PLAGUE AND PUBLIC HEALTH IN RENAISSANCE

EUROPE

http://jefferson.village.virginia.edu/osheim/plaguein.html

This project involves the creation of a hypertext collection of materials on the Impact of Bubonic Plague on Renaissance Society between the initial outbreak in 1348 and the mid-sixteenth century.

A. Bubonic Plague In Renaissance Europe

The coming of the Black Death, when in just two years perhaps one third to one half of Europe's population was destroyed, marks a watershed in Medieval and Renaissance European History. Bubonic plague (Yersinia pestis) had been absent from Western Europe for nearly a millenium when it appeared in 1348. The reaction was immediate and devastating. Up to two thirds of the population of many of the major European cities succumbed to the plague in the first two years. Government, trade and commerce virtually came to a halt. Even more devastating to Europeans, there was hardly a generation which did not experience a local, regional or pan-European epidemic for the next two hundred years. There was virtually no aspect of European society that was not affected by the coming of plague and by its duration. At the most basic level, recurrent plague tended to skim off significant portions of the children born between infestations of plague, dampening economic and demographic growth in most parts of Europe until the late seventeenth century. The responses of Europeans are often treated as irrational or superstitious. Yet medical tracts, moral treatises and papal proclamations make clear that for most Europeans there were, within the medieval world view, rational explanations for what was happening. Plague stimulated chroniclers, poets and authors, and physicians to write about what might have caused the plague and how the plague affected the population at large the framing story of Boccaccio's Decameron is merely the most famous of the writings. Nonetheless, in the wake of the first infestations there were attacks on women lepers and Jews who were thought either to have deliberately spread the plague or, because of their innate dishonor, to have polluted society and brought on God's vengeance. The violence against outsiders demonstrated, in a tragically negative manner, the nature and the limits of citizenship in Europe. This was a society which defined itself as Christian and recurrent plague changed religious practice, if not belief. Christians had long venerated saints as models of the godly life and as mediators before God, in this case an angry and vengeful one. A whole new series of "plague saints" (like St. Roch) came into existence along with new religious brotherhoods and shrines dedicated to protecting the population from plague. The recurrence of plague also affected the general understanding of public health. Beginning in Italy in the 1350s there were new initiatives aimed at raising the level of public sanitation and governmental regulation of public life. And, finally, by the sixteenth century a debate over the causes of plague spread in the medical community as old corruption theories inherited from Greece and Rome were replaced by ideas of contagion. The story of plague in Renaissance society is not merely a medical, religious or economic subject. To properly understand the impact of plague it is necessary to consider almost all aspects of society, from art and music to science.

B. Nature Of The Document Collection

Although we like to recount history in a logical, linear narrative, in reality, matters usually are not so straight-forward. War, plague, economic depression all affect people differently depending on age, class, sex and the like. Collections of texts and images, since they do represent multiple points of view, are ideal ways to accurately convey the multi-faceted nature of human reality. Through a collection, annotation, and translation, where necessary, of chronicles, diaries, letters, government documents, religious literature and contemporary images this project aims at the creation of a hypertext archive through which scholars and students can study the medical, governmental, religious and personal responses to the problem of epidemic disease.

The collection initially will be concentrated in three parts of Europe: Tuscany in central Italy, the Avignon-Montpelier region in France, and the Rhineland towns of Germany. The three areas are not unique, but they do offer sources that deal with the initial infestation of plague in the 1340s and 1350s as well as information on the subsequent plagues that almost generationally swept through parts of Europe. They also have the advantage of offering a sense of Europe's geographical diversity and how the experience of plague differed in various economic and social environments. Thus the archive should function much like a well designed archeological excavation in which by digging deeply at various point on a site one can study spatial as well as temporal variations. Searchers will be able to follow topics of special interests either by moving throughout Europe at a particular time or by following particular themes in subsequent plagues. From the very earliest plagues, for example, there were simple embargoes preventing movements of goods and people from one area to another. By the sixteenth century, however, there were well articulated systems of quarantine in place in many parts of Europe. Similarly, during the epidemics, physicians and medical writers in various parts of Europe had to deal with questions of the nature of medical knowledge and the extent of the doctor's ethical responsibility to the ill. Medical consilia from each of the three areas include discussions of each of these issues. Over the course of the fourteenth and fifteenth centuries, European Christians developed a number of saints who set an example of helpful charity toward victims and who also were understood to preserve the healthy from the ravages of plague. The veneration of St. Roch of Montpelier grew steadily during the fifteenth century, especially in Italy and Germany. And finally, spatial and temporal comparisons of how chroniclers and diarists described plague and the social response to epidemics can demonstrate how commonplace observations like Boccaccio's description of abandonment were picked up by other writers. Images of abandonment can be traced from Florence to Avignon and from Avignon into the towns of Germany.

The initial stages concentrating on three core areas will provide a basic context into which selected images, medical consilia and narrative fragments from other parts of Europe can be fitted. Marchione di Coppo Stefani, The Florentine Chronicle

Marchione di Coppo Stefani was born in Florence in 1336. He wrote his Florentine Chronicle in the late 1370s and early 1380s. Stefani, Marchione di Coppo. Cronaca fiorentina. Rerum Italicarum Scriptores, Vol. 30. , ed. Niccolo Rodolico. Citta di Castello: 1903-13.

Rubric 643: Concerning A Mortality In The City Of Florence In Which Many People Died.

In the year of the Lord 1348 there was a very great pestilence in the city and district of Florence. It was of such a fury and so tempestuous that in houses in which it took hold previously healthy servants who took care of the ill died of the same illness. Almost non of the ill survived past the fourth day. Neither physicians nor medicines were effective. Whether because these illnesses were previously unknown or because physicians had not previously studied them, there seemed to be no cure. There was such a fear that no one seemed to know what to do. When it took hold in a house it often happened that no one remained who had not died. And it was not just that men and women died, but even sentient animals died. Dogs, cats, chickens, oxen, donkeys sheep showed the same symptoms and died of the same disease. And almost none, or very few, who showed these symptoms, were cured. The symptoms were the following: a bubo in the groin, where the thigh meets the trunk; or a small swelling under the armpit; sudden fever; spitting blood and saliva (and no one who spit blood survived it). It was such a frightful thing that when it got into a house, as was said, no one remained. Frightened people abandoned the house and fled to another. Those in town fled to villages. Physicians could not be found because they had died like the others. And those who could be found wanted vast sums in hand before they entered the house. And when they did enter, they checked the pulse with face turned away. They inspected the urine from a distance and with something odoriferous under their nose. Child abandoned the father, husband the wife, wife the husband, one brother the other, one sister the other. In all the city there was nothing to do but to carry the dead to a burial. And those who died had neither confessor nor other sacraments. And many died with no one looking after them. And many died of hunger because when someone took to bed sick, another in the house, terrified, said to him: "I'm going for the doctor." Calmly walking out the door, the other left and did not return again. Abandoned by people, without food, but accompanied by fever, they weakened. There were many who pleaded with their relatives not to abandon them when night fell. But [the relatives] said to the sick person, "So that during the night you did not have to awaken those who serve you and who work hard day and night, take some sweetmeats, wine or water. They are here on the bedstead by your head; here are some blankets." And when the sick person had fallen asleep, they left and did not return. If it happened that he was strengthened by the food during the night he might be alive and strong enough to get to the window. If the street was not a major one, he might stand there a half hour before anyone came by. And if someone did pass by, and if he was strong enough that he could be heard when he called out to them, sometimes there might be a response and sometimes not, but there was no help. No one, or few, wished to enter a house where anyone was sick, nor did they even want to deal with those healthy people who came out of a sick person's house. And they said to them: "He is stupefied, do not speak to him!" saying further: "He has it because there is a bubo in his house." They call the swelling a bubo. Many died unseen. So they remained in their beds until they stank. And the neighbors, if there were any, having smelled the stench, placed them in a shroud and sent them for burial. The house remained open and yet there was no one daring enough to touch anything because it seemed that things remained poisoned and that whoever used them picked up the illness.

At every church, or at most of them, they dug deep trenches, down to the waterline, wide and deep, depending on how large the parish was. And those who were responsible for the dead carried them on their backs in the night in which they died and threw them into the ditch, or else they paid a high price to those who would do it for them. The next morning, if there were many [bodies] in the trench, they covered them over with dirt. And then more bodies were put on top of them, with a little more dirt over those; they put layer on layer just like one puts layers of cheese in a lasagna.

