A Short History of Disease

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A Short History of Disease Page 9

by Sean Martin


  The king listened to him, stood up and said nothing for a long while. He had heard what Ivain had said. He ran to Iseult and took her by the hand.

  Iseult cried out: ‘Sire, mercy! Burn me here instead of giving me to them!’

  The king handed her over to the lepers, and a good hundred crowded around her. Everyone who heard the noise and the shouting took pity on her. But whoever might be sorrowful, Ivain was happy. He led Iseult away along the sandy path.174

  Beroul not only portrays the fear of leprosy and its perceived link with sexual activity, but also shows how leprosy could be used to dispose of troublesome people. It became, under certain circumstances, a method of social control. The Third Lateran Council (1179) segregated lepers from society, which led to an increase in the building of lazar houses across Europe. Lepers were banned from London in 1346 and 1472, while in France in 1321 lepers were accused of poisoning the wells in an attempt to spread their disease. Many were subject to mob violence, and burnt at the stake. The French king, Philip V, attempted to sequester property and goods belonging to the lepers, finding scapegoats to be a useful source of much-needed revenue. The Jews were also implicated in this apparent plot, although Philip ordered that Jewish communities should not be attacked. Accusations of well poisoning would recur within a generation, and this time the Jews would find themselves bearing the brunt of a Europe-wide paranoia, being accused of spreading the one disease that became feared even more than leprosy: plague.

  The Black Death

  Plague reached Italy in the autumn of 1347. Ships from the east arrived in Sicily with their crews dead or dying of a strange illness. The sailors had boils in the neck, armpit or groin, suffered from fever, intense pain and delirium, and died within days. The sickness soon spread from the ships into the towns, and people began dying in what seemed like uncontrollable numbers. Relics were brought out of churches, processions held, the intercession of saints sought, but nothing seemed able to stop the progress of the disease. Some ships were repelled, forcing them to put in at other ports, unwittingly spreading the sickness further. The disease quickly reached mainland Italy, and travelled along the Mediterranean coast of France. By the following spring, the whole of Italy, France and the Iberian peninsula were ablaze with plague.

  It was like nothing anyone had ever seen before. People could be alive one day, seemingly healthy, only to be found dead in their beds the next morning. So great were the numbers of the dead that the cemeteries were soon full to overflowing. Each city or town hastily dug pits to act as mass graves. When the undertakers died, the dead were left unburied in their houses or in the streets. In Dubrovnik, wolves ran wild in the streets, picking at bodies. (And, in the process, the animals too contracted plague.) To chroniclers and poets, it seemed as if the end of the world was at hand.

  The Piacenzan chronicler Gabriel de Mussis, who wrote one of the earliest plague chronicles, echoed the common belief that the plague had been sent as a punishment from God for humanity’s sins. God saw ‘the entire human race wallowing in the mire of manifold wickedness’, and pronounced judgement: ‘May your joys be turned to mourning, your prosperity be shaken by adversity, the course of your life be passed in never-ending terror. Behold the image of death. Behold I open the infernal flood-gates... Let the sharp arrows of sudden death have dominion throughout the world. Let no one be spared… Let the innocent perish with the guilty and no one escape.’175

  The great poet Boccaccio witnessed the ravages of the plague in Florence, where mortality was so high the epidemic was known as the ‘Plague of Florence’. In his epic The Decameron, Boccaccio has a group of wealthy Florentines fleeing to the hills and entertaining themselves with stories while the plague rages outside their isolated villa. The introduction is perhaps the most celebrated description of the Black Death, and is worth quoting at length as it conveys the sheer scale of the disaster:

  In the year 1348, the deadly pestilence appeared in the illustrious city of Florence, the fairest of all Italian cities. Whether it was disseminated by the influence of the planets, or sent by God in His wrath for our iniquities, it had had its origin some years earlier in the East, when, after killing innumerable people, it had spread without mercy from place to place, and, ultimately, to the West.

  ... in both men and women the pestilence first betrayed itself by the emergence of tumours in the groin or in the armpits, some of which grew as large as an apple, or an egg. From these two parts of the body the tumours soon began to spread themselves in all directions; black or livid spots of varying sizes appeared after this on the arm or the thigh or even around the waist. Like the tumours, these spots were also seen as a sign of approaching death. Doctors could do nothing. Whether they were at fault or whether the disease was untreatable, I do not know. To make things worse, men and women, none of whom were qualified in medicine, tried to treat people as well. Hardly anyone survived. Almost all died within three days from the appearance of the tumours, in most cases without any fever or other symptom.

  What’s more, the virulence of the disease was increased through merely talking to the sick, just as fire burns things that are brought close to it. And if that wasn’t bad enough, it was possible to become infected even by touching the clothes of the sick or anything else that they had touched or used. Once I saw two pigs in the street come up to the clothes of a poor man. He had died of the disease and his things were scattered outside his house. The pigs took the garments between their teeth and chewed them. Almost immediately, they fell down dead, as if poisoned. Had I not seen this with my own eyes, I would have hardly dared believe it, much less set it down in writing.

