Üsküdar Üniversitesi Faculty of Medicine organized a seminar titled “A Historical Perspective on Epidemics.” The speaker of the event, moderated by Dr. Zozan Güleken from Üsküdar University Faculty of Medicine, was Prof. Dr. Haydar Sur, Dean of Üsküdar University Faculty of Medicine. Referring to the history of plague and smallpox diseases, Sur stated that over 60 million people lost their lives in the great plague epidemic of 1788.
“The history of plague is as old as human history”
Prof. Dr. Haydar Sur stated that in ancient times, plague epidemics were sent from times when Gods were very angry and attempted to impose deadly sanctions on humankind; “The history of plague is as old as human history. Very old writings on plague are not regular and do not speak of plague to the reader. Many epidemic records from ancient and medieval times are thought to be diseases other than plague. The people of these ages named every great epidemic disease 'plague'. The first known written record regarding a plague epidemic is in the Torah. It is recounted that the plague that emerged in Achdad, a coastal city, spread inland, and 50,000 people became ill or died because of it. Plague appeared as an epidemic many times over centuries. In 68 AD, there was a Roman epidemic. To describe the severity of the epidemic, it was enough to know that more than 10,000 people died daily. Plague epidemics also occurred in Rome in 79, 125, and 164 AD. In 224, the plague again caused a severe epidemic; according to records, half of the population of the entire Roman Empire died. Records indicate that the great physician Galen fled the country due to the disease. The first plague pandemic occurred in 542 AD in Egypt. The Egyptian city of Palesium was an important trade center on east-west trade routes. The epidemic followed trade routes, spreading from Susa and Constantinople to Ireland. The 6th-century Roman writer Procopius described and depicted the skin symptoms of the disease so accurately that any health professional reading it today could immediately understand that the disease was plague. Procopius wrote that at the peak of the epidemic's severity in Constantinople, the daily death toll from the plague reached 5-10 thousand.” He said.
“Over 60 million people lost their lives in the great plague epidemic”
Sur stated that for 8 centuries following this severe epidemic, the civilized world of that time did not see plague; “In the mid-14th century, the plague returned to Europe, following trade routes. The horsemen of the plague in black attire, according to the people of that time, sent people to the other world, reaching city to city with lightning speed. The disease is known to have started in a remote corner of Central Asia and reached the shores of the Black Sea in the spring of 1346. From there, it is said to have passed to Constantinople, and then to Genoa and Venice. In the spring of 1348, it reached almost everywhere in Europe. The pandemic lasted a few years and then subsided. The epidemic of 1388 was very devastating. The methods of protection from this epidemic, still recounted orally, were unknown under the conditions of the time. The dead, the sick, and the healthy lived together, piled on top of each other. The situation led to great demoralization and panic. Eventually, an interesting reason for the disease was found. The Jews had poisoned the land, wells, and air. In Europe, the greatest genocide witnessed by history began. In the city of Basel, 2,000 Jews were burned alive, but the city of Mayence gained the record for burning the most Jews in a single instance with 12,000. The Jews were gone, but the plague was not. It was not difficult to find new culprits. The spreaders of the disease were grave diggers. Even though they only buried charred bone remains, who else could be guilty? Then, attacks by unconscious masses of people on the disabled and beggars began all over Europe; they were called 'The Cursed by God'. When Pope Clement V tried to determine the number of deaths from the plague, the number he found was 42 million 836 thousand 486. However, the real number was over 60 million. In China alone, the number of deaths exceeded 13 million. For the European continent, the number was around 25 million. Later, the plague caused what could be called smaller epidemics in Europe. Epidemics were seen between 1377-1403. However, there were no large-scale outbreaks. Then, Europeans discovered the practice of quarantine. This is the Latin word 'Quarantine', meaning "fortieth". Passengers and crew of ships arriving from the high seas were kept in special buildings or inside the ships for 40 days, without interacting with anyone. This practice was very effective against the plague, and apart from a few isolated cases, there was no longer a plague epidemic in Europe. Europeans called other epidemics 'plague epidemics'. ” he stated.
“Smallpox is actually an Asian and African disease”
Sur stated that Islamic Physician Razi (Rhazes) was the first to differentiate and describe smallpox from measles; “Razi noted that the disease was prevalent in Eastern and Islamic countries. Before Razi, there is evidence showing that smallpox appeared in China and Egypt in the years when written history began (4000-3000 BC). In the 6th century, smallpox was well known in Europe and the Near East, caused an epidemic in Arabia towards the end of the century, and spread from there to Europe, devastating France and Italy in 570 AD. Father Marius, who documented the situation, was the first person to call the disease 'variola' in Latin. Smallpox is actually an Asian and African disease. The reason for its spread to Europe was the Crusaders. Although the disease has been known for centuries, it was still confused with scarlet fever, chickenpox, and later syphilis. While preventing the disease, recovering if infected, and surviving with minimal smallpox scarring were always considered important measures, they were not very successful initially. Meaningless types of treatment were tried to prevent smallpox, such as dressing in red clothes, and using red covers and curtains. In the 18th century, it was known that 60 million people died from smallpox in Europe. Epidemics occurred every few years in Europe. As survivors gained immunity, 80 percent of the European population at that time had acquired immunity against smallpox. Of course, at that time, the formation of immunity was not known. Smallpox was common not only in Europe but throughout the world. In China, it affected children and infants so severely, and the mortality rate was so high, that mothers did not count their children who had not yet contracted smallpox among their total number of children.” he said.
Smallpox immunization method
Sur stated that popular intelligence always worked practically; “People would transfer the disease from someone who had a mild case while they themselves were strong and healthy. They survived death with a few smallpox scars on their faces. Smallpox is the first disease to bring the idea of immunity or similar protection to humankind's mind. Europeans also learned this practice through the method of a Venetian physician living in Constantinople. The physician introduced the method to Europe in 1713. The method of immunization against smallpox did not enter Europe through medical channels. What slowed the transfer of Eastern immunization to Europe was the widespread folk medicine knowledge against this disease in Europe. The beginning of this event was Lady Mary Wortley Montagu, the wife of the British ambassador in Constantinople, writing a letter to her friend in London about this practice she observed in Constantinople. Lady Montagu applied to the court to prove its success. The court experiment on 7 condemned prisoners was successfully concluded, and vaccination began. The spread of smallpox in America was terrifying. No disease in history had caused such devastation. Germ warfare is also considered an invention of the 1900s. The first application of this warfare is seen among the Native Americans in Canada. A British commander, to defeat the Native Americans, threw smallpox-infected blankets outside the fort and gave them to the Native Americans, and 6 million of the Native Americans, whose numbers were thought to reach 12 million, were annihilated.
“The solution found for smallpox is one of humanity's greatest victories”
Speaking about the resolution of the disease, Sur said; “There was no guarantee that the disease would be mild in a person vaccinated once. Although Jacob Castro found a method of transferring the disease from a vaccinated person to a candidate for vaccination in 1721, this method never became widespread. The problem was solved by an Englishman named Edward Jenner. Today, smallpox no longer exists on Earth; this outcome can be called one of humankind's greatest victories.”