A Short History of Disease

by Sean Martin

  In Siena, work had to be halted on the new cathedral. The Black Death struck just as the transept had been built and the foundations of the choir and the nave had been laid; the masons died and no one was left to continue their work. The wool industry effectively ceased to exist, and the import of oil was halted. On 2 June, all Siena’s courthouses were closed down for three months and gambling was banned for all time. (The loss of revenue was so great, however, that this prohibition had to be repealed six months later when the worst of the epidemic was past.) So much money was bequeathed to the church in inheritances and donations (made no doubt with the salvation of at least the donor in mind) that all the regular taxes the Church collected were suspended until 1350.

  One of the best-known of Sienese plague chronicles was written by Agnolo di Tura. ‘Father abandoned child,’ he writes, ‘wife, husband; one brother, another, for this illness seemed to strike through the breath and the sight. And so they died. And no one could be found to bury the dead for money or for friendship… And in many places in Siena 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 so many dead throughout the city who were so sparsely covered with earth that the dogs dragged them out and devoured their bodies.’

  Some merchants, fleeing across the Alps, tried to find safe haven in the Lombard town of Bobbio. They sold what goods they had, but either they themselves were carrying plague, or their merchandise was flea-infested, for the man who purchased their goods suddenly died, along with his entire family and several neighbours. One can only assume that the merchants must also have died and been buried together in the common pit. More woes from the same town are noted by de Mussis: ‘one man, wanting to make his will, died along with the notary, the priest who heard his confession, and the people summoned to witness the will, and they were all buried together on the following day’. In Piacenza, de Mussis’ hometown, ‘Cries and laments arise on all sides. Day after day one sees the Cross and the Host being carried about the city, and countless dead being buried… pits had to be dug in colonnades and piazzas, where nobody had ever been buried before.’ Another chronicle notes ‘the physician would not visit; the priest, panic-stricken, administered the sacraments with fear and trembling… no prayer, trumpet or bell summoned friends and neighbours to the funeral, nor was mass performed.’ In Padua ‘the bodies even of noblemen lay unburied and many, at a price, were buried by poor wretches, without priests or candles.’

  The Chronicle of William of Nangis, perhaps the best contemporary account of what happened in Paris, records that, ‘There was so great a mortality among people of both sexes… that it was hardly possible to bury them. In the Hôtel-Dieu de Paris… for a long time more than 500 corpses were carted daily to the churchyard of St Innocent to be buried. And those holy sisters, having no fear of death, tended the sick with all sweetness and humility, putting all fear behind their back. The greater number of these sisters, many times renewed by death, now rest in peace with Christ.’

  Although 500 deaths a day in one parish alone seems like a typically inflated mediaeval figure (it has been suggested that this is a misprint of 50), the death toll in Paris was severe, with perhaps as many as 50,000 people dying during the second half of 1348. The rich fled, leaving the poor to face the brunt of the plague as it stalked the narrow streets. William of Nangis records that priests fled, too, making his ‘holy sisters’, who no doubt went to the grave in their droves while attempting to alleviate the suffering that raged around them, all the more remarkable.

  Some people reacted with less than Christian actions. Knowing they were almost certainly going to die, they spent what little time remained to them in drinking and dancing. Looting and licentious living were commonplace, even more so than in Florence. To a casual observer, there can have seemed little difference between plague victims experiencing the feverish convulsions known as the dance of death, the Danse Macabre that inspired countless paintings, and those who staggered out into the street too drunk to walk in a straight line. When even Pope Clement had agreed that the plague had been sent by God as a punishment for their collective sins, what use was it in trying to remain alive? Eat, drink and be merry, for tomorrow we die.

  Extreme forms of behaviour got worse as the plague progressed through Europe. In Germany, a group known as the Flagellants began holding public penances, at which group members would whip themselves in an attempt to appease the Almighty. Onlookers were encouraged to confess their sins. At first welcomed even by the Pope, the Flagellants’ processions became ever more extreme. They began to see themselves in an increasingly messianic light: not only did they need to rid the world of plague, but Christendom itself needed to be saved. When they announced that they could absolve sins, the Pope withdrew his blessing, and the movement faded into obscurity.

  The Flagellants were responding to one of the main theories about the cause of the Black Death, namely that it had been caused by the sins of humanity. Such had been the thinking behind the causes of the Plague of Justinian eight hundred years earlier. Penance and prayer were encouraged across Europe. In Hungary, pillars were erected as a sign of collective repentance. The pillars often depicted figures whose intervention was sought to lift the pestilence: the Virgin Mary, Saint Sebastian (a patron saint of pestilence victims), Saint Roch (a patron saint of epidemics, depicted on later pillars), Saint Joseph, Saint Augustine of Hippo, Saint John the Baptist, and Saint Christopher.

