Diseases of the Renaissance and Early Modern Europe

The Renaissance in European history was a time of political, intellectual, and cultural change that had its origins in Italy during the fourteenth century. Beginning roughly during the lifetime of the poet Francesco Petrarch, who died in 1374, literati began to look to classical Greece and Rome for models of human political behavior and stylistic models of discourse and artistic representation. This humanistic quest involved the energies of philosophers and artists throughout the fifteenth, sixteenth, and seventeen centuries, as Renaissance ideas spread northward. Though narrowly conceived in scholarly and artistic circles, the Renaissance matured in urban settings. Because this time period coincides with technological innovations and the subsequent exploration and conquest of new worlds, we are inclined to associate the issue of Renaissance diseases with both the growth of cities and the age of European discovery. The period also frames the era of recurrent epidemics of bubonic plague in Europe.

Population growth in Europe was steady during the central, or "High," Middle Ages but did not lead to the growth of large metropolitan centers. Urbanization was earliest and most dramatic in the Mediterranean lands, where city cultures had also been the basis of ancient Roman hegemony. By the late thirteenth century, Florence and Venice, as successful commercial centers, had populations of more than 100,000. Rome, Milan, and Barcelona may have been equally large. Smaller urban areas of 50,000 to 80,000 individuals existed throughout northern Italy and Spain. These cities were roughly twice as large as the "urban" areas of England, including London. Uniformly dense, mixed urban and village networks were also characteristic of the Low Countries at the end of the Middle Ages, and the Seine valley could boast of at least one true city, Paris.

Outside the urban Mediterranean, the period of the Renaissance is better labeled the late Middle Ages. Most people lived in small villages and market towns, where goods, information, and epidemic disease passed through at a more leisurely rate. The British Isles, for example, had no town larger than 50,000 people until after 1600. But by the late sixteenth century, France, Germany, and England began to grow in population and in number of cities. The Thirty Years' War effectively eclipsed growth in Germanic Europe during the early seventeenth century. London and Paris, however, became the largest cities of Europe. By the eighteenth century, Scotland and Scandinavia began the processes of urbanization, commercialization, and protoindustrialization. A general improvement in health and longevity accompanied economic growth, even though the prevalence of infectious diseases remained high.

The "Black Death" epidemic of bubonic plague in 1348—50 caused up to 40 percent overall mortality in large cities, and as much as 60 percent mortality in smaller Italian cities such as Siena. Nevertheless, the greatest proportional destruction of the plague and subsequent periodic epidemics of disease in the fourteenth century seems to have fallen on villages and towns of western Europe, necessitating changes in landholding and land usage, and forcing individuals to migrate to cities in search of nonagricultural work. From 1350 to 1500, recovery was slow and uneven, but as early as the 1450s the great cities of Italy, Spain, and the Low Countries began to wrestle with the sanitary pressures brought about by new growth. These cities grew at the expense of the sur rounding countryside, and market economies responded to this growth with the development of local industries, particularly in cloth, and with the development of trading networks that would facilitate further urban growth. During the sixteenth century, an impressive demographic recovery of rural populations seems to have fueled still more urban growth as more and more individuals migrated steadily, even relentlessly, to the cities from the countryside. Thus, even though struck by epidemics of plague, the populations of Venice, Florence, Milan, and Rome all exceeded pre-1348 levels. During the sixteenth century, Madrid expanded 10-fold in population while increasing only 4-fold in size, a dramatic example of the problems of crowding that the growth of Renaissance cities created.

In both Renaissance and early modern Europe, social and economic conditions help to identify and define the diseases then common. Naturally the disease experience of urban settlements differed significantly from that of rural town networks. City administrators were forced to deal with increasingly serious health threats, particularly with problems of refuse disposal and the provision of clean water, and of course with recurrent epidemic diseases.

At a time when at least one-third of all babies born died before their fifth birthdays, chronic infections mediated the lives of most adults, and two-thirds of rural residents did not survive to reproductive age, the acute crises of plague and other epidemics may not have been the most important diseases of the Renaissance. But they were certainly the most visible disease threats, and this shapes modern-day perceptions of the period as a dark age of plagues and other acute infections.

In early modern Europe the specter of famine loomed over the rural landscape. Although the adage "First famine, then fever" did not hold true for all periods of food shortage, periodic subsistence crises tended to provoke mortality crises. Normal annual mortality was as high as 3 percent of a population. But these crises generally carried away 6 to 10 percent of the population, and when very acute could claim as much as 30 to 40 percent. This short-run instability of mortality rates, what Michael Flinn (1981) has described as the demographic system of the ancien régime, was also nonuniform, so that neighboring towns could be affected quite differently during any given crisis. Across a community, the highest death rates occurred among those less than 10 years of age, with most deaths occurring within the first 2 years of life.

The basic problem, then, is to identify the cause or causes of such high mortality. Famine, epidemics, or war could singly or in combination precipitate a mortality crisis, though infectious disease usually became the proximate cause of death. Yet rural populations often made up the losses quickly through reproduction, and years immediately before and after a period of crisis were times of lower than average mortality. Certainly it would seem that the most vulnerable members of a population were systematically pruned away during a mortality crisis, a classic Malthusian picture.

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