8. Religion and tradition: health below or heaven above?
Religion and health care
Religion is often criticized for offering its adherents “pie in the sky when you die.” But do religions really hold the loyalty of their followers by offering an afterlife? Few religious believers, however devout, seem overly enthusiastic about moving onward and upward to paradise. I argue that whether a religion is successful in practice depends on protecting its followers from the hazards of life on planet Earth. For most of history, infectious disease was the major killer, so how religion responded to disease was a crucial aspect.
We must distinguish between the supernatural and natural aspects of religion. Most religions offer prayers for the sick. In addition, most religions perform rites designed to prevent infection or cure disease. The intent in either case is to invoke supernatural intervention on behalf of the patient. Religious believers might accept these procedures as supernatural and believe that they cure disease, even if they do not work.
In contrast to these supernatural aspects, religion also provides physical benefits to health, whether consciously intended or not. Religious rites, such as those for segregating the “unclean” or for removing ritual impurity by washing, often promote hygiene. These measures work even though the practitioners might not understand how infections are transmitted and are not even attempting to prevent the spread of disease. Whether dressed in religious trappings or not, medical care, nursing, and hygiene benefit the sick. Survival of the sick is noteworthy, and if any gods were invoked during the health-care process, they receive credit.
Today in advanced nations, religious faith is dwindling. One factor could be that infectious disease is largely a thing of the past, and religion can do little for heart disease and cancer. Miraculous healing, as a formal part of religion, is often mocked nowadays, even by those who attend church. Yet Christian denominations that merely provide moral guidance and bingo sessions are losing their congregations. Despite its primitive aura, physical healing is in many ways the heart—or the lungs and liver—of religion. After all, if an omnipotent god truly exists, miraculous healing should present no problem.
Meanwhile, in many third-world countries, Christianity has displaced traditional religions. When people saw their own culture as inferior to European civilization in terms of life span and infant mortality, many concluded that the Christians’ god must be more powerful than their own. They then switched allegiance. Today, Christianity is numerically the largest religion, with Islam second and gradually closing the gap.
Belief and expectation
Why do some disasters shake religious beliefs while others have little impact? Expectation is a major factor. If you mostly live on hot dogs and hamburgers, you view steak or lobster as a treat. But if you live on cornmeal and greens, as many poor Africans do even today, a hamburger is a delicacy. All things are relative. Animals and humans respond not to constant stimulation, but rather to changes, whether in temperature, noise, diet, or prosperity.
If you live in a society where infant mortality is greater than 50% and life expectancy is around 30 years, you are used to losing friends and relatives at an early age. In medieval England, children were not usually officially named until they had survived their first year. Mortality was so high that families avoided getting overly attached to newcomers whose chances of lasting a whole year were less than even. In contrast, in our modern industrial society, with life expectancy at over 70 years, we do not expect children to die before adulthood, and when this does occasionally occur, people become deeply upset.
When a virulent epidemic rages through a population, its effects on religious faith depend on how long people normally expect to live and how frequently they expect to lose friends to infectious disease. Diseases such as malaria that take a steady toll each year in areas where they are endemic do not shock society. Endemic diseases are part of the natural scenery and are viewed much as other constant natural problems, such as the cold of winter or the barrenness of the desert.
In contrast, virulent epidemics resemble earthquakes or hurricanes. An epidemic of bubonic plague gallops through society like the four horsemen of the apocalypse. Within a few weeks, half the population is dead and the corpses are piled too high for the survivors to bury. Society goes into communal shock. Religious belief is threatened. People might lose faith in their gods and look for other, stronger deities. Alternatively, they might blame their priesthood for failing to intercede successfully. A third possibility is that the priests might convince the people that the plague is divine punishment for sins committed by the people or their rulers.
Observations on surviving hunter-gatherers illustrate the link between disease and religious rites. For instance, the majority of Navaho ceremonies concern disease, and a typical Navaho spent 25% to 30% of his waking time on religious activities. Among the San of the Kalahari Desert, the curing dance is the most important ritual. After entering the spirit world during a dance, the shamans plead with their god to cure the sick. In addition, the shamans chase away the evil spirits of the dead, who are believed to shoot the living with invisible arrows of disease.
Roman religion and epidemics
Before the days of the empire, the Romans responded to a series of severe but not devastating epidemics by switching their loyalty from the original Roman gods to Apollo, the Greek god of healing; then Asklepios; and finally Hygieia. Later, when the Roman Empire was devastated by a series of catastrophic plagues, the whole fabric of Greco-Roman polytheism came apart. Thus, between 150 and 500 A.D., the population of Rome fell from roughly one million to a mere 60,000; from 250 to 500 A.D., the population of the empire dropped by half after successive epidemics.
In the early days of the Christian era, there was a massive emphasis on caring for the sick. Undoubtedly, such care greatly reduces the death rate for many diseases such as smallpox, typhoid, and malaria. Although these diseases are life-threatening, the death rate can be as low as 10% among patients who are kept clean, dry, warm, comfortable, and supplied with food and drink. Victims of the same infections who are shunned and left to fend for themselves are much more likely to die. Unlike many others at the time, the early Christians were willing to take the risks of nursing the sick, and their God was credited with great healing powers as a result. The Black Death is a different story. For those infected with bubonic plague, nursing has little effect. Ebolavirus is the same way. Outbreaks of swift, high-mortality diseases such as these proved beyond the control of man or god.