  For the Viennese, the Black Death was thought to be spread by the Pest Jungfrau, a beautiful maiden who flew through the air in the form of a blue flame and killed people by simply raising her hand. When her victims expired, they were seen to exhale a blue flame, which was taken to be the Jungfrau’s departure as she sought her next victim. In Lithuania, there was a similar legend: that the plague was a woman who killed her victims by waving a red scarf at their windows or doors.

  But the main theory was that a miasma was responsible. Miasma theory – the belief that foul air could disseminate disease – was as old as Hippocrates. When the Pope sat beside a fire in his palace in Avignon, he believed he was keeping the miasma at bay. His ploy was successful, and he survived the plague, but not for the reasons he assumed. There was no miasma for the fire to dispel: the fire saved the Pope’s life by keeping the rats away.

  Philip VI of France commissioned the hallowed Medical Faculty at the University of Paris to find out exactly what had caused the unparallelled calamity of the Black Death, and they quickly reported back to him with their findings. The cause, it seemed, was astrological in nature, not medical: an unfavourable conjunction of Saturn, Jupiter and Mars that took place in Aquarius at 1pm on 20 March 1345 seemed to be at the root of all their suffering. Conjunctions of Jupiter and Saturn were regarded as bringers of death, and the added presence of the fiery Mars would indicate that, had they but known it three years earlier, disaster was bearing down upon them. (Planetary movements would also be implicated when syphilis first reached Europe in the late fifteenth century, as immortalised in a print by Albrecht Dürer. See Chapter 4.)

  The general feeling was that the epidemic had struck because the atmosphere had become corrupted, and the plague had spread from place to place like a cloud of poison gas. One theory held that this miasma was caused by the sea becoming choked with dead fish. Another believed that the noxious atmosphere was caused by corpses that had lain too long unburied after a war that had no doubt been raging recently somewhere in the East.

  Others believed earthquakes were responsible, pointing out that the plague had arrived in mainland Italy the same month that an earthquake hit the Friuli region (it struck on 25 January 1348). As with the fire/miasma theory, this was correct, but not for the reasons that contemporary chroniclers believed. They held, once again, that the earthquake had released foul airs from the bowels of the earth. In reality, the earthquakes that may have played a part in the pande
mic were those that struck China in the early 1330s, displacing the rodent populations, who carried the plague bacillus with them to new lands.

  Another theory held that the Jews were responsible, causing plague by poisoning the wells. Such an accusation had been made against lepers in the Languedoc in 1321, who had, so the rumour went, been acting on instructions given to them by the Jews. On that occasion, the lepers had come off worse, and many were burned at the stake. Now the Jews bore the brunt of rumour. At Chillon in Switzerland in the autumn of 1348, a number of Jews admitted to poisoning the wells, their confessions extracted under torture. The Pope tried to intervene, pointing out that Jews were dying of the pestilence as well as Christians, but his entreaties fell on deaf ears. The Chillon Jews went to the stake. Worse was to come. In Basle the Jews were herded into a specially constructed building and burned to death. Mass burnings occurred across Germany. At Esslingen in December 1348, the Jewish community committed mass suicide rather than go to the stake.

  Ruprecht von der Pfalz took the Jews living on his lands under his personal protection and nearly provoked a revolution, earning himself the nickname ‘Jew Master’ in the process. Only Casimir, King of Poland, seems to have been almost entirely successful in preventing slaughter in his lands. (Detractors claimed he had been under the thumb of Esther, his Jewish mistress.) Despite the efforts of figures such as Casimir and Ruprecht, many Jewish communities were wiped out altogether, or permanently displaced. Europe would not see anti-Semitism on this scale again until the rise of Hitler.

  There was little people could do except flee the plague, as Boccaccio’s characters did. In the Moroccan town of Salé, a certain Ibn Abu Madyan gave the idea of isolation an unusual twist: he walled himself up alive in his own home. He had enough food and drink laid in to last, he reasoned, and decided to sit out the plague. His gambit worked: he survived, emerging into a world very different from the one he had left.

  One isolation tactic has survived to the present day. During a later outbreak of plague in 1377, the city of Ragusa (modern Dubrovnik) insisted that ships coming in from Venice and elsewhere be kept in the harbour for 30 days. This was later extended to 40, from which we get the modern word quarantine (from the Italian quaranta giorni, meaning 40 days).

  Miasma theory prevailed, as did the teachings of Hippocrates and Galen but, as neither had had experience of a plague epidemic, their works weren’t much use. Indeed, the first person to call was the priest so that the last rites