The beccamorti [literally vultures] who provided their service, were paid such a high price that many were enriched by it. Many died from [carrying away the dead] , some rich, some after earning just a little, but high prices continued. Servants, or those who took care of the ill, charged from one to three florins per day and the cost of things grew. The things that the sick ate, sweetmeats and sugar, seemed priceless. Sugar cost from three to eight florins per pound. And other confections cost similarly. Capons and other poultry were very expensive and eggs cost between twelve and twenty-four pence each; and he was blessed who could find three per day even if he searched the entire city. Finding wax was miraculous. A pound of wax would have gone up more than a florin if there had not been a stop put [by the communal government] to the vain ostentation that the Florentines always make [over funerals]. Thus it was ordered that no more than two large candles could be carried [in any funeral]. Churches had no more than a single bier which usually was not sufficient. Spice dealers and beccamorti sold biers, burial palls, and cushions at very high prices. Dressing in expensive woolen cloth as is customary in [mourning] the dead, that is in a long cloak, with mantle and veil that used to cost women three florins climbed in price to thirty florins and would have climbed to 100 florins had the custom of dressing in expensive cloth not been changed. The rich dressed in modest woolens, those not rich sewed [clothes] in linen. Benches on which the dead were placed cost like the heavens and still the benches were only a hundredth of those needed. Priests were not able to ring bells as they would have liked. Concerning that [the government] issued ordinances discouraging the sounding of bells, sale of burial benches, and limiting expenses. They could not sound bells, sell benches, nor cry out announcements because the sick hated to hear of this and it discouraged the healthy as well. Priests and friars went [to serve] the rich in great multitudes and they were paid such high prices that they all got rich. And therefore [the authorities] ordered that one could not have more than a prescribed number [of clerics] of the local parish church. And the prescribed number of friars was six. All fruits with a nut at the center, like unripe plums and unhusked almonds, fresh broadbeans, figs and every useless and unhealthy fruit, were forbidden entrance into the city. Many processions, including those with relics and the painted tablet of Santa Maria Inpruneta, went through the city crying our "Mercy" and praying and then they came to a stop in the piazza of the Priors. There they made peace concerning important controversies, injuries and deaths. This [pestilence] was a matter of such great discouragement and fear that men gathered together in order to take some comfort in dining together. And each evening one of them provided dinner to ten companions and the next evening they planned to eat with one of the others. And sometimes if they planned to eat with a certain one he had no meal prepared because he was sick. Or if the host had made dinner for the ten, two or three were missing. Some fled to villas, others to villages in order to get a change of air. Where there had been no [pestilence], there they carried it; if it was already there, they caused it to increase. None of the guilds in Florence was working. All the shops were shut, taverns closed; only the apothecaries and the churches remained open. If you went outside, you found almost no one. And many good and rich men were carried from home to church on a pall by four beccamorti and one tonsured clerk who carried the cross. Each of them wanted a florin. This mortality enriched apothecaries, doctors, poultry vendors, beccamorti, and greengrocers who sold of poultices of mallow, nettles, mercury and other herbs necessary to draw off the infirmity. And it was those who made these poultices who made alot of money. Woolworkers and vendors of remnants of cloth who found themselves in possession of cloths [after the death of the entrepreneur for whom they were working] sold it to whoever asked for it. When the mortality ended, those who found themselves with cloth of any kind or with raw materials for making cloth was enriched. But many found [who actually owned cloths being processed by workers] found it to be moth-eaten, ruined or lost by the weavers. Large quantities of raw and processed wool were lost throughout the city and countryside.

This pestilence began in March, as was said, and ended in September 1348. And people began to return to look after their houses and possessions. And there were so many houses full of goods without a master that it was stupefying. Then those who would inherit these goods began to appear. And such it was that those who had nothing found themselves rich with what did not seem to be theirs and they were unseemly because of it. Women and men began to dress ostentatiously.

Rubric 635

How Many Of The Dead Died Because Of The

Mortality Of The Year Of Christ 1348

Now it was ordered by the bishop and the Lords [of the city government] that they should formally inquire as to how many died in Florence. When it was seen at the beginning of October that no more persons were dying of the pestilence, they found that among males, females, children and adults, 96,000 died between March and October.

Rubric 636

How They Passed Ordinances Concerning Many Things

In Florence

In the said year, when the mortality stopped, women and men in Florence were unmindful of [traditional modesty concerning] their dress. And ordinances were passed concerning this giving authority to the Judge of the Grascia to enforce these ordinances. The tailors made such boundless demands for payment that they could not be satisfied. Authority was granted [to the judge] that he should handle all matters himself. Servants were so unhappy about the very high prices [they paid] that it was necessary to make great efforts to restrain [the price rises]. The workers on the land in the countryside wanted rent contracts such that you could say that all they harvested would be theirs. And they learned to demand oxen from the landlord but at the landlord's risk [and liability for any harm done to the animal]. And then they helped others for pay by the job or by the day. And they also learned to deny [liability for] loans and [rental] payments. Concerning this serious ordinances were instituted; and [hiring] laborers became much more expensive. You could say that the farms were theirs; and they wanted the oxen, seed, loans quickly and on good terms. It was necessary to put a brake on weddings as well because when they gathered for the betrothal each party brought too many people in order to increase the pomp. And thus the wedding was made up of so many trappings. How many days were necessary and how many women took part in a woman's wedding. And they passed many other ordinances concerning [these issues]. PISTOIA, "ORDINANCES FOR SANITATION IN A TIME OF MORTALITY"

Pistoia was a provincial city of about 11,000 in the early fourteenth century located in the region of Tuscany, less than thirty kilometers northwest of Florence. Its government was in the hands of a small executive council made up of the Anziani or Elders of the People and the Standardbearer of Justice. The chief administrative officers were the Captain of the People and the Podesta who served six-month terms. They could not be Pistoian or even Tuscan. They were allowed limited social contact with Pistoians and their behavior was audited, or "syndicated" at the end of their terms of office. This allowed anyone who felt wronged by their actions to bring charges. The eight Anziani and the Standardbearer of Justice were citizens of the city selected by lot to serve two-month terms from among the citizens of the city who met age, professional and property qualifications. This small council debated all issues and made recommendations to a general city council, the Council of the People which was required either to approve or reject proposals without amendment. As will be clear from the ordinances, there were virtually no issues which affected life in the city which the government could not debate. The context of the Ordinances was the arrival of the Plague early in the Spring of 1348. Plague probably cost the city and surrounding countryside about one fourth of the total population. The statutes themselves reflect both the scientific knowledge and the practical issues which this crisis brought to a head.

In the name of Christ Amen. Herein are written certain ordinances and provisions made and agreed upon by certain wise men of the People of the city of Pistoia elected and commissioned by the lords Anziani and the Standardbearer of Justice of the said city concerning the preserving, strengthening and protecting the health of humans from various and diverse pestilences which otherwise can befall the human body. And written by me Simone Buonacorsi notary. . . in the year from the Nativity of the Lord MCCCXLVIII, the first Indiction.

First. So that no contaminated matter which presently persists in the areas surrounding the city of Pistoia can enter into the bodies of the citizens of Pistoia, these wise men provided and ordered that no citizen of Pistoia or dweller in the district or the county of Pistoia . . . shall in any way dare or presume to go to Pisa or Lucca or to the county or district of either. And that no one can or ought to come from either of them or their districts ... to the said city of Pistoia or its district or county on penalty of £ 50 ... And that gatekeeper of the city of Pistoia guarding the gates of the said city shall not permit those coming or returning to the said city of Pistoia from the said cities of Pisa or Lucca, their districts or counties to enter the said gates on penalty of £ 10 ... It is licit, however, for citizens now living in Pistoia to go to Pisa and Lucca, their districts and counties and then return if they have first obtained a license from the Council of the People ....

II. Item. The foresaid wise men provided and ordered that no person whether citizen, inhabitant of the district or county of the city of Pistoia or foreigner shall dare or presume in any way to bring ... to the city of Pistoia, its district or county, any used cloth, either linen or woolen, for use as clothing for men or women or for bedclothes on penalty of £ 200. ... Citizens of Pistoia, its district and county returning to the city, district or county will be allowed to bring with them the linen or woolen cloths they are wearing and those for personal use carried in luggage or a small bundle weighing 30 pounds or less. ... And if any quantity of cloth of the said type or quality has been carried into the said city, county or district, the carrier shall be held to and must remove and export it from the said city, county and district within three days of the adoption of the present ordinance under the foresaid penalty for each carrier or carriers and for each violation.

