massacre ensued. Instead, white elites succoured the afflicted: charity and compassion were the upshots.

The epidemic disease that best fits the present view that diseases inspired hatred with the victims of the disease often being victimized was smallpox in America, which historians have yet to realize. This disease’s social violence was also one of class struggle, but the perpetrators and victims of violence now switched sides. Smallpox ‘mobs’ were mostly comprised of small-town white citizens, businessmen, or propertied farmers and were led (unlike cholera protesters) by adult males. In such cases, the victims were doubly victimized, first by the disease, then by elite violence. Smallpox violence differed in another respect. Although these crowds could number in the thousands, more characteristically, gangs or small vigilante groups greeted those seeking help with double-barrel shotguns, or worse, burnt their pesthouses to the ground, sometimes with the incumbents cremated inside. Other epidemics showed more complex alignments, as in Milan in 1630. Those who perpetuated myths of plague spreaders and persecuted those who were accused by means of brutal legal procedures participated in an unspoken alliance between the poor—often women—and elites, comprised of physicians, senators, and the Cardinal-Archbishop. The alleged untori on the other hand were not outsiders or the lowest of plague cleaners, as historians now assume, but insiders, native Milanese, who proudly announced it when summoned before the authorities who interrogated and tortured them.


Across the wide sweep of recorded epidemics, blame and persecution were not the usual outcomes. As Livy and authors in antiquity highlight, epidemics often interrupted the course of human events, ending, at least temporarily, conflict between (p.534) tribes and nations, such as between Rome and Velitrae or the Volscians during the fifth century BCE, or internal battles, such as the ongoing strife between senatorial classes and plebeians. When epidemics were particularly mysterious, oracles or sacred books were consulted. Instead of casting out beggars or persecuting ‘others’, ancients heeded oracles’ calls by opening their doors to strangers, breaking the manacles binding prisoners, granting work-free holidays, providing grain for the poor, and inventing new forms of hospitality. Similarly, with the two great pandemics of late antiquity, the Antonine Plague of 165–180 CE and the Justinianic Plague beginning in 541, unity and charity, not division and hatred, were the outcome. Emperor Marcus Aurelius was praised for his charitable offerings to the afflicted, and despite war with the Germanic tribes, his previous persecution of Christians, and the fact that this pestilence was new, mysterious, and originated beyond the Empire’s borders, no blame or persecution ensued. Instead, new opportunities and privileges were extended to ‘barbarian’ outsiders.

The depiction of the Justinianic Plague once it reached Constantinople was more extraordinary, especially given the disposition of its principal historian, Procopius, towards Emperor Justinian. Before the pandemic, Procopius depicted Justinian’s greed, corruption, and cruelty that divided the city through factional strife, sponsoring the circus of the Blues and murdering their rivals. Yet with the coming of the plague, Procopius heaps praise on Justinian’s charity, which through his minister, Theodorus, rallied public assistance to the poor and afflicted, and buried the mounds of plague corpses threatening the city’s survival. The circuses’ perennial divisions temporarily ended. Those who before the plague despised one another now united to honour the dead.

The late Middle Ages also experienced these moments of unity in the midst of pestilence. Not only was the Black Death unique in its horrific socially inflicted carnage, half a century later, a flagellant movement was born from a plague that was the polar opposite of the previous movement in 1349. Instead of re-enacting Black-Death division and hate, the Bianchi was a peace movement that united elites and commoners, crossed city walls into the countryside, and brought men, women, and children together to end social conflict from everyday litigation to factional strife among aristocratic clans and war between territorial states.

