1. Infectious Diseases in the Ancient & Medieval World

2. Basic Concepts  Infectious diseases are a major cause of human mortality  Up until late 19 th century, infections kills the majority of people  In developed countries today, 4% of mortality attributed to infections –Not including STIs and AIDS

3.  Defined as a disease that can be passed from one person to another  Basic modes of transmission –Direct contact –Indirect contact  Incidence –Endemic –Epidemic –Pandemic

4. Limits to our Current Knowledge  Do not know exactly what diseases were experienced –No dedicated data gathering strategies –Confusing descriptions

5.  Evident they understood epidemics & non-epidemics  Typical explanations: –Gods –Demons –Corruption of the air –Imbalance of individual constitutions

6.  Hippocratic emphasis on individual predisposition created a particular perspective  Galen silent on contagion  Religious beliefs created other perspective –Job & divine punishment

7. Leprosy  Primary exemplar of divine punishment  Disease resembling leprosy mentioned in old & new testaments  Caused by Mycobacterium Leprae  Causes considerable disfigurement of facial features & skeleton

8.  Uncertain if biblical accounts believed to be about leprosy were in fact that disease  Skeletal evidence for presence in Europe by 6 th century, but not before

9.  Leper was social & religious outcast  Associated with lust and sexual misconduct  Leviticus 13: 1-8 –“unclean, unclean”  Segregation from mainstream society

10.  Rise of lazarettos by 7 th century  Height of incidence in 14 th century

11. Smallpox  Viral infection caused by variola major  Case fatality rate 20-40% if untreated  Spread by –Direct contact –Indirect contact

12.  Antonine plague (Rome) believed to be smallpox  Imported by troops returning from Mesopotamia  ¼ to 1/3 of population died

13.  Consequences –Civil disorder –Population decline –Decreased tax revenues –Military unrest

14. Plague  Caused by Yersinia pestus  Zoonosis  Transmitted by bite of flea which lives on rats  Originated in Himalayan border between India & China

15.  Three forms 1. Bubonic 1.50-60% fatality rate 2. Septicemic 1.100% fatality rate 3. Pnemonic 1.100% fatality rate

16. Plague of Justinian  1 st known outbreak in Europe  Centred around Constantinople  542-543 CE  Believed to be imported from Egypt on trade ships

17. Social Impact  Estimated 10,000 people/day died  Killed 40% of population of city  Estimated 100 million people died in empire  Overwhelmed capacity to deal with bodies  Beginning of Dark Ages

18.  Political Impact –Ended Justinian’s efforts to reunite Rome & Constantinople –Rise of the Islamic Empire –Decline of Mediterranean as centre of Western civilization

19.  Medical Impact –Physicians had little to offer

20. The Black Death  After 6 th – 8 th century, plague disappeared in Europe for about 700 years  Re-appeared in 1347  Probably originated in China  Moved to Central Asia  Broke out in Crimea amongst Tartar troops fighting the Italians  Taken to Mediterranean

21.  From there, spread to rest of Europe  Within 2 years, killed 25-30% of population of Europe

24.  Plague re-appeared regularly for next 4 centuries  Great Plague of London (1665)  After this plague disappeared from N. Europe  Marseilles 1720-21 last major outbreak in Europe

25. Social Impact  Flight  Violence  Scapegoating  Decline in authority of Church  Changes in personal practices  “A more troubled age”

30. Medical Responses  Still had little to offer  Individual focus  Typical therapies –Diet –Herbs –Fumigation

31.  Still focussed on miasma, corruption of air  Astronomy  No power to enact public health reglations

33. Political Responses  Institutionalization of public health measures –Quarantine –Regulations –Bills of Mortality

34.  Population Decline –Recovery of population took over a century –Laws re: agricultural workers –Threats to food security –Higher wages –Possibly de-stabilized feudalism

35.  Decline in Spain’s Imperial power

36.  So... What in general can we say about the impact of infectious diseases on Europe?