  In these circumstances, people began to shun all contact with the sick, and vowed to stay as healthy as possible. Some thought that to live temperately and avoid all excess would be best. Small groups of people banded together, and lived in isolation. They exercised the utmost care, avoiding every kind of luxury, and ate and drank in moderation. They spoke to no one, in case they should hear about sickness or death, and kept themselves busy with music and discussions and games.

  Other people thought that debauchery was the answer, and resorted day and night to taverns, drinking with total disregard for everything, or visiting other people’s houses if they saw anything in them that they liked, which wasn’t too difficult, as their owners, expecting to die at any moment, had become as reckless as their guests, and threw their houses open to all comers. In this extremity of suffering all laws, both human and divine, were ignored for lack of people to uphold them as they were either dead or sick, and everyone was free to do whatever they wanted.

  Some people steered a middle course, neither being wary of their health nor living a life of dissipation. They walked around carrying flowers or fragrant herbs, which they held to their noses, thinking that it would provide some comfort against the air which reeked with the stench of the dead and dying.

  Yet others, the most sound of judgement, perhaps, felt that the best medicine was to flee; a multitude of men and women deserted the city, their houses, their estates, their families, their goods, and went into voluntary exile, fled to the country, hoping that God would not pursue them with His wrath, but would only destroy those who stayed behind.

  Whatever course of action people took, many died. Citizen avoided citizen, neighbours lost all feeling for each other, families met only rarely; so afraid were people of this disease, that brother forsook brother, nephew uncle, brother sister, and often husbands their wives; what’s more, scarcely believable, is that parents abandoned their children, and left them to their fate, as if they had belonged to strangers. The huge numbers of sick had no choice but to rely on the charity of what few friends they had left, or servants, who demanded high wages for their care, (despite not being qualified) and who merely looked after the immediate wants of the sick, and watched them die; they very often died too. There were so few people left to care for the sick that no woman, however fair or wellborn she might be, shrank, when stricken with the dis
ease, from the ministrations of a man, and willingly exposed to him every part of her body; some received the man’s physical attention rather than medical aid. Possibly, with better care, some may have survived, but the combination of so virulent a plague and such poor medical aid resulted in huge mortality, with deaths taking place day and night; those who witnessed it – or even heard about it second hand – were struck dumb with amazement.

  Traditionally, during a funeral, the women would gather inside the house and wail their laments, while the men would gather outside with the priest to carry the body to the church requested by the deceased in their will. However, with the pestilence raging so furiously, these arrangements were soon dropped. Most died without a crowd of mourning women; most would-be mourners were either dead or out getting drunk, which was good for the health of the women, who did not have to go near a corpse or mix with others. Most biers were not carried by friends and neighbours, but by the desperate becchini, who hired themselves out for such awful tasks, and would carry the body, not to the church of the deceased’s choice, but to whichever one was nearest to hand, with four or six priests in front carrying possibly a candle or two; nor did the priests bother to conduct too long and solemn a funeral service, and with the help of the becchini hastily dumped the body in the first open grave they could find. It was worse for the poor. They stayed in their homes, where they sickened by the thousand each day, and, being without help of any kind, could not hope to escape death. They died at all hours in the streets; those who died at home were not missed by their neighbours, until they noticed the stench of their putrefying bodies; the whole city was a sepulchre.

  It was common practice for people, moved more by fear of contamination than by charity towards the deceased, to drag the corpses out of the houses with their own hands, aided, perhaps, by a porter (if there was a porter to be had), and to lay the bodies in front of the houses, where any funeral cart that made the rounds might have seen them. Sometimes, in the morning, there would be more dead piled up in the streets than the cart driver could count; often, whole families were loaded onto the biers. Priests arrived to find that they were burying not one, but six or eight, sometimes more. People had become indifferent to the suffering all round them, and the dead were disposed of as if they were goats.

  There was not enough consecrated ground for the vast number of corpses which day and night – almost every hour – were brought to the churches for burial. When the cemeteries were full, they dug a huge trench which they put the new corpses in as they arrived by the hundred, piling them up like goods in the hold of a ship, tier upon tier, each layer of bodies covered with a little earth, until the trench could hold no more.

  The surrounding countryside suffered as harshly as the city. There, in villages, or in open fields, by the roadside, on the farm, in the home, the unfortunate husbandmen and their families, bereft of doctors’ or servants’ care, died day and night, not as men, but rather as beasts. They too, like the Florentines, abandoned normality, believing each day to be their last, and stopped working in the fields and tending their animals, and instead drank and ate all they had stored. They denied shelter to their cattle, sheep, goats, pigs, fowl, even to their dogs, and drove them out into the fields to roam in the unreaped corn.

  Boccaccio believed that, between March and July 1348, one hundred thousand people in Florence and the surrounding countryside fell victim to the plague. Mediaeval figures are notoriously unreliable; ‘one hundred thousand’ should be taken to mean probably half that figure. Still, it was an appalling mortality rate, and it was happening right across Europe.

