Infectious Diseases in the Ancient

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Infectious Diseases in the Ancient Medieval
World
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Basic Concepts

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

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• 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

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Limits to our Current Knowledge

• Do not know exactly what diseases were
  experienced
• No dedicated data gathering strategies
• Confusing descriptions

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• Evident they understood epidemics non-epidemics
• Typical explanations
• Gods
• Demons
• Corruption of the air
• Imbalance of individual constitutions

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• Hippocratic emphasis on individual predisposition
  created a particular perspective
• Galen silent on contagion
• Religious beliefs created other perspective
• Job divine punishment

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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

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

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• Leper was social religious outcast
• Associated with lust and sexual misconduct
• Leviticus 13 1-8
• unclean, unclean
• Segregation from mainstream society

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• Rise of lazarettos by 7th century
• Height of incidence in 14th century

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Smallpox

• Viral infection caused by variola major
• Case fatality rate 20-40 if untreated
• Spread by
• Direct contact
• Indirect contact

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

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• Consequences
• Civil disorder
• Population decline
• Decreased tax revenues
• Military unrest

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Plague

• Caused by Yersinia pestus
• Zoonosis
• Transmitted by bite of flea which lives on rats
• Originated in Himalayan border between India
  China

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• Three forms
• Bubonic
• 50-60 fatality rate
• Septicemic
• 100 fatality rate
• Pnemonic
• 100 fatality rate

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Plague of Justinian

• 1st known outbreak in Europe
• Centred around Constantinople
• 542-543 CE
• Believed to be imported from Egypt on trade ships

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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

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• Political Impact
• Ended Justinians efforts to reunite Rome
  Constantinople
• Rise of the Islamic Empire
• Decline of Mediterranean as centre of Western
  civilization

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• Medical Impact
• Physicians had little to offer

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The Black Death

• After 6th 8th 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

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• From there, spread to rest of Europe
• Within 2 years, killed 25-30 of population of
  Europe

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• 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

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Social Impact

• Flight
• Violence
• Scapegoating
• Decline in authority of Church
• Changes in personal practices
• A more troubled age

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Medical Responses

• Still had little to offer
• Individual focus
• Typical therapies
• Diet
• Herbs
• Fumigation

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

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Political Responses

• Institutionalization of public health measures
• Quarantine
• Regulations
• Bills of Mortality

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

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• Decline in Spains Imperial power

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