Infectious disease and early religious practices
If we regard disease as the consequence of sin, as many ancient cultures did, we might interpret the Garden of Eden as a memory of the disease-free days before urbanization spread a succession of pestilences. In biblical genealogies, the most ancient ancestors are credited with extremely long life spans. The records of ancient Middle Eastern kingdoms also give exaggerated life spans for the rulers of the earliest dynasties. Is this just hyperbole attached to the memory of heroes, or is it a half-forgotten memory of days gone by when life expectancy was indeed much longer?
In the ancient world, sickness was often thought to result from spirits of some kind invading the body. Some were merely spirits of the dead looking for a new home; others were genuinely evil spirits, or demons, with malevolent intent. Today we tend to think of evil spirits as an archaic explanation for mental disease. This could be because, in our own culture, explaining brain malfunction has lagged behind understanding other, more physical illnesses. But to those who lived long ago, swellings, spots, and rashes were just as mysterious as mental aberrations. We should also remember that many infectious diseases produce fever and delirium if left untreated, thus obscuring the gulf between physical and mental conditions.
As late as the nineteenth century, diseases such as typhoid, diphtheria, and scarlet fever were blamed on invisible vapors from smelly drains and other sources of putrefaction. It was not just the poor whose dwellings stank:
“I have met just as strong a stream of sewer air coming up the back staircase of a grand London house from the sink, as I have ever met at Scutari….”—Florence Nightingale, Notes on Nursing, 1859
Blaming evil-smelling vapors is not so different from invoking evil spirits. Both are nebulous and invisible. And today, instead of invisible spirits, we have microscopic germs, carried through the air or water and still invisible to the naked eye.
Worms and serpents
The earliest form of infectious disease whose cause primitive people could actually see was infestation by parasitic worms. Consequently, worms that “poisoned” people from the inside, and snakes that poisoned people by biting, were regarded as relatives; the same terms were often used for both. Moreover, serpents were sometimes associated with the devil and sometimes with medicine. This derives from the ancient viewpoint that pestilence, or perhaps just a single disease, belonged to a particular god.
It was not so much that disease was evil and healing was good. Rather, sending plagues and removing them both came under the authority of the same god, who used disease as a means of retribution for human disobedience. Although most deities could intervene if cajoled with prayers and sacrifice, it made most sense to beg the god who sent disease to remove it. Thus, in many ancient cultures, the god of pestilence is also the god of healing. Later, a division of labor generated deities concerned solely with the healing aspect of disease. For example, Apollo, who both dispensed and withdrew pestilence, was succeeded by Asklepios, who was concerned only with the healing aspect of disease.
Sumerians, Egyptians, and ancient Greece
Religion and medicine were not distinct in early civilizations, and treating disease involved religious incantations as often as procedures that we regard today as medical. The Sumerians, who founded urban Middle Eastern civilization around 4,000 B.C., generally considered sickness due to three main kinds of spirits. These were the ghosts of the dead, genuine demons, and spirits that were the hybrid offspring of demons and humans. Individual disease was wrought by evil spirits wandering around on their own, whereas large-scale plagues were sent by angered gods.
Although any god could send disease, the specialist was Nergal, the Sumerian god of pestilence. Nergal represented the blazing sun at noon, as did his Egyptian opposite number, Sekhmet, the lioness goddess, who breathed fire at the Pharaoh’s enemies. She was also called Lady of Pestilence. The valleys of the Tigris and Euphrates and the marshlands of the Egyptian delta were fertile for both agriculture and disease. Nergal was kept so busy that he needed 14 assistants (more properly, 7 pairs) to give mankind fever. Sekhmet, too, is linked with the holy number seven. The seven arrows of Sekhmet brought evil fates, especially as disease.
The ancient Egyptians had several solar deities. In addition to the supreme sun god, Re, several goddesses represented aspects of the sun. Bastet, the cat goddess, was the friendly warmth of the sun, whereas Sekhmet was the noontime sun. Hathor, the great mother goddess, usually depicted as a cow, also represented the all-seeing sun, or “eye of Re.” As such, she was sent by Re to punish mankind. As Re got old, he started to worry that mankind was plotting against him. So Hathor went down to Earth and started to slaughter the conspirators. She drank their blood, which transformed her into Sekhmet. Naturally, sun gods and goddesses work only during the day, so Sekhmet went back to heaven for a good night’s rest. Meanwhile, Re and the other gods had got cold feet. If mankind was wiped out, who would provide the gods with sacrifices? So Re told his priests to put red dye into 7,000 pitchers of beer. They poured it out in the desert, and when Sekhmet came down the next morning, she lapped up the red beer, thinking it was blood. In her drunken stupor, Sekhmet forgot about exterminating the rest of the human race and reverted to the kinder and gentler Hathor.
