Understanding disease – Then and Now
Smallpox is caused by a virus – but that’s recent knowledge. We’ve only known of the existence of viruses since the late 19th century, and it wasn’t until 1947 that scientists with an electron microscope actually saw what the smallpox virus looked like.
(Right) A statue of Shapona, the West African God of Smallpox, decorated with monkey skulls, cowrie shells, and nails. © The Centre for Disease Control and Prevention In the centuries before virology, people came up with different theories to explain the presence of disease. And according to what they believed, they proscribed treatments and cures.
For example, many different cultures throughout history have explained disease as a punishment from God. In parts of India, China, Africa and Latin America, sacrifices were made to appease the gods of Smallpox. In medieval Europe, prayer and godly living were recommended as one way to guard against sickness.
Alongside these religious ideas, different cultures developed a range of medical theories explaining the workings of the body. Disease was explained either as a breakdown of the body’s natural functions, or as a consequence of body being ‘poisoned’ by some unknown external agent. Sometimes (for instance in 16th century England) these contradictory ideas developed in parallel – as in the treatments for smallpox recommended by Lady Grace Mildmay (see module “Aresenic and Old Lace”).
The Four Humours
Medicine in Europe from the medieval era to the 16th century was heavily influenced by a theory that originated in the classical world: the theory of the ‘four humours’.
(Right) A man holds his arm out in preparation for bleeding. © The Wellcome Library, London Greek and Roman doctors believed that the body needed to be held ‘in balance’. Just as there were four seasons and four ‘elements’ (air, fire, water, earth), so too the body had four ‘humours’ – blood, phlegm, and black and yellow bile. Imbalance in the ‘humours’ led to changes of mood and wellbeing. Sickness could be treated by adjusting the body’s natural balance, for instance, by ‘bleeding’, draining off excess blood.
This theory explains the dangerous treatment for smallpox recommended by Lady Grace Mildmay in the 1570s:
Medicine in the Moslem World
(Right) TA page from al-Razi’s “The Comprehensive Book of Medicine”. © Bodleian Library, University of Oxford In the 9th century AD, a Persian scholar called al-Razi was the first to distinguish between smallpox and measles. His work was translated more than a dozen times into Latin and other European languages.
After the fall of the Roman Empire, Europe collapsed into the barbarism of the Dark Ages. In the centuries that followed, classical ideas were preserved and developed by Moslem scholars. It was from these Moslem scholars that Elizabethan doctors inherited their medical knowledge.
Al-Razi’s understanding of smallpox adapted and refined the idea of the Four Humours, based on his own observations:
"Smallpox appears when blood 'boils' and is infected, resulting in vapours being expelled. Thus juvenile blood (which looks like wet extracts appearing on the skin) is being transformed into richer blood, having the colour of mature wine.”
Elizabeth I and the ‘red’ treatment
In 1562, four years into her reign, Elizabeth I fell sick with smallpox. The nation received the news with anxiety. The queen had no heir, and her illness threatened to plunge England into a succession crisis and a return to religious discord.
The royal physician was called. He recommended that the queen lie by a fire wrapped in red cloths, and be given a red liquid to drink.
A gold coin commemorating Elizabeth I’s recovery from smallpox. © The Science Museum, London In part, this treatment can be explained in terms of the ‘four humours’. To sit by a fire wrapped in cloth makes the body sweat, which, like blood-letting, was believed to restore the body’s natural balance.
But why red cloths? And why drink a red liquid?
The idea of using the colour red to combat smallpox has been around for centuries. Al-Razi recommends ‘red treatment’ in his writings. Smallpox patients in ancient China and imperial Japan were dressed in red clothing, and quarantined in rooms decorated with red hangings.
The treatment is said to stem from the idea that like repels like: the colour red was believed to repel the red rashes of smallpox. Unlikely as it may seem, ‘red light therapy’ was used as an alternative cure for smallpox in America and Scandinavia even in the 20th century.
The external source of disease
Is disease caused by something within the body, or contagion from outside? The ancients believed it came from within. So did Al-Razi, who described smallpox as the result of an ‘innate seed’.
In the 16th century, for the first time, people began to question this assumption. They could see that isolating victims of smallpox, plague and leprosy was an effective way to stop the spread of disease; this suggested that disease was something external, passing from victim to victim.
In 1546, Girolamo Fracastoro of Verona published a theory of ‘specific contagion’, which suggested that every disease had a particular cause, passing from human to human externally, either by direct contact, or through intermediate agents, such as clothes and wooden objects, or through the air.
No one knew exactly what the ‘cause’ was. But they called it a ‘virus’ – the Latin word for ‘poison’. (In time, the word would come to describe the real cause of viral diseases – micro-organisms, invisible to the human eye, invading and infecting human cells).Girolamo Fracastoro of Verona. © Lodestar The idea of an ‘external’ source of disease changed the way people thought about treatment. For the first time, targeted ‘cures’ were suggested, each appropriate for a particular ailment. Lady Grace Mildmay recommended the use of arsenic. Other suggested cures for smallpox included mercury and sheep droppings.