A short history of respiratory illness epidemics (2)

*This blog post first appeared in Dutch on NL-lab.net. *

Last week, I discussed that from antiquity until well into the nineteenth century, the idea that contagious diseases were caused by the influence of celestial bodies, the weather, and climate, was common. We still see these ideas in our language: think of catching a cold. This explains why until the twentieth century, quarantines and isolations were not used to battle epidemic respiratory illnesses. After all, if an illness is caused by the weather, isolating patients has little use. The best option, usually only available to the wealthy, was to stay inside, warmly wrapped up.

Quarantining was an existing practice, but it was mostly used in other diseases. During a plague epidemic in Italy in the fourteenth century for example, the crew of mooring vessels was kept on the boat for forty days (quarantaine) to prevent infections.[1] So even though the contagious nature of some diseases and the fact that their spread can be stopped by isolating (suspected) patients have been understood for centuries, isolating patients with respiratory illnesses is a much more recent phenomenon. Only in 1898 did Dutch microbiologist Martinus Beijerinck coin the term ‘virus’ to describe what, up till that point, had been considered extremely small bacteria. And only in 1901 an influenza virus was first isolated, in poultry. The Spanish flu epidemic of 1918 was, in all likelihood, the first flu epidemic in which quarantine was used widely to manage the disease.

Detail of Jan Luyken, The Apothecary (1694), ets. Rijksmuseum RP-P-OB-44.502

Of course, people did try to manage and cure respiratory illness before the late nineteenth century too. Until the 1850s, most people depended on selfcare: ‘cures’ bought at the pharmacist, from herbal healers, or made from supplies from their own garden or pantry. Those who could afford it asked a doctor for advice, who would visit the patient at home and might give them a recipe for the apothecary. Hospitals were places where poor people would go if they were at the end of their tether, and no one could take care of them at home. Most people who went into a hospital had little hopes of coming out alive.[2]

Physicians like the Amsterdam medical doctor Steven Blankaart (1650-1704) advised rest and warm coverings in case of coughing and colds, very much in line with Hippocratic understandings of colds as caused by the weather. He also prescribed cures prepared by pharmacists, which could contain ingredients that we still use in cough medicine today, such as ginger and aniseed, but also plants and substances that have been nearly forgotten now. Blankaart warned that using sugary syrups and pastilles was useless, and that so-called plasters, swaths of fabric drenched in extracts, were no good either. The only possible exception were plasters containing substances like camphor, because the smell – much like Vicks VapoRub today – could ease the patient: “Some place plasters on the chest, but I cannot see what use they have, because this means should penetrate the lungs through the breastbone, which would be absurd, therefore these means are of no importance, unless they reek of Musk, Saffron, or Camphor, &C. And that smell by breathing it in could do something useful in our blood.”[3]

Sweets and substances that are quite similar to modern liquorice were popular though, something we see reflected in books like ‘The Perfect Dutch Kitchen Maid’ (De Volmaakte Hollandsche Keuken-Meid, 1752). Here ‘chest sugar’, sugar pastilles with expensive exotic spices like saffron or cloves, and ‘tablets of liquorice’, made from liquorice extract, aniseed, Arabic gum, and rosewater were recommended for colds and coughs respectively.[4]  Less prosperous citizens had to make do with drinks made of cucumber juice or marjoram, or brews with aniseed, fennel seed, liquorice, honey, or hyssop.[5]

Cures for colds and coughs, Steven Blankaart, Verhandelinge van de Opvoedinge En Ziekten Der Kinderen (Amsterdam: Hieronymus Swierts, 1684), p. 176.

Although such preparations, either made by the apothecary or at home from the pantry, were probably easing colds, they of course did not cure respiratory illnesses – although that is not that different today. In premodern descriptions of epidemics of respiratory illness, it is often noted in a rather off-hand way that it were mostly the elderly who died from them. ‘Elderly’ is relative of course, and in the past people grieved the loss of their loved ones too. But such remarks do suggest that death was much more present in everyday life than it is today; and that would not change until the second half of the nineteenth century.

Finally, we have seen over the past few weeks that scientists are trying to find a vaccine against covid-19. The first rudimentary vaccines in Europe, against smallpox, date back to the eighteenth century. In China and Asia, such immunisation practices had existed much longer.[6] Bacterial pneumonia could increasingly be treated successfully from the start of twentieth century, especially when penicillin became commercially available.  The Spanish flu epidemic of 1918 led to a search for new treatments for flu. This would eventually result in the first flu shots during World War II, developed by the American army.

The history of our understanding of and ways of dealing with epidemic respiratory illnesses thus shows that we have come to understand the causes, spreading, and effects of respiratory infections in completely new ways over the past 150 years. However, there is still a lot of confusion among the general public about the differences between flu, colds, and infections like covid-19. We have become much more successful in treating severe cases of lower respiratory tract infections, but the treatment of upper respiratory tract infections has not changed significantly since the seventeenth century. We have relatively little experience in the prevention, curtailing, and ‘flattening’ of epidemics of respiratory infections, which partly explains the wide variety of current measures.

[1] See e.g. Monica Green (ed.) “Pandemic Disease in the Medieval World”, special issue of The Medieval Globe, vol. 1, 2014.

[2] See e.g. Ruth Richardson, Death, Dissection, and the Destitute (Chicago: University of Chicago Press, 2001).

[3] Steven Blankaart, Verhandelinge van de Opvoedinge En Ziekten Der Kinderen (Amsterdam: Hieronymus Swierts, 1684), p. 173-180: “Op de borst leggen sommige Pleisters, maar ik kan niet sien wat groote nut zy konnen uitrichten, want dit Middel zoude moeten door het Borst-been tot in de Longe doordringen, het welke absurd soude zijn, derhalven zijn die Middelen mede al van geen belang, ten zy ze riekende zijn van Moschus, Saffraan, Campher, &c. En die reuk door het inademen onse sappen en bloed eenig nut aanbracht.”

[4] De Volmaakte Hollandsche Keuken-Meid… Als Meede Eenige Huismiddelen. Voor de Verkoudheid (Amsterdam: Steven van Esveldt, 1752)

[5] Evert Jan Thomassen a Thuessink, Prysverhandeling over de Vraag, Voorgesteld Door Het Geneeskundig Genootschap […] Servandis Civibus, in Hoe Verre Zou Men, by Gebrek van de Apotheek, Uit Kelder En Keuken de Vereischte Geneesmiddelen […] Kunnen Bekomen. (Amsterdam: Petrus Conradi, 1789), p. 11, 192. Heyman Jacobaus, Schat Der Armen, of Huismedicyn Boekje, 1606, p. 49, 197.

[6] See e.g. Anne Eriksen, “Cure or Protection? the Meaning of Smallpox Inoculation, ca. 1750—1775”, Medical History 57(4):516-36 (2013).

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