The Burdens of Disease: Epidemics and Human Response in Western History

Introduction

1 Introduction Disease and illness have obvious importance to human life. In recent years, popular awareness of them has sharpened with concerns about a new worldwide pandemic, perh aps of some form of Asian bird flu spreading to humans. More than ever some understanding of the workings of disease within Western (and world) history should inform our responses to present and future epidemic crises. This book, a second and revised version of the original, presents a view that emphasizes alike the individual reality of sickness and death, the social responses to such physical illness, and the changing ways in which Western societies have constructed the meaning of disease. Disease is both a pathological reality and a social construction. Both material evidence for it and convictions about it exist; concentration on one to the exclusion of the other (as some earlier historical writing has done) has sometimes made a neater story, but an incomplete one. Especially during the period from the late nineteenth century through the mid-twentieth, disease seemed an objective biological phenomenon, and those who combated it were scientific physicians . A large literature in the history of medicine resulted, one that focused on those figures from the past whose actions and thoughts most closely foretold the model of modern Western biomedicine. That literature usually said little about the effects of disease on social structures or on individual, everyday lives. More recently two other conceptions of disease complicated this positivist picture. Many social scientists and historians came to consider disease above all as a cultural construct , rooted in mental habits and social relations rather than in objective biological conditions of pathology. Other writing saw disease as a force in its own right, an implacable product of a biological world in which humans are prey as well as predators. That view, associated with historians’ concern with the long-term conception of time and with environment rather than events, shifted attention from the medicine-centered approach to disease, but in doing so it may have reduced human responses to insignificance. The rich volume of scholarship in the last three decades on the history of particular diseases and disease episodes has shown the connections between diseases and social and political changes, the role of disease in the uncovering of social tensions, and the interactions of disease and changes in medical practice. It has explored the complex role of governments in the provision of health care, and the even more complex factors of professionalization that lay behind modern scientific medicine. It has recovered both the variety and persistence of folk traditions and other responses to disease outside the realm of official medicine. This book aims to apply such approaches to the history of disease in Western civilization as a whole, while also insisting on the importance of the biological and pathological realities of disease and hence of the traditions of scientific medicine. Disease has affected Western civilization in a number of ways in different times and places. Some of its most obvious effects have been demographic: disease has led to periods of stagnant or falling human population, for example, in Europe in the late fourteenth and early fifteenth centuries. In the last two centuries human responses (especially in the West) to disease have themselves affected demography, in ways still subject to historical argument. Disease has had social effects, as in the sharpening of class lines between immigrants and “natives” in nineteenth-century American cities. Its political effects have been numerous, and sometimes dramatic: it played a crucial role in the overwhelming of Native American polities by European invaders, and it has decided both battles and the fates of European dynasties. Disease has affected economies, both by demographic pressure that has changed the supply and hence the price of labor and by its effects on the productivity of a particular region or social group. Disease’s intellectual and cultural effects have been far-reaching and profound; it has channeled (or blocked) individual creativity, and it may on occasion have set its stamp on the “optimism” or “pessimism” of an entire age. In perhaps less obvious ways, civilization has also affected disease. Some civilizations , by their very restlessness, have increased disease’s opportunities. European incursions in the tropics have meant contact with yellow fever; European contacts with Native Americans resulted in a complex interchange of microorganisms and diseases; the networks of medieval trade, both by sea and land, made the movement of plague easier, as did the steam transportation of the...