Advances in Bioethics

Karl Marx could only pen the memorable line, “the history of all hitherto existing society is the history of class struggles” because he was heir to the sanitary and public health reforms of the nineteenth century (Marx [1848] 1972, p. 335). The Black Death, which had wiped out much of fourteenth-century Florence and which had regularly decimated sixteenth- and seventeenth-century London, was now but a faint memory. Yet had a historian of some earlier period of European history thought to pen a line as presumptuous as Marx's, it might have read: “the history of all hitherto existing society is the history of struggle with plague or pestilence.” Epidemics and pandemics have haunted human societies from their beginnings. The congregation of large masses of humans in urban settings, in fact, made the evolution of human infectious disease microorganisms biologically possible (McNeill, 1976; Porter, 1997, pp. 22–25). Epidemics have been as determinative of the course of economic, social, military and political history as any other single factor – emptying cities, decimating armies, wiping out generations and destroying civilizations.