Health and sickness
By the dislocation of markets and communications and the destruction of shipping, and by diverting toward destructive ends an excessive proportion of government funds, war tended to sap the wealth of the community and narrow the scope for governments and individuals to plan and invest for greater production. The constructive reforms of the French statesman Jean-Baptiste Colbert in the 1660s, for example, would have been unthinkable in the 1640s or ’50s; they were checked by the renewal of war after 1672 and were largely undone by the further sequence of wars after his death. War determined the evolution of states, but it was not the principal factor affecting the lives of people. Disease was ever present, ready to take advantage of feeble defense systems operating without the benefit of science. The 20th-century French historian Robert Mandrou wrote of “the chronic morbidity” of the entire population. There is plenty of material on diseases, particularly in accounts of symptoms and “cures,” but the language is often vague. Christian of Brunswick was consumed in 1626 “by a gigantic worm”; Charles II of Spain, dying in 1700, was held to be bewitched; men suffered from “the falling sickness” and “distemper.”
There are no reliable statistics about height and weight. It is difficult even to define what people regarded as normal good health. The average person was smaller than today. Even if courtiers flattered Louis XIV, deemed to be tall at 5 feet 4 inches (1.6 meters), the evidence of portraits and clothes shows that a Frenchman of 6 feet (1.8 meters) was exceptionally tall; the same goes for most southern and central Europeans. Scandinavians, Dutch, and North Germans were generally larger; protein in meat, fish, and cheese was probably as important as their ethnic stock. Even where there were advances in medicine, treatment of illness remained primitive. The majority who relied on the simples or charms of the local wise woman may have been no worse off than those for whom more learned advice was available. Court doctors could not prevent the death of the duke de Bourgogne, his wife, and his eldest son in 1712 from what was probably scarlet fever; the younger son, the future Louis XV, may have been saved by his nurse’s removing him from their ministrations.
The work of William Harvey, concerning the circulation of the blood; of Antonie van Leeuwenhoek, observing through his microscope blood circulating in minute capillaries or spermatozoa in water; of Francesco Redi, developing by experiment (in a book of 1668) Harvey’s principle that “all living things come from an egg”; or of Hermann Boerhaave, professor of chemistry, medicine, and botany at Leiden, carrying out public dissections of human bodies, reveals the first approaches to modern knowledge and understanding. A striking example of what could be achieved was the efficacy of vaccine against the rampant smallpox after the discoveries of Edward Jenner and others, but vaccination was not much used until the beginning of the 19th century. As in other scientific fields, there was a long pause between pioneering research and regular practice. Trained by book, taking no account of organic life, envisaging illness as a foreign element lodged in the sick person’s body, even tending to identify disease with sin, doctors prescribed, dosed, and bled, leaning on pedantic scholarship blended with primitive psychology. Therapy was concerned mainly with moderating symptoms. For this purpose mercury, digitalis, ipecac root, and, especially, opium were used; the latter was addictive but afforded relief from pain. The wisest navigators in this frozen sea were those who knew the limitations of their craft, like William Cullen, an Edinburgh physician who wrote: “We know nothing of the nature of contagion that can lead us to any measures for removing or correcting it. We know only its effects.”
To peer in imagination into the hovels of the poor or to walk down streets with open drains between houses decayed into crowded tenements, to visit shanty towns outside the walls, such as London’s Bethnal Green or Paris’s Faubourg Saint-Marcel, to learn that the latter city’s great open sewer was not covered until 1740, is to understand why mortality rates among the poor were so high. In town and country they lived in one or two rooms, often under the same roof as their animals, sleeping on straw, eating with their fingers or with a knife and spoon, washing infrequently, and tolerating lice and fleas. Outside, dung and refuse attracted flies and rodents. Luckier people, particularly in the north, might have had glass in their windows, but light was less important than warmth. In airless rooms, thick with the odors of dampness, defecation, smoke, and unwashed bodies, rheumatic or bronchial ailments might be the least of troubles. Deficient diet in childhood could mean rickety legs. Crude methods of delivery might cause permanent damage to both mothers and children who survived the attentions of the local midwife. The baby who survived (one in four died in the first year of life) was launched on a hazardous journey.
