Madeline Laguaite: Hello and welcome to "To Health and Back," a podcast about how health, medicine, and wellness decisions from the past help inform us today. I'm your host, Madeline Laguaite.
Laguaite: In this episode, we're talking about early pandemics and epidemics, and what some of those earlier outbreaks can teach us today. We'll hear from Dr. Nan McMurry, the director for collection development at the University of Georgia libraries. She earned a doctorate in the history of medicine and teaches in the UGA History Department on a part-time basis.
Laguaite: So I actually met Dr. McMurry through a class I took with her during my undergraduate career here at the University of Georgia. It was called the history of medicine. And in truth, the material we covered in that class and Dr. McMurry herself inspired this podcast, so I thought she would be the perfect first-ever guest to talk for this episode about earlier outbreaks and how they can relate to the pandemic we're living through.
Laguaite: From the Black Death in the 1300s, to outbreaks of cholera in the 1800s, to the current COVID-19 pandemic today, experts that study the history of medicine say the one thing that doesn't change is human nature. Here to talk about that human nature with us is Dr. Nan McMurry. Hi, Dr. McMurry, and welcome to the show.
Dr. Nan McMurry: Hey, how are you?
Laguaite: I'm good. How are you?
McMurry: I'm good, too. It's been a long time.
Laguaite: I know, I know.
McMurry: So I'm Nan McMurry and I have kind of an unusual job at UGA. My primary responsibility is in the university libraries, and I'm the director for collection development and collection development is the part most people have never heard of. It's the part of the library where we choose the materials we're going to have in the collection, so books or journals or databases. There are real human beings who do that, not robots. And so we have a team of people, and I'm the head of that team. But I also work directly with certain subjects.
McMurry: And then because I have this academic background, where my doctorate is specifically in the history of medicine, I've been able to teach on kind of part-time basis in the history department. So that's how my class that you took came about.
Laguaite: OK, awesome.
McMurry: You might think that somebody like me would really find living through a pandemic now really— I mean, I find it interesting, but I don't find it fun. You know, it's kind of a little lesson that I learned, ooh, this isn't so good to be in the middle of it.
Laguaite: OK, so you've studied all sorts of earlier outbreaks, epidemics, and pandemics. What are some of the things that stand out to you most, especially with regard to human nature?
McMurry: You know, our medicine and our public health and the knowledge and the technology have changed a lot, but the human nature? Mmm mm. That's been really striking to me watching this pandemic unfold is just how little we've changed in our attitudes, and our fears. We tend to think, 'Oh, we're so invincible with their science.' But when you have a new disease, that medicine and science are not as effective against or not as effective right away, then all those old attitudes come right, right out of the woodwork.
McMurry: Here's a historical example. It's so easy when you look back in the past to say, 'Oh, yeah, that was so dumb.' And yet we do it all the time. So there's a particular smallpox epidemic that happened in 1721 in Boston, and smallpox came in onboard a ship. And the captain of the ship steered the ship away from the docks and onto an island where it could be isolated with this person who had smallpox. But then there were other sailors on board who said, 'I'm not sick. Oh, you know, I've been at sea a long time and I want to have some fun.' So they sneak rides on little boats into town, and party it up and mingle and all that, and then they go back to their ship, and oops, then they come down with smallpox. So that's how smallpox got into the city and caused a horrible epidemic. And it's that kind of thing where people are just thinking about, 'Well, what do I want?'
Laguaite: Dr. McMurry said there are plenty of striking similarities to earlier outbreaks and the COVID-19 pandemic that come to mind.
McMurry: Well, let's pick a cholera epidemic, for example.
Laguaite: OK.
McMurry: So when cholera was ravaging Europe, in England in 1832, Americans knew about it because there were newspapers and they were aware of what was happening, but there was kind of a complacency like, 'Oh, we have the big ocean between us.' There were two kinds of complacency, so 'the ocean will save us.' And then the other complacency was, 'Well, cholera is just a disease that affects poor people, and we're Americans and we don't really have we don't have those kind of masses of poor peasants and city dwellers. We have sturdy, American farmers.' American exceptionalism, basically another form of that.
Laguaite: OK.
McMurry: And so a lot of people thought even if cholera made it across the ocean, it wouldn't be a problem, because Americans would just fight it off. And I think we had not exactly that attitude, but I think we were a little too complacent about the excellence of our public health, that— because you remember all that, 'Oh, it won't come here. Oh, it won't make many people sick. Oh, it won't be a big problem.' There was a lot of dismissive—and not so much among our public health officials, but among some other people—that it wouldn't be a problem. And it turned out to be a terrible problem, and we lost the opportunity to get on top of it early.
Laguaite: The way in which authorities communicate risk is similar to whether it's a natural disaster like a flood or a pandemic, the central concepts of risk communication are present throughout history.