At their New Year’s festival, held just before the flooding of the Nile in July, the ancient Egyptians attempt to appease Sekhmet and ward off her “seven arrows.” In addition to the main sacrifices are many offerings of alcoholic drinks. The drunken feast that follows supposedly re-enacts Sekhmet’s distraction by using red-dyed beer. The timing is appropriate. Although the flooding of the Nile is vital to agriculture, it also spreads epidemics. For several weeks, slow-moving water covers everything. Bacteria and viruses that cause dysentery and diarrhea are spread by contaminated water. Malaria-carrying mosquitoes breed in stationary or slow-moving water, and water snails spread the parasitic worms of schistosomiasis (bilharzia).
In ancient Greece, Apollo was both sun god and archer god. As with Sekhmet, his arrows represented pestilence, and he was invoked for healing together with his son Asklepios and granddaughter Hygieia. The Greeks felt it was unmanly for Apollo to shoot women, so they became the first to introduce affirmative action into medicine. Artemis, the twin sister of Apollo, carried a bow and arrows, which she used for bringing disease upon women. The general idea of demons spreading disease by shooting invisible arrows lasted through the centuries. In medieval England, sick animals were referred to as “elf-shot” and were treated by holy water and singing masses.
Hygiene and religious purity
One practical advantage of attributing sickness to spirit possession was that the sick were seen as unclean from a religious viewpoint. In the biblical book of Leviticus, religious impurity itself is viewed as at least partially contagious. Thus, menstruating women, who were ritually impure, could spread their impurity to other persons they contacted. Here again, we see the overlap between a “spiritual” condition and infection. Those regarded as unclean were often quarantined or excluded from society until their symptoms (or their souls) departed. Though often cruel, quarantine greatly reduced the spread of contagious disease. Because most people in antiquity died from infections, quarantine was beneficial overall.
The Sumerians regarded the spirits of the dead as homeless rather than malicious. Sickness then resulted from the misfortune of providing refuge for a homeless spirit rather than deliberate sin. The more rigid Semitic cultures that followed were less tolerant of the sick. Disease was seen as divine punishment, and sickness and sin became intertangled. Sometimes the individual was guilty; sometimes the guilty party was the parents or the tribe or nation as a whole. Somewhere there was sin, and, increasingly, the priest’s job was to uncover it and pin the blame on someone.
A similar change from a freewheeling outlook to a narrower attitude occurred during the growth of the Christian church. Most early church fathers believed that demons assaulted even innocent Christians because the demons were evil. According to St. Augustine (354–430), “All diseases of Christians are to be ascribed to these demons; chiefly do they torment fresh-baptized Christians, yea, even the guiltless, newborn infants.” Thus, caring for the sick, by either secular or spiritual means, opposed the demons and was therefore commendable.
Later the church saw disease more as punishment from God. This at times led to the extreme position, rarely stated explicitly, that curing disease by nonreligious means was a blasphemous attempt to usurp God’s authority and, therefore, was itself sinful. This attitude sometimes had disastrous effects. Even as late as 1885, during a smallpox epidemic in Montreal, the Catholic Church opposed vaccination. The Abbé Filiatrault expressed the official view, “If we are afflicted with smallpox it is because we had a carnival last winter, feasting the flesh…it is to punish our pride that God has sent us smallpox.” Eventually, the rising death toll prompted a reversal of the official position.
Financial motivations sometimes lurked behind these attitudes. For example, in 1547, Pope Leo X sold tokens bearing a cross and the inscription, “He who kisses it is preserved for seven days from falling sickness, apoplexy, and sudden death.” To be fair, most secular remedies of the day left much to be desired. The physician of the Habsburg Emperor Rudolf II (1552–1612) provided this recipe against plague: “Desiccated toads and pulverized chickens. The menstrual blood of a young maiden. White arsenic, pearls, and emeralds from the Orient. This concoction is to be baked into a toad cake and then worn next to the heart in an amulet.”
The Protestant Reformation greatly improved matters by returning to the position of the early Church Fathers and emphasizing that disease came from Satan rather than being approved by God. When faced with the opinion that taking medicine was sinful, Luther asked, “Do you eat meat when you are hungry? Even so you may use physic, which is God’s gift….”
Protecting the living from the dead
Disease presented our ancestors with a ticklish technical problem: What to do with the corpses? The earliest hunter-gatherers constantly moved around. Whether they buried their dead within their territory, left their remains in a sacred cave, or merely abandoned them is lost in the mists of time. Later, when agriculture spread, and humans settled in one place, the problem became more acute. Corpses are a source of contagion. The earliest communities began to bury their dead. In the earliest cities, the dead were often buried beneath the floors of inhabited dwellings.
Çatalhöyük (now in central Turkey) was the world’s first real city. Nine thousand years ago, it boasted several thousand occupants living in several hundred mud-brick buildings. It lasted for slightly more than 2,000 years and disappeared before the Bronze Age. It was apparently the center of local Neolithic culture, although its political relationships, language, and religion are still obscure. The remains of more than 60 people have been found in burial pits beneath the floors of the living quarters in Çatalhöyük. The bodies were tightly folded with the knees close to the chest, and the pits were plastered over. Some pits were reopened later to accept more bodies. Although this was better than leaving bodies exposed, burying them so close to where people lived and prepared food was not ideal. However, many infectious diseases emerged only after agricultural civilizations created dense populations. When Çatalhöyük first arose, few present-day epidemic diseases had yet appeared, so burying the dead under the floor was still relatively safe.
