Health Needs - Development and importance of health

The diseases of the past have long been as baffling to modern historians as they once were to physicians and patients. Old terms like fever and pox hide a wide multitude of different afflictions, with different patterns of spread in terms of season and vectors. Contemporary descriptions of typhoid or syphilis do not always correspond to those of modern medical textbooks, and the possibility of the mutation of a bacillus or a virus only serves to render identification yet more difficult.

In seventeenth-century England, diseases were often ascribed to changes in the lifestyle of the sick or in the surrounding air. Bad air was more than a bad smell; some might think of it as an aerial poison, but precisely in what way it was bad or poisonous was a matter for theoretical debate. A learned Italian had proposed that the atmosphere contained little seeds of specific diseases, which, once trapped in a receptive body, produced harmful changes. Others thought in terms of the air becoming putrid, heavy with stinking moisture; a blanket of fog might thus be a veritable shroud.

Where one lived, as well as how one lived, had constituted a medical rule of thumb ever since the Ancient Greeks. The Hippocratic treatise Airs, Waters and Places had long been read as a manifesto emphasizing the primacy of environmental medicine, and the doctor who wrote Epidemics Books One and Three had been at pains to discover the climatic conditions prevailing throughout the whole year on Thasos and to correlate them with the medical conditions he and his colleagues had recorded. Their successors in the Renaissance, particularly in Paris, had rediscovered the importance of wind and weather, and by the eighteenth century medical topographers throughout Europe had endeavoured to relate the health of this or that locality to its setting, whether physical or climatic. Local historians, often themselves doctors, readily noted that this village was unusually healthy, that town a near death-trap. Their observations were often correct, their explanations equally often wrong or contradictory.

Modern demographic historians have not fared much better. Quantitative history has provided a general outline for demographic facts that is often at variance with the evidence from a particular locality. A town healthy one year, when all those around it were suffering badly, might itself endure a massive population reverse at a time of apparent healthiness. General trends might hide surprising differences at a local level even between neighbouring villages. A theoretical understanding of disease might seem inadequate when faced with the complexity of disease patterns, even within a small area.

Mary J. Dobson’s remarkable study shows precisely why this baffling situation arose. By looking at Essex, Kent and East Sussex from 1600 to 1800, and by employing both quantitative and qualitative analyses of a variety of sources, she demonstrates the complex interaction between a multitude of different factors, while at the same time revealing certain underlying patterns that can be readily transferred to other areas. A laborious computer analysis of burial records identifies healthy and unhealthy parishes, and allows a comparison over a long period of time. One conclusion stands out: the huge death rate in coastal and marshy areas, especially when contrasted with the long-lived inhabitants of the Downs or Essex uplands; and, particularly in this period for Romney Marsh, the precipitous decline in the death rate after the marshes had been drained. The villain here is identified as malaria, the bad air par excellence in the form of plasmodium vivax and plasmodium malariae, transmitted by anopheline mosquitoes, especially at the end of a hot summer. The methodology here used to identify both disease and vectors is careful and cautious, and might well be followed by other historians of disease.

Computer analysis is supplemented by a broad reading of local topographers, doctors, diarists and parish registers to find out what contemporaries felt was happening around them. The results then form a local chronology of disease that is correlated against evidence for climate and for epidemics both in the region and in England as a whole. The results are illuminating. They show how, at a local level, disease patterns did not always fit the wider picture. Often the South-East was free of disease when other parts were devastated; one town might suffer numerous deaths from plague, its neighbour none. The big killers were not plague or smallpox, but a variety of fevers, usual enteric, and it was more often the cumulation of disasters, whether in terms of poor harvests or of individual illnesses, that proved fatal, rather than any individual outbreak.

No wonder that contemporary observers struggled to make sense of the complexity that they saw around them.

Historians should also note the growing effect of London (and travellers) as a source of disease within a generally healthy countryside, where, from 1700 onwards, market towns like Tonbridge became as healthy as a Wealden village.

Medical men there were aplenty, and their advice, especially regarding private and public cleanliness and better housing, contributed to the general improvement in public health between 1700 and 1800, even if their remedies did little. Yet health might be bought at a price. One faced an uneasy choice between living to a ripe old age on the Downs in abject poverty, and migrating to London or Faversham for better wages and an inevitably early death. Not everyone preferred the former.

Source: TimesOnline

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