Introduction: Looking for lessons in history

Among the many spiraling effects of the current COVID-19, pandemic has been an intense interest in finding historical frames of reference for our current predicament [1]. Past epidemics, from the plague to the Spanish flu, have been brought back to the public consciousness, to search for both instructive patterns and lessons, and perhaps also as a way to cope with uncertainties and anxieties; a reminder that we have been here before, facing down an unknown disease. As hand-washing, mask-wearing, and quarantining suddenly have become part of our everyday lives, images of plague doctors with beaked masks, photographs from 1918 of mask-wearing citizens, or tuberculosis campaign posters reminding people to not spit in public, all suddenly hold renewed relevance and resonance.

The long history of epidemics, long before the advent of microbiology and the deepened understanding of disease biology that followed from it, might seem antiquated or even pointless. Are we not armed with scientific knowledge and technical mastery that puts us in a completely different position than, say, 18th-century doctors still leaning on medical theories developed in antiquity? Yes and no. One of the interesting lessons from the history of epidemics is that there are also patterns that hold greater continuity as much as there are real differences across time, space, and disease. As the medical historian Charles Rosenberg pointed out in his classical text “What is an epidemic?” from 1989, epidemics tend to have a distinct narrative. They unfold as dramas in three acts: “Epidemics start at a moment in time, proceed on a stage limited in space and duration, follow a plot line of increasing revelatory tension, move to a crisis of individual and collective character, then drift toward closure” [2]. The first act takes the shape of a progressive revelation. It starts with the subtle signs, often willfully overlooked, that something is awry. Concern and worry sweep across the population, but action is often stalled in the hopes of maintaining social stability and economic interests. As illness and deaths accelerate and the reality of the epidemic can no longer be ignored, the second act begins, in which explanations are demanded and offered. These explanations can be either moral, social, cultural, or scientific and generate a cascading set of public responses. The explanations are motivated by a desire to control randomness, to assign blame and fault, and find courses of action. Before the advent of microbiology, religious or moral interpretations dominated. Epidemics, with all their suddenness and randomness, slotted easily into explanatory paradigms focused on divine power and human fallibility. Social and cultural explanations have also abounded, focusing on particular groups or social classes as particularly dangerous or susceptible. Finally, in the third stage, the epidemic subsides and society regathers into a new normality, and the primary task is to negotiate the public responses that developed in the second act. The rituals invoked, the societal actions taken, the cultural beliefs stirred up, the lessons learned, all have to be reckoned with and their trailing effects understood. This paper unfolds two examples of such narratives, both in Copenhagen, Denmark: the plague in 1711 and cholera in 1853. It will describe both medical and political responses. These stories are small examples of the narrative laid out by Rosenberg, and the hope of the article is that by recounting them, we might get a different perspective on the pandemic that, at the time of writing, is still ongoing.

中文翻译：

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微生物学之前的流行病：1711 年哥本哈根鼠疫和 1853 年霍乱的故事

简介：寻找历史教训

在当前 COVID-19 的众多螺旋式影响中，大流行一直引起人们对为我们当前困境寻找历史参考框架的浓厚兴趣 [ 1 ]。过去的流行病，从鼠疫到西班牙流感，已经重新回到公众意识中，寻找有指导意义的模式和教训，也许也是应对不确定性和焦虑的一种方式；提醒我们以前来过这里，面对过一种未知的疾病。随着洗手、戴口罩和隔离突然成为我们日常生活的一部分，戴着鸟嘴口罩的瘟疫医生的照片、1918年戴口罩公民的照片，或者提醒人们不要在公共场合随地吐痰的结核病宣传海报，所有这些突然间产生了新的相关性和共鸣。

流行病的悠久历史，早在微生物学出现以及随之而来的对疾病生物学的深入理解之前，可能看起来已经过时，甚至毫无意义。难道我们没有掌握科学知识和掌握技术，这使我们与仍然依赖古代医学理论的 18 世纪医生处于完全不同的境地吗？是的，也不是。流行病历史中有趣的教训之一是，尽管时间、空间和疾病之间存在真正的差异，但也有一些模式具有更大的连续性。正如医学历史学家查尔斯·罗森伯格在其经典著作《什么是流行病？》中指出的那样。从 1989 年开始，流行病往往有一个独特的叙述。它们以三幕戏剧的形式展开：“流行病在某个时间点开始，在空间和持续时间有限的舞台上进行，沿着日益紧张的启示性情节，发展到个人和集体的危机，然后走向结束”[ 2 ]。第一幕采取渐进式启示的形式。它始于一些微妙的迹象，而这些迹象往往被故意忽视，表明某些事情出了问题。忧虑和忧虑笼罩着人们，但为了维护社会稳定和经济利益，行动往往停滞不前。随着疾病和死亡人数的增加以及流行病的现实不再被忽视，第二幕开始了，要求和提供解释。这些解释可以是道德的、社会的、文化的或科学的，并产生一系列的公众反应。这些解释的动机是控制随机性、分配责任和错误以及找到行动方案。 在微生物学出现之前，宗教或道德解释占主导地位。流行病以其突发性和随机性，很容易被归入以神力和人类易犯错误为重点的解释范式中。社会和文化解释也很丰富，重点关注特定群体或社会阶层特别危险或易受影响。最后，在第三阶段，疫情消退，社会重新进入新常态，首要任务是协商第二幕中形成的公众反应。所引发的仪式、采取的社会行动、激起的文化​​信仰、吸取的教训，所有这些都必须得到考虑，并理解其后续影响。本文展示了此类叙述的两个例子，均发生在丹麦哥本哈根：1711 年的鼠疫和 1853 年的霍乱。它将描述医学和政治反应。这些故事只是罗森伯格叙述的小例子，这篇文章的希望是，通过叙述它们，我们可能会对这场流行病有不同的看法，而在撰写本文时，这场流行病仍在继续。