As urbanization spread, infectious disease increased in frequency and corpses became steadily more of a liability to public health. In response, the dead were buried a safe distance from the living, and graveyards outside the town walls became standard. Later, cremation came in vogue in some societies. The ashes were sometimes kept in urns, sometimes buried, and sometimes scattered to the four winds. Whether burnt or buried, the dead were no longer a focus of infection. These activities were all dressed in religious trappings and given spiritual explanations. Members of those primitive societies often feared that the spirits of the recently deceased would come back to harm them. To avoid this, the dead were properly buried or cremated. Although our culture now thinks of ghosts having clanking chains and haunting castles, the original problem was that corpses were a public health hazard unless properly disposed of. Over the ages, ever more complex ceremonies have accreted around procedures such as burial, but avoiding the spread of disease has remained a critical issue.
In many early societies, contact with dead bodies caused ritual uncleanness. Becoming ritually clean involved purification by washing, often followed by a period of quarantine. The relevance to public health is obvious. Thus, many religious rites, especially those for ritual purity, had positive effects on hygiene.
Diverting evil spirits into animals
A student of mine once claimed that the more people you give your cold to, the faster you recover yourself! Although this was meant as a joke, primitive cultures doubtless noticed that as one person recovered, others fell sick. One obvious interpretation was that evil spirits were moving from one person to another. So what could be more sensible than to break the chain of human infection by diverting the evil spirit into an animal. Even today, the people of the Ewe tribe of West Africa transfer disease-causing spirits to chickens and then chase away the chickens with brooms.
In the Bible, we read of the scapegoat ceremony. A goat, chosen by lot, was designated for Azazel, a demon who lived in the wilderness. The chief priest laid his hands on the goat’s head and transferred the sins of the people of Israel into the goat. Such a transfer made the scapegoat unclean, so it could not be sacrificed to God. It was driven away into the desert. It is particularly noteworthy that the priest was instructed to remove his vestments and bathe his body immediately after driving away the scapegoat (Leviticus 16:20–25). Note that this use of animals to remove disease was not a form of sacrifice. The animals that received the disease-causing spirit were never killed, as their role was to carry the evil spirit far away.
Other Middle Eastern cultures had similar rites to transfer sin or impurity into an animal, which was then banished. In the ancient world, where disease was regarded as a manifestation of divine displeasure, infection and iniquity were inextricably bound together. Although the biblical scapegoat carried “transgressions and iniquities,” we should remember that punishment for sin often came as pestilence.
Ancient Hittite texts prescribe such rituals “if pestilence afflicts the army or the land of Hatti.” One such Hittite ritual used animals of two species, a bull and a ewe—the first in case a male deity had sent the plague, the second in case the deity was female. The scape-bull and scape-ewe were marked with colored wool and then, very sensibly, driven into enemy territory. Do we see here the beginnings of biological warfare?
The Hittites were Indo-European intruders into the Middle East. Did they borrow the idea of a scape-animal from the Semitic peoples of the Middle East, or did they import it? It is interesting that the ancient Vedic culture of India, also Indo-European in origin, practiced similar rites. Demons blamed for disease were transferred to animals, not during official communal ceremonies, as with the Hittites and Israelites, but on an individual basis using small animals that ordinary people could afford or catch. For example, the demon Takman, which caused assorted fevers, was often banished into a frog, which hopped away:
“Homage be to the deliriously hot, the shaking, exciting, impetuous Takman! Homage to the cold Takman, to him that in the past fulfilled desires! May the Takman that returns on the morrow, he that returns on two days, the impious one, pass into this frog!”
—Atharvaveda VII: 116
In the Odyssey, when Homer refers to the long illness of Odysseus, he uses the phrase “wasting long away.” The term for “wasting away” is tekomenos, a word remarkably similar to the Takman of the Vedas. Although historians have sometimes guessed that “tekomenos” refers to malaria or tuberculosis, there is no way to be certain.
Cheaper rituals for the poor
Few people in ancient times could afford to eat meat except on special occasions. Nor could most victims of disease afford an expensive animal for a healing ritual. So the Assyrians, and probably most other Middle Eastern cultures, had a down-market, vegetarian, version of the procedure. In the “surpu” ritual, the priest smears the patient with flour. The flour is then wiped off and thrown into the fire. The idea is that the flour absorbs the impurity (or evil spirit), which is then destroyed by the fire. Finally, the priest sprinkles the patient with water.
In China during the Ming period (1368–1644), fever was attributed to malevolent spirits, and a similar but more vulgar rite was performed to expel them. The patient was given a pill of cinnabar plus the seeds of plants containing emetics, held together by bee’s wax. A fire was lit and cinders placed all around the patient. When the emetic started to work, the patient was supposed to vomit into the fire. As the fire consumed the vomit, the priest made a magical sign over the fire and the evil spirits were killed.
