The idea of writing this book grew on me slowly. I date its inception,
at least in its 'germ' form, to when I first read Charles-Edward A. Winslow's
The Conquest of Epidemic Disease in 1995. It was there where I first encountered
the colorful characters of Benjamin Rush and Max von Pettenkofer, two legendary
personalities whose disease theories were so strikingly new to me as to
make me realize how ignorant I was of the richness of beliefs concerning
the origin of epidemic disease before the reality of the microbial world
came into being.
The most fascinating objective has been the history of ideas,
the slow and gradual evolution of human thought. How did the leaders of
science really visualize a given problem in a given century, what was their
solution and what were the reasons which dictated that solution? (Winslow)
Rush is classified as one of, if not the, leading physician in America
at the end of the 18th century. He is also known for his 'heroic' use of
bloodletting to cure disease, which has been said to have caused more deaths
than the French Revolution and the Napoleonic Wars combined! Pettenkofer
too gets a bad historical press, although he is recognized as one of the
leading German hygienists of the 19th century. History books, short of
space, tell us only about his having deliberately drunk a culture of cholera
bacillus, often without even bothering to inform the reader why anyone
would commit such an apparently suicidal act.
Both Rush and Pettenkofer are often portrayed as medical anomalies,
lacking any sense. Yet Winslow, for good reasons, invests heavily in telling
both their stories, Rush's in connection with the 1793 yellow fever epidemic
in Philadelphia, and Pettenkofer's in connection with the series of cholera
pandemics that struck Europe during the 19th century. We learn how both
evolved epidemic causation theories that were fully consistent with earlier
thinking whose roots trace back to Hippocrates.
Despite Winslow's extensive accounting of different theories from antiquity
to the 20th century, I still did not have a clear picture of how they vied
with each other, i.e. why did some believe in one theory while others preferred
another. At that point I realized that by writing a book I could hopefully
come to that understanding and in the process explain these theories in
simpler and more accessible terms.
It was only when I had completed the first draft that I ran across
references to Marsilio Ficino, an ordained priest with some medical training
who is best known for his translations of Plato from Greek to Latin in
the 1460s. Although Winslow makes several brief references to Ficino's
plague treatise, he does not refer to how Ficino's translations of the
legendary figure of Hermes Trismegistus led Ficino, followed by other physicians
in the 16th and 17th centuries, to incorporate 'Hermetic' ideas in their
medical writings. At this point, the goals of my book became a little more
ambitious; I wanted to understand how religious beliefs influenced medical
theories of epidemics, an orientation rather lacking in the work of Winslow
(who concentrated on "leaders of science"), and many other medical historians
who have written about disease.
By now the reader may have guessed that I am not a professional historian.
While I don't think this lessens my enthusiasm for the subject in any way,
it is a handicap. Not only do I not know Latin and other languages that
would have allowed me to explore original texts, amateurs are always at
greater risk of being taken in by the historical misreading and exaggeration
of others and introducing some themselves. Hopefully these risks are compensated
for by whatever fresh point of view I have been able to bring to this subject.
If readers get as much pleasure out of this book as I had in writing
it, which I truly hope proves to be the case, they will be additionally
pleased to learn that the literature covering this subject is vast and
mostly accessible. Some suggestions are given in the Further Reading section.
Legend is a wonderfully ambivalent term. A legend may sometimes have no
basis in fact, but more often than not it is built on a mixture of fact
and fiction, both of which might contain "sensational" and even "ludicrous"
elements. Even real figures of legendary stature rarely escape having some
fictitious tale woven into their biography.
Please sir, don't legends always have a basis in fact? …
'Well,' said Professor Binns slowly, 'yes, one could argue that, I suppose.'
… However, the legend of which you spoke is such a very sensational, even
ludicrous tale …' (from J.K. Rowling's Harry Potter and the Chamber of
Both Hippocrates and Pasteur are of legendary stature. But whereas
factual microbes account for much of Pasteur's fame, "miasmas" are strictly
fictitious; it is not for them that Hippocrates owes his current fame.
