Medicine stands still, 1000-1500.

Case Study: The Black Death

A.  THE COMING OF THE PLAGUE

B.  THE NATURE OF THE DISEASE

1.  "The disease was bubonic plague, present in two forms: one that infected the bloodstream, causing the buboes and internal bleeding, and was spread by contact; and a second, more virulent pneumonic type that infected the lungs and was spread by respiratory infection... So lethal was the disease that cases were known of persons going to bed well and dying before they awoke, of doctors catching the illness at a bedside and dying before the patient."

Barbara Tuchman: A Distant Mirror (1979)

2.  "The mortality...lasted seven months. It was of two types. The first lasted two months, with continuous fever and spitting of blood, and from this one died in three days. The second lasted for the rest of the period, also with continuous fever but with swellings and boils, principally in the armpits and groin. From this one died in five days."

anon: La Grand Chirurgie (contemporary)

3.  "In men and women alike the plague first showed itself by the appearance of swellings in the groin and armpits, some as large as apples or eggs, some less. From these two parts of the body the boils spread in all directions and after this black or reddish spots often appeared on the arm, the thigh or in other places. Sometimes they were few and large, sometimes they were tiny but numerous. And just as the swellings had been an unfailing sign of approaching death, so were the spots..."

Boccaccio: Decameron (1353)

4.  "Death comes into our midst like black smoke,
a plague which cuts off the young,
a rootless phantom which has no mercy for fair countenance.
Woe is me of the shilling in the armpit!
It is seething, terrible...a head that gives pain
and causes a loud cry...a painful angry swelling...
Great is its seething like a burning cinder...
a grievous thing of ashy colour...
the early ornaments of black death... a mixed multitude, a black plague
like halfpence, like berries..."

Welsh Lament (contemporary)

C.  THE NUMBERS OF DEAD

1.  "As added up by Pope Clement VI at Avignon, the total of reported dead reached 23,840,000... Although the mortality rate was erratic, ranging from one fifth in some places to nine tenths or almost total elimination in others, the overall estimate of modern demographers has settled...around the same figure expressed in Froissart's casual words: 'a third of the world died'."

Barbara Tuchman: A Distant Mirror (1979)

2.  Figures from the early chroniclers:

3.  "Most of the neighbours, moved by fear of contamination … dragged the corpses out of the houses with their own hands … and laid them round in front of the doors, especially in the morning, more of them than he could count. Afterwards they would have biers brought up or, in default, planks whereon they laid them. And on many occasions the same bier carried two or three corpses at once … one bier sufficing for husband and wife, two or three brothers, father and son, and so forth.

      At times without number it happened that, as two priests bearing the cross were on their way to perform a funeral for someone, three or four biers were brought up at the rear by beggars; so that whereas the priests supposed that they had but one corpse to bury, they discovered that there were six, or eight, or sometimes more… It was come to this, that a dead man was of no more account than a dead goat would be today."

Boccaccio: Decameron (1353)

4.  "Then the grievous plague penetrated the seacoasts from Southampton, and came to Bristol, and there almost the whole strength of the town died, struck as it were by sudden death; for there were few who kept their beds more than three days, or two days, or half a day; and after this the fell death broke forth on every side with the course of the sun. There died at Leicester in the small parish of St. Leonard more than 380 … the pope granted full remission of all sins to whoever was absolved in peril of death.

Henry Knighton: Chronicle (1349)

5.  "It passed most rapidly from place to place, swiftly killing ere mid-day many who in the morning had been well, and without respect of person (some few rich people excepted), not permitting those destined to die to live more than three, or at most four days.

Roger of Avesbury: De Gestis Edwardii III (contemporary)

D.  HUMAN REACTIONS

1.  "One man shunned another ... kinsfolk held aloof, brother was forsaken by brother, oftentimes husband by wife; nay, what is more, and scarcely to be believed, father and mother were found to abandon their own children to their fate, untended, uninvited, as if they had been strangers ...

     (The rich fled to the country) … removed on every side from the roads, with wells of cool water and vaults of rare wines ... .

     (The poor died in their houses) ... only the stench of their bodies informed neighbours of their death."