Rather more radical was the practice of cutting a hole in the skull. This procedure, referred to as trepanation, was practiced as early as the Bronze Age. It started as a ritual performed on corpses, presumably to help speed the spirits of the dead on their way to the afterlife. Then it was used on the living to allow evil spirits to exit. Remarkably, many of the victims survived, to die later of something else, as indicated by the signs of healing around the holes in their skulls. By the time of Hippocrates (around 400 B.C.), trepanation was used to treat bruising or fracture of the skull, mostly due to being bashed on the head during war. As late as the nineteenth century, certain primitive tribes still trepanned cases of convulsions or chronic headache to allow evil spirits to escape. Be grateful for aspirin!
Vampires, werewolves, and garlic
Among the “evil spirits” seen on TV today are werewolves and vampire bats. It is widely known, at least to those who imbibe their medical information from the silver screen, that garlic protects against these terrors of the dark side. Sadly, however, the characters in modern-day horror movies have forgotten how to use their garlic correctly. Onions and garlic, especially, contain allicin and related smelly sulfur compounds. Despite the risk of bad breath, garlic should be eaten, not festooned in bunches around the heroine’s bedroom. Allicin is a potent antimicrobial agent; in particular, it cures amebic dysentery. In ancient times, garlic was widely used to drive away the “evil spirits” that caused intestinal disturbances. This is remembered in distorted form in folk tales and the modern Hollywood legend.
In eighth-century Japan, eating large amounts of onions and related vegetables to combat diarrhea was not merely a folk remedy, but was recommended in official state directives. In the year 737 A.D., Japan suffered a great smallpox epidemic. Among the directives issued by Ki no Ason, Great Liaison of the Right, senior 4th rank, lower grade, was the following: “If diarrhea should develop, boil onions and scallions well and eat many.” (Note that the diarrhea was due to secondary intestinal infections of those weakened by smallpox.) Allicin works well against intestinal infections because it is poorly absorbed and much of it remains in the intestines.
Divine retribution versus individual justice
Who should be punished for a sin or a crime? Should only the criminal be punished, or should his family be included? Ancient writings often give the impression of great injustice, in the sense that innocent people were frequently punished along with the guilty. Many law codes of the ancient world reveal an apparent contradiction. Most punishments carried out by human authorities were inflicted on the guilty individual alone. Thus, Deuteronomy 24:16 commands, “The fathers shall not be put to death for the children, nor shall the children be put to death for the fathers; every man shall be put to death for his own sin.” In contrast, when the gods themselves punish someone, both in the Bible and in other ancient cultures, they often strike down the criminal, his family, servants, and even domestic animals.
This paradox is readily understood once we remember that infectious disease was regarded as the means by which the gods usually punished mankind. It was a matter of simple observation that infections appeared mysteriously and generally affected several people in close contact. If the gods struck someone with a virulent infection, chances were good that his wife and children would catch it, too. In the Bible, divine punishments are often reserved for those whose sins were secret and would have gone unpunished if God had not seen and acted. The book of Leviticus calls for those whose impurity goes unnoticed by the priesthood to voluntarily give sacrifices. The implication is that sins can be hidden from man, but if God intervenes, the punishment will be worse. This was a strong inducement to wrongdoers to confess, even when crimes were unsolved. Unfortunately, this way of thinking led to the belief that those who were struck down by infections must have committed hidden sins. Worse, they must also have declined the opportunity to confess and make voluntary restitution by sacrifice.
Although monotheism is usually regarded as a step upward from polytheism, from a medical viewpoint, it was a step backward. The idea that assorted evil spirits inflicted infections comes closer to the germ theory of disease than later rationalizations. Under monotheism, the victims of disease were thought guilty of secret sins, despite lack of evidence. In contrast, polytheism often regarded the sick as unlucky victims of some passing demon rather than as evildoers. Consequently, treatment of the sick was more humane. In practice, the common people have tended to retain a belief in spirits and demons even in officially monotheistic societies. Is having a demon driven out any less rational than being assumed guilty of invisible sin? During the European Middle Ages, when the educated establishment regarded disease as the result of an imbalance among the four humors (blood, phlegm, bile, and black bile), the common herd stuck to a “primitive” belief in contagion.
The Middle Ages reveal another uneasy compromise between official monotheism and popular polytheism, namely witchcraft. When humans or cattle miscarried or produced offspring with genetic defects, and when infectious disease or food poisoning struck, especially if the symptoms were unfamiliar, witchcraft was often blamed. Blaming such misfortunes on witchcraft allowed the victims to be declared innocent of sin while retaining belief in a single all-seeing God. Although this Jesuitical maneuver relieved the victims of infection and poverty from being blamed for their own misfortunes, it also implied that somewhere there lurked witches who needed to be hunted down. A new form of scapegoat was thus born.
The rise of Christianity
As discussed earlier in this book, around 500 B.C., the first major population centers became large enough to keep virulent epidemic diseases in circulation. Several major population crashes largely lost to history probably occurred. During and following this general period, major religious changes happened. Local city-state and fertility cults were replaced with religions shared by both aristocracy and commoner and both urban and rural populations. I have already argued in Chapter 7, “Venereal Disease and Sexual Behavior,” that the emergence of sexually transmitted infections played a major part in the transition away from fertility cults.