Some diseases, such as measles, seem to have been more virulent then than now. Typhus, spread by lice and fleas, and typhoid, waterborne, killed many. Tuberculosis was less common than it was to become. Cancer, though hard to recognize from contemporary accounts, was certainly rare: with relatively little smoking and with so many other diseases competing for the vulnerable body, that is not surprising. There were few illnesses, mental or physical, of the kind today caused by stress. Alcoholism was less common, despite the increase in the drinking of spirits that debauched city dwellers: cheap gin became a significant social problem in William Hogarth’s London. Abnormalities resulting from inbreeding were frequent in mountain valleys or on remote coasts.
Syphilis had been a growing menace since its introduction in the 16th century, and it was rife among prostitutes and their patrons: it was a common cause of blindness in children. Women, hapless victims of male-dominated morality, were frequently denied the chance of early mercury treatment because of the stigma attached to the disease. Scrofula, a gangrenous tubercular condition of the lymph glands, was known as “the king’s evil” because it was thought to be curable by the king’s touch: Louis XIV practiced the ceremony conscientiously. Malaria was endemic in some swampy areas. Though drainage schemes were taken up by enlightened sovereigns, prevention awaited inexpensive quinine. Nor could doctors do more than let smallpox take its course before the general introduction of vaccines. The plague, chiefly an urban disease that was deadliest in summer and dreaded as a sentence of death, could be combated only by measures of quarantine such as those enforced around Marseille in 1720, when it made its last appearance in France. Its last European visitation was at Messina in 1740. Deliverance from plague was not the least reason for Europeans of the Enlightenment to believe that they were entering a happier age.
Poverty
Though its extent might vary with current economic trends, poverty was a constant state. It is hard to define since material expectations vary among generations, social groups, and countries. If those with sufficient land or a wage large enough to allow for the replacement of tools and stock are held to be above the poverty line, then at least a quarter of Europe’s inhabitants were below it. They were the bas peuple whom the French engineer Sébastien Le Prestre de Vauban observed in the 1690s, “three-fourths of them…dressed in nothing but half-rotting, tattered linen”; a century later the philosopher the Marquis de Condorcet described those who “possess neither goods nor chattels [and are] destined to fall into misery at the least accident.” That could be illness or injury to a breadwinner, the failure of a crop or death of a cow, fire or flood, or the death or bankruptcy of an employer. Sometimes poverty showed itself in a whole community demoralized through sickness—as by malaria in Italy’s Pontine Marshes and goitre in Alpine valleys—or through the sapping of vitality when the young left to find work. Factors could be the unequal struggle with a poor soil or the exactions of a landowner: so the agricultural writer Arthur Young, at Combourg, wondered that the seigneur, “this Monsieur de Chateaubriant, …has nerves strung for such a residence amidst such filth and poverty.” Many were victims of an imprisoning socioeconomic regime, such as Castilian latifundia or Polish serfdom. A trade depression, a change of fashion, or an invention that made traditional manufacturing obsolete could bring destitution to busy cities such as Leiden, Lyon, Florence, or Norwich or to specialized communities such as the silk weavers of 18th-century England’s Spitalfields.
Taxes, on top of rents and dues, might be the decisive factor in the slide from sufficiency to destitution. A member of the Castilian Cortes of 1621 described the results: “Numerous places have become depopulated and disappeared from the map. …The vassals who formerly cultivated them now wander the roads with their wives and children.” Some had always been beyond the reach of the collector of taxes and rents, such as the bracchianti (day laborers) described by a Mantuan doctor as “without a scrap of land, without homes, lacking everything except a great brood of children…with a humble train of a few sheep and baggage consisting of a tattered bedstead, a mouldy cask, some rustic tools and a few pots and pans.”
