Chronic Infectious Diseases

The attention of demographers and others trying to explain the modern rise of population has seldom turned to the chronic infectious diseases. Thus, the steady silent killer, tuberculosis, and the flashy new infection of Renaissance Europe, syphilis, are seldom discussed in this context. Yet there exists a reciprocal relationship between copathogens, acute and chronic. For example, survivors of smallpox might have been weakened by this disease and thus succumbed to tuberculosis. Conversely, an underlying tuberculosis infection should have weakened the ability of individuals to fight off smallpox and other epidemic illnesses. A reduction in the morbidity of chronic infectious disease may play an important role in the decline of mortality from acute infectious disease. Thus, Stephen Kunitz (1983) has argued that the cause of the modern rise of population was stabilization of mortality from all causes.

Those historians, such as Alfred Crosby (1972), William McNeill (1976), Emmanuel Le Roy Ladurie (1981), Kenneth Kiple (1984), and others, who have taken very grand perspectives of the period from 1400 to 1800 have seen Europeans participating in a saga of unprecedented success because of their outward migration and colonization. European population expanded externally far beyond the bounds of a modest modern rise of population. They unintentionally exported both chronic and acute infectious diseases, which had disastrous consequences for the native populations of the Western Hemisphere and Australasia. In return, Europeans brought back home only a few infections that caused serious concern.

Foremost among these may have been syphilis. Imported, at some time during the late fifteenth century, possibly with the Spanish colonization of the Americas, possibly with earlier Portuguese conquests in western Africa, syphilis suddenly appeared in the mid-1490s, uncharacteristically as a pustular rash, a large pox in contrast to the small pox. Within half a century, however, syphilitic patients suffered the same general pathology that untreated victims would in the twentieth century, including long, chronic bouts with ulcers and fistulae. The records of both the initial pandemic wave and individual cases of syphilis from 1550 to 1800 are intertwined with heightened moral concerns and fears of stigmatiza-tion, so that it is difficult to assess the prevalence of syphilis during this period. Police and public health officers of the nineteenth century took an aggressive interest in the control of syphilis, especially in the control of prostitution. They thereby generated our earliest numerical surveys of syphilis, comparable to earlier records of plague and smallpox.

Because of European contacts with Africa and the tropical world, mosquitoborne diseases also traversed Europe increasingly after 1500. Malaria may have increased in prevalence, partially from increased contact with Africans and partly from increased rice cultivation. A more alarming mosquitoborne disease, however, was yellow fever, epidemics of which increased in frequency through the seventeenth and eighteenth centuries and culminated in the catastrophic Barcelona outbreak of 1821. The eighteenth-century expansion of urban environments, especially of port cities and other trade centers, along with the construction of irrigation ditches for agriculture and canals for transport between markets, increased the number of breeding places for mosquitoes.

Finally, we should mention again tuberculosis, as John Bunyan called it in Pilgrim's Progress, "captain of all these men of death." Scourge of the wealthiest Renaissance families and a persistent problem in Renaissance Italian cities, tuberculosis followed the pulse of European urbanization, moving northward as cities appeared, to peak in the eighteenth century. Most city children were infected early in life, recovered, and lived a normal life span, then 40 to 55 years. The heaviest mortality from tuberculosis occurred in infancy, the heaviest morbidity probably in the middle adult years. A small percentage of older children died of pulmonary tuberculosis, chronic diarrhea, or any of the many varieties of extrapulmonary infection. A slightly larger percentage of the once-infected succumbed as young adults.

Thus far we have concentrated mainly on mortality. But the biography of Alexander Pope by Marjorie Nicholson and George Rousseau, This Long Disease, My Life (1968), provides a classic illustration of the process of chronic disease in individuals who escaped plague and the ravages of smallpox. Pope was struck by a tubercular infection that left him disabled. He labored to keep up his correspondence and wrote poetry between visits to the baths and visits from physicians. Throughout his life, he valiantly bore the great pain of travel by coach, a harrowing experience for a body as gnarled as his, bravely sampled the latest remedies, and occasionally confessed his trials to his numerous invalid friends: "I am grown so tender as not to be able to feel the air, or get out of a multitude of Wastcotes. I live like an Insect, in hope of reviving with the Spring." One of the last visitors to Pope's deathbed observed, "He dyed on Wednesday, about the Middle of the Night, without a Pang, or a Convulsion, unperceived of those that watched him, who imagined he was only in a sounder Sleep than ordinary."

One suspects that the gradual recession of both acute and chronic infectious diseases also went unperceived even among those who were watching. But the human costs of epidemic diseases as well as chronic infections lessened as people gained greater access to food, as well as more nutritional variety, and developed means of distancing their exposure to acute infectious diseases during the economic expansion of the eighteenth century.

Ann G. Carmichael

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