Responses to Epidemics before the Nineteenth Century

The ancient Greeks and Romans commonly, though not universally, believed that epidemics were brought into human communities from outside. Thucydides, for example, described the plague that struck Athens during the Peloponnesian War as having arrived by sea. This belief was the basis of official reactions to epidemics in medieval Europe. Following the closure of the port at Venice to all shipping for thirty days as the plague threatened in 1346, regulations imposed in Marseilles in 1384, and in other ports thereafter, prescribed the biblical period of isolation for a "quarantine" (forty days) outside the harbor for any ship thought to have called previously at a place infected with the plague. In 1423 the Venetians set up a hospital where plague victims were isolated, and by 1485 the city had a sanitary authority armed with wide-ranging powers during epidemics. In some epidemics, as in the Great Plague of London in 1665, victims were compulsorily isolated in their own houses, which were marked with a red cross to warn the healthy not to enter. Compulsory screening was not an issue before the late nineteenth century, however, because diseases were recognized as such only after the onset of obvious symptoms, and the concept of the asymptomatic carrier did not exist. In addition to these measures, the authorities in many medieval towns, working on the theory that epidemics were spread through the contamination of the atmosphere, ordered the fumigation of the streets to try to clear the air. Doctors and priests were expected to attend to the sick; and those who fled, as many did, are strongly criticized in the chronicles of these events.

Popular reactions to epidemics included not only flight from infected areas and evasion of public health measures, but also attacks on already marginalized and stigmatized minorities. As bubonic plague spread in Europe in 1348-1349, for example, rumors that the Jews were poisoning water supplies led to widespread pogroms. Over nine hundred Jews were massacred in the German city of Erfurt alone (Vasold). Such actions reflected a general feeling, reinforced by the church, that plagues were visited upon humankind by a wrathful Deity angered by immorality, irreligion, and the toleration of infidels. A prominent part in these persecutions was played by the flagellants, lay religious orders whose self-flagellating processions were intended to divert divine retribution from the rest of the population. Jews were scapegoated because they were not part of the Christian community. Drawing upon a lengthy tradition of Christian anti-Semitism, which blamed the Jews for the killing of Christ, the people of medieval Europe regarded Jews at such times as little better than the agents of Satan (Delumeau).

State, popular, religious, and medical responses such as these remained essentially constant well into the nineteenth century. The medical understanding of plague continued throughout this period to draw heavily on humoral theories, so that therapy centered on bloodletting and similar treatments designed to restore the humoral balance in the patient's body. They were of limited effectiveness in combating bubonic plague, which was spread by flea-infested rats. The isolation and hospitalization of victims also therefore did little to prevent the spread of plague. Nevertheless, the disease gradually retreated from western Europe, for reasons that are still imperfectly understood. The introduction of more effective quarantines with the emergence of the strong state in the seventeenth and eighteenth centuries was almost certainly one of these reasons, however, and helped prevent the recurrence of epidemics in the seventeenth and eighteenth centuries (Vasold).

State intervention also played a role in reducing the impact of smallpox, the other major killer disease of the age after bubonic plague. Its spread was first reduced by inoculation, before compulsory programs of cowpox vaccination brought about a dramatic reduction in the impact of the disease in nineteenth-century Europe. Despite the imperfections of these new methods, which sometimes included accidentally spreading the disease, vaccination programs in particular may be regarded as the first major achievement of the "medical policing" favored by eighteenth-century absolutist monarchies such as Prussia. Police methods that paid scant attention to the liberties of the subjects were used to combat the spread of epidemics. They included the use of troops to seal off infected districts, quarantines by land and sea, and the compulsory isolation of individual victims. Most of these measures had little effect, however, either because of lack of medical knowledge or because poor communications and lack of police and military manpower prevented them from being applied comprehensively (Rosen).

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