McMurry: A parallel that kind of cuts through all epidemics is, the first thing your authorities will tell you is there's nothing to worry about, sort of every time. And sometimes newspapers or the news media will suppress it as well, sometimes not. Sometimes they're right out there, investigating and revealing but smallpox epidemics, yellow fever epidemics, even the plague, where they tried to be communicative with each of the towns and say, 'Oh, there's plague. It's coming.' Usually, you tried to keep it a secret until it was sort of impossible to keep a secret, then you'd admit 'Oh, yeah, by the way, we've got plague.'
Laguaite: But why try to keep things quiet?
McMurry: There's several reasons communities do that. And one is just leaders always assume that people will panic if they're told the truth, and maybe they would. But when they're not told the truth, all kinds of other things go wrong. So you know, I don't know what the answer to that is. But it's particularly disheartening to be told there's nothing to worry about. And then any choices you might have made at that stage—if you had been told there was something to worry about—aren't available to you anymore.
McMurry: But the other reason, at least in the past, that leaders and news media, will try to keep it quiet, it was because of the economic impact. So as soon as you admit you've got a deadly disease in your midst, well, a bunch of people are going to leave town, first of all. And who can afford to leave town? Wealthier people who run the businesses. If they all go, then the people who are left not only are having to face a disease, but they don't have any way to make a living. So you know, it was terribly disruptive to cities to communities. But also, as soon as everybody else gets wind that you've got a disease, nobody's going to do business with you. You sort of cut yourself off or somebody else cuts you off. But that would be another reason for trying to keep it quiet.
Laguaite: Who people should turn to for advice during a public health crisis is another long-standing debate and an issue that was relevant centuries ago.
McMurry: This is another smallpox connection. So in the 1700s... I mean, the normal response to an unfamiliar or just any disease, a scary disease is, is to run away if you can. That's a very common thing or to or to try to avoid it anyway, shut yourself in your house or shelter at home, all those things we're familiar with. But in the 1700s, they came up with a treatment that was called inoculation. I mean, it's kind of confusing, because we use that word today. But what they meant back then was actually giving somebody a real case of smallpox, not a safe virus or anything.
Laguaite: Got it.
McMurry: But the idea was they had seen that some cases of smallpox really were mild and you weren't very sick, and then you were immune for the rest of your life. So some people thought if they could figure out a way to control it so that you got a mild case, it was a risk that—it wasn't perfectly safe—but it was a risk worth taking. And of course, this provoked a huge debate because you were giving people something that could kill them. So all of that just to say, a feature of the debate was who really ought to be the authority to speak on this.
McMurry: And I think that's something we've seen over and over again with COVID. It's interesting, in the case of the smallpox epidemic, it was actually the ministers, the religious figures and leaders of the time that were saying, 'Let's try this new technique.' And it was the doctors who were saying, 'No, that's dangerous.' Which is exactly opposite of what you would expect. But in today's world, we've seen a lot of that where we have scientists who know what they're talking about. They don't know everything, and they have to revise what they say, but they sure know a lot more than I do.
McMurry: But who are we listening to? We're listening to politicians who feel perfectly free to say whatever they like and to think that they are well informed. Why do they think that? Or celebrities, there's so much celebrity culture. 'I'm going to do what my favorite movie star does.' So that whole question of whom should you listen to?
Laguaite: Even the concept of quarantining—a concept I wasn't really familiar with until I had to quarantine for 10 days during the novel coronavirus pandemic—has been used as a preventative measure since the 14th century, with the spread of black death.
McMurry: Yeah, so so that's a really interesting point because I remember reading back last summer, somebody was complaining about our public health response. And they said, 'It's just been so medieval.' And I thought, 'Oh, don't be so...' you know, because it's really during the Middle Ages that a lot of our public health—the things we do for public health, even today. We've evolved a lot, but those basic ideas of yeah, quarantine. And that's not to say that those things weren't ever done before. But it's really the experience with the plague that sort of cements it in places. This is the way you try to keep your community safe.
Laguaite: That's not to say that quarantining in the Middle Ages is the same process as today. Still, the general principles are there.
McMurry: You know, the first thing you would try to do was find out if plague was headed your way. And so some communities like like Venice is a really good example would basically send out spies, because Venice was sort of a... we think of it as a city, but in that time, it was it was a big city state that spread over a big region, almost like a country. And so the Venetians, they have this trading empire, and they were always on the alert for, and they're also kind of on the frontier with the Ottoman Empire and the Holy Roman Emperor Empire to the north. And at least the Venetians thought that those two empires were really slack about keeping the plague away. So they sent their own agents or often merchants to say, 'Keep your ear to the ground. If you hear about anything, we got to know about it.'