The decline of classical civilization and its replacement by Christianity was one of the greatest cultural changes in European history. The two main aspects were the collapse of the Roman Empire and then the loss of faith in traditional polytheistic religion. Christianity grew up during a period when overcrowding was followed by pestilence. The success of Roman culture resulted in territorial expansion and population growth. Population density and the ease of communications, especially via the famous Roman roads, increased markedly. Both factors prompted the growth and spread of infectious disease.
The debilitation of large sectors of the population by endemic malaria greatly weakened the Roman Empire. Several massive outbreaks of pestilence followed, culminating in bubonic plague, which exacerbated the situation. These diseases affected both agricultural production and the availability of recruits for the military, leading to political decline. The failure of classical religion to cure the sick or halt the spread of pestilence caused many to lose faith in the gods of traditional religion. Why did Christianity emerge triumphant from this historical hot zone? Why not polytheism, with a new family of healing deities? Why not a mother goddess cult? Why not Mithraism?
We have relatively little information about history’s losers, and much of this is biased. Presumably each of these other religions failed in some way, although we can only guess how.
In his The History of the Decline and Fall of the Roman Empire, Edward Gibbon cites the zeal of the early Christians, their doctrine of future life, and their pure and austere morals, among other reasons. More recently, Daniel Reff in Plagues, Priests and Demons (2005) has compared the demographic collapse at the time when Christianity was adopted in Europe with the population crash on the American continent triggered by the arrival of the Spanish. He regards epidemics as the “most powerful evangelisers of all.”
To its credit, Christianity did tackle the issue of disease. The Gospels place heavy emphasis on healing the sick, and early Christians had a reputation for caring for those who were ill. Miraculous healing was an integral part of early Christianity, not merely in theory, but in practice. Even if we assume that miracles are impossible, can we still explain the success of Christianity when faced with ancient epidemics? I think so.
First, let’s remember that no one expected early Christians to heal broken legs or cure tumors. Second, early Christians sincerely believed that they would go to heaven and that life on Earth was merely a temporary interlude. Nonetheless, they also believed in helping the sick and, due to their belief in an afterlife, were willing to take risks that nonbelievers avoided.
I believe that the critical point lies in the Christian custom of caring for the sick. Even severe infectious diseases are rarely anywhere near 100% fatal. Thus, diseases such as smallpox and typhoid can kill anywhere from 10% to 50% of their victims. The death rate depends partly on the strain of microorganism causing each particular epidemic. Nevertheless, the actual survival rate is also greatly affected by whether the afflicted are abandoned to their fate or cared for. Members of a Christian community who fell ill with virulent infections were much more likely to receive care than the rest of the population. Consequently, their probability of surviving was much greater. Furthermore, for those unfortunates who did lose their families to disease, the church provided a new family.
By the fourth century A.D., Christianity was spreading vigorously. It was especially popular among women, often those from the upper classes. Fabiola, a widow from a distinguished Roman family, founded the world’s first free public hospital in Ostia, the port city that serves Rome. Fabiola originally went to the Holy Land, to join the Christian scholar Jerome who was translating the Bible into Latin with the help of several rich female religious activists. However, the Huns burst into the Middle East, and Jerome and his clique fled to Rome. After returning, Fabiola organized other rich women into founding a hospital. They not only contributed money, but also took part themselves in doctoring and nursing. Fabiola personally collected poor patients off the streets. This was no task for the squeamish. According to Jerome, “They have leprous arms, swollen bellies, shrunken thighs, dropsical legs…their flesh gnawed and rotten and squirming with little worms….”
Fabiola died in 399 A.D. and was later made a saint. When you consider the positive contributions and personal bravery of these Christian women, it is not surprising that early Christianity gained respect. Both the increased survival of the ordinary Christians and the sincerity of those who died while nursing others must have greatly raised Christianity in the public esteem. Few of us really want to die, even those who believe in an afterlife. Whether the cures were miraculous was not the point—they were attributed to Christianity.
Coptic Christianity and malaria
The Copts were a Christian sect centered in North Africa. They wrote their earliest religious texts in Coptic, a language derived from ancient Egyptian. Later, the Copts also wrote in Greek. Although modern-day Christianity dislikes admitting it, these early Christians practiced what can only be described as a form of magic. Spells were written on papyrus sheets, which were then folded into long strips and worn as amulets. Many of these were designed to protect their wearers against disease, and they invoke not only Jesus Christ, but also a mixture of saints and often also Jewish demons.
Here is part of a fifth-century spell, originally written in Greek on an amulet (Oxyrhynchus 1151) and designed to protect a woman named Joannia from fever (undoubtedly, malaria):
Flee, hateful spirit! Christ pursues you; the son of God and the Holy Spirit have overtaken you. O God of the sheep-pool, deliver from all evil your handmaid Joannia, whom Anastasia, also called Euphemia, bore. … O Lord, Christ, son and Word of the living god, who heals every disease and every infirmity, also heal and watch over your handmaid Joannia, whom Anastasia, also called Euphemia, bore, and chase away and banish from her every fever and every sort of chill—quotidian, tertian, quartan—and every evil.
