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Contro un nemico invisibile: Epidemie e strutture sanitarie nell'Italia del Rinascimento (Biblioteca storica) (Italian Edition) (Italian)
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Cipolla was a well-known economic historian, prolific author, and professor at University of California, Berkeley when this volume was published in 1985. It is an updated compilation of several of his earlier works and presents a detailed view of the medical profession and the human and socio-economic impact of epidemic disease in Renaissance Tuscany. The heart of the book lies in the three major pieces at its center which are bracketed by two minor explanatory essays, the first of which serves as an introduction. Cipolla writes with a light and eloquent touch, and his distinctly humanist style is evident throughout. He addresses the reader directly, and wants us to understand that the economic and social reality experienced in the cities and towns of pre-industrial Tuscany is a critical, and all too often overlooked factor in understanding the epidemiology of infectious diseases in Renaissance Italy. A recurrent element woven through each essay is how the earnest efforts of dedicated and brave men to combat epidemic diseases were stymied as much by bureaucratic infighting and fiscal crises as by their overwhelming ignorance of the nature of their "invisible enemy".
The book opens with an introduction that ushers the reader into the unique world of Italian Renaissance medical bureaucracy. Using a vast array of archival documents and a variety of travel diaries, Cipolla reveals Northern Italy at the vanguard of Continental medicine in terms of both the recognition of the dangers of epidemic disease and the enactment of countermeasures to both prevent and contain outbreaks.
Cipolla describes the system of "Health Magistracies" that was established and eventually made permanent by various rulers across Italy to combat the periodic eruption of epidemics. In times of mass infection these bureaucratic officials were empowered to enact the measures then believed most effective in controlling and counteracting contagious diseases. These measures included isolation, quarantine, the suspension of trade, the establishment of sanitary cordons, and upon the waning of danger, the issuance of individual travel "bills of health".
However, they were fighting a nearly impossible struggle. In the face of a poverty stricken populace, the officials had to manage a frightened and uncooperative public determined to take advantage of every loophole in the laws designed to protect them. The efforts the Health Magistrates made to overcome these obstacles, from the creation of "mortality registers" in Milan, to the regulation of canal cleanliness in Venice are examples of their few victories. Cipolla segues into his first essay with a reminder that these men, while putting forth valiant efforts in a climate of "terror, misery, and death" (p.25) were battling an enemy that they could neither see nor understand, an enemy they could approach only obliquely through trial and deadly error.
Cipolla shows his background as an economic historian in the first essay of the book, Lice and the Grand Duchy. The focus is upon a 1621 typhus outbreak in Florence and the complex combination of economic, social, and biological factors which played critical and interconnected roles in the epidemic. In the first chapter, "Scarcity, Unemployment, Epidemic," Cipolla reveals that the circumstances surrounding the outbreak were much more complicated than contemporary officials realized. By analyzing harvest records and correlating the economic cycles of the city with its surrounding countryside, Cipolla effectively demonstrates the complicated interrelationship between economic scarcity, the contraction of the Florentine economy, its consequent drop in employment, and the influx of beggars from the countryside. Cipolla contends that the combination of these factors, when coupled with pre-industrial hygienic standards, served to reduce the ability of many of the city's poorest members to physically resist infection when exposed to typhus.
In the second chapter, "Hospitals, the State, and the Church," Cipolla sets the stage for the jurisdictional conflicts between the Health Magistracy and the Church which remain a constant feature throughout the remainder of the book. The vast chasm between rich and poor was perhaps most obvious in the disparity of medical treatment. The wealthy were treated at home while the poor were confined to hospitals, the conditions of which were, even from a Renaissance perspective, terrifically substandard. As mortality rates began to climb, the Magistrates began to take emergency measures to prevent the collapse of the hospital system. Recognizing that the severity of the problem was beyond full remediation, the Magistrates attempted to take steps to ameliorate the severity of the situation only to find officials of the Church standing squarely in their way. These territorial battles between city and ecclesiastic officials serve to highlight Cipolla's point that the ability to effectively combat disease was continually hindered by political disputes.
The themes of hygiene and politics are further developed through the final three chapters of the essay. Cipolla portrays a society desperately attempting to balance economic and humanitarian needs in a time of crisis. He couples issues of sanitation, trash collection, polluted drinking water, and sewage disposal with a lack of comprehension of the nature of contamination and communicability. The tragic fact remained that without knowledge of modern medicine (or microbiology), even the most intelligent and assiduous efforts at understanding the nature of their enemy were doomed to failure.
In the second major essay of the book, Cristofano and the Plague, Cipolla offers the first of two dramatic portrayals of communities besieged by the plague and the valiant and problematic efforts taken to regain control. The primary focus is upon the Health Magistracy of the city of Prato during the plague of 1630 and the efforts of the head official, Director Cristofano Ceffini. Through the use of mortality tables, hospital and convalescent records, and archival documents from both the city and Health Magistracy, Cipolla effectively recreates the struggles Cristofano confronted and his creative efforts to resolve them. Typical to the practices of the time, Cristofano was a bureaucrat, not a physician, and his charge was to anticipate and obviate the myriad issues involved in administering a city under epidemiological siege.
