August 16, 2014

Pathological musings

So Ebola is back in the news lately, and I've just watched a couple of documentaries on YouTube about the Black Death of the 14th century... hence the topic of this blog post.

I've always been interested in diseases-- what causes them, how they are spread, what people of the past believed about them, and how they affect society.

Basically, western medicine until just a couple of hundred years ago was based on the following beliefs:

1) that good health depended upon the balance of human body fluids, called "humors." Blood, yellow bile, black bile, and phlegm. If you were sick, it meant that your humors were out of balance. This is why people, even up through the 19th century, often tried to "cure" people by bloodletting. If you were feverish, it was because you had excess blood.

2) that, in general, when something bad befell you, it was a judgement from God. Needless to say, when the Black Death arrived on the shores of Sicily in 1348, people were convinced that God was punishing them. This would give rise to weird fringe groups, called Flagellants, who didn't think that the Church was dealing decisively enough with the crisis, and who would walk through the streets whipping themselves. Considering that they were roaming around populated areas, and that they were literally getting blood all over the place while mortifying their flesh, they were probably actually helping the disease to spread.

3) That diseases were caused by foul-smelling air, called miasma. Even in the 19th century, people believed that the disease malaria was caused by breathing noxious night air (malaria literally means "bad air") instead of by the bites of the mosquitos which occupied that air.

This is why plague doctors of the 17th and 18th centuries wore those strange costumes and creepy-looking masks with beaks. These beaks were stuffed with sweet-smelling herbs and flowers to prevent the wearers from breathing in the stink of the plague patients, and thus, it was thought, to prevent them from getting sick. These outfits inadvertently functioned like modern-day decontamination suits, and so actually did offer protection.

I can only imagine that, if a victim of plague didn't die directly from his illness, opening his eyes to this vision of Big Bird from hell might have given him a heart attack.

Germ theory gradually replaced the miasma theory from the mid to late Victorian era, so people of the 14th century would have had no idea that coughing and sneezing spread disease; most people today automatically know that they should cover their noses and mouths. I imagine that this basic rule of courtesy and health didn't exist back then, since there would have been no reason in their minds to do so.

This brings us to another question: what exactly was the Black Death? It's thought by most to be bubonic plague, transmitted by the fleas which accompanied rats. Many scientists believe that the disease had to have become airborne to have spread as rapidly as it did in Europe. This form would be called pneumonic plague.

But we can't be completely certain what the disease actually was.

The plague would return periodically after this initial epidemic, once about every ten years, but never as virulently as before. Makes me wonder how a pestilence like this started, why it finally ended, and what caused its periodic resurgence?

As nightmarish as the initial three-year rampage of the Black Death was, in which Europe's population was almost cut in half, it did have benefits for those who survived-- and would dramatically change European society. Before the Black Death struck, labor was plentiful and cheap. Peasants, called serfs, had worked for lords, in return for a small share of property and protection. After the epidemic was over, peasants could afford to demand better pay and more rights. The Black Death, in short, ended feudalism-- and those who had escaped the disease found that they were much better off than they had been before.

It also changed the psyche of Europeans... making them more individualistic and questioning of authority; they had seen how little the Church and their rulers could do for them in this crisis.

Strange to think that a single but devastating epidemic of disease could have such a huge impact on a civilization.

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