No, We Haven't Lived with Diseases for Millions of Years. They've Killed Us.

A history lesson.

Richard Miller

You almost never hear about the yellow fever outbreak of 1793. Wealthy slave owners brought it to Philadelphia that year, fleeing revolutions in the Caribbean. During its peak, a hundred people were dying every day. Back then Philadelphia was a city of 50,000 people. The city government collapsed under the pressure, and almost everyone evacuated. Doctors thought it was spread by rotting vegetables. They were wrong. It didn’t end until a cold front came through in October, killing off carrier mosquitoes. The death toll settled to 20 or so a day, and people began to return. In the end, the epidemic killed more than 5,000 people.

It was 10 percent of their population.

You hear this a lot: Apparently humans have lived with germs and diseases for millions of years. There’s no need for masks or vaccines. Nobody needs clean air. Natural immunity works just fine.

It’s wrong.

It couldn’t be more wrong.

We’ve never been able to live with diseases, not like we do now. Most westerners have no idea. Before medicine, life looked different.

You couldn’t even drink the water.

As an article in Scientific American points out, “water was unsafe to drink for most of human history.” According to Paul Lukacs, humans had to drink wine. It wasn’t fun, either. Ancient texts describe wine as “wretched, horrible, vinegary, foul.” The only thing worse was plain water. You often had no idea if it was safe to drink. For thousands of years, humans opted for beer and wine instead. There was just enough alcohol to kill germs. Even coffee had antiviral and bacterial properties, so it became a preferred beverage in other parts of the world.

When Jesus turned water into wine, he wasn’t throwing a party.

He was killing germs.

Scientists and historians from all disciplines agree on this point: For most of our history, our lives were short. Average life expectancy remained well below 50 for millennia. We didn’t get eaten by tigers.

We got eaten by plagues.

When you look at the last 2,000 years across the world, you see the same thing. About half of all children died before reaching adulthood. Scientists confirm this trend all the way back to the stone age. As Oxford scholar Max Roser says, “Whether in Ancient Rome, in hunter-gatherer societies, in the pre-Columbian Americas, in Medieval Japan or Medieval England, in the European Renaissance, or in Imperial China, every second child died.”

Epidemics have upended countless civilizations, from Rome to the Akkadian Empire. These societies didn’t just live with it. Death and grief played a central role in their cultures, because it happened all the time. It was a different world that most people today can’t wrap their heads around.

They didn’t shrug it off.

They chased answers.

History is full of doctors and scientists who devoted their entire lives trying to treat and cure diseases that plagued us. It’s also full of quacks and charlatans who made fortunes by selling fake miracle cures. There’s a reason why historical novels and movies feature apothecaries and snake oil salesmen. Almost everyone was sick or scared of getting sick and dying.

They got desperate.

Doctors even tried bleeding their patients. Women often bore several children to offset the astonishing infant mortality rate. Despite that, global population growth remained close to zero.

It was flat.

Politicians and billionaires complain about declining birthrates now. Well, that was the norm before modern medicine.

Societies didn’t grow.

They treaded.

Historians say we’re probably underestimating child mortality. During certain periods, it was higher than 50 percent. Every few years, an outbreak of disease drove infant deaths upward to 75 percent.

During the 18th century, big cities like London actually shrank due to awful sanitation and living conditions. More people died in a given year than were born. They relied on a steady stream of gullible migrants from the countryside. Raw sewage frequently contaminated the drinking water. Garbage rotted in the streets. Rats and fleas nested practically everywhere, even in rich homes. Graveyards overflowed. The city buried their excess dead in “poor holes” next to homes and businesses. If you lived anywhere near a cemetery, decaying corpses could leach into your wellwater and poison you. Nobody really understood how disease spread. Doctors operated with dirty surgical instruments and unwashed hands.

These conditions persisted through the 19th century.

In the 1830s, a series of especially bad outbreaks of cholera, flu, and typhoid ravaged London. Social activists and public health experts pushed for sanitation. The city finally started listening in the late 1840s. They passed laws and formed a board of public health. Even then, it took several more outbreaks to motivate investment in a modern sewer system. Politicians waited until the stench of human waste became unbearable in every corner of the city.

The 19th century was a brutal time.

As city populations grew, diseases flourished and wiped out millions of people. Most of them died in agony, without medicine or painkillers, literally puking themselves to death. The world spent decades fighting endless pandemics. Mortality rates for a disease like cholera ranged between 3 and 10 percent. At any given moment, there were three or four major killers circulating.

Before modern medicine, there was a good chance you’d die from plague, cholera, smallpox, typhoid, malaria, polio, flu, tuberculosis, or scarlet fever. Every single one of these diseases terrified people. Without treatment, you might as well flip a coin as to whether you’d live, die, or wind up with lifelong illness. In many places, life expectancy hovered around 40.

Diseases have always hit the poor worse than everyone else. Throughout history, the rich have invested in sanitation for themselves first while leaving everyone else behind and blaming them for their own deaths. According to an article in Science, “the mortality rate from infectious diseases among nonwhite people living in the U.S. was a shocking 1,123 deaths per 100,000 people.” That’s more than the death rate for white people during 1918 flu pandemic. As one sociologist says, it was like living through the 1918 flu, every year.

The last 100 years changed everything.

We’ve developed vaccines and treatments. We’ve learned how diseases spread. We’ve educated the public on sanitation. We’ve done it despite resistance from a vocal minority who thought it wasn’t necessary or couldn’t be done. They wanted us to keep watching half our children die every year.

We made major progress.

Now we’re backsliding.

Life expectancy is falling. Infant mortality is rising. Vaccine skepticism grows by the year, egged on by sociopaths in politics and media who think they’re practicing their free speech. We face crucial shortages of antibiotics and other drugs, with predictions we’ll run out later this year. Healthcare workers are quitting. ER departments are closing over staffing shortages. Everywhere you look, the healthcare systems we spent generations building are falling apart.

That’s not fear talking.

As history shows, we’ve been here before. We’ve seen life without vaccines and masks. We’ve seen life without clean air and drinkable water. That’s how humans lived for 95 percent of our existence.

We hated it.

Humans invested in public health and sanitation because they got tired of dying from diseases. They dragged their leaders kicking and screaming into public health, after it became painfully clear there was no alternative.

Well, here we are again. It would be nice if we could pay attention to history instead of constantly repeating it.

We don’t have to speculate about what our dystopian future looks like. It’s a return to the 18th and 19th centuries when life expectancy hovered in the mid 40s and deadly outbreaks of diseases shut down entire cities and civilizations. The only difference is that many of us will remember a brighter past.

A massive reinvestment in public health would stop this, but it can’t be just for rich people. It has to be for everyone.

We’ll see.