THE RENAISSANCE (1500–1750)
Commerce, industry, trade, merchant fleets, and voyages of
discovery to seek new markets led to the development of
a moneyed middle class and wealthy cities. In this period,
mines, foundries, and industrial plants flourished, creating
new goods and wealth. Partly as a result of the trade generated
and the increased movement of goods and people, vast
epidemics of syphilis, typhus, smallpox, measles, and the
plague continued to spread across Europe. Malaria was still
widespread throughout Europe. Rickets, scarlet fever, and
scurvy, particularly among sailors, were rampant. Pollution
and crowding in industrial areas resulted in centuries-long
Box 1.1 "This is the End of the World": The Black Death
"Rumors of a terrible plague supposedly arising in China and
spreading through Tartary (Central Asia) to India and Persia,
Mesopotamia, Syria, Egypt and all of Asia Minor had reached
Europe in 1346. They told of a death toll so devastating that
all of India was said to be depopulated, whole territories covered
by dead bodies, other areas with no one left alive. As
added up by Pope Clement VI at Avignon, the total of reported
dead reached 23,840,000. In the absence of a concept of contagion,
no serious alarm was felt in Europe until the trading
ships brought their black burden of pestilence into Messina
while other infected ships from the Levant carried it to Genoa
and Venice.
By January 1348 it penetrated France via Marseille, and
North Africa via Tunis. Ship-borne along coasts and navigable
rivers, it spread westward from Marseille through the ports of
Languedoc to Spain and northward up the Rhone to Avignon,
where it arrived in March. It reached Narbonne, Montpellier,
Carcassone, and Toulouse between February and May, and at
the same time in Italy spread to Rome and Florence and their
hinterlands. Between June and August it reached Bordeaux,
Lyon, and Paris, spread to Burgundy and Normandy into southern
England. From Italy during the summer it crossed the Alps
into Switzerland and reached eastward to Hungary.
In a given area the plague accomplished its kill within four
to six months and then faded, except in the larger cities, where,
rooting into the close-quartered population, it abated during
the winter, only to appear in spring and rage for another six
months."
Source: Tuchman, B. W. A Distant Mirror: The Calamitous 14th Century, op cit. page 93.
6 Chapter | 1 A History of Public Healthepidemics of environmental disease, particularly among
the urban working class.
A virulent form of syphilis, allegedly brought back
from America by the crews of Columbus, spread rapidly
throughout Europe between 1495 and 1503, when it was
first described by Fracastorus. Control measures tried in
various cities included examination and registration of
prostitutes, closure of communal bath houses, isolation in
special hospitals, reporting of disease, and expulsion of sick
prostitutes or strangers. The disease gradually decreased in
virulence, but it remains a major public health problem.
In Russia, Czar Ivan IV (Ivan the Terrible) in the sixteenth
century arranged to hire the court physician of
Queen Elizabeth I, who brought with him to Moscow a
group of physicians and pharmacists to serve the court.
The Russian army had a tradition of regimental doctors. In
the mid-seventeenth century, the czarist administration
developed pharmacies in major centers throughout the country
for military and civilian needs, and established a State
Pharmacy Department to control pharmacies and medications,
education of doctors, military medicine, quarantine,
forensic medicine, and medical libraries. Government revenues
from manufacturing, sale, and encouragement of vodka
provided for these services. Preparation of military doctors
(Lekars) with 5–7 years of training was instituted in 1654.
Hospitals were mainly provided by monasteries, serving both
civilian and military needs. In 1682, the first civic hospital
was opened in Moscow, and in the same year, two hospitals
were opened also in Moscow by the central government for
care of patients and training of Lekars.
In European countries, growth of cities with industrialization
and massive influx of the rural poor brought the
focus of public health needs to the doorsteps of municipal
governments. The breakdown of feudalism, the decline of
the monasteries, and the land enclosures dispossessed the
rural poor. Municipal and voluntary organizations increasingly
developed hospitals, replacing those previously run
by monastic orders. In 1601, the British Elizabethan Poor
Laws defined the local parish government as being responsible
for the health and social well-being of the poor,
a system later brought to the New World by British colonists.
Municipal control of sanitation was weak. Each citizen
was in theory held responsible for cleaning his part of
the street, but hygienic standards were low with animal
and human wastes freely accumulating.
During the Renaissance, the sciences of anatomy,
physiology, chemistry, microscopy, and clinical medicine
opened medicine to a scientific base. Medical schools in
universities developed affiliations with hospitals, promoting
clinical observation with increasing precision in
description of disease. The contagion theory of disease,
described in 1546 by Fracastorus and later Paracelsus,
including the terms infection and disinfection, was contrary
to the until-then sacrosanct miasma teachings of
Galen.
From 1538, parish registers of christenings and burials
were published in England as weekly and annual abstracts,
known as the Bills of Mortality. Beginning in 1629, national
annual Bills of Mortality included tabulation of death by
cause. On the basis of the Bills of Mortality, novelist Daniel
Defoe described the plague epidemic of London of 1665
100 years later.
In 1662, John Graunt in England published Natural
and Political Observations Upon the Bills of Mortality.
He compiled and interpreted mortality figures by inductive
reasoning, demonstrating the regularity of certain
social and vital phenomena. He showed statistical relationships
between mortality and living conditions. Graunt’s
work was important because it was the first instance of
statistical analysis of mortality data, providing a foundation
for use of health statistics in the planning of health
services. This established the sciences of demography
and vital statistics and methods of analysis, providing
basic measurements for health status evaluation with
mortality rates by age, sex, and location. Also in 1662,
William Petty took the first census in Ireland. In addition,
he studied statistics on the supply of physicians and hospitals.
Microscopy, developed by Antony van Leeuwenhoek in
1676, provided a method of study of microorganisms. In the
seventeenth century, the great medical centers were located
in Leyden, Paris, and Montpelier. Bernardino Ramazzini
published the first modern comprehensive treatise on
occupational diseases in 1700.
In Russia, Peter the Great (1682–1725) initiated political,
cultural, and health reforms. He sent young aristocrats
to study sciences and technology in Western Europe,
including medicine. He established the first hospital-based
medical school in St. Petersburg and then in other centers,
mainly to train military doctors. He established the Anatomical
Museum of the Imperial Academy of Sciences in
St. Petersburg in 1717, and initiated a census of males for
military service in 1722. In 1724, V. N. Tateshev carried
out a survey by questionnaire of all regions of the Russian
empire regarding epidemic disease and methods of treatment.