III. Item. They provided and ordered that the bodies of the dead, after they had died, can not be nor ought to be removed from the place in which they are found unless first such a body has been placed in a wooden casket covered by a lid secured with nails, so that no stench can issue forth from it; nor can it be covered except by a canopy, blanket or drape under a penalty for £ 50 of pennies paid by the heirs of the dead person.... And also that likewise such dead bodies of the dead must be carried to the grave only in the said casket under the said penalty as has been said. And so that the foresaid shall be noted by the rectors and officials of the city of Pistoia, present and future rectors of the parishes of the city of Pistoia in whose parish there is any dead person are held to and must themselves announce the death and the district [of the city] in which the dead person lived to the podesta and captain or others of the government of the said city. And they must notify them of the name of the dead person and of the district in which the dead person had lived or pay the said penalty for each contravention. And the podesta and captain to whom such an announcement or notification has been made, immediately are held to and must send one of their officials to the same location to see and inquire if the contents of the present article and other statutes and ordinances concerning funerals are being observed and to punish anyone found culpable according to the said penalty.... And the foresaid shall not be enforced nor is it extended to poor and miserable persons who are declared to be poor and miserable according to the form of any statutes or ordinances of the said city.

IV. Item. In order to avoid the foul stench which the bodies of the dead give off they have provided and ordered that any ditch in which a dead body is to be buried must be dug under ground to a depth of 2 1/2 braccia by the measure of the city of Pistoia.

V. Item. They have provided and ordered that no person of whatever condition or status or authority shall dare or presume to return or to carry to the city of Pistoia any dead body in or out of a casket or in any manner on penalty of £ 25 of pennies paid by whoever carries, brings, or orders [a body] to be carried or brought for each occasion. And that the gatekeepers of the said city shall not permit such a body to be sent into the said city on penalty of the foresaid fine by each gatekeeper at the gate through which the said body was sent.

VI. Item. They have provided and ordered that any person who will have come for the burial or to bury any dead person can not and may not be in the presence of the body itself nor with the relatives of such a dead person except for the procession to the church where it will be buried. Nor shall such persons return to the house where the defunct person lived or enter into that house or any other house on the said occasion on penalty of £ 10

VII. Item. They have provided and ordered that when anyone has died no person should dare or presume to present or to send any gift before or after burial to the former dwelling place of such a dead person or any other place on the said occasion or to attend or to go to a meal in that house or place on the said occasion on penalty of £ 25.... Children, carnal brothers and sisters, nieces and nephews of such a dead person and their children, however, shall be expected [from this provision].

VIII. Item. They have provided and ordered that in order to avoid useless or fruitless expenses no person should dare or presume to dress in new clothing during the period of mourning for any dead person or during the eight days after that, on penalty of £ 25 of pennies for whoever contravenes [this] and for each time. Wives of such dead persons however, shall be exempted; they can be dressed in whatever new clothing they wish without penalty.

IX. Item. They have provided and ordered that no paid mourner... shall dare or presume to mourn publicly or privately or to invite other citizens of Pistoia to go to the funeral or to the dead person; nor may anyone engage the foresaid mourner, hornplayer, cryer or drummer.

X. Item. So that the sounds of bells might not depress the infirm nor fear arise in them [the Wise Men] have provided and ordered that the bellringers or custodians in charge of the belltower of the cathedral of Pistoia shall not permit any bell in the said campanile to be rung for the funeral of the dead nor shall any person dare or presume to ring any of these bells on the said occasion.... At the chapel or parish church of the said dead person or at the friary if the person is to be buried at a church of the friars, they can ring the bell of the chapel, parish church or the church of the friars so long as it is rung only one time and moderately, on the foresaid penalty in the foresaid manner [for each violation].

XI. Item. They have provided and ordered that no one shall dare or presume to gather or cause to gather any persons for the purpose of bringing any widow from the former habitation of a dead person, unless at the time she is being returned from the church or cemetery where such a dead person was buried. [Blood relatives] of such a widow, however, wishing to bring the widow from the house at times other than at the time of burial may send up to four women to accompany the said woman, who is to be brought from the foresaid house of the dead person....

XII. Item. They have provided and ordered that no person should dare or presume to raise or cause to be raised any wailing or clamor over any person or because of any person who has died outside the city, district or county of Pistoia; nor on the said occasion should any persons be brought together in any place except blood relatives and associates of such a dead person, nor on the said occasion should any bell be rung or caused to be wrung, nor announcements be made through the city of Pistoia by mourners, nor on the said occasion should any invitation [to join the mourners ] be made on a penalty of £ 25.... It must be understood, however, in any written ordinances speaking of the dead and of honoring the burial of the dead that the foresaid shall not have force in the burial of the body of any soldiers of the militia, doctors of laws, judges or physicians whose bodies, because of their dignity, may be honored licitly at burial in a manner pleasing to their heirs.

XIV. Item. They have provided and ordered that butchers and retail vendors of meat, individually and in common, can not, nor ought to hold or maintain near a tavern or other place where they sell meats, or near a shop or beside or behind a shop any stable, pen or any other thing which will give off a putrid smell; nor can they slaughter meat animals nor hang them after slaughter in any stable or other place in which there is any stench on a penalty of £ 10.

XXII. Item. So that stench and putrefaction shall not be harmful to men, henceforth tanning of hides can not and must not be done within the walls of the city of Pistoia on penalty of £ 25....

XXIII. Item. For the observance of each and every provision contained in the present articles and everything in the article speaking of funerals of the dead, of butchers and retail vendors of meats, they provided and ordered that the lord podestˆ and captain and their officials charged pro tem with the foresaid [duties] shall and must proceed against, investigate, and inquire. . . concerning acts contrary to the foresaid [ordinances], and cause whatever of the foresaid ordained to be reviewed as often as possible, and punish the guilty by the foresaid fines. . . . Also any person may accuse or denounce before either the said podestˆ or captain any persons acting against the foresaid or any of the foresaid or the content of the said statutes or ordinances. And such denunciations or accusers shall, can and may have one fourth of the fine after it is levied and paid, which fourth part the treasurer pro tem of the treasury of the said city shall be held to and have to pay and give to the said accuser and informer as soon as the fine and penalty have been paid. And sufficient proof shall be offered by one witness worthy of belief, or four persons of good reputation who have learned [of the contravention]. . . .

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Last Modified: Friday, 28-Oct-1994 16:20:19 EDT

An Image of Plague by Giovanni Sercambi

Giovanni Sercambi (1348-1424) was an apothecary in the town of Lucca, about sixty kilometers to the west of Florence. He was Lucca's best known author in the fourteenth century. In addition to a collection of stories patterned on Boccaccio's Decameron and a commentary on a portion of Dante's Divine Comedy, he wrote a Chronicle of the history of Lucca in which he included ink sketches of important events. The image of plague in Lucca was probably only composed in about 1400 when Sercambi finished the fine copy of the chronicle on which he had been working since 1368. Arrows were a typical image for plague since like the plague they seem to bypass some and strike others. The addition of an Angel of death pouring out corruption over the dead and dying is, however, an unusual way to represent the general miasma that seemed typical of plague. Chroniclers and medical authorities did discuss the question of how plague spread and in what sense it seemed to be caused by a general corruption of the air or soil.

Last Modified: Friday, 28-Oct-1994 16:21:03 EDT

                                         Volume 35, no. 4, Winter 1997

Brief Articles

Tennyson and Cholera

Roger S. Platizky

        “Our social, political, religious and moral conceptions influence our perceptions of disease, just as do different scientific and medical theories.”1

In his book The Healthy Body and Victorian Culture, Bruce Haley writes that “no topic more occupied the Victorian mind than health.”2 In response to epidemics like smallpox, scarlet fever, typhus, measles, typhoid, whooping cough, consumption, syphilis, rabies, and cholera that collectively took hundreds of thousands of lives during the nineteenth century, the progressive element of Victorianism responded by focusing greater attention on science and physiology, by passing bills like the Anatomy and Public Health Acts (1832 and 1848, respectively), by improving statistics on mortality, by revolutionizing sanitation, by creating more specialized hospitals, by prescribing moral management of illness, and by advocating what came to be a “sports mania” for cricket, badminton, croquet, and even ice skating (Haley, pp. 3-22). There was, however, also a darker, more primitive reaction by Victorians, particularly to “shock diseases” like cholera, that were not only responded to with rigorous scientific debate, but also, like AIDS today, with phobic reactions.  As François Delaporte writes in an influential study of the 1832 cholera epidemic in France, “Any society confronted with an epidemic will exhibit certain defensive reactions. Deadly disease evokes widespread fears, shaped in part by popular beliefs.”3