Even if the Black Death was not a turning point in epidemics’ power to fuel hatred, it awakened a new awareness of the transmission of diseases, inspiring new regulations and organizations to protect communities in plague time by evicting suspected carriers and undesirables. Yet it was the birth of a new disease in Europe at the end of the fifteenth century—the Great Pox—that launched endeavours to track the movement of disease, as physicians turned from their reliance on antique and Arabic sources, to chart Columbus’s voyages and the possible routes by which the new disease progressed to Naples, then across Europe and beyond. With this disease, however, tracking of contacts did not lead to blaming and certainly not to persecution. Instead, the leading edge of hate-fuelled disease in early modernity was Europe’s old companion, known now for two centuries—plague. The sixteenth- and early seventeenth-century accusations, (p.535) tortures, and executions did not hinge on ignorance or a sudden unleashing of folkloric superstition previously locked in mountain hollows. Instead, those at the forefront of medicine and science were the ones to justify the state’s onslaught on innocents. Yet these injustices did not amount to massacres, certainly not on a scale comparable to the Black Death slaughter or to cholera and plague riots in the nineteenth and twentieth centuries.


Even with modernity and new notions that diseases were carried by people (although miasmas continued to figure), few epidemic diseases ignited collective violence against victims of disease, outsiders, insiders, or elites. Instead, some of the most feared and deadly diseases, whose causative agents remained mysterious into the twentieth century, provoked waves of compassion and volunteerism rather than division and hate. Like Livy’s ancient plagues, yellow fever in America and the Great Influenza of 1918–20 globally eased class, ethnic, sectional, and racial tensions and extended care and charity through the donation of resources and relief provided by priests, nuns, doctors, nurses, and others who often journeyed from distant places and died as a consequence of their charity. The mass evacuation of Philadelphia in 1793, New Orleans in 1853, Memphis in 1878, and many smaller towns across the Deep South throughout the nineteenth century suggests that yellow fever sparked greater fear and panic than any disease in US history. Fear and panic did not, however, spell blame and violence. Instead, it cut in the opposite direction, spurring clubs and business to assist the afflicted, with people from the North volunteering in the South and blacks sacrificing their lives for the white afflicted. These waves of abnegation, moreover, sprouted in historical contexts not conducive to such sentiments, such as the South’s epidemic of 1853, when sectional tensions between North and South were on the rise, or in 1878, during a racist backlash against the advances of post-Civil War reconstruction.

Charitable outpouring and self-sacrifice were more widespread during the Great Influenza and differed from earlier waves of disease-inspired volunteerism. Women now played the principal role, at least across much of Canada, the US, and Australia. No doubt, the war played its part in the shift. But here too the general contexts—war-spun xenophobia, worldwide industrial strife, red-scare hysteria, the longest, most violent race riots in US history, and rising anti-Mexican hatred, even warfare, along the Texan–Mexican border—ran counter to humanitarian urges. But in El Paso, middle-class women and debutant girls crossed into the city’s most impoverished and afflicted Mexican neighbourhoods to sweep floors, make meals, care for children, and nurse the dangerously ill. Such sentiments flourished across the country against advice from government bulletins and municipal decrees pillorying spitters, sneezers, coughers, and big talkers, and urging ‘patriots’ to blame them for flu’s fatal spread. No collective violence, however, ensued against sufferers or any other ‘others’.

(p.536) The Importance of Disease

This book has argued that local and national contexts are insufficient to explain how a disease such as cholera could have produced such similar and distinctive fantasies of blame and patterns of collective violence across radically different political and cultural regimes from Asiatic Russia to New York City. Moreover, other epidemic diseases struck some of these places at the same moments without stirring blame or igniting mass violence, such as an influenza pandemic in Paris, other places in France, and Europe in 1831 that caused more deaths than cholera did a year later. Similarly, a wave of typhus raged through Britain and Ireland in 1826, felling 20,000 in London alone, and again in the 1830s with no ramifications of social violence, and attacks of plague and typhus spread through the Volga in 1892, when cholera and the riots associated with it were rife, but here neither plague nor typhus spawned a single disturbance. In addition, many disastrous epidemics fill modern European history, such as typhus which accompanied the ‘Great Hunger’ in Ireland in the 1840s or that spread from Siberia in 1920–2 through parts of Russia and into Eastern Europe, but did not stir up violence.