McMurry: So they were very vigilant about where plague might come from and about setting up border crossings and making ships quarantine in the harbor. They had all kinds of things they could do. So they would also do things with travelers. They had things that you can think of as health passes. If you were a traveler, it's kind of like having a COVID test today: 'Look, see? I'm negative. I'm safe.' They would just have some kind of document that you could carry with you if you're traveling during plague times and say, 'It's OK, I'm safe. You can let me in your town.'
Laguaite: But what if all of those preventative measures fail?
McMurry: If all that failed, and it often did, and you get a plague outbreak in your own town, well, the first thing they would try to do is isolate people in their homes. So that's another kind of quarantine. And so when we say that we generally mean... I mean the myth about it is, 'Oh, people were shut up and locked in and left to starve.' Well, no, it just meant they tried to keep you from coming out of your house. But you could still have somebody bring food to you or that kind of thing. And sometimes people sneaked out anyway.
McMurry: It was a good idea, except that the plague is really being spread via the rats and the fleas. So even if you keep the people apart, the disease tends to still spread. If keeping people in their homes wasn't doing it, then the next thing they would often do when they got just too many victims all over the town, then the next thing you would do would be, try to put up a plague hospital and isolate people there. Partly from the standpoint of, 'Well, we can care for people better if they're all together,' but also from the standpoint of, 'Let's put them all together where they can't spread it to the rest of us.' And that tended to be more people who were poor or otherwise powerless. If you were wealthy and you lived in your big mansion, they probably weren't going to drag you away to a plague hospital, you got to stay home. But yeah, so they had a lot of things that they would try to do. And there was the same kinds of turmoil over like, say they do want to, 'Let's start a hospital for these people,' then there would be, 'Well, not in my neighborhood. Not in my backyard. You can't use this building.' There's that same kind of conflict that we see today.
Laguaite: While many people usually look down upon past health measures, she said we can and should look at our own current public health system through an equally harsh lens.
McMurry: And when we say, 'Oh, yeah, but those things didn't work because they kept having plague outbreaks.' Well, yes. But then you can't measure the epidemics that didn't happen. You can't say those didn't happen because of the quarantines. You just don't know. It's just always interesting to me that we're really quick to criticize people in the past and say, 'Well, they had quarantines but they didn't work at all,' and seeing that as a failure of public health. We've got a COVID pandemic all over the world. Does that mean our public health efforts are totally useless and misguided? No.
Laguaite: Even though the outbreaks, epidemics, and pandemics we've been talking about happened centuries ago, Dr. McMurry said there are many lessons we can take from them.
McMurry: [We need] to think really, really, really carefully about the kind of communications that are done. I know I know people can react in really crazy ways. I mean, people who are going to react in crazy ways are going to do that anyway. And there are other people who are really concerned and intelligent and conscientious. How about tell them?
McMurry: And I think it's also really hard for people to understand that an epidemic is always an evolving thing. And so you're told one thing today and something different tomorrow. Well, sometimes that's because people have been trying to withhold information, but sometimes it because they just don't know. They're doing the best they can at any point along the spectrum. If leaders would communicate better with the rest of us, and if we would understand that they don't know everything, and the situation is going to change and have some patience and compassion about that... It's just so hard.
McMurry: And I think another thing would be—this cuts across way more than just medicine—trying to be prepared for bad things to happen. Because if you go a long time with no bad things happening, you tend to get complacent, and nobody wants to spend money on something that might not happen. So natural disasters, we could be better prepared for that. We can't always predict them or prevent them, but we could be better prepared to manage them. Same thing with a disease outbreak, it's a kind of natural disaster, but it's sort of a different kind. Some of the sorts of public health infrastructure that we've had in the past that cost money to be well prepared. Don't let that go away. That's worth spending money on, and try to educate people to say that, if we don't have an outbreak of disease, that doesn't mean that somebody was just trying to scare you. It means that your public health worked, and value that instead of just saying, 'Oh, we put all that tax money into something that never happened. Well, yeah, that's exactly what you want to happen.'
Laguaite: During the COVID-19 pandemic, xenophobia and blatant discrimination toward Asian Americans in the U.S. was a huge issue. In fact, we have an upcoming episode specifically on xenophobia that we've seen in the U.S. this past year. But as it turns out, that was an issue in the past too, and it's one of the most valuable lessons we can apply to today's pandemic.
McMurry: Well, you know, I guess another thing would be try to avoid blaming people for— because you were talking about discrimination against Asians for this. You know, using ugly words like the 'China virus.' Nobody can help where it comes from.