Although more deaths in nineteenth-century Great Britain were caused by endemic diseases like smallpox, typhus, measles, whooping cough, and consumption, it was cholera, a foreign disease that could kill with astonishing rapidity and seemed to come from out of the blue, that drew the most international attention and social response, especially during the first epidemics of 1832 and 1848.4 According to historian Asa Briggs, “The Surgeon General’s Catalogue alone records 777 expert works on cholera published in London . . . , and these were the medical part only of a huge international literature.”5 In comparing the Asiatic cholera to more traditional diseases, W. T. Gairdner assessed, “Our other plagues were homebred, and part of ourselves.”6 Cholera, on the other hand, “was something outlandish, unknown, monstruous; . . . its insidious march over whole continents . . . invested it with a mystery and a terror which thoroughly took hold of the public mind” (Haley, p. 6). Since no one was really sure what caused cholera or whether it was contagious until Robert Koch discovered the cholera bacillus in 1883,7 mythologies about the disease easily developed. Variously attributed to miasma, religious transgressions, overcrowdedness, poor sanitation, and the vices of the poor, cholera arrived with a foreign etiology and a host of frightening symptoms that often led to rapid death. As William McNeill writes in Plagues and Peoples, “the speed with which cholera killed was profoundly alarming, since perfectly healthy people could never feel safe from sudden death when the infection was anywhere near.”8

With all the attention cholera drew and the fear it imposed, the disease, as might be expected, did not escape the nineteenth-century literary eye or pen.  British writers from Carlyle and Dickens to Gaskell and Nightingale addressed the disease with varying degrees of fortitude and despair. And while Tennyson’s response to cholera, both in his prose and poetry, has not been critically assessed yet, one might expect that a poet as interested in science and as hypochondriacal as Tennyson was 9 would be concerned about this mysterious killer disease that so challenged Victorian ideas about progress, nature, medicine, and religion. In examining, however, the surprisingly few references Tennyson makes to cholera in his collected writings, one discovers the poet’s reaction most often to be detached and defensive rather than empathetic or consolatory, as if he were trying to ward off the disease by emphasizing its otherness instead of identifying with its universality.

For Tennyson, other personal stresses during the first wave of cholera (1831-32)—the death of his father, leaving Cambridge, financial problems, and doubts about his gifts as an artist—may have preempted or muted his reactions to what the British trade papers had labeled “choleraphobia.”10 While Carlyle writes of how “all the world is in apprehension about the cholera pestilence,”11 and Macaulay ranks the panic over cholera higher than the interest in the Reform Bill,12 Tennyson’s first documented response to the disease in a letter to Elizabeth Bourne (March 18, 1832) seems quite relaxed by comparison: “Burking [grave robbing for anatomical dissection] and Cholera have ceased to create much alarm: they are our least evils, but reform and St. Simonism are and will continue to be subjects of the highest interest.”13 Although Tennyson’s tone might seem dismissive—as if cholera were just a sensationalized event that would never recur—that cholera “ceased to cause alarm” implies it once did also for Tennyson, who was no more likely to be immune to the fear than his contemporaries were.

Nevertheless, in his writings on cholera Tennyson repeatedly finds ways to defend himself against identifying too closely with that fear.

Two slightly more personalized responses to the same 1832 epidemic by Arthur Hallam suggest other reasons Tennyson may have been able to insulate himself emotionally from the first wave of cholera.  In a letter to Tennyson (April 10, 1832), Hallam alludes to the assumed target population for cholera when he writes, “The cholera is certainly abating; the preliminary symptoms have been very widely prevalent; disorders which are cured without difficulty in our rank of life turn to malignant cholera in the poor.”14  Here Hallam is subscribing somewhat sympathetically to the widely held view (by Edwin Chadwick and others)15 that epidemics were the special province (though not necessarily the Providence) of the miserable poor.  In a letter that same week to Emily Tennyson (April 14, 1832), Hallam also partially subscribes to an ethnocentric view of the disease: “Great reason have we English, particularly we of London, to be thankful for our immunity compared with the far more awful spread of the same malady in France.”16 If Tennyson and Hallam were of like minds on this issue, as they were on many others, Tennyson’s relative detachment could be a sign that he did not really regard himself as part of a “risk group” for this disease.  Epidemics, whether of cholera or AIDS,17 tend to remain abstractions for people who do not consider themselves in the same “rank of life” as those who are more likely to be targeted because they are already socially marginalized.  In addition, neither Tennyson’s family nor friends were directly impacted by cholera—perhaps because they were living in Somersby at the time, away from the epicenter of the disease. Conversely, Dickens whose daughter Mary nearly died of cholera during the third wave of the epidemic (1854), wrote emphatically about the threat of this disease.18 But since, as Hallam relates, the first wave of cholera, for some still unexplained reason, caused fewer fatalities in London than in other industrial cities, Tennyson would have had both more reason to feel immune at the time and less cause to be personally alarmed.

Tennyson’s first direct encounter with cholera and quarantine (also in 1832) would occur in a foreign land. Years later (1879), his only direct poetic reference to cholera, in “The Defence of Lucknow,” would also occur in a foreign land. In July 1832, a joint letter from Tennyson and Hallam to John Mitchell Kemble vividly describes the Dutch quarantine for cholera that rudely interrupted their Rhine excursion. Sounding more exasperated than frightened in his account of the enforced quarantine, Tennyson lists complaints that could rival those of his own St. Simeon Stylites (a poem written the following year): “I am bugbitten, flybitten, fleabitten, gnatbitten, and hungerbitten. I have had no sleep for the last three nights and have serious thoughts of returning to England . . . in an open boat” (Letters, 1:77). Although Tennyson’s tone certainly seems humorously detached, his being closer to the epidemic—in fact right next to it—makes one wonder how much fear is actually being suppressed through a kind of gallows humor. There is a trace of that fear in Tennyson’s remark about not having slept for three nights; Robert Bernard Martin adds that he was not able to write, nor could Hallam read (p. 153). Do biting bugs, however annoying, cause this kind of unrest unless they are associated with pestilence?  The last portion of Tennyson’s letter mixes humor with the kind of ethnocentrism that will become more blatant by the time Tennyson writes “The Defence of Lucknow”: “Is it not infinitely more reasonable that Dutchmen should die of cholera than that English gentlemen should be detained on board a villainous ex-steamboat, where they are charged 3s.4d. every night for the supper which the fleas make of them?” (p. 77). While Tennyson and Hallam eventually escaped this ordeal, Tennyson would live through three more cholera epidemics, remaining mostly reticent about this plague until it finally flared up politically, as well as metaphorically, in a late imperialistic poem.

In “The Defence of Lucknow,” written more than fifty years after the quarantine on the Rhine and twenty years after the Sepoy Mutiny (1857), Tennyson uses his speaker to politicize a disease for nationalistic reasons.  Today it is not difficult to read this poem—with its traitorous Indian “moles” and “tigers” and its “wholesome white faces”—as blatantly racist even though the speaker praises the “loyal” Indians who fought with the British during the siege.  Furthermore, in comparing India’s miasmic heat to “the mouth of hell” (l. 81),19 the speaker xenophobically associates that climatic hell with contagions spawned of filth:

Stench of old offal decaying, and infinite torment of flies,

Thoughts of the breezes of May blowing over an English field,

Cholera, scurvy, and fever, the wound that would not be healed. (ll. 82-84)

Although cholera is syntactically paired with scurvy and fever in l. 84, the emphasis is on cholera since by the time this poem was written, international sanitary conferences had proclaimed India the “natural home” of this killer disease; moreover, cholera took far more lives of British soldiers in India than did the battles themselves.20 Figuratively, the “wound that would not be healed” could refer both to the betrayal of the British Empire by the Indian “butchers” and to the insidious cholera that collaborated in that campaign of hell.  Deconstructively, however, “the wound that would not be healed” could also refer ideologically to the primitive impulse to blame diseases that we cannot control on foreigners. This kind of blaming is as old as Thucydides’ blaming the Peloponnesians for the Athenian plague and as contemporary as the moral majority’s blaming gays and IV-drug users for AIDS.21 And such blame would be sanctioned, indeed encouraged, by cultures that had socially constructed certain diseases as foreign, or “other.” According to Sander Gilman and Dorothy Nelkin, “blaming has always been a means to make mysterious and devastating diseases comprehensible and therefore possibly controllable.”22 They add that blame is a “social construct” and that “disease is frequently associated with the ‘other,’ be it the other race, the other class, the other ethnic group.”

