Prologue

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)

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.
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.

Introduction

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 Secrets)

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.
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' notions.
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 disease.
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. . . .
Table of Contents and Illustrations:
History / Medicine

ISBN: 1-888725-33-8 Plague Legends - From the Miasmas of Hippocrates to the Microbes of Pasteur. $24.95

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