Contagion – Historical Views of Diseases and Epidemics

The concept of contagion is entangled with so many themes in the history of medicine that any on-line collection on the subject can hardly fail to generate interest among the scholarly community. Harvard University’s Contagion: Historical Views of Disease and Epidemics does not disappoint. Presenting a wide range of digital sources – including published works and some unpublished manuscripts from Harvard’s libraries - it balances coverage of specific and for the most part familiar disease episodes with thematic and biographical material, each section being prefaced by an introductory essay. The digital resources range form the late 14th century to the 20th, specific topics including the Great Plague of London, the Boston smallpox epidemics and cholera. Each topic is linked to relevant sections in the ‘General materials’ part of the website, which includes sources relating to disease theory, domestic medicine and international health. It is impossible to do justice to all the essays and sources contained in the collection but it is hoped that this review will give a sense of what the site has to offer.  

One set of material that is sure to be of interest to many historians of medicine, as well as social and cultural historians, is the collection of sources gathered under the heading of ‘Syphilis, 1494–1923’. Some historians will immediately raise an eyebrow at the time-frame, which implies that ‘syphilis’ was more or less stable as a concept and as a disease entity over these many years. Others would be more or less happy with the heading, acknowledging a probable link between the ‘pox’ and the ‘French disease’ of the early modern period and the more specific concept of syphilis that emerged in the 19th century. The introductory essay, however, is clearly not intending to make any particular historiographical point, but merely to provide some contextualization of the source material gathered under this head. This inclusive approach is probably the right one for a collection such as this, letting the reader seek further enlightenment from the select bibliography of secondary sources which accompanies the essay. The value of the primary source material, however, largely speaks for itself. Early-modernists will find it handy to have on-line access to such classics as Frascatoro’s Syphilis and Ulrich von Hutton’s Of the Wood Called Guaiacum. Historians of the modern period will also find much original material, grouped under the sub-headings of ‘Morality and regulation’ (sources concerning prostitution and its regulation in the USA, Britain and France) and ‘Diagnosis and treatments’. There is also a miscellaneous section entitled ‘Other medical works’ which includes some interesting texts on ‘venereal diseases’ in English, French and German.

The secondary bibliography accompanying the introductory essay on syphilis comprises 12 works which are helpful to scholars new to the subject, including some quite general works on disease, as well as studies of specific locations and time periods. Some have clearly been chosen because they make important points about how historians ought to interpret disease concepts and epidemics while others relate more to the social and cultural aspects of this disease. While not exhaustive, therefore, the works are wisely chosen. Links are also made to other parts of the website which might aid understanding of the topic. Overall, this section provides a useful point of departure for persons entirely new to the subject as well as a useful resource for historians seeking access to the material for their research, be they students or established scholars.  

The part of the collection grouped around syphilis is in some senses untypical of the website as a whole, however. The remaining sections on specific diseases deal with more constricted time periods, spanning a century at most, or in some cases a particular epidemic. In the coverage of such events there is a marked bias towards Europe and the Americas: for example, the Great Plague of London (1665), the Boston smallpox epidemics (1721), the yellow fever epidemic in Philadelphia (1793) and the ‘Spanish’ influenza of 1918–9 in America. This limits the utility of the site to some extent but it is compensated for by more global coverage in the thematic sections listed under ‘General materials’. The latter will be considered in a moment but first it is necessary to look at little more closely at some of the other disease-specific episodes covered by this collection.

It will come as no surprise to find that plague finds a place in the pantheon of epidemics covered by the collection. Of the outbreaks singled out here, the Great Plague of London is one of the best known, having been the subject of many historical works, some of which are listed in the bibliography accompanying the introductory essay. However, there are some notable gaps here. By comparison with some of the other essays, the bibliography for the Great Plague is rather brief and ignores some important recent studies of the London outbreak, such as those by Justin Champion. None the less, the collection of primary source material on this subject is useful, especially for teaching purposes. The classic eye-witness accounts which one would expect to find in such a collection are all here, including Pepys’ Diary and Defoe’s Journal. There is also an interesting collection of medical works and receipt books containing information about preservation and treatment.  

The Philadelphia yellow fever epidemic of 1793 occupies a similar place in American folk-lore and historiography as the Great Plague does in England and is thus an obvious candidate for inclusion in a Harvard collection on contagion.  Apart from the social drama associated with the outbreak, the epidemic has become famous because of the important role played in it by Dr Benjamin Rush, a signatory of the Declaration of Independence as well as an eminent physician. The texts selected include Rush’s often-cited treatise on the epidemic and most bare directly on the question of contagion, which had become a vexed, politically-charged issue in Europe and America by the 1790s. The wider political ramifications of the epidemic and the debate over contagion are, however, not alluded to in the historical essay which is rather brief by comparison with some of the others. Some important secondary sources which are useful on this dimension – specifically Martin Pernick’s work on the epidemic and the formation of the first party system – are omitted from the bibliography.

The other specifically North American parts of the collection are the sections on the on the Boston smallpox epidemic of 1721 and the Spanish influenza of 1918–9. The former contains classic texts on inoculation (then new to the Americas) as well as eye-witness accounts of the epidemic itself. The bibliography for this section is useful and seems up to date. The holdings placed on-line for the Spanish influenza are notable for the inclusion of some manuscript sources as well as published ones, including the papers of Kenneth Griggs Merrill (which contain accounts of the aviation pioneer Amelia Earhart’s battle with influenza) and those of the President of Harvard during the time of the epidemic.