Boccaccio: Decameron (1353)

2.  "And no bells tolled, and nobody wept whatever his loss because almost everyone expected death... And people said and believed, 'This is the end of the world'.

      Father abandoned child, wife husband, one brother another for the plague seemed to strike through the breath and sight. And so they died. And no-one could be found to bury the dead for love or friendship... And in many places great pits were dug and piled deep with huge heaps of the dead... And I, Agnolo di Tura, called the Fat, buried my five children with my own hands, and so did many others likewise. And there were also many dead throughout the city who were so sparsely covered with earth that the dogs dragged them forth and devoured their bodies."

A. di Tura: Cronica Senese (Siena, Italy) (contemporary)

3.  "Men and women wandered about as if mad ... because no one had any inclination to concern themselves about the future"

Bavarian Chronicle

4.  " ... at once instruct and induce, yourselves or by some other, all who are sick of the present malady, or who shall happen to be taken ill, that in articulo mortis, if they are not able to obtain any priest, they should make confession of their sins even to a layman, and, if a man is not at hand, then to a woman."

Bishop of Bath & Wells: Letter to his clergy (17 Jan 1349)

5.  "… the whole world was, as it were, placed in the grasp of the Evil One... I leave parchment to continue this work, if perchance any survive of the race of Adam... "

Brother John Clyn of Kilkenny, Ireland (1350)

6.  "They asked 'and what will happen to show that it is the time for your coming and the end of the age'?

      Jesus answered, 'Be on your guard… Countries will fight each other… There will be famines and earthquakes everywhere... Many will give up their faith at that time; they will betray one another and hate one another... Such will be the spread of evil that many people's love will grow cold...

      Soon after the trouble of those days, the sun will grow dark, the moon will no longer shine, the stars will fall from heaven, and the powers in space will be driven from their courses... The great trumpet will sound, and he will send out his angels to the four corners of the earth."

Matthew 24 vv1-31: Jesus on the end of the world

E.  CAUSES

1.  "Medieval thinking, trapped in the theory of astral influences, stressed air as the communicator of disease, ignoring sanitation or visible carriers. The existence of two carriers confused the trail, the more so because the flea could live and travel independently of the rat for as long as a month, and if infected by the particularly virulent septicemic form of the bacillus, could infect humans without reinfecting itself from the rat. The simultaneous presence of the pneumonic form of the disease, which indeed communicated itself through the air, blurred the problem further."

Barbara Tuchman: A Distant Mirror (1979)

2.  "In the East, in a certain province near where India extends to the north, horrors and unheard-of tempests overwhelmed the whole province for the space of three days. On the first day there was a rain of frogs, serpents, lizards, scorpions and many venomous beasts of that sort. On the second, thunder was heard, and lightening and sheets of fire fell upon the earth, mingled with hailstones of marvelous size; which slew almost all, from the greatest to the least. On the third day there fell fire from heaven and stinking smoke, which slew almost all that were left of men and beasts, and burned up the cities and towns in those parts. By these tempests the whole province was infected; and it is thought that the foul blast of wind that came from the South, the whole seashore and surrounding lands were infected, and are growing more and more poisonous from day to day. The catching nature of the disease is indeed the most dreadful of all the terrors for when anyone ... is infected by it ... all who see him in his sickness, or visit him, or do any business with him, or even carry him to his grave, quickly follow him there. The sick are served by their kinsfolk as dogs would be. Food is put near the bed, then they all run away."

De Smet: Chroniques de Flandres (contemporary)

3.  "Many people were in doubt about the cause of the great death. In some places it was believed that the Jews had poisoned the people ... But whatever the people said, the truth is that there were two causes, one general, one particular. The general cause was the close position of the three great planets, Saturn, Jupiter and Mars. This had taken place in 1345... Such a coming together of planets is always a sign of wonderful, terrible or violent things to come… The particular cause of the disease in each person was the state of the body -bad digestion, weakness and blockage, and for this reason the people died." People fell ill even by looking at the sick…

Guy de Chauliac: Surgery (the Pope’s physician)

4.  "Death is seen seated on the face ... (one sick person) could infect the whole world"

Simon de Covino, French physician (contemporary)

5.  "In those days (at the start of the plague) many people were very upset because when jousting competitions were held ... a band of women would arrive as if they had come to join in the sport, dressed in a variety of the most lavish male costumes ... There and thus they spent or, rather, squandered their possessions and wearied their bodies with fooleries and wanton buffoonery... But God, in this matter, as in all others, brought marvelous remedy."

