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source: GreshamCollege 2012年10月4日
Epidemic diseases have been as important as war in their devastating effects on human society through the ages. This series of lectures looks at them in their relation to society, the economy, culture and ideas, and the state. Almost always their origin and spread are conditioned by human interactions, and the effectiveness of medical intervention still depends heavily on the social and political context. We will be examining the extent to which epidemics have brought about social change, how they have affected politics, and where they have affected, or been affected by, the state. The lectures will consider the cultural impact of epidemics, in art and literature, and in religious belief. And we will be looking at the possibilities of future epidemics and the threats disease poses for human society today. The transcript and downloadable versions of the lectures are available from the Gresham College website: http://www.gresham.ac.uk/lectures-and...
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1 57:32 The Black Death
Bubonic plague first swept Europe in the age of Justinian, in the sixth century, killing an estimated 25 million people in the Byzantine Empire and spreading further west. Its most devastating outbreak was in mid-fourteenth-century Europe, when it destroyed perhaps a third of the continent's population. Italian city-states pioneered the policies of quarantine and isolation that remained standard preventive measures for many centuries; religious revival and popular disturbances, crime and conflict may have spread as life was cheapened by the mass impact of the plague. The economic effects of the drastic reduction in population were severe, though not necessarily negative. Later outbreaks of the plague culminated in outbreaks in Seville (1647), London (1665), Vienna (1679) and Marseilles (1720) and then it disappeared from Europe while recurring in Asia through the nineteenth century. The plague set the template for many later confrontations with epidemic disease, discussed in the following lectures.
2 54:19 The Great Pox: The History of Syphilis
The sexually transmitted disease syphilis is generally thought to have been imported into Europe from the Americas in the late fifteenth century as part of the 'Columban exchange', in which other diseases, notably smallpox, travelled in the other direction, with terrible consequences for Native American society. It spread rapidly through Europe, spread above all by armies moving across the continent in the many wars of the time. Painters from Dürer to Rembrandt represented the ravage it wrought, while the threat it posed gave rise to numerous treatments in literature and drama (notably Ibsen' Ghosts) and strongly affected attitudes to sexuality and prostitution, both explored in this lecture. It remained common well into the twentieth century and still kills millions worldwide every year; reasonably effective treatment only became possible just before the First World War, and the search for a complete cure led to dangerous medical experiments on involuntary human subjects later in the twentieth century, raising major issues of medical ethics.
3 56:52 The White Plague: A Social History of Tuberculosis
Of all diseases tuberculosis is the most widely represented in literature, opera and drama. The disease has been present in humans since prehistory and hence has a particularly long pedigree of representation in myth and culture, being one of the sources of vampire stories on the one hand, and playing a key role in novels of slow deathbed decline on the other. Though many characters in the fictional representation of tuberculosis are well-off, most famously of course in Thomas Mann's 'The Magic Mountain', it was in fact a disease of the poor, and reached new levels in the industrial revolution. Correspondingly the slow decline of its incidence owed more to housing reform, slum clearance and increasing prosperity than to medical intervention. The discovery of the vector of the disease in the late nineteenth century led to effective prevention through the BCG vaccine from the 1920s, and after 1945 the arrival of antibiotics promised its complete eradication. Since the 1980s however resistant strains of the disease have been spreading, and it has once more become associated with poverty, poor state management and control of disease, and wretched housing conditions, above all in India.
4 59:38 Blue Funk and Yellow Peril
'Asiatic cholera', which arrived in Europe in the early nineteenth century, was widely seen as Asia's revenge on Europe for the extension of European empires in the East. During the nineteenth century governments reacted first by trying to establish quarantines, then when these did not work, the 'miasmatic' theory of disease communication became dominant. Some have argued this won favour because it furthered the interests of free trade and conformed to the beliefs of liberalism. Later in the century, with the discovery of the cholera bacillus, more effective preventive measures were introduced. Cholera was spread by armies (Crimean War) and trade. It hit the urban poor hardest, and epidemics often produced popular protest, with medical officials in Russia being lynched during the epidemic of 1892. Later outbreaks have almost always been associated with the breakdown of the state through civil war (Peru) or natural disaster (Haiti).
5 1:02:06 'The Great Unwashed'
Typhus, the subject of the fifth lecture in the series, was caused by a bacterium hosted by the human body louse, and has thus always been associated with dirty and overcrowded conditions and spread above all by armies marching across the countryside and living in filthy and unhygienic conditions. In 18th-century England it was known as 'gaol fever'. The 'hyginenic revolution' of the Victorian era reduced its incidence. Preventive measures taken on the Western Front reduced casualties, but it recurred during the Second World War, especially at Stalingrad and in Nazi concentration camps. The Nazis carried out numerous experiments on involuntary human subjects to try and develop preventive measures; in Nazi propaganda, the spread of typhus was attributed to the Jews, who were likened to bacilli or lice in order to make their mass murder at Auschwitz and elsewhere acceptable.
6 47:51 Lessons from the Past, Warnings for the Future
The concluding lecture takes the example of HIV/AIDS and discusses how reactions to the epidemic mirrored those found in the social and cultural perception of earlier epidemics. As in earlier epidemics, sufferers have been ostracized, persecuted or blamed for their own misfortune. In South Africa the government of Thabn Mbeki dismissed AIDS as an ideological construct of neo-colonialism building on racist stereotypes of Africans as sexually irresponsible, with disastrous consequences. HIV/AIDS has spread rapidly through modern means of communication, such as air travel, just as cholera was spread by traffic on railways and steamships. Future epidemics may spread even more rapidly, and the series concludes by asking what, if anything, can be done to prevent them.
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