Of course, neither cholera nor smallpox spread hate and blame everywhere. As we have seen, smallpox’s social violence was situated mostly in the US and before 1881–2 had been extremely rare. Cholera also showed peculiar patterns. So far, only one major cholera riot has appeared in its birthplace, India, although cholera was rife at moments when plague protest neared its peak in May 1897 on the eve of the ‘Tragedy of Poona’ and with mass plague violence in Kolkata, Mumbai, and elsewhere. On the other side of the hate–compassion divide, an epidemic of poliomyelitis erupted in New York City in 1916. However, unlike influenza two years later, elite ladies, instead of risking their lives to clean, feed, and nurse the poor, blamed the poor for the disease and patrolled impoverished neighbourhoods to report habits they judged unsavoury to the police.

As shown in the chapter on smallpox and collective violence, pundits in the nineteenth century thought cholera was the disease most likely to provoke social violence in America. International news, however, and not their own history, fixed their views. In places such as Ireland, Britain, America, and to a large extent France, waves of cholera after the 1830s failed to spark mass social violence; whereas in Russia, Spain, Portugal, Persia, and places in the Middle East, the riots persisted throughout the nineteenth century, and, in Italy, may have reached their zenith during its last major wave in 1910–11. Moreover, in North America, cholera crowds in the thousands appeared only once. Even in the 1830s, when cholera pushed westward, devastating cities such as New Orleans and St Louis, no rioting or fantasies of doctors culling populations arose.

Certainly, such differences depended on multiple factors, which can be uncovered only through new comparative research, investigating attitudes and practices of ruling elites and medical authorities along with those of the poor, especially on sensitive matters of ritual and religion, such as the burial and handling the dead. In places, authorities appear to have learnt lessons, such as the reforms made by the (p.537) British for the provisioning of cadavers to anatomy colleges. In other places, such as Russia from the 1830s to at least the 1890s, elites instead stood fast to the same accusations, blaming the disease on the poor, castigating their supposed ‘ignorance’ and ‘superstitions’, and creating their own mythologies that labelled any cholera disturbance the work of outside agitators, while the state imposed heavier controls and harsher repression.

Similar measures by local and national authorities continued to provoke distrust and cholera unrest in Italy. From the first cholera wave in Italy in 1836–7 to the last major one in 1910–11, local authorities prohibited non-elites from performing their traditional burial rites, visiting afflicted friends and relations, and viewing the bodies of loved ones before burial, while elites were allowed to bury theirs in traditional church grounds. Such class-based impositions supported fears that doctors and the state were murdering the poor. Seeing their relatives unceremoniously ‘thrown into ditches’ of newly created cholera grounds, the popolo of Ostuni rioted in 1837. In 1910, the state’s class-based burial restrictions remained in place, and fears of poisoning and burials alive resurfaced. In mid-November, Ostuni’s collective violence exploded beyond any of its previous incidents: 3000 in a town of 18,500 wrecked the cholera hospital, ‘liberated the patients’, burnt down the town hall and health department, took possession of the town square, attacking health workers, stoning carabinieri, and destroying doctors’ homes.

On the other hand, other places succeeded in quelling fears and distrust, which could have sparked social violence among populations unaccustomed to hospital care and where mythologies of doctors plotting to poison the poor already existed. Such was the experience during yellow fever’s 1905 finale in Louisiana’s bayous. Recently arrived Sicilian peasants, working the sugar plantations and imbued with cholera fantasies from their homeland of little more than a decade earlier, initially resisted doctors and fumigators entering their homes. In Old World fashion, they accused them of spreading the disease to cull their numbers. Through door-to-door canvassing by Italian-speaking neighbours and priests, and letters and lectures from trusted community leaders, their fears, however, faded: threats of collective violence turned to disease prevention.

A Model for Epidemic Diseases?

