Cultures of Plague: Medical Thinking at the End of the Renaissance (review)

Samuel K. Cohn's Cultures of Plague applies a modern epidemiological method to Early Modern accounts of the bubonic plague in Italy and draws some surprising conclusions about how the plague was seen and managed. Cohn argues against the prevailing view that writings about the plague changed little from the period of the Black Death in the middle of the fourteenth century to the end of the sixteenth century. He focuses his argument on the plague of 1575-78 to demonstrate that these writings were based on what the writers saw and experienced. His public health approach also denies that plague writings were couched in the intellectual traditions of antiquity (Aristotle and Galen) and modified by Arab writers of the early and middle medieval period. Although Cohn's survey is restricted to the plague in Italy, it creates a lively account of life during an outbreak of plague and carefully traces the steps taken by physicians, clerics and public officials to trace the course of the disease in their community and their attempts to contain it.

Cohn's argument begins with a list of plague writers who dismiss the advice of ancient authorities because they have not seen or experienced the plague as these contemporary authorities had. It was from this position of experience that these authorities could report and recommend various remedies. This examination of writers demonstrates that, from the late fourteenth century, there was an understanding that plague was caused by contagion - through touching, breathing or sight. This assumption was made because the physicians noted that, if one member of a household became ill with plague, it was likely that all members of the household would become ill. Although later plague writings returned to the ancients to describe causes, it was the plague of 1575-78 that produced a remarkably modern view of plague and saw the implementation of public health measures to combat the disease.

In Chapter 2, Cohn examines how plague writers described the signs and symptoms of plague from the Black Death to the plague of 1575-78. He argues that there was no attempt to make a systematic catalogue of the signs and symptoms, especially accounts of skin swellings, described in plague writings. Cohn also makes the point that accounts of the plague from the early twentieth century describe a variety of signs and symptoms that do not always include skin swellings. When returning to Early Modern plague writings, Cohn investigates how signs and symptoms are described throughout Italy. He examines different words describing similar skin swellings and how these skin swellings could be catalogued as predictors of the prognosis. For Cohn, these writings demonstrate that, if the bubonic plague is the same disease as described in early twentieth-century accounts, the course of the disease has actually changed in the intervening centuries. This assertion adds further weight to his claim that Early Modern physicians wrote from their own observations and experience, rather than relying on writings from antiquity.

In the following two chapters, Cohn closely examines plague writings from across Italy, beginning with the writings of the Sicilian physician, Giovanni Filippo Ingrassia. These writings are compared with writings from Milan, Padua, Venice, and Verona to show how similar each account is, again demonstrating that the writers were recording their own observations and experiences. The fifth chapter looks at verse responses to the plague and its demise, noting how public officials were praised for their efforts in containing the disease through their public health measures.

The last three chapters describe how the observations and the lived experiences of plague writers led to many public health measures which were designed to contain the spread of the disease in urban areas. This is the crux of Cohn's argument; without direct observation and experience, many public health measures would not have been instituted. It is also unreasonable to assume, therefore, that plague...