Civilization and Its Discontents 273farmers into urban centers in Mexico, Central America,
and South America means that Chagas disease has be-
come a problem in urban areas as well.Anthropology and Cities of the Future
Not until relatively recent times did public health mea-
sures reduce the risk of living in cities, and had it not been
for a constant influx of rural peoples, areas of high popu-
lation density might not have persisted. Europe’s urban
population, for example, did not become self-sustaining
until early in the 20th century.^22
What led people to live in such unhealthy places? Most
likely, people were attracted by the same things that lure
people to cities today: They are vibrant, exciting places
that provide people with new opportunities and protec-
tion in times of warfare. Of course, people’s experience in
the cities did not always live up to advance expectations,
particularly for the poor.
In addition to health problems, many early cities faced
social problems strikingly similar to those found in cities all
over the world today. Dense population, inequalities of class
systems, and oppressive centralized governments created
internal stress. The poor saw that the wealthy had all the
things that they themselves lacked. It was not just a ques-
tion of luxury items; the poor did not have enough food or
space in which to live with comfort, dignity, and health.
Evidence of warfare in early civilizations is common.
Cities were fortified. Ancient documents list battles, raids,
and wars between groups. Cylinder seals, paintings, and
sculptures depict battle scenes, victorious kings, and cap-
tured prisoners of war. Increasing population and the ac-
companying scarcity of fertile farming land often led to
boundary disputes and quarrels over land between civi-
lized states or between so-called tribal peoples and a state.
When war broke out, people crowded into walled cities for
protection and for access to irrigation systems.
What we would call development today—the trans-
formation of rural open spaces into densely populated
and built-up environments—posed similar problems in
the past. At the Maya city of Copan, in the present-day
country of Honduras, much of the fertile bottom lands
along the Copan River were paved over as the city grew,
making the people more and more dependent on food
grown in the fragile soils of the valley slopes. This ulti-
mately led to catastrophic soil loss through erosion and
a breakdown of food production. Similarly, in ancient
Mesopotamia, evaporation of water from extensive irriga-
tion works resulted in a buildup of salt in the soil, ruining it
for agricultural use.rules confining poor Jews to the ghettos (compounded by
social and religious rules about marriage), the frequency
of the Tay-Sachs allele would never have increased. In re-
cent times, cultural mechanisms such as prenatal and pre-
marital genetic testing have resulted in a decrease in the
frequency of the Tay-Sachs allele.
Before the discovery of antibiotics in the early 20th
century, individuals infected with the bacteria causing TB
would invariably waste away and die. While antibiotics
have reduced deaths from TB, resistant forms of the bac-
teria require an expensive regime of multiple drugs. Not
only are poor individuals more likely to become infected
with TB, they are also less likely to be able to afford expen-
sive medicines required to treat this disease. For people in
poor countries and for disadvantaged people in wealthier
countries, TB—like AIDS—can be an incurable, fatal, in-
fectious disease. As Holger Sawert from the World Health
Organization has said, “Both TB and HIV thrive on pov-
erty.”^20 Before the social stratification accompanying the
emergence of cities and states, as far as infectious microbes
were concerned, all humans were the same.
Colonialism and Disease
Infectious disease played a major role in European coloni-
zation of the Americas. When Europeans with immunity
to so-called Old World diseases came to the Americas for
the first time, they brought these devastating diseases with
them. Millions of Native Americans—who had never been
exposed to influenza, smallpox, typhus, and measles—died
as a result. The microbes causing these diseases and the
human populations upon which they depend developed
in tandem over thousands of years of urban life in Eurasia,
and before that in village life with a variety of domesti-
cated animal species. Thus anyone who survived acquired
immunity in the process. See this chapter’s Biocultural
Connection for more on the death and disease Europeans
brought with them when they colonized the Americas.
Very few diseases traveled back to Europe from the
Americas. Instead, these colonizers brought back riches
that they had pillaged and papers that gave them owner-
ship of lands they had claimed. One rare exception is that
Charles Darwin seems to have returned from his famous
journey on the H.M.S. Beagle with Chagas disease, a para-
sitic infection caused by a bug bite.^21 Traditionally it was a
disease of the rural poor, but today the large influx of poor
(^20) Sawert, H. (2002). TB and poverty in the context of global TB control.
World Health Organization. http://www.healthinitiative.org/html/Conf/
satsymp/index.htm#2
(^21) Adler, S. (1959). Darwin’s illness. Nature, 1102–1103; Bernstein, R. E., et
al. (1984). Darwin’s illness: Chagas’ disease resurgens. Journal of the Royal
Society of Medicine 77, 608–609.^22 Diamond, p. 203.