continued from History of Public Health(part 3)
THE RENAISSANCE AND THE PLAGUE CENTURIES
It was during the Renaissance, a period of great commercial, scientific, cultural, and political development, that the bubonic plague, or "Black Death," swept over Europe and the Near East killing an estimated one-fourth to one-third of the population between 1347 and 1351. For the following two-and-a-half centuries, periodic epidemics of plague decimated these populations.
There were other epidemics as well. In the sixteenth century two new diseases, syphilis and the "English sweat," an ill-defined condition, possibly a form of influenza, were widespread in Europe. The ever-present smallpox was transported to the Americas, where it decimated the native populations. These catastrophic events precipitated the three most important contributions to public health of the Renaissance: the organization of boards of health, the promulgation of a theory of contagion, and the introduction of health statistics.
With the recurrence of plague epidemics, it finally became apparent in the cities of northern Italy that the ad hoc arrangements of the city councils were inadequate to deal with these episodes. By the middle of the fifteenth century, the major cities of the region had established permanent boards of health who were responsible for determining the existence of plague, establishing quarantine, issuing health passes, arranging for the burial of plague victims and the fumigation of their residences, and the management of lazarettos (houses and institutions of quarantine). The boards maintained close relations with the local physicians who provided medical care and prophylactic advice. As time passed, the boards expanded their purview to the control of markets, sewage systems, water supplies, cemeteries, and the cleanliness of streets; and they took jurisdiction over the professional activities of physicians and surgeons, the preparation and sale of drugs, and the activities of beggars and prostitutes. With the disappearance of plague at the end of the seventeenth century, the boards of health of northern Italy withered away. Nevertheless, they provided a model for nineteenth-century organization of public health activities.
Although vague theories of the contagious nature of certain diseases had existed since ancient times, it was the Italian physician and scholar, Girolamo Fracastoro (who had written an epochal description of syphilis, giving the disease its name), who, in 1546, published On Contagions and the Cure of Contagious Diseases. Fracastoro proposed that many diseases are caused by transmissible, self-propagating, disease-specific agents called "germs" (seminaria), which propagate themselves in tissues of the infected host and cause disease by setting up chemical processes. Most importantly, Fracastoro proposed that germs are spread by direct contact (person to person), by contact with fomites (inanimate objects), and by distant transmission.
By early in the fifteenth century, the Italian boards of health instituted a system of death registration, first for contagious diseases and subsequently for all diseases. The resulting bills of mortality have provided continuous data on mortality in Italy from the Renaissance to the present. In seventeenth-century London, analysis of bills of mortality by John Graunt in his epochal treatise Natural and Political Observations … Made Upon the Bills of Mortality (1662) laid the basis for the modern use of statistics for the planning and evaluation of public health activities.
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