Similar spells were found down to the eleventh century, often containing magical formulas from the medieval Jewish cabala, mixed with more orthodox Christian terminology. These spells illustrate the great importance of both malaria and magic among the Christians of North Africa. They also confirm that early Christianity was in many ways a healing cult.
Messianic Taoism during the collapse of Han China
During the early centuries of the Christian era, when successive epidemics weakened the Roman Empire, a similar process occurred at the far end of the Eurasian landmass. Early Chinese civilization was centered in the temperate north, especially in the valleys of the Yellow and Yei rivers. (Southern China, though watered by the more famous Yangtse Kiang River, was civilized much later, largely due to tropical diseases.) From 170 A.D. onward, massive plagues preceded by floods hit the Yellow River valley of northern China. Depopulation was followed by peasant revolts and political turmoil, resulting in the collapse of the Han Empire around 220 A.D.
Just as Christianity emerged from the chaos in the Roman world, a messianic religion based on Taoism emerged in the disintegrating Han territories. By 184 A.D., the Taoist sect of the “Great Peace” had 360,000 armed followers. Chang Chiao, who claimed healing powers, led them. These Taoists worshipped the lord Huang Lao, a hybrid of the fabled Yellow Emperor, Huang Ti, and a deified Lao Tzu, founder of the original Taoist movement. They believed that disease was the consequence of sin, and they distributed healing amulets at the spring and autumn equinoxes. Unlike Christianity, this messianic version of Taoism failed to survive over the long term. Buddhism, from India, displaced it over the next few centuries.
Buddhism and smallpox in first-millennium Japan
During the years 735–737 A.D., a massive smallpox epidemic swept through Japan. The smallpox epidemic was preceded by a famine in 732–733, and the resistance of the population was doubtless lowered. Although sparsely populated regions were scarcely affected, the death rate was 70% or greater in some of the most crowded areas. The overall mortality for the whole of Japan was probably at least 30%. Smallpox was on the rampage in China during the fourth century or earlier and had moved to Korea by the mid-500s. It presumably moved from Korea to Japan: It was first reported in the port of Dazaifu, which is on the Japanese coast opposite the Korean peninsula.
The depopulation of Japan resulted in several major reforms in the areas of taxation, farming loans, and land tenure. It also had a great effect on religion. Emperor Shomu had been brought up as a Confucian. At the beginning of his reign, Buddhism, an import from India via the Chinese mainland, was tolerated but strictly controlled. When the famine struck, Shomu felt responsible: “The rivers are dry and the five grains have been damaged. This situation has come about because of our lack of virtue.”
When the plague of smallpox followed, Shomu was even more certain he was to blame: “Recently untoward events have occurred one after the other. Bad omens are still to be seen. I fear the responsibility is all mine.” Shomu responded to the crisis by donating massive sums and ordering Buddhist temples to be built all over Japan. Although the economy was already tottering as a result of so many taxpayers dying in the epidemic, his daughter, Empress Shotoku, followed his example. Like her Roman counterpart, Fabiola, she cared deeply for the sick. Sadly, her excessive contributions helped bankrupt the state. Despite these unfortunate financial side effects, Buddhism was instituted at the expense of Confucianism.
The European Middle Ages and the Black Death
The Black Death is especially terrifying. Unlike most infectious diseases, nursing has little effect on the fatality rate from plague. Until antibiotics became available, the death rates for the bubonic (60%–70%) and pneumonic (99%) forms of plague remained unchanged by any treatment. As noted earlier, in the major Roman epidemics of the second and third centuries, the Christians made major progress because nursing greatly reduced the fatality rate. However, neither nursing nor prayer stopped the relentless march of the Black Death.
The effects of the Black Death on religion were complex and, in some ways, contradictory. The inability of the Church to stop the plague or cure the sick resulted in a great loss of faith, not so much in God as in the religious establishment. To be fair, although many of the higher clergy fled, the high death rates among the ordinary priests indicate that most of them performed their duties until the end. Many writers of the day, including William Langland (1322–1400), noted the unworthiness of the higher clergy. As a supporter of a purified Christianity, Langland saw their worldliness as a threat to the Holy Church and remarked, “So we need an antidote strong enough to reform these prelates … who are hindered by their possessions.” Education in the 1300s was largely under ecclesiastical control, and doctors of medicine were therefore taught and licensed by the Church authorities. Thus, the failure of medicine to cure the plague was also associated with the Church.
Unlike in the Roman era, no viable alternative religion was waiting for an opportunity to take over. The result was fragmentation of authority within the realm of Christianity rather than the infiltration of a new religion. One aspect of this was a great upsurge in the veneration of previously obscure saints who were supposed to have healed plague victims. Shrines were richly endowed, and new religious brotherhoods formed themselves around these healing saints. In a way, this was a reversion to the polytheism of the Romans and Greeks, when many gods and goddesses hawked their wares in a marketplace of theologies. But instead of autonomous gods and goddesses, a multiplicity of saints remained within the bounds of Christianity. Many ordinary people believed that God was displeased, presumably because the established church or Christian society was impure and corrupt in some manner. Outbreaks of violence occurred, directed at Jews, loose women, lepers, and other outcast groups. Sometimes these groups were accused of actually spreading the plague; at other times, they were accosted for polluting society by their very existence, so bringing down the wrath of God.