McMurry: So like with yellow fever, because most people who had it who lived in the South in the 1800s, in, at least in these cities, where yellow fever would tend to occur, would often have had... And this is another parallel with COVID. A bad case of yellow fever has really striking symptoms. But a mild case of yellow fever is no different from any little flu kind of bug with a fever and aches and pains, but then you get over it in a couple days. And you have immunity after that. So a lot of people were immune without even knowing it or thought that their protection derived from living in a particular place for a long time. They didn't know about viruses, and they didn't really know about immunity, but they knew if you had grown up in someplace like New Orleans, you weren't likely to get yellow fever.
McMurry: So what that meant was that they would blame it—they would call it a stranger's disease—and they would blame it on immigrants, or anybody who had lived there a long time. You know, these people are saying, 'We would be fine if we didn't have all these extra people coming in among us,' and so I mean, that was a reality in the sense that people who had never been exposed to yellow fever before are more likely to get it. But it wasn't their fault, and they didn't bring it on purpose. So that kind of thing is very discouraging when you see that still happening today.
Laguaite: Dr. McMurry said another critical lesson we need to consider is being aware of how outbreaks and pandemics like the COVID-19 pandemic affect different populations disproportionately.
McMurry: If we could be more aware and sympathetic to how epidemics affect different parts of the population... That's been brought home to us and that people who are frontline workers and often people of color are in that category. If a new disease is affecting them more, well, respond to that. It's kind of a legacy, really, of blaming diseases in the past on poverty, not in the sense of oh, in a sympathetic way, but in a 'these people are dirty and ignorant and lazy and they don't care. They don't bother to keep themselves clean or try to avoid disease.' All of that kind of negative thinking.
McMurry: Even though if you ask somebody, 'Is that what you think today? They say, 'Well, no, of course not.' And yet, I feel like it's in the background somewhere, that when people who maybe don't look like you are getting sick, it's a little too easy to dismiss it or to say, you know, to sort of use the same excuses, some people use, 'Well, you didn't try hard enough' or 'You made bad choices.' Those kinds of lines that we hear a lot sometimes migrate over into the disease world as well. And that's just really unfortunate. I wish we could confine ourselves to scientific ideas and think about how the diseases really spread. If they are more prevalent in a particular population, there's a reason for that, and that reason's probably not moral.
Laguaite: Now, there have been a lot of comparisons drawn between the COVID-19 pandemic and the 1918 influenza pandemic lately, because there are tons of similarities there. It's interesting to think about how historians will look back on this pandemic, and Dr. McMurry, can you shed some light on this hypothetical?
McMurry: Yeah, I've thought about that. I think there'll be that tendency to pass judgment and say, 'With all of their scientific prowess, why did this disease have...?' They will be analyzing our failures, so to speak, and they won't be fair about it, because I don't think people will become better at judging human nature in the future than we are now. That will still be a problem. So it's good that they will analyze it that way and see where failure occurred where it didn't have to, but at the same time, any new disease or any big scale pandemic, people do the best they can, most of the time. I mean, yes, there are these negative attitudes and problems and things that go wrong, but most people are trying really hard. And I think the situation is evolving so quickly, in terms of what you know, and what you're able to do. And the future will not be forgiving about that. Because by that time, it's all over and they see hindsight and they see a final outcome, whereas we're still right in the middle of it.
McMurry: You know, I think they will judge our inability and our unwillingness to do fairly simple things to stay safe. And that is still just mind-boggling to me. I just don't understand that attitude of, 'Yeah, but you know, I haven't been out to eat in a really long time, so I'm just gonna go.'
Laguaite: Right.
McMurry: I think in the future historians, or whoever it is, will be just kind of astonished in, like, we look back at the Black Death. And we see things like persecution of the Jews or the flagellants who went around beating themselves. We see bizarre things like that that we just can't count for. Well, I think in the future, people will look at like refusal to wear a mask, and the way that became politicized, and that people would actually harm each other, kill each other over being asked to take simple precautions. They'll lok back on that and they'll say, 'Oh, how medieval,' which is still unfair. So it's kind of a mixture of saying, there will be some things that we really couldn't help and we did our very best that we'll get criticized for, and then there'll be other things where we absolutely deserve condemnation of posterity.
Laguaite: Well, thank you so much for talking with me today, Dr. McMurry. It was so good to hear from you.
McMurry: You bet. Bye.
Laguaite: Just because human nature hasn't changed much doesn't mean that we're doomed to make the same mistakes today. Being aware of some of these past public health situations and responses should help inform the decisions we make today.
Laguaite: As new variants emerge, public health officials continue to urge people to wear a mask, stay 6 feet from other people who don't live in your household, and to avoid crowds.
Laguaite: This has been "To Health and Back." Thanks again for joining me on this health history journey. Tune in next time for a discussion on the history of mask wearing. Until then, don't forget to rate the podcast and subscribe. And feel free to shoot me an email at healthand [email protected]. I'm also on Twitter, Instagram and Facebook as @healthandback. See you guys next time.