In a somewhat analogous way, Tennyson had used this mythic kind of blaming for disease twenty years earlier than “The Defence of Lucknow” in his poem “Guinevere” (1858) as King Arthur, his Round Table in shambles, denounces his adulterous and, hence, diseased wife:

She like a new disease, unknown to men,

Creeps, no precaution used, among the crowds,

Makes wicked lightnings of her eyes, and saps

The fealty of our friends.  (ll. 515-518).

While the association of adulterous women with contagion23 is as old as misogyny (and as topical as the Contagious Diseases Acts), the reference to a “new disease unknown to men,” might not only apply historically to medieval scourges, but also, within the mid-Victorian context of the poem, to new diseases like cholera that crept “among the crowds” particularly in urban centers where it sapped the lives of unsuspecting people with lightning speed. Although Arthur ultimately forgives his wife at Almesbury (ll. 541-543), in both “Guinevere” and “The Defence of Lucknow,” the contagion-spreading woman and natives, respectively, are primarily branded for betraying a nationalistic cause, be it the health of the Round Table or of the British Empire. For that reason, Guinevere and the Indians are both associated with killer illnesses. Furthermore, since as Frank Mort writes, “The level of national health [reflects] the degree of civilization attained by the state,” 24 it is no coincidence that as the cholera of India spreads miasmically in “The Defence of Lucknow,” heroes are said to be thinking (nationalistically as well as nostalgically) of the “breezes of May blowing over an English field” (l. 83).

Based on the aforementioned examples of the Rhine quarantine and “The Defence of Lucknow,” one can not imagine Tennyson ever empathizing with cholera victims to the extent that Walt Whitman does in Section 37 of Song of Myself :

Not a cholera patient lies at the last gasp,

but I also lie at the last gasp,

My face is ash-color’d, my sinews gnarl, away

from me people retreat.25

Indeed, one wonders how Tennyson would respond if he were writing about a shock disease like AIDS today.  And yet, can one really expect a British author who was often reticent about physicality (the healthy body as well as the diseased one) to be as comfortable with the proxemics of disease as Whitman was? On the other hand, since Tennyson was able to write less defensively about other diseases, it may have been something about the nature of cholera itself that he wanted to avoid or cast off by emphasizing its otherness. In two other poems written around the period of “The Defence of Lucknow,” “In the Children’s Hospital” (1880) and “Happy” (1889), Tennyson creates speakers who embrace rather than distance themselves from people with terrible diseases: in “Happy,” a woman decides to be the spouse of a leper despite the risks to her own health; and “In The Children’s Hospital,” a Florence Nightingale-like nurse overcomes her aversion to disease because of the Christian command: “‘Ye do it to me, when you do it to these’” (l. 26). Why, then, should Tennyson’s representation of cholera be so different?  Perhaps, as with today, there are some diseases that are simply perceived as more “untouchable” than others for historical as well as irrational reasons.

In his encyclopedic study of cholera in Germany, Death in Hamburg, Richard Evans describes the nature of cholera in a way that might explain Tennyson’s aversion to personalizing this disease even metaphorically: “The massive loss of body fluids, the constant vomiting and defecating of vast quantities of liquid excreta, were horrifying and deeply disgusting in an age which, more than any other, sought to conceal bodily functions from itself.”26 Since the disease’s symptoms were unusually raw, perhaps Tennyson felt it indecorous to refer to the disease in any personalized or directly physicalized way. On the other hand, there could have also been a less conscious motive. We recall Edward FitzGerald’s famous remark about Tennyson’s hypochondria, that altogether this really great man thought more about “his bowels and nerves than about the Laureate wreath” he was born to inherit.27 Although Tennyson certainly was hardly alone in worrying about his digestive tract in the nineteenth century, FitzGerald’s comment suggests an obsessive preoccupation. While other diseases like typhoid could cause serious bowel disturbance, the most notorious bowel-related disease of the time was cholera since the premonitory and, if untreated, often lethal symptom was fulminating diarrhea, which would have been particularly appalling to a bourgeois sensibility.  It is no mere coincidence, I believe, that during the worst of the four cholera epidemics in Victorian England (1848), biographers find Tennyson undergoing rigorous hydropathic purges and traveling about as far away from the urban epicenters of cholera as he could get.28 Although one might argue that Tennyson just felt like traveling and that he had undergone hydropathy before, that both occurred simultaneously during a period of heightened creativity and emotional stress suggest a flight reaction and no small degree of understandable anxiety. His resort to months of hydropathy at Malvern during this period was a talismanic way to bolster his immune system and, in effect, to ward off threatening contagion, much as he had earlier warded off cholera figuratively by detaching himself from it during the Rhine expedition and would later by politicizing it as a “foreign disease” in “The Defence of Lucknow.” According to Tennyson’s biographer, Peter Levi, hydropathy was used to treat cholera as well as other diseases.29 While Tennyson may have also gone to Malvern in 1848 to treat his more visible and chronic problem of gout, the hydropathic “crises” he experienced at Malvern—in particular the spasmodic bodily purgings, the violent vomiting and other excretions—basically replicated the premonitory symptoms of cholera, paradoxically, as much “poison” was released homeopathically from the body.  Thus, hydropathy served a ritual function for Tennyson’s hypochondria by purifying the body (or in modern terms, bolstering the immune system) so that it had a better chance of warding off pestilence and other forms of contagion, both real and imagined. Apparently the ritual worked, for this would be the last time that Tennyson resorted to treatment at a hydropathic institution.

Similarly, the last time Tennyson would allude to cholera in his poetry would be in his late prophetic poem “Locksley Hall, Sixty Years After” (1886). Written in the same year he was mourning the death of his son Lionel (to fever in India), the poem like its predecessor, “Locksley Hall” (1842), shows an overall ambivalence toward the power of science alone to cure all of mankind’s ills.  While not naming cholera specifically, the speaker refers implicitly to the disease when he compares decadent writers who strip “foul passions bare” and show nature’s “mortal shame” to those who send drainage from the sewer into the fountain, “lest the stream should issue pure” (ll. 143-144). Recalling Dr. John Snow’s famous experiment with cholera-tainted water from a contaminated fountain pump, the conservative speaker’s use of pure and impure streams refers as well to Chadwick’s sanitation project, which was initiated in England to thwart sewage-spawned diseases like cholera.  The metaphor is, therefore, simultaneously emblematic of the need to clean up language as well as the public streams. Carrying over the water metaphor, the speaker hopes for a day when “all diseases [will be] quenched by Science” (l. 163). While the word “cured” might make more sense in this context, the choice is appropriate for a poet who had repeatedly undergone hydropathy to ward off disease.

By the time “Locksley Hall Sixty Years After” was written, the Public Health Act (1848) had been in operation for forty years, the Red Cross for twenty (1863). Numerous international medical conferences had convened, the first one (1851) initiated as a global response to cholera. Germ theory was being promoted, as were the antiseptic practices of Lister and Pasteur. And Robert Koch had already discovered the cause of cholera (1883). Clearly diseases were beginning to be “quenched by Science.” But neither Tennyson’s speaker in this visionary poem nor Tennyson himself is as optimistic as many of the scientists of the period were. For caught between the oscillations of Progress—between “Cosmos, Chaos!”(l. 127)—man can only “half-control his doom” (l. 277). Furthermore, as the history and social construction of epidemics demonstrates both in Tennyson’s age of diseases and our own, sometimes despite all attempts at progress, “the course of Time will swerve / Crook and turn upon itself in many a backward streaming curve” (ll. 235-236).

Notes

1   Elizabeth Fee and Daniel M. Fox, AIDS: The Burdens of History (Berkeley: Univ. of California Press, 1988), p. 121.

2   Bruce Haley, The Healthy Body and Victorian Culture (Cambridge: Harvard Univ. Press, 1978),  p. 3.

3   François Delaporte, Disease and Civilization: The Cholera in Paris, 1832  (Cambridge: MIT Press, 1986), p. 5.

4   Margaret Pelling, Cholera, Fever. and English Medicine, 1825-1865 (Oxford: Oxford Univ. Press, 1978), p. 4. Pelling believes that one of the main reasons cholera drew so much attention was that outbreaks corresponded to periods of social and political unrest.

5   Asa Briggs, The Collected Essays of Asa Briggs (Sussex: Harvester Press, 1985), 2:154.

6   Quoted in Haley, p. 6.

7   For a detailed discussion of the difference between nineteenth-century contagionists and anti-contagionists, see Roger Cooter, “Anticontagionism and History’s Medical Record,” pp. 87-108, in Peter Wright and Andrew Treacher, eds., The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh Univ. Press, 1982).