In the long term, the greatest effects on religion were indirect and took place over the next two centuries. The Black Death shook the feudal system apart and freed up Western society. Lack of manpower led to mechanization and a readier acceptance of new inventions, such as printing. The collapsing feudal system spurred the growth of nationalism. This, in turn, led to local rulers resisting the centralized control of the papacy. Hence, the religious reforms of Luther in the early 1500s found widespread support, especially among the northern countries. The prime example of this is, of course, Henry the Eighth of England, who split away from the Catholic Church and founded the Church of England. When the monopoly of the Vatican was broken, the growth of religious freedom was free to proceed. Slowly, our modern forms of parliamentary democracy and industrialization emerged.
The Great Plague of London
The Great Plague of 1665 was the last time an epidemic of bubonic plague ravaged London. Although it was nowhere near as terrible as that of the 1300s, it was still terrifying. The government instituted public prayer and days for fasting and public confession of sins. The churches were crowded with people imploring God to stop the pestilence. By the 1600s, British Christians were split between those loyal to the Church of England and the Dissenters (Puritans, Presbyterians, and other nonconformist sects). During the crisis, they prayed together in each other’s churches. When the plague passed, the barriers among the separate denominations gradually arose again.
During the early days of the outbreak, London was rife with fortune tellers and soothsayers who, for a small consideration, would tell you your chances of surviving the plague. These prophets for profit merged imperceptibly with conjurors who claimed to possess magical cures and a multitude of quacks selling secret and infallible remedies of a more “scientific” nature. Many Londoners took to wearing charms and amulets to ward off the evil spirits causing the pestilence. These amulets were remarkably similar to those the Coptic Christians used in earlier centuries. They included magic words, such as Abracadabra, signs of the zodiac, and the Jesuits’ mark of IHS (Iesus Hominorum Salvator, Latin for “Jesus, Savior of Men”).
Loss of Christian faith in industrial Europe
It is a common misconception, especially in the United States, that intellectuals led the movement away from religion. If anything, the reverse was true. Just as political correctness finds its most avid supporters on today’s university campuses, the intellectuals of earlier times generally went along with the religious establishment. He who pays the piper calls the tune. By the time Darwin proposed the theory of evolution, organized religion was already losing its grip. In England, the world’s first industrial democracy, the first demographic group to desert religion en masse was the urban working class. As industrialization proceeded, there was a bulk flow of population from the countryside into the manufacturing towns. These migrants mostly came from rural areas where religion was a significant part of community life. As they settled in the towns, they tended to leave religion behind.
Villages have a sense of community, and middle-class suburbia values respectability. Both are major contributors to religious conformity. But other factors were at work. The overcrowded urban poor were the most susceptible to infection. Thus, those who were most often the victims of plague and pestilence abandoned a religion that seemed increasingly ineffective. Rural populations were more spread out, and the rural poor often escaped the worst effects of epidemics circulating in the towns. The more prosperous lived more spaciously and more hygienically, so they, too, paid a lower toll to infectious disease. Villagers who prayed together in their parish church for the plague to pass them by often had their prayers answered. In contrast, the inner-city poor who attended church were as likely to be infected there as anywhere else. The great epidemics of the age of industrialization were aided and abetted by the crowding from increasing population and urbanization. Thus, the urban working classes were alienated from traditional religion.
Cleanliness is next to godliness
“We should hear no longer of ‘Mysterious Dispensations,’ and of ‘Plague and Pestilence’ being ‘in God’s hands,’ when, so far as we know, he has put them into our own.”—Florence Nightingale, Notes on Nursing, 1859
During the nineteenth and twentieth centuries, technology took the field against infectious disease. Clean water, sewers, flush toilets, toilet paper, soap, antiseptics, warm and dry housing, and better nutrition all combined to reduce the spread of infectious disease. Toward the end of the 19th century, Louis Pasteur declared, “It is now in the power of man to cause all parasitic diseases to disappear from the world.”
Although this was a trifle optimistic, the gains in life expectancy and general health were impressive. Already reeling from the onslaught of civil engineering, infectious disease took another massive beating from the successive discoveries of vaccination in the late nineteenth century and of antibiotics in the mid–twentieth century. Life expectancy in the advanced nations today is nearly twice that at the start of the nineteenth century.
Not only did religion fail to cope with epidemic disease, but science was successful where religion failed. Religion lost its monopoly on healing, and medicine became an independent, secularized profession. Before the modern era, organized religion jealously guarded its right to dispense healing and exert control over life and death. Today even those who still practice religion routinely go to a doctor when they are sick. We sometimes hear the saying “doctors acting like God.” While intended to puncture pomposity, there is a deeper truth here. As long as scientific medicine is effective, many people today feel little need for supernatural intervention.