Cipolla's masterful combination of both municipal and ecclesiastic records, as well as the record left by Cristofano himself provides for a well-rounded presentation of the Director as both man and administrator. Once again the main themes running through his story are the jurisdictional battles between church and state and the city's terrible economic crisis that disease served to exacerbate.
Cipolla's background as an economic historian is again on display in his presentation of the fiscal reality behind each difficult compromise Cristofano is forced to make in order to stretch his disappearing funds as far as he can to save as many lives as possible. In detailing the struggles to obtain charitable contributions, the reticence of city authorities to provide needed funds, and the reluctance of the poverty stricken populace to strictly adhere to the Health Magistracy's guidelines of burning all potentially infected objects (potentially everything one owned), it becomes understandable why Cristofano constantly and consciously "sacrificed hygiene to economy" (p.131).
The final chapter and epilogue to his essay provide a general description of the course of the 1630 plague outbreak in Tuscany and the technical efforts employed by the Health Magistracy to combat it. Cipolla concludes with a reemphasis upon the economic and human costs of plague epidemics and a pointed reminder of the ultimate futility of all of the efforts of men such as Cristofano, the fact that once prevention failed, "the battle was lost" (p.150).
In Who Broke the Barriers at Monte Lupo?, Cipolla uses the mystery of an unsolved crime to explore the tension between local politicians, church officials, and Health Magistrates during a plague outbreak in the small Tuscan village of Monte Lupo. He hints at the trouble to come by opening with a discussion of church and state in his first chapter "Health Officials and Men of the Church." He describes the contentious relationship between the Health Magistracy and ecclesiastic officials, especially regarding restrictions against religious processions and the use of church property for convalescent hospitals. By portraying the ideological differences between the two bureaucracies in their understanding of the causes of epidemics and the methods to counteract them, Cipolla effectively foreshadows the conflicts he is about to describe.
Delving deeply into the Florentine archives Cipolla recreates the tumultuous village of Monte Lupo and its cantankerous inhabitants during its most trying hour, the bubonic plague outbreak of 1630. Again we see the Health Magistrate's imposition of the restrictions Cipolla has described in previous essays, however this time they are upon a population unwilling to acquiesce. In the absence of the effective exercise of authority, the entire system breaks down. As Florentine officials attempt to fill the power vacuum, the situation comes to a head when the parish priest, interpreting the plague as divine wrath, conducts an enormous religious procession ostensibly designed to deliver the region from the pestilence. This extraordinary event and the subsequent destruction of the barricades closing the town are the devices Cipolla employs to explore the issue of conflict between the various and competing authorities.
It is in the aftermath of this massive violation of the Health Magistracy's regulations that Cipolla most effectively demonstrates the challenges faced by municipal officials in their attempts to contain outbreaks of contagious disease. The elegance of Cipolla's presentation becomes clear when the actual impact of these infractions is revealed. By interpreting mortality tables with a modern understanding of incubation and communicability, Cipolla is able to conclusively determine that the flagrant violations had a negligible impact on the actual mortality rate. Thus his point becomes clear: in Renaissance Tuscany prevention was paramount and abidance by the rule of law served as the only chance for containment. The unsolved mystery of the barriers of Monte Lupo is an apt metaphor of the ultimate impotence of the authorities in their battle to control an uncontrollable foe.
Cipolla concludes his book with a short essay detailing the state of the medical profession in Renaissance Tuscany. His basis for this piece is the official census of physicians and surgeons, the "Inquiry of 1630," conducted by the Florentine Health Magistracy as part of their actions against the plague epidemic raging around them.
Again Cipolla brings to vivid life the very human faces of the men of the time. He describes the great difference in the social status of physicians over surgeons and the complex systems of university, guild, and college membership, and their concomitant power structures. Cipolla uses archival records and statistical analysis from across Italy (and Europe) to trace the development of the contract and salary system of payment for medical professionals in different cities and the competition between different municipalities for the best practitioners.
Cipolla closes with a reminder of the differences between ours and the pre-industrial world. He shows the controversy beginning to develop between the older practitioners and the younger generation of doctors, who have less faith in traditional medicine, and are beginning to look towards the rest of Europe for new answers to their old problems. Nothing could better sum up this crisis than Cipolla's recognition that at the time "the most important practical effect of the medical profession ... was moral support" (p.322).
In this unforgettable book, Carlo Cipolla has presented a beautiful synthesis of his earlier works and created an overarching presentation of the nature of epidemic disease in Renaissance Italy and the struggles inherent in its combat. His creative and comprehensive analysis of primary sources coupled with his literary flair serve to considerably broaden both the historical field and our understanding of the challenges, successes, and failures faced by the whole of society in living with and fighting "against an invisible enemy."