8   William H. McNeill, Plagues and Peoples (Southampton: Camelot Press, 1976), p. 261.

9   Anne C. Colley and Robert Bernard Martin discuss Tennyson’s hypochondria throughout their respective books, Tennyson and Madness (Athens: Univ. of Georgia Press, 1983), and Tennyson:  The Unquiet Heart (Oxford: Clarendon Press, 1980); see also Roger S. Platizky, A Blueprint of His Dissent: Madness and Method in Tennyson’s Poetry (Lewisburg: Bucknell Univ. Press, 1989), pp. 11, 17, 26, 29, 41, 45,103.  For two of several studies of Tennyson’s long-standing interest in science, see Kilika Ranjan Chatterjee, Studies in Tennyson as a Poet of Science (New Delhi: S. Chand and Co., 1974);  Lionel Stevenson, Darwin Among the Poets (Chicago: Univ. of Chicago Press, 1932).

10  For one of several studies of “choleraphobia,” see Michael Durey, The Return of the Plague: British Society and Cholera, 1831-32 (Dublin: Gil and Macmillan Humanities Press, 1979), pp. 135-136, 153ff.

11  Quoted in Haley, p. 70.

12  Quoted in Durey, pp. 135-136.

13  Cecil Y. Lang and Edgar F. Shannon, eds., The Letters of Alfred Lord Tennyson, Vol, 1. 1821-1850 (Cambridge: Harvard Univ. Press, 1981), p. 69.

14  Arthur Hallam’s letter is cited in Hallam Tennyson, Alfred Lord Tennyson: A Memoir By His Son (New York: Greenwood Press, 1969), 1:85.

15  See M. W. Flynn, ed., The Sanitary Condition of the Labouring Population of Great Britain, by Edwin Chadwick, 1842 (Edinburgh: Edinburgh Univ. Press, 1965). Chadwick was one among many, including Dr. Southwood Smith, Kay Shuttleworth, and Thomas Malthus, who made the connection between poverty and diseases like cholera.

16  The Letters of Arthur Henry Hallam, ed.  Jack Kolb (Columbus: Ohio State Univ. Press, [1981]), p. 552.

17  Interesting comparisons between cholera and AIDS as socially constructed diseases can be found, among other places, in Charles E. Rosenberg, Explaining Epidemics And Other Studies in the History of Medicine (Cambridge: Univ. of Cambridge Press, 1992), p. 265; W. F. Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Univ. of Cambridge Press, 1994), p. 74.

18  Peter Ackroyd, Dickens (London: Sinclair-Stevenson, 1990), p. 824.

19  The Poems of Tennyson, ed. Christopher Ricks (Berkeley: Univ. of California Press), 3:38.

20  Roy Macleod and Milton Lewis, eds., Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion (London: Routledge, 1988), pp. 39, 44.

21  Terrance Ranger and Paul Slack, Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge: Cambridge Univ. Press, 1992), p. 37.

22 Dorothy Nelkin and Sander Gilman, “Placing Blame for Devastating Disease,” in Arlen Mack, ed., In Time of Plague: The History and Social Consequences of Lethal Epidemic Disease (New York: New York Univ. Press, 1991), pp. 40-41.

23   See Mary Douglas, Purity and Danger: An Analysis of the Concepts of Pollution and Taboo (London: Ark Paperbacks, 1984), p. 3.

24  Frank Mort, Dangerous Sexualities: Medico-Moral Politics in England Since 1830 (London: Routledge and Kegan Paul, 1987), p. 66.

25  Walt Whitman, Leaves of Grass, ed.  Harold W. Blodgett and Sculley Bradley (New York: New York Univ. Press, 1965), p. 72.

26  Richard J. Evans, Death in Hamburg: Society and Politics in the Cholera Years, 1830-1910 (Oxford: Clarendon Press, 1987), p. 229.

27  Cited in Colley, p. 60.

28   For a chronology of these extensive travels, see F. B. Pinion, A Tennyson Chronology (London: Macmillan, 1990), pp.

49-51. From January 1848 through mid-July, Tennyson travelled through Ireland and Cornwall, mostly visiting Arthurian sites, but also showing a decided preference for coastal areas (waves and cliffs) that would have been considered healthier than urban centers because there would be less likelihood of miasma.

29   Peter Levi, Tennyson (London: Macmillan, 1993), pp. 173-174.  Levi disagrees with those critics (e.g. Martin) who believe Tennyson underwent hydropathy primarily for epilepsy. In addition, for an illuminating discussion of nineteenth-century homeopathic procedures like hydropathy, as opposed to allopathic ones, see Jane B. Donegan, Hydropathic Highway toHealth: Women and the Water-Cure in Antebellum America (New York: Greenwood Press, 1986), esp. pp. 13, 26, 73, 85, 90-91. According to Donegan, it was the bourgeoisie in England as well as America that primarily sought the water-cure as an alternative to medical practices like venesection.  Hydrophathists were against drugs and believed in general that “those who took drugs in the expectation they were curing their ailments in fact actually were inducing additional disease and debility” (p.26).

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http://www.thebody.com/siecus/college.html

Sexuality Information and Education Council of the United States

SHOP Talk: School Health Opportunities and Progress Bulletin

Volume 6, Number 18

November 30, 2001

Changes in College Students' Knowledge About AIDS

         A study published in the November issue of AIDS Education and Prevention examines patterns in college students’ knowledge and attitudes over time about AIDS and people with AIDS. Participants were students enrolled in Introductory Psychology at a mid-sized southeastern university over a 14-year period between 1986 and 2000.

         Participants anonymously completed an AIDS Attitude Scale (AAS) consisting of "tolerant" and" intolerant" items such as: "I would like to feel at ease around people with AIDS" or "I would not allow my children to play with the children of people with AIDS." Students were asked to rate their degree of agreement from 1 (strongly disagree) to 5 (strongly agree).        

                  Additional questions were used to rate the participants’ knowledge about HIV, perceived susceptibility to HIV, concerns about infection through casual contact, and opinions about the effectiveness of condoms to prevent the spread of HIV. Researchers chose these variables because they reflect components of decision-making models used to conceptualize HIV-prevention efforts.

                  Researchers also collected demographic data, including participants’ age, gender, race/ethnicity, year in school, and sexual orientation. Data was only analyzed from students who identified exclusively as heterosexual.

Results

Participants

              Over the course of 15 years, there were 1,571 participants; 571 were male and 1,000 were female. 89% of the participants were freshmen or sophmores. The average age of participants was 19. 90% of participants were Caucasian, 6% were African American, and 4% were another race/ethnicity.

Data Analysis

Attitudes/Comfort Level

              Females typically scored higher on the AIDS Attitude Scale (AAS), indicating more tolerant attitudes toward people with AIDS. Tolerance toward people with AIDS and HIV infection generally increased over time. Higher comfort ratings for being close to people with HIV/AIDS correlated with higher tolerance scores on the AAS.           

              Since 1991, the comfort rating for being close to a classmate or roommate with HIV or AIDS generally increased. Ratings indicate, however, that students feel less comfortable being close to a roommate than to a classmate.           

              There was a significant increase in the percentage of students who reported personally knowing someone with HIV infection.            

Perceived Risk/Vulnerability

              Perceived susceptibility to HIV appears to have decreased over time. Students reported more vulnerability to HIV immediately after Magic Johnson’s announcement that he was HIV-positive and again in the fall of 1995. Females were consistently less fearful of infection through casual contact than males.

Condom Effectiveness

              Perceptions regarding the effectiveness of condoms for preventing the spread of HIV infection have been mixed over time.           

              Condoms were rated more effective in 1990 and 1991 than they were either in 1987, 1988, or 2000. Males reported more confidence in the effectiveness of condoms in reducing the spread of HIV than females.

                       The data suggest that as AIDS has become more prevalent in the United States, perceived knowledge about it has increased and college students’ attitudes about it and people with HIV/AIDS have become more tolerant.

                  The authors state that one explanation for this finding is that when individuals feel more confident about their HIV knowledge they are less likely to fear infection through casual contact and are more tolerant of people with HIV/AIDS.

                  The authors suggest that the decreasing concerns of HIV infection from casual contact may relate to increases in personal contact with an HIV-positive individual and societal events such as Magic Johnson’s announcement that he was HIV-positive.

                  Interestingly, the data suggest little relation between students’ perceived susceptibility to HIV/AIDS and attitudes about people with AIDS. The authors suggest that while this might seem disheartening to prevention efforts, a correlation between high tolerance toward people with AIDS and perceived invulnerability would imply that students empathize with people with AIDS only if they feel that HIV/AIDS is something that cannot happen to them. The lack of a correlation, therefore, may actually indicate that students are empathetic toward people with AIDS regardless of their own perceived susceptibility to the disease.     