  Boccaccio’s belief that the pestilence originated somewhere in the interior of Asia was widely shared and, unlike the numbers mentioned in contemporaneous death tolls, is almost certainly correct. The Arab historian Ibn al-Wardi, who witnessed the Black Death at Aleppo and died of it himself in 1349, believed that the pestilence had originated some fifteen years earlier in the ‘land of darkness’, by which he probably meant Mongolia. If this were the case, then it would mean that plague was raging in Central Asia in the early-to-mid 1330s.

  Chinese records note that the Great Mongol Khan Jijaghatu Toq-Temür died on 2 October 1332, aged 28, and his sons followed him in rapid succession. The chronicles are peppered with stories of natural disasters and cataclysms that were afflicting China at the time with alarming – one might be tempted to say almost Old Testament – severity. In 1333, famine followed a drought; following the famine, there was a deluge; 400,000 are said to have died. An earthquake caused Mount Tsincheou to partially collapse, and huge faults appeared in the landscape. The following year, 1334, was no better: Houkouang and Honan provinces experienced drought, followed by a famine attended by clouds of locusts; an earthquake in the Ki-Ming-Chan Mountains brought floods that were so bad they created a new lake; in Tche the dead were said to amount to more than five million. If this wasn’t bad enough, the earthquakes that had caused Mount Tsincheou to cave in continued up until 1345, along with further floods and crop-destroying locusts.

  Amidst all this chaos, humans would not have been the only occupants of China and Mongolia to have become virtual refugees in their own land: the lives of the rodent population would have been equally disrupted. It is probably this series of disasters that forced them to migrate, taking with them the plague bacillus. They must have headed south, taking the plague to India, and west, where they would have infected traders on the Silk Road. The plague-carrying fleas easily made the jump from rats and marmots to establish a new home in the cloths, rugs and furs bound for Europe and the markets of the Middle East. By 1346, the plague had reached the Crimea, where the ships that brought the Black Death to Sicily in October of the following year are thought to have originated.

  The Black Death transformed Europe into a giant theatre of mortality, the kind of nightmare landscape imagined by Pieter Bruegel in his painting The Triumph of Death, in which armies of the dead relentlessly round up and mow down the living. Arriving in mainland Italy in January 1348, it immediately began to capitalise on the work already started by poor harvests and famine; 600 a day were said to have died in Venice. Genoa, Pisa, Rome and Florence soon fell. Riven by political infighting, Italian city states were forced by the plague to put their differences aside, or perish.

  The town of Pistoia provides a good example of how the city fathers coped with the crisis, as here the civil ordinances published during the Black Death have survived. On 2 May 1348, when the first reports of cases were coming in, the council drew up its first set of preventative measures. No one was to visit any area where plague was already raging, such as Pisa; if anyone was already there, they were forbidden to come back. No goods were to be imported into the town, including corpses. Markets were monitored closely, with only local produce being allowed to be offered for sale. Funerals were to be family-only affairs, and bells were not to be rung. Town criers and trumpeters were likewise silenced. Three weeks later, on 23 May, the travel restrictions were lifted, as, by now, regardless of whether one went to Pisa or not, one was just as likely to catch the plague in Pistoia. Food regulations, on the other hand, were tightened up. On 4 June, a team of town gravediggers was appointed; no one else was to bury bodies but these 16 men. On 13 June, the rules for the defence of the town were redrafted, to allow the rich to choose a proxy to serve in the ranks for them if they so desired. This is unusual, as despite their obvious advantages of wealth, Church and State did their inadequate best to protect all members of society during the Black Death.

  Although in Pistoia, the council did as much as they could to limit the damage, in Orvieto the council performed less conscientiously. The town had around 12,000 inhabitants and had been prosperous, despite heavy losses incurred during the ceaseless struggles between the Guelphs and the Ghibellines. The political uncertainty and instability this produced, in addition to the famines of 1346 and 1347, had crippled Orvieto’s economy and, by the time the Black Death struck in the spring of 1348, the average Orvieta
n was in no mood for yet more disaster. The town council met on 12 March, and all mention of disaster was studiously avoided. The plague was raging 80 miles away in Florence, and perhaps they felt that there was nothing they could do to avoid it. The town had one doctor and one surgeon, who both worked full time. There were also a good half dozen citizens who were qualified in medicine and could be prevailed upon to offer their services as and when the need arose. For a town of Orvieto’s size, this was not bad going. There was only one properly equipped hospital, however, with several other institutions managing as best they could on private donations and worse facilities. Public hygiene, as in most mediaeval cities, was virtually non-existent. In repeated – and seemingly ineffectual – ordinances, the council forbade such traditional street activities as the rearing of animals, the tanning of skins and the disposal of waste from windows.

  The Black Death hit Orvieto particularly hard: around 50 per cent of the population were dead within three months of its arrival in April 1348. Unlike Pistoia, no ordinances were published with preventative measures. In fact, the plague does not appear in city records until June, when a new council was elected. But it was too late: the plague was raging at near to full strength, and of the seven councillors elected, two were dead by 23 July and three more were in their graves by 7 August. Any pretence of trying to hold council meetings was scrapped; even the city’s most important religious ceremony, the procession of the Assumption, had to be abandoned.

 

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