Henry Knighton: Chronicle (contemporary)

6.  “The cause was poisonous air, corrupted by the planets spread by means of air breathed out and in"

Gentile da Foligno (University of Bologna and Padua)

7.   The Scandinavians and Lithuanians blamed a 'Pest Maiden' who emerged from the mouth of the dead, and entered the next house through an open window.

8.

Illustrated manuscript (14th Century).

9. Events in Florence preceding the plague:

F.  COMBATTING THE PLAGUE

1.  "For cures - bleeding and purges, cordials and medicinal powders can be used. The swelling should be softened with figs and cooked onions, peeled and mixed with yeast and butter, then opened and treated like ulcers. Doctors were useless and indeed shameful especially as they dared not visit the sick for fear of becoming infected. When they did visit them there was little they could do and they earned no fee for all their patients died except for a few towards the end who recovered after their swellings burst."

Guy de Chauliac: Surgery (contemporary)

2.  "6th April, Langley Castle.

      To the Lord Mayor of London. Order to cause the human faeces and other filth lying in the streets and lanes in the city and its suburbs to be removed ... and to cause the city and suburbs to be cleaned from all odour and to be kept as clean as it used to be in the time of the preceding mayors so that no greater cause of mortality may arise from such smells.

      The King has learned how the city and suburbs ... are so foul with the filth from out of the houses by day and night that the air is infected and the city poisoned to the danger of men ... especially by the contagious sickness which increases daily."

Edward III: Letter to Lord Mayor of London (1349)

3.  "Some banded together and ... formed communities in houses where there were no sick, and lived a separate and secluded life ... eating and drinking very moderately of the most delicate meats and the finest wines ...

      Others ... maintained that to drink freely, to frequent places of public resort and to take their pleasure with song and revel ... was the perfect remedy for so great an evil ... "

Boccaccio: Decameron (1353)

4.  Picard peasants celebrated all day, believing they could stop the plague entering "by the jollity that is in us. That is why we dance ... "

Grand Chroniques de France (contemporary)

5.  List of some of the medicines prescribed:

   •   powdered stag's horn

   •  myrrh

   •  saffron

   •  potions of potable gold

   •   powdered pearls and emeralds

   •   bland diets and avoidance of excitement

   •   pomanders, and washing the nose & mouth with vinegar and rosewater smelling the foul smell of the public latrines.

6.  "About Michaelmas 1349 over 600 men came to London from Flanders, mostly of Zeeland and Holland origin. Sometimes at St Paul's and sometimes at other points in the city they made two daily appearances wearing cloths from the thighs to the ankles, but otherwise stripped bare. Each wore a cap marked with a red cross in front and behind. Each had in his right hand a scourge with three tails. Each tail had a knot, and through the middle of it there were sometimes sharp nails fixed. They marched naked in a file one behind the other and whipped themselves with these scourges on their naked and bleeding bodies. Four of them would chant in their native tongue and another four would chant in response like a litany. Thrice they would all cast themselves on the ground ... it is said that every night they performed the same penance."

Robert of Avesbury: Acts of Edward III (contemporary)

7.

(15th Century woodcut).

8.

An illustration from The Romance of Alexander (c.1340) showing the burning of plague victims’ clothes.

9.  In Rome de Chauliac ordered Pope Clement to sit alone all summer between two huge fires. The Pope survived the epidemic.

10.  Giovanni Visconti, the despot of Milan, ordered the three houses in which the plague first broke out to be bricked up, well, sick, dead and all. Milan escaped lightly in the Plague.

11.  List of attacks on the Jews in central Europe

12.

The Triumph of Death with the Dance of Death, by Giacomo Borlone de Burchis (15th Century).

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