                  The authors go on to note that while students in general are expressing more tolerant attitudes toward AIDS and people with AIDS today compared with students a decade ago, there is still a large difference in the perception of males and females. This indicates that HIV-prevention and intervention programs must focus on the particular concerns of males and females. The authors conclude by saying that analyzing changes in attitudes over time is a useful approach that has practical applications. Such comparisons can both describe trends and evaluate the effectiveness of education programs. By focusing on both the similarities and differences in attitudes over time, health professionals will be able to adapt programs to students’ current needs and concerns.

For more information: K. E. Bruce and L. J. Walker, "College Students’ Attitudes About AIDS: 1986 to 2000," AIDS Education and Prevention, vol. 13, no. 5, pp. 428-37.      

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http://www.aegis.com/PUBS/CDC_FACT_SHEETS/1995/CPATH003.html#13

HIV/AIDS and College Students

A CDC Pathfinder - 1995

Introduction

This pathfinder is designed to serve as a guide to information resources about college students and HIV/AIDS. It contains information about behaviors that may place college students at risk of HIV infection and materials used for HIV/AIDS education. The information in the first section responds to questions frequently asked of the CDC National Prevention Information Network (CDC NAC) reference staff on a variety of topics related to HIV/AIDS and college students. The following section lists selected organizations that provide HIV/AIDS-related services for college students, administrators, and educators. Pertinent materials available from CDC NAC and other sources are included.

Basic Information About HIV/AIDS and College Students

HIV Infection Among College Students

The Centers for Disease Control and Prevention (CDC) and the American College Health Association estimate that 1 in 500 college students is infected with HIV1. This estimate is based on the results of a blind study conducted at 19 American universities, where anonymous blood samples were tested at campus health centers. A follow-up to this study, which was expanded to include 24 colleges, found the incidence of HIV infection on these college campuses to be about .2 percent, which is consistent with the earlier findings.2 The CDC estimates that 1 in 250 Americans (all age groups) is infected with HIV.

College Students' Risk For Contracting HIV

Factors such as peer pressure, lack of maturity, and alcohol and drug use put college students at risk for HIV infection3-7. College students may have unprotected sex while under the influence of alcohol or other drugs, which they ordinarily might not do. Abandoning safer sex techniques, failing to use condoms correctly and consistently, and having sex while under the influence can lead to possible infection with HIV or other sexually transmitted diseases. Also, date rape, an increasing problem on college campuses, is associated with alcohol use and may present a risk for infection.

Researchers have conducted many studies to determine whether the threat of HIV infection causes college students to alter risky behaviors 5,8-13. Researchers have used Knowledge, Attitude, Belief, and Behavior (KABB) models and have developed questionnaires that attempt to measure behavior change. HIV/AIDS prevention theorists believe that increased knowledge, along with positive attitudes and beliefs about HIV/AIDS, will lead to positive behavior changes, i.e., behaviors that are less risky, or safer, such as use of condoms, abstinence, and avoidance of risky situations. However, studies indicate that increased knowledge of HIV/AIDS does not always result in a positive behavior change. Use of alcohol or other drugs often alters judgments about the perceived risks of a particular situation.

In addition, many of the studies mentioned above include a questionnaire measuring HIV/AIDS Knowledge, Attitudes, Beliefs, and Behavior. The CDC Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health (DASH) is in the process of developing a KABB survey for colleges that will be administered in 1995.  Effective Ways to Educate College Students About HIV/AIDS The American College Health Association has developed a handbook that guides campus authorities in establishing HIV/AIDS policies and effective education programs.

Peer education programs often have been used to facilitate AIDS education, as well as general health education courses. The entire May 1993 issue of The Journal of American College Health 14 is devoted to evaluation and discussion of peer health education programs. Researchers have conducted numerous studies to determine the effectiveness of peer education programs and most show that knowledge and positive attitudes and beliefs increase as a result of peer education. However, behavior change is often extremely difficult to measure 15-17. The Sexuality Information and Education Council of the U.S. (SIECUS) is another resource for peer educators. SIECUS can identify materials on their database and create bibliographies on sexuality education.

Some colleges and universities offer courses on HIV/AIDS for credit 4,18-21. These courses generally cover basic HIV/AIDS information. One such program at Rutgers University covers the basics, as well as in-depth information on a variety of specialized topics. For-credit HIV/AIDS courses have provided an organized, logical, nonjudgmental, comprehensive approach to sexuality. Studies indicate that many college students already have a broad-based knowledge of basic issues, and a more in-depth approach is often needed to provide challenging courses.

Bibliography

1 "Prevalence of the Human Immunodeficiency Virus Among University Students," The New England Journal of Medicine, 1990, Vol. 323, p.1538-41.

2 "College HIV Rate Holds Steady, but Risk of Exposure Remains High," AIDS Alert, November 1994, Vol. 9, No. 11, p. 153-156.

3 "Alcohol-Induced Sexual Behavior on Campus," Journal of American College Health, 1993, Vol. 42, p. 27-31.

4 "Knowledge About AIDS and Reported Risk Behaviors Among Black College Students," Journal of American College Health, 1989, Vol. 38.

5 "High-Risk STD/HIV Behavior Among College Students," Journal of the American Medical Association, 1990, Vol. 263, p. 3155-3159.

6 "Gender, Knowledge About AIDS, Reported Behavioral Change, and the Sexual Behavior of College Students," Journal of American College Health, 1991, Vol. 40, p. 5-12.

7 "Acquaintance Rape and Alcohol Consumption on College Campuses: How Are They Linked?," Journal of American Public Health, 1991,Vol. 39, p. 165-169.

8 "AIDS: Attitudes/ Knowledge/ Beliefs/ - Special Issue," Journal of Health Education, January/February 1991.

9 "Knowledge of AIDS and Safer Sex Practices Among College Freshmen," Public Health Nursing, 1993, Vol. 10 p. 149-165.

10 "An Assessment of AIDS-Related Knowledge, Attitudes, and Behaviors Among Selected College and University Students," AIDS and Public Policy Journal, 1989, Vol. 4, p. 112-119.

11 "Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis," Journal of American College Health, 1992, Vol. 40, p. 254-263.

12 "A Research-based HIV/AIDS Education Program Via the University Computer System: Bridge to Prevention," Journal of Health Education, 1992, Vol. 23, p. 198-203. (The survey tool is available by writing to the author at Ball State University, AIDS Coordinator, Muncie, IN 47306-0265.)

13 "College Students and AIDS: A Preliminary Survey of Knowledge, Attitudes, and Behavior," Journal of American College Health, 1988, Vol. 37, p. 127-130.

14 "Peer Health Education on Campus" (A Theme Issue), Journal of American College Health, 1993, Vol. 41.

15 "Did an AIDS Peer Education Program Change First Year College Students Behaviors?" Journal of American College Health, 1994, Vol. 42, p. 163-65.

16 "Effects of a Peer-counseled AIDS Education Program on Knowledge, Attitude and Satisfaction of Adolescents," Journal of Adolescent Health, 1991, Vol. 12, p. 38-43.

17 "Effects of a Peer-Led AIDS Intervention With University Students: Evaluation, Treatment, and Prevention," Journal of American College Health, 1991, Vol. 40, p. 75-78.

18 "Evaluating HIV/AIDS Education in the University Setting," Journal of American College Health, 1994, Vol. 43, p. 11-14.

19 "Evaluating the Effectiveness of a Credit Semester Course on AIDS Among College Students," Journal of Health Education, 1991, Vol. 22, p. 35-41.

20 "What is the Impact of a Campus AIDS Education Course?" Journal of American College Health, 1991, Vol. 40, p. 87-92.

21 "Development of a Classroom-Based AIDS Education at New Jersey State College," Journal of American College Health, 1991, Vol. 40, p. 95-96.

Organizations

These organizations provide services related to HIV infection and the college population. Most offer services targeting college educators, while others directly benefit students.

American College Health Association (ACHA)

P.O. Box 28937

Baltimore, MD 21240-8937

(410) 859-1500

ACHA provides guidelines, technical assistance, educational materials, consultation, research tools, and speakers on HIV/AIDS to colleges and universities. ACHA offers free brochures on HIV/AIDS, STDs, alcohol use, acquaintance rape, and other college health issues.