Moneylenders were pivotal figures in village society. In southern Italy, merchants advanced money on wheat in contratti alla voce (oral agreements). The difference between the arranged price and that at harvest time, when the loan was repaid, represented their profit. Throughout Europe, land changed hands between lender and borrower: foreclosure and forfeit is an aspect of primitive capitalism often overlooked in the focus on trade and manufacturing. Society, even in long-settled areas, revealed a constant flux. As the 20th-century French historian Marc Bloch pointed out, hierarchy was always present in some degree, even in districts where sharecropping meant dependence on the owner’s seed and stock. In the typical village of western Europe, there were gradations between the well-to-do farmer, for whom others worked and whose strips would grow if he continued to be thrifty, and the day laborer, who lived on casual labor, hedging, ditching, thatching, repairing terraces, pruning vines, or making roads.
Urban poverty posed the biggest threat to governments. The situation became alarming after 1750 because the rise in population forced food prices up, while the employers’ advantage in the labor market depressed wages. Between 1730 and 1789, living costs in France rose by 62 percent; in Germany the price of rye for the staple black bread rose by up to 30 percent while wages fell. In Italian cities the poor depended on the authorities’ control of markets, prices, and food supplies. The riots of Genoa in 1746 show what was liable to happen if they failed. The causes of riots varied. In England, in 1766, grievances included the Irish, Roman Catholics, the press-gang, and gin taxes. The source was almost invariably poverty measured against a vague conception of a “fair wage,” fanned by rumors about hoarding and the creating of false prices. Paris was not uniquely dangerous. Before 1789, when the fury of the mob acquired political importance, the Gordon Riots (1780) had shown the way in which London could be taken over by a mob. The problem originated in rural poverty. Improvements in agriculture, such as enclosure, did not necessarily provide more work. Where there were no improvements or old abuses continued—such as the short-term leases of southern Italy, which encouraged tenants to over-crop and so exhaust the soil—the city provided the only hope. Naples, with the greatest profusion of beggars in the streets, was the most swollen of cities: at 438,000 in 1797, the population had risen by 25 percent in 30 years.
The typical relationship of mutual support was between poor hill country and large town; Edinburgh or Glasgow provided support for the Scots Highlanders, Vienna or Marseille for the Alpine poor. In Marseille a settled population of 100,000 supported 30,000 immigrants. Younger sons from the European fringes went for bread to the big armies: Croats to the Austrian, Finns to the Swedish, Scots and Irish everywhere. Women were usually left behind with the old men and children to look after the harvest in areas of seasonal migration. Domestic service drew many girls to towns with a large bourgeois population. Certain other occupations, notably lacemaking, were traditionally reserved for women. Miserably paid, young Frenchwomen risked their eyesight in fine work to earn enough for dowry and marriage. In a society where contraception was little known, except through abstinence, and irregular liaisons were frowned upon, the tendency to marry late was an indication of poverty. Almost half the women of western Europe married after 25; between 10 and 15 percent did not marry at all. The prevalence of abortion and infanticide is painfully significant: it was clearly not confined to unmarried couples. In 18th-century Brussels, more than 2,000 babies were abandoned annually to be looked after by charitable institutions. Repairs to a drain in Rennes in the 1720s revealed the tiny skeletons of 50 babies. Every major city had large numbers of prostitutes. There were approximately 20,000 in Paris, and, more surprisingly, in staid, episcopally governed Mainz, it was estimated that a third of the women in the poorer districts were prostitutes. Victims and outcasts, with the beggars and derelicts of crowded tenements, they helped create the amoral ambience in which criminals could expect tolerance and shelter.
