Kristy Wilson Bowers is a Associate Professor in the Department of History at University of Missouri and a 2024-2025 Consortium Research Fellow.
Though it is well known that early modern populations suffered numerous epidemics of infectious diseases including plague, smallpox, measles, typhus, diphtheria, and others, the most consistent attention has long been focused on plague. Bubonic plague began disrupting life for Europeans in the mid-fourteenth century, with the outbreak known as the Black Death. Plague spread rapidly and carried a high mortality rate, prompting civic and medical officials to develop new practices of public health, including monitoring and limiting travel, quarantining both people and goods, and isolating the sick. Plague (pest, pestilence) is easy to find in the archives as officials kept records of local illnesses and deaths, public health regulations, expenditures for hospitals, medicines, and convalescent homes, the creation of new burial grounds and a variety of other urban management issues. Other diseases are harder to pin down in the archives, in part because early modern Europeans most often used descriptive terms for diseases (pestilence, contagion, malignant fever, and so forth). Specific disease names (smallpox, measles, typhus) were used at times, but they were not clearly defined. My current research focuses on two diseases that physicians began to write about and more clearly define in the sixteenth century but that have remained largely unstudied in this era by historians of medicine: typhus and diphtheria. While these were and are very different diseases, they are linked by the fact that both began to receive attention the same era and both received the earliest and most focused attention from physicians in Spain.
The support of a Consortium Fellowship was crucial for enabling me to access early printed treatises from Spain and the Spanish empire on these (and other) diseases at three libraries: the Wellcome Collection library in London, the National Library of Medicine in Bethesda, Maryland and the Kislak Center for Special Collections, Rare Books and Manuscripts at the University of Pennsylvania. At each of these institutions, I was able to access a variety of early modern medical treatises. Treatises focused specifically on typhus were first published in Mexico and Spain in the 1570s, while those focused on diphtheria began to be published in the 1610s. In writing about these diseases, early modern physicians engaged in a number of debates: over whether they were new (unknown to ancient medical writers such as Hippocrates and Galen) or simply newly re-emergent, how they spread (by contact or through air), how to distinguish them from other kinds of pestilential disease (particularly “true” pestilence or plague), and how to treat them. In other words, the treatises offer a window into an era of intellectual upheaval, as physicians working through repeated epidemics grappled with how to align their experiences and observations with the traditional theories of disease in which they had been trained. They then used this knowledge to better treat patients and to help inform civic authorities on useful public health responses. This was not as simple or straightforward as it may sound, but was in fact a long process with many voices offering differing opinions. The varying experiences of physicians during epidemics led them to compose a steady stream of treatises over the ensuing centuries creating an ongoing dialogue of conflicting expertise about the nature of and best responses to these diseases. To give just one example, in 1599 much of Spain was in the midst of an epidemic now often referred to as the Atlantic plague (1596-1601). In Seville, the city council, in response to debates about the nature of the disease then circulating and whether strict (and disruptive) public health regulations needed to be imposed, called a meeting of seven leading physicians and surgeons in the city. After some debate, they were unable to reach a consensus and each published their own treatise, offering their observations and theories on whether this was a dangerous pestilence (plague) or a more common and less harmful one (typhus). Accessing these treatises is enabling me to see the similarities and differences in their various views and rationales, which in turn offers a window onto how experience was shaping theory.
Reading these treatises has reinforced for me the practical utility of using the modern terms “typhus” and “diphtheria” despite the dangers of applying modern names to premodern conditions. I am not seeking to assert whether epidemics “really were” typhus or diphtheria as we define them today, but am employing these names as umbrella terms. Both of these diseases were often known by many names. The treatises I have been studying acknowledge the confusion of naming even in the sixteenth century. In Spanish, typhus was most often referred to as either tabardillo or tabardete, but it was also commonly known by many other names (fiebre punticular, fiebrelenticular, pintas, pulgas) all of which refer to the appearance of the characteristic rash. Physicians writing in the 1570s list these and many other names, asserting them all to be the same disease. The term “typhus”, from the Greek tuphos, meaning smoke, vapor, or stupor (a reference to the mental state produced by high fevers) became common in the mid-eighteenth century, when it was (re)introduced by French physician François B.C. de Sauvages in 1759. Alongside the variety of Spanish names noted above we might add the more familiar English names which included putrid malignant fever, camp fever, ship fever, jail fever, and many others. Similarly, diphtheria was often referred to in Spanish as garrotillo, a diminutive form of garrote, an old method of execution by strangulation. This common name again refers to the most striking symptom of the disease, the “little strangulation” caused by inflammation and the growth of a pseudomembrane across the throat. But Spanish sources also use terms such as esquinancia and angina suffocante. The term “diphtheria" was not coined until the 1820s, based upon the Greek term for leather, a reference to the leathery pseudomembrane in the throat. Here again, the name diphtheria was created specifically to encompass what had previously been known by various names: throat distemper, malignant croup, malignant sore throat, and so forth. Given the wide variety of diagnostic terms used in these treatises, I use the modern terms to help simplify the discussion. The focus of my analysis, then, can remain on understanding how people of the sixteenth and seventeenth centuries defined these diseases (particularly in reference to pestilence) and how they responded to them.