Other Epidemics

During the Renaissance period, influenza pandemics recurred frequently enough to be well described by the fifteenth century. At least three influenza epidemics were quite severe during the sixteenth century, those of 1510,1557-8, and 1580. The last in particular resembled the devastating influenza of 1918, in that the first wave occurred in the summer and early fall, and morbidity and mortality were high among young adults. The periodic influenza in the seventeenth century has not been a subject of scholarly study, though the epidemics of 1627 and 1663 seem to have been quite lethal. In contrast, epidemics of the eighteenth century have received considerable attention. K. David Patterson (1986) points to two epidemic periods in particular, from 1729 to 1733 and from 1781 to 1782, that mirror sixteenth-century pandemic influenza, suggesting that worldwide distribution of this common infectious disease antedated advances in global transportation.

Virulent smallpox, by contrast, may have appeared in Renaissance Europe only in the mid-sixteenth century (Carmichael and Silverstein 1987). Before that time measles and smallpox were described as relatively mild infections of childhood, an observation resting on those of ninth- and tenth-century Muslim physicians, Rhazes and Avicenna. Unless many of the fourteenth- and fifteenth-century epidemics of plague were in fact mixed epidemics of plague and smallpox, with the latter masked by the horror of the plague, records of epidemics of smallpox were sparse before the 1560s and 1570s. More likely a milder strain of smallpox prevailed before virulent smallpox entered England in the seventeenth century. Smallpox has a much more prominent — if not preeminent — place among the diseases of the seventeenth and eighteenth centuries and will thus be discussed later in more detail.

The history of other infections transmitted by airborne droplets is a patchy one during the Renaissance. Diphtheria was certainly described well in epidemics of malignant sore throat, as was whooping cough, the earliest examples dating from the sixteenth-century epidemiologist Guillaume de Bail-lou. In Spain, accounts of epidemics of garoffilo appeared during the early seventeenth century, depicting what was presumably a considerable threat to young children. Yet diphtheria was confused with epidemics of streptococcal sore throat as late as the mid-nineteenth century.

The German physician Daniel Sennert is credited with having written the first unambiguous description of scarlet fever. Rheumatic fever, another manifestation of severe streptococcal infection, was described well by Baillou in the sixteenth century and by the English physician Thomas Sydenham in the seventeenth century. Epidemic typhus fever seems to have been a new disease in Renaissance and early modern Europe.

One of the great problems facing historians of Renaissance diseases is the difficulty of discerning the precise cause of an epidemic much before 1500. For example, the following account from a Parisian chronicler in 1414 suggests both whooping cough and influenza:

And it pleased God that a foul corrupt air should fall upon the world, an air which reduced more than a hundred thousand people in Paris to such a state that they could neither eat, drink, nor sleep. They had very sharp attacks of fever two or three times each day, especially whenever they ate anything. Everything seemed very bitter to them, very rotten and stinking, and all the time, where ever they were, they shook and trembled. Even worse, besides all this they lost all bodily strength so that no one who had this disease could bear to touch any part of his body, so wretchedly did he feel. It continued without stopping three weeks or more; it had begun in early March of the same year and was called the tac or herion As well as all the misery described above, people had with it such a fearful cough, cattarh, and hoarseness that nothing like a high mass could be sung anywhere in Paris. The cough was so much worse, night and day, than all the other evils that some men suffered permanent rupture of the genitals through it and some pregnant women gave birth prematurely because of this coughing, alone and without help, and died, mother and child, in great distress. When people began to get better they passed a lot of clotted blood through nose, mouth and below, which frightened them very much. Yet no one died of it. But it was with great difficulty that people managed to recover from it, even after the appetite came back it was still more than six weeks before they were really cured. No physician could say what this disease was. (Shirley 1968)

This vivid description is echoed by a brief mention of a contemporary catarrhal illness in the other urban areas of Europe, suggesting that the disease was influenza. The cough and low case fatality, however, indicate whooping cough (the chronicler is unlikely to have noted the deaths of babies). But if either whooping cough or influenza was a truly new disease in the early fifteenth century, then the implications for changing disease patterns in the later Renaissance would be considerable. It is more likely that the criteria for diagnosis and the medical theo ries governing the description of disease changed during the Renaissance, making difficult a retrospective assessment of what was new and different then.

In others words, evidence for the sudden appearance of many common diseases in the sixteenth and seventeenth centuries is somewhat artifactual - a "reporting phenomenon." During the Renaissance, physicians increasingly turned to models of contagion to explain (and, hence, control) the spread of plagues and pestilences, and were aided considerably by adoption of ontological theories of disease. That is, physicians crafted new medical definitions of diseases, which had long possessed common lay names, describing them as individual entities with unique and distinguishing characteristics. Though chronic "diseases," such as fevers, consumption, arthritis, gout, cancer, ulcers, and fistulae, were still best explained and treated only by a thorough understanding of the Galenic-Hippocratic humoral system that dominated medicine until the nineteenth century, medical accounts from the sixteenth century onward tended to identify acute health problems in terms of specific diseases. These new ways of looking at illness had a profound effect on the recognition and description of diseases known today. Moreover, the spread of medical information through the medium of print accelerated and normalized the understanding of many diseases as specific and individual.

In the sixteenth and seventeenth centuries, dozens of "new" diseases seemed to demand or defy medical explanation, which resulted in some of the earliest medical descriptions we possess for scurvy, rickets, typhus, syphilis, scarlet fever, the "English sweate" (whatever that was), and even anorexia nervosa. Thus, one of the fundamental problems for historical epidemiologists is determining which of these, if any, were indeed new or newly important during the period from 1400 to 1800. And by "newly important," we mean diseases that changed in incidence and prevalence in a society rather than those that became important to some groups within these societies. For example, was gout "important" to Renaissance and early modern elites because it became a noble form of suffering - in contrast, for example, to the ignominy of syphilis - or because meat consumption among the upper classes, together with a heavy consumption of dehydrating alcohol, increased the clinical expression of gout? In many cases we will never know the answer, and thus must make some assumptions based on those data that did not change over the reporting period while considering significant shifts in the criteria for definition and diagnosis. In this respect, much scholarly attention has been devoted to smallpox and syphilis, which thus form two illustrative case studies of the problems involved in tracing the history of diseases of early modern Europe.

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