Manuscript sources also figure prominently in the section of cholera and having on-line access to such material provides a great service to historians, especially those outside the United States, who might wish to view it for comparative purposes. The rest of the collection on cholera includes the classic investigative studies of Snow, Pettenkofer and Koch, but sadly no primary sources which examine the disease at its supposed point of origin in India. Manuscript sources loom large, too, in the collection on Tuberculosis in Europe and North America, 1800–1922, providing insights into volunteer organizations involved in nursing tuberculosis patients and into the lives of patients themselves. Some unpublished sources also appear in the collection on ‘“Pestilence” and the printed books of the late 15th century’, although this section is dominated by an impressive number of incunabula, including such classic texts as Marsilio Ficino’s Consiglio Contro la Pestilenza. It is very helpful to have such rare texts available on line.

In some respects, the anomaly among the collections on disease is the section on ‘Tropical diseases and the construction of the Panama Canal’. While concentrating on the eradication of a specific disease – yellow fever – the emphasis here is very much upon the endeavours of William Gorgas whose sanitary work in the Canal Zone helped to remove the threat of yellow fever and malaria. In some ways this is the least satisfactory of the different sections, the range of primary source material being quite limited.

The second major part of the Contagion collection is headed ‘General materials’. It seems to have been designed to fill in some of the gaps left in the coverage of specific diseases and to deepen the user’s understanding of key concepts running throughout the collection. It includes distinct sections on ideas of contagion and epidemics, humoral and germ theories, and public health and vaccination. The introductory essay to the section on ‘Concepts of contagion and epidemics’ does a pretty good job of rendering what were often very imprecise notions of contagiousness intelligible to non-expert readers. The bibliography used to compile this section is, however, rather limited and does not provide much assistance to readers who seek a deeper understanding of the subject. Although some classic historical studies are cited many important works are not, most notably Contagion: Historical and Cultural Studies, edited by Alison Bashford and Claire Hooker.(1) Anyone wishing to understand the complex evolution of the notion of contagion would do well to read Margaret Pelling’s essay in this volume. But what the introduction to this section lacks in guidance for the reader is more than made up by a treasure-trove of fascinating primary sources which illustrate debates over the contagiousness of epidemic diseases and measures commonly taken to control them.

The section on ‘Concepts of contagion’ is augmented by two others, on ‘Humoral theory’ and ‘Germ theory’ respectively. The former contains some classic works, including the Hippocratic texts which provided the primary reference point for subsequent work on the environmental causes of disease, as well as some unusual items which illustrate various facets of the ‘environmentalist’ outlook, including Ebenezer Sibly’s astrological treatise A Key to Physic and the Occult Sciences and two texts on non-Western medical traditions. Some of these themes are taken further in the section on ‘Medical geography’. As one might expect in a collection such as this, the section on Germ Theory is particularly strong. It is prefaced by a useful introductory essay (although the bibliography is oddly selected) and the primary source material is abundant. There are texts representing early germ theories, on Justus Liebig’s notion of zymosis, and, of course, works by Pasteur, Lister, Koch and other luminaries.

For this reviewer, one of the greatest strengths of the collection is the wealth of primary sources on public health and preventive medicine. Apart from the specific interventions covered in sections dealing with particular disease outbreaks, the site’s ‘General materials’ contain a wide range of sources on disease prevention in various contexts, including non-Western ones. The sections on ‘Public health’ and ‘Colonial and international medicine’ are admirably diverse, with primary sources ranging from the 16th to the 20th century, and relating to several continents. The ‘Vaccination’ section is more restricted geographically but contains three useful manuscript sources in addition to classic works on vaccination. However, one of the most valuable parts of the collection from a public health historian’s point of view is that on the International Sanitary Conferences. The site has the proceedings of 11 of these conferences from the first, at Paris, in 1851, through to the 11th at Paris in 1903. The Pan-American Sanitary Conferences also appear in the Public Health section, making this site invaluable to anyone interested in international health. It is rare to find the proceedings of so many of these conferences in one place and having them available on-line is tremendously helpful.

The general and disease-specific sections of the site are complemented by a time-line and a biographical section which provides essays on some important individuals including William Gorgas, Robert Koch, Florence Nightingale, Max Pettenkofer and Rudolf Virchow. In addition, there are some less widely known figures whose lives and works complement the other sections. The site as whole is extremely easy to navigate and the connections between sections are evident throughout. There are also many useful links to other potentially relevant websites at Harvard and outside, for example the Centers for Disease Control, the American Society of Tropical Medicine and Hygiene, the World Health Organization Historical Collection, and the Library of Congress. The team of scholars, librarians and web-designers who shaped the project is clearly listed although it is not always apparent which members of the team contributed to the writing and compilation of sources for different sections. The design of the site is attractive and the search functions for individual texts worked well in the examples selected by this reviewer.

All told, Contagion: Historical Views of Diseases and Epidemics is a valuable resource. Historians will find in it much material that will augment their teaching and which will be useful for their own research. The introductory essays rarely do the primary source material justice but this deficiency is outweighed by the enormous advantages of the site as a whole. It certainly succeeds in its aim of assisting teachers and researchers in the history of medicine and in providing a historical context for discussions of health policy and their outcomes.

Notes

1. Contagion: Historical and Cultural Studies, ed. Alison Bashford and Claire Hooker (London, 2001).Back to (1)