Naturally associated with poverty, crime was also the product of war, even the very maintenance of armies. Desertion led to a man’s living an outlaw’s life. Despite ferocious penalties (having the nose and one ear cut off) the Prussian army lost 30,000 deserters between 1713 and 1740. The soldier’s life might not equip a man for settled work. It was hard, in unsettled times, to distinguish between overtly treasonous acts, as of leaders in revolts, and the persistent banditry that accompanied and outlasted them. Another gray area surrounded the arbitrary actions of officials—for example, billeting troops, sometimes, as in the dragonnades employed by Louis XIV against the Huguenots, for political reasons. Tax collection often involved violence and chicanery. The notorious Mandrin, whose prowess Tobias Smollett recorded, had also been a tax collector. Leader of a gang of some 500, he used his knowledge of the system to construct a regime of extortion. Eventually betrayed and broken on the wheel, he remained a local hero.
Banditry was a way of life on the Cossack and Balkan marches, but it was not only there that roads were unsafe. Barred by magistrates from the towns, gangs of beggars terrorized country districts. Children, pursuing victims with sorry tales, were keen trainees in the school of crime, picking pockets, cutting horsetails, soliciting for “sisters,” and abetting smuggling. The enlargement of the role of the state, with tariffs as the main weapon in protectionist strategies, encouraged evasion and smuggling. Just as few country districts were without robbers, few coasts were without smuggling gangs. A Norman seaman could make more by one clandestine Channel crossing than by a year’s fishing. Only the approval of the poor could make romantic figures of such criminals as Dick Turpin or Marion de Fouet.
The savagery of punishments was in proportion to the inadequacy of enforcement. To traditional methods—hanging, dismemberment, flogging, and branding—the possession of colonies added a new resort toward the end of the 18th century, that of transportation. By then, notably in the German and Italian lands of the Habsburg brothers Joseph II and Leopold II, who were influenced by arguments of reason and humanity, crime was fought at the source by measures to liberate trade, moderate punishments, and increase provision for the poor.
A central theme in Christian teaching was the blessed state of the poor. Holy poverty was the friars’ ideal; ardent reformers ensured that some returned to it. The ascetic Father Joseph, personal agent of Cardinal Richelieu, and Abraham Sancta Clara, preacher at the court of Leopold I, were representative figures. With the acceptance of poverty went awareness of a Christian’s duty to relieve it. Alms for the poor figured largely in wills and were a duty of most religious orders. Corporate charity had a larger place in Counter-Reformation Catholicism than in the thinking of Protestants, who stressed private virtues and endowments. The secularization of church property that accompanied the Reformation reduced levels of relief. However, meticulous church elders in Holland and parish overseers in England were empowered to raise poor rates. In Brandenburg a law of 1696 authorized parishes to provide work for the deserving poor and punishment for others. In Denmark the government pronounced in 1683 that the pauper had the legal right to relief: he could work in land reclamation or road building. Different was the approach of Vincent de Paul (1581–1660), whose instructions to the Sisters of Charity, founded to help “our lords the poor,” were both compassionate and practical. His idea of the hôpital général, a privately funded institution for the aged, crippled, and orphaned, was taken over in 1662: an edict commended the institution of hôpitaux throughout the land. Care for the poor was tinged with concern for their souls: beggars and prostitutes were carefully segregated.
With emphasis on the rights of the individual, the French Revolution did not lead to improvement in poor relief but to the reverse. Nor was the record of the Enlightenment impressive in this area. Impatient with tradition and anticlerical, the philosophes tended to be more fluent in criticism of existing systems than practical in proposals for better ones. The new breed of economists, the physiocrats, were opposed to any interference with the laws of nature, especially to any support that did not show a productive return. The threat of social disorder did alarm the upper class, however, and contributed to the revival in Britain of Evangelical religion, which stressed elementary education for the poor, reform of prisons, and abolition of the slave trade and slavery. Meanwhile, the Holy Roman emperor Joseph II had harnessed new funds for orphanages, hospitals, medical schools, and special institutions for the blind and the insane. In 1785 the Vienna General Hospital had 2,000 beds. There was provision for deprived children of all sorts. Graduated charges and free medical care for paupers were among features of a policy that represented the utilitarian spirit at its most humane.