Few scholars have pointed to which diseases in the past or which of their characteristics were likely to spark social violence. Margaret Humphreys has delved deeper than others, arguing that childhood diseases and those that were endemic, despite being big killers—diphtheria, scarlatina, whooping cough, dysentery, typhoid, tuberculosis, and influenza—were not prone to ignite blame or hatred. Instead, those that struck suddenly and disappeared quickly were the socially dangerous ones. At times, this was certainly the case. However, America’s socially most toxic disease—smallpox—was an endemic disease with epidemic outbreaks, and children more than adults were the victims. The same goes for poliomyelitis, which in 1916 was blamed on the poor, ethnic minorities, and victims of the disease, or (p.538) their mothers. As for diseases that struck fast and vanished rapidly, this theory only partially works with cholera and plague: plague after 1348 and into the sixteenth century provoked no riots and rarely social loathing. Moreover, with modern plague, collective violence was confined mostly to India and the years 1896 to 1902, well before the disease reached its heights in the subcontinent. Other epidemic diseases also rose and disappeared quickly, such as yellow fever and the Great Influenza, which in many places wreaked its havoc within a month. Yet, these failed to spark mass violence or social victimization of the diseased victim.

Three further characteristics may have influenced epidemics’ potential for hate and social violence. First, diseases that kill quickly such as cholera (in a day or two), plague in medieval and early modern Europe (in two to three days), and modern plague (around a week in bubonic form, twenty-four hours in pneumonic form, and less with septicaemia) could all provoke hatred, blame, and rioting. Yet fast killers, such as yellow fever (within a week) or influenza in 1918–20 (often within forty-eight hours) did not rouse violent recriminations. By contrast, smallpox, whose record of hatred and violence arose only in the late nineteenth century, was usually a slow killer. Second, diseases with signs and symptoms that produced reactions of disgust also could spread hate and blame. Here, the prime candidates were smallpox, leprosy, and syphilis and other venereal diseases that engulfed early modern Europe. But as we have observed, leprosy during the Middle Ages until the mid-nineteenth century rarely ignited hatred and sparked mass slaughter only once, in 1321, when no epidemic of it raged. Similarly, neither syphilis nor other venereal diseases spread blame or persecution of their victims until late into the sixteenth century and then it was limited mostly to England. Of the diseases renowned for disgust, only smallpox engendered popular hatred or rioting and this occurred principally in the US and only by the late nineteenth century.

Finally, lethality (and certainly not mortality) was a key variable. Lethality rates of medieval and early modern plague were high. As calculated from lazaretti records, they could range between 50 and 90 per cent and remained as high with modern plague until the diffusion of antibiotics. Cholera’s rates were also high, usually over 50 per cent into the twentieth century, as were Ebola’s in West Africa in 2014–15.2 With both diseases, this lethality sparked repeated claims by victims’ friends and families: ‘Here, if the people come into the hospital, they don’t leave alive.’ And for both, these suspicions led to deadly consequences for doctors, health workers, and police. In addition, with cholera and Ebola, as well as plague in India, anger arose when health workers tried to disrupt traditional rituals of dressing and burying the afflicted. Yet as the recent history of Ebola in West Africa has shown, along with examples in this book stretching from Mumbai’s slums to Louisiana’s bayous, relations between governors and health (p.539) boards and the communities of victims were crucial. When the latter were permitted to negotiate and participate in measures such as search parties, the rioting and assassinations ended. While this book knows no easy answers, it has uncovered parallels and stark differences over the long history of epidemics. Just as different diseases affect our bodies differently, so too they have affected differently our collective mentalities.


(1) I know of only one riot during cholera’s first wave. In Manila, 9 October 1820, thirty to forty Europeans and eighty Chinese were massacred; Peckham, ‘Symptoms of Empire’, 192.

(2) By contrast, lethality rates of yellow fever and especially influenza, even the Great One, were much lower. In places with repeated strikes of yellow fever, mild cases arise that often go undetected. Even in severe epidemics like Philadelphia’s in 1793, estimates of lethality are less than 20 per cent.