5 Advances That Followed Pandemics

For those who survived, the Black Death that devastated Europe in the 14th century resulted in fundamental change for large swaths of society—namely, the working poor. The plague created a shortage of labor that empowered workers and eventually pulled down the oppressive tradition of serfdom.

“Agricultural workers were able to demand better payment and conditions from their manorial lords,” says David Routt, professor of history at the University of Richmond.

Not only were more people able to find work, living and working conditions improved.

“In urban areas, where the plague delivered its harshest blow, the authorities became more aware of the importance of public sanitation in the curbing of epidemics,” Routt says. “And quarantining of infected citizens was implemented in some cities—practices that were precursors to modern conceptions of public health.”

The 1918 flu pandemic, also (inaccurately) called the “Spanish flu,” wiped out some 20 to 50 million people worldwide. But it also led to a serious rethinking of public health policies in the United States and elsewhere.

In the 1920s, many governments embraced new concepts of preventive medicine and socialized medicine, says Nancy Mimm, specialist in population health at Harrisburg University. Russia, France, Germany and the U.K., among others, put centralized healthcare systems in place, while the United States adopted employer-based insurance plans. Both systems expanded access to healthcare for the general population in the years following the pandemic.

“Physicians started focusing on the occupational and social conditions that promoted illness, not only to cure the illness but to suggest ways to prevent it,” Mimm says. “Also, public health started to look more like it does today, based on the practice of epidemiology—the study of patterns, causes and effects in disease.”

Kelly Ronayne, professor of history at Adelphi University, says that pandemics tend to generate overall improvements to patient care, often in small ways that are easy to overlook. For instance, Ronayne says, hospital beds changed over time from wood to metal for improved sanitation. Massive public health crises tend to generate bigger changes, too.

“Pandemics have led to innovation in vaccination, including measles, mumps, rubella, malaria and polio, to name but a few,” Ronayne says.

Records suggest that the concept of social distancing has a very long history. The classic medieval doctor’s plague mask featuring a big beak-like front, was designed in part to insert physical distance between the doctor and the patient. According to the miasma theory, disease spread through the air through a foul smell. The beak-shaped mask filled with herbs was designed to allow diseased air to be diffused before reaching the doctor's air waves.

The concept of social distancing has also influenced residential building designs. After the 1918 pandemic, public health officials recognized that closely packed urban housing was contributing to the spread of disease. Subsequent legislation addressed the issue.

“In the 1930s, Franklin D. Roosevelt’s New Deal required all apartments to have fire escapes, main hallways that were three feet wide, and separate bathrooms,” Ronayne says.

Social distancing has even had an impact on fashion.

“Crinoline within women’s dresses provided much needed distancing from men,” Ronayne says, referring to hoops skirts popular in the 19th century. “This was due in part to social norms, but it also helped women to avoid contracting a fatal disease.”

As pandemics inflicted suffering and loss upon millions of people, artists have responded by channeling their experiences into art, literature and music.

“The medieval author Giovanni Boccaccio set his masterwork The Decameron (1351) in the midst of the 1348 bubonic plague, which the author witnessed firsthand in his city of Florence,” says cultural historian Rebecca Messbarger, co-founder of the Medical Humanities program at Washington University.

The list goes on: British author Daniel Defoe and the Italian writer Alessandro Manzoni wrote historical novels based on the 17 century plague pandemic that swept through Europe. The 1918 influenza crisis sparked some of the most important literary works of the early 20 century, including T.S. Eliot’s Wasteland, William Butler Yeats’ The Second Coming, and Virginia Woolf’s Mrs. Dalloway. And the AIDS pandemic of the 1980s produced artists such as David Wojnarowicz, Therese Frare and Keith Haring.

“These artists translated their personal experiences of the ravages and loss of the disease into graphic images that in other times would have been hidden by the forces of social and political quarantine,” Messbarger says.

In 1793, a yellow fever epidemic swept through the streets of Philadelphia, then the largest city in America and the nation’s temporary capital. At the time, Philly was home to some influential policy makers, including George Washington, John Adams, Thomas Jefferson and Alexander Hamilton.

The Philadelphia epidemic convinced the Founding Fathers that the social, economic and political health of the nation was inextricably tied up with public health, according to University of Denver professor Jeanne Abrams, author of the book Revolutionary Medicine: The Founding Fathers and Mothers in Sickness and in Health.

As part of the first steps in addressing public health in 1798, President John Adams stated the need for stricter quarantines enforced nationwide in the event of epidemics. Adams also signed the Act for the Relief of Sick and Disabled Seamen, which mainly set up hospitals at ports across the country to care for sick seamen. But the institution's function expanded to eventually become what is now the Public Health Service.

As Abrams says, "The founders' early experience with epidemics led them to realize early on that the government has compelling reasons to shoulder some responsibilities with respect to the health of its citizens."