Fictitious as they are, however, miasmas dominated the world of epidemics
up until the time that microbes came to be accepted as real disease-causing
agents. Today some might find miasma-related legends somewhat ludicrous,
but their place and importance in history cannot be denied.
Hippocrates used the word miasma to express the idea of a contaminated
atmosphere that could give rise to epidemics. In time miasmas were joined
by disease-carrying demons, wind-borne morbific matter, and countless other
ways of identifying the mysterious nature of a diseased atmosphere. Never
far from any of these explanations, however, was Gods' punishment.
Major epidemics were nearly always seen as a form of divine judgement.
They provided religious and medical authorities with a convenient opportunity
to identify their foes. Thus, the plague epidemic in Munster in Westphalia
in 1550 was seen as God's punishment for the heretical activities of the
Anabaptists and London's 1665 plague was due to the government having allowed
Thomas Hobbes, an atheist, to return there following a long exile in France.
Where there were no designated targets, as such, the sinful populace as
a whole was always available to be blamed.
Religious factors played a crucial role in shaping medical beliefs
and practices well through the 17th century. Religious beliefs constrained
as well as motivated certain lines of argument concerning what the epidemic-causing
process might be. When the Church was more tolerant towards Neo-Platonic
beliefs, during a brief period in the 16th and 17th centuries, many physicians
rallied around occult disease theories of the most fantastic kind. These
beliefs were the source material for some of the more "sensational" legends
of the time.
Many medical history books give short shrift to the legends rooted
in Neo-Platonic and other occult ideas. There is almost an embarrassed
silence surrounding such a personality as Robert Fludd, for example. Other
legendary figures, such as Paracelsus and van Helmont, who also were deeply
involved in similar mystical philosophy, generally find a place in history
books because their influence and accomplishments are simply too important
to be overlooked. However, little attention is given to their 'philosophical'
History books can and do distort on occasion by over exaggerating the
importance of a certain personality, attempting to create a modern legend
as it were. Winslow, says of Fracastoro, for example, that his "philosophical
statement of the contagionistic theory of disease (was) a mountain peak
in the history of etiology perhaps unequalled by any other writer between
Hippocrates and Pasteur." Fracastoro wrote about "germs" in the 16th century
but only achieved great fame during his lifetime as a poet and a learned
physician. And about Sydenham, the English Hippocrates, Winslow judges
that "his almost complete neglect of contagion as a practical factor in
the spread of epidemic disease and his major stress upon the metaphysical
factor of epidemic constitution held back epidemiological progress for
two hundred years." Sydenham lived some one hundred and fifty years after
Fracastoro, and while it is true that he was influential in determining
the direction that medical education would take in the 18th century, he
was not alone in his neglect of 'contagion' as a factor in the spread of
The book is divided into three parts. Part I covers history up to Sydenham,
i.e. up until the end of the 17th century. Part II introduces the specific
epidemic diseases that are touched upon in this book. By understanding
how each epidemic disease differs, the reader can better appreciate the
epidemiological puzzle they presented scientists of the 18th and 19th centuries.
Part III picks up the history of plague legends, covering these two centuries.
Part III differs in approach from that taken in Part I. To begin with,
more attention is given to specific major disease outbreaks, especially
those of yellow fever and cholera, two diseases not known in Europe before
the 18th century. Also, Part III uses each example to review relevant past
histories, sometimes taking the reader back to earlier centuries. On several
occasions a forward look is made to the early years of the 20th century
to better portray the impact of the microbial basis of disease upon public
health thinking and practice.
The short epilogue that concludes the book is a reflection on the fact
that microbes are still with us and public health is at best fighting a
holding action. Part of the failure to control plague diseases better than
we have is due to the fact that public health in the 19th century developed
along lines that were somewhat antagonistic to the new science of bacteriology.
Although this is not a major objective of this book, it is hoped that
the reader will come to realize that something important was lost when
microbes were seen to be the end-all of disease thinking.
. . .
of Contents and Illustrations:
History / Medicine
ISBN: 1-888725-33-8 Plague
Legends - From the Miasmas of Hippocrates to the Microbes of Pasteur.
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