Association on Higher Education and Disability

AIDS Task Force, Special Interest Group

P.O. Box 21192

Columbus, OH 43221-0192

(614) 488-4972

The AIDS Task Force provides information on the services being made available to HIV-affected individuals on college campuses. The newsletter "HIV on Campus," which is published on an irregular basis, provides information for service providers on accommodations, preventive education and other health issues for persons with disabilities.

Association for the Advancement of Health Education (AAHE)

1900 Association Dr.

Reston, VA 22091

(703) 476-3437

AAHE is a professional membership organization representing health educators. AAHE distributes many journal articles about HIV/AIDS education issues for young adults and college students, including information on KABBs and teaching guides. Educational publications and collaborative training workshops help support AIDS education and prevention in schools, including colleges.

Jackson State University

National Alumni AIDS Prevention Project

P.O. Box 18890

Jackson, MS 39217

(601) 968-2512

Jackson State University has developed a number of KABB studies and distributes educational materials which are both for and about college students. It develops and implements AIDS intervention and prevention strategies aimed at decreasing transmission of HIV within the African American community.

National Association for Equal Opportunity in Higher Education (NAFEO)

Black Higher Education Center

Lovejoy Bldg.

400 12th St., NE

Washington, DC 20002

(202) 543-9111

NAFEO has developed a number of materials for colleges about HIV/AIDS education programs including a manual titled "HIV/AIDS Education: A Manual for Peer Educators of Historically Black Colleges and Universities." NAFEO has also produced a video titled "AIDS: The Real Deal." The organization also produces a bimonthly newsletter for university administrators: "NAFEO þ HIV Info Notes."

Sexuality Information and Education Council of the U.S. (SIECUS)

130 West 42nd St.

Suite 2500

New York, NY 10036

(212) 819-9770

SIECUS provides information and education on sexuality and related issues to health care professionals, educators, policymakers, students, and the public. SIECUS can provide HIV/AIDS information from its resource library. Technical assistance is available for educators, health care professionals, and religious leaders.

Resources and Materials From The Clearinghouse

A customized search on the CDC NAC Educational Materials Database will identify a variety of materials for college students, educators, and administrators. Some of these materials are directly available through the CDC National Prevention Information Network inventory; CDC NAC also provides availability information for materials produced by other organizations.

National and local organizations, which may be able to provide you with additional information, can be identified from the Clearinghouse's Resources and Services Database. Materials for and about college students can also be identified on the Centers for Disease Control and Prevention's Comprehensive School Health Database.

Call (800) 458-5231 to speak with a CDC NAC Reference Specialist who can search these databases for your and provide additional information on HIV/AIDS and college students.

CDC NAC Materials for Use With College Students

CDC Fact Sheets (I566)

Women, Sex, and HIV (D532)

Background Information on the Morbidity and Mortality Weekly Report: Effectiveness of Condoms (D459)

The Surgeon General's Report to the American Public on HIV Infection and AIDS (D323)

HIV Infection and AIDS: Are You At Risk? (D539)

Using Condoms to Prevent HIV Infection and Other STDs (D547)

Voluntary HIV Counseling and Testing: Facts, Issues, and Answers (D545)

A Guide to Locating Information About HIV/AIDS (D317)

CDC National Prevention Information Network Catalog of HIV and AIDS Education and Prevention Materials (D499)

HIV/AIDS and Sports: A Pathfinder to Information (B685)

To order CDC NAC publications, call (800) 458-5231.

Other Materials

Manual: "A Peer Dilemma (Students Working Together to Stop the Spread of AIDS)," manual, 23 p., Jackson State University, National Alumni

AIDS Prevention Project, P.O. Box 18890, Jackson, MS 39217, (601) 968-2512

Journals and Newsletters

These journals may be located in your local college or university library.

Health Education: Theory and Practice

Journal of American College Health

Journal of College Student Personnel

Journal of Health Education

Journal of School Health

HIV on Campus, Association on Higher Education and Disability, AIDS Task Force (see Organizations section)

NAAPP Sack, Jackson State University National Alumni AIDS Prevention Project (see Organizations section)

NAFEO: HIV Info Notes, National Association for Equal Opportunity in Higher Education (see Organizations section)

Inventory No. B437

950301

CPATH003

Always watch for outdated informaton. This article first appeared in 1995. This information is designed to support, not replace, the relationship that exists between you and your doctor.

©1997. AEGIS.

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http://nr.stic.gov.tw/ejournal/ProceedingD/EJ04_v8n2.htm#t77

Aboriginal Children's Alternative Conceptions of Animals and Animal Classification

     This study examined aboriginal children's conceptions of animals and animal classification. Thirty-six students were selected from the 2nd, 4th, and 6th grades of two elementary schools in Hualien. A clinical interview and a classification task, involving the sorting of pictures of animals into major classes, were administered. The results indicated four forms of classification thinking: (a)living; (b)non-living; (c)animal, with scientifically acceptable attributes; and (d)animal, with scientifically unacceptable attributes. Children in all grades usually used a combination of the last two forms. Movement and eating were the most commonly used attributes for identifying animals. The label "animal" was usually applied to large, terrestrial mammals found in zoos or in the jungle Humans were not categorized as animals by a substantial number of children, particularly in the lower grades Although some of those in the higher grades were aware that humans were animals, the reasons given were irrelevant to animal attributes and improperly derived from the biological concept of   "evolution" It was also found. that the children's understanding of biological classification was generally poor. Even when the children could classify an animal instance as a subset of "animal" correctly, they still tended to consider it as a "non-animal" set. It seems that the children considered the subsets of animals as comparable sets to the set of animals.

     Keywords: aborigines, animal, conceptions of animals, classification                         

     A Study on the Technological Literacy of Elementary and Junior High School Students in Taiwan

     The purpose of this study was to investigate the current status of technological literacy of Elementary and Junior High School students in Taiwan. A stratified random and cluster sampling method was employed in this study. A total of 3066 ninth graders from 44 Junior High Schools and 3420 sixth graders from 60 Elementary Schools have completed the technological literacy test developed by the researchers. The results show that : (1) These Taiwanese Junior High and Elementary students are fairly technologically literate especially in communication technology. The students are more literate in basic technology principles or theories than in practical and applicable knowledge. (2) At the Elementary level, female students scored higher than male students. But at the Junior High school level, male students scored higher than female students especially in terms of the application of technological knowledge. (3) The Junior High School students are very technologically literate in the fundamental section, but not in the advanced section. (4) Mass media, including newspapers, magazines, TV and radio, were evaluated as the most important sources of knowledge of technology for these Junior High School students.

          Keywords: technological literacy, test                        

     Science Teachers' Intentions to Teach about HIV/AIDS

     Results of this study showed that most science teachers did intend to teach about HIV/AIDS in science classes. The theories of reasoned action and planned behavior were applied to examine and predict science teachers' intentions to teach their students about HIV/AIDS. Three variables of theories, attitude toward teaching about HIV/AIDS, subjective norms, and perceived behavior control, could explain 74% of the variance in science teachers' intentions. Attitude toward teaching about HIV/AIDS was the most significantly important factor in the prediction. Variables representing science teachers who taught biology, grades 7 and 12, and had past experiences of teaching about HIV/AIDS also made significant contributions to the prediction of teachers?intentions. Analysis of variance significantly found that respondents who intended to teach about HIV/AIDS had a higher HIV/AIDS knowledge score, more positive attitudes toward teaching about HIV/AIDS, less negative social influence mostly from principals, school board members, and parents, as well as adequate resources and material to teach about HIV/AIDS. Teachers with higher intentions were also less embarrassed to talk about sexual information and felt more comfortable dealing with the contents of HIV/AIDS education and their moral beliefs. These factors which influence teaching about HIV/AIDS should be recognized so as to encourage science teachers' participation  

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The Role of Academic Discipline and Gender in High School Teachers'

AIDS-Related Knowledge and Attitudes.

                Summary:

                            Adolescents represent the fastest growing segment of HIV+ individuals in the United States. Therefore, high school teachers should be both knowledgeable of and comfortable with issues related to HIV/AIDS. This study examined high school teachers' AIDS-related knowledge and attitudes. One hundred forty-one high school teachers from nine central Massachusetts high schools participated Participants completed the "HIV/AIDS Knowledge and Attitudes Scales for Teachers," as well as questions regarding their teaching experience and academic disciplines. Results indicated a direct relationship between teachers' knowledge of HIV/AIDS and positive or supportive attitudes toward HIV/AIDS. Significant differences were found based on academic discipline, with allied health teachers scoring significantly higher on the knowledge scale than teachers in any other discipline. Specific examples are discussed, as is the need for increased teacher training and comprehensive AIDS education. (J Sch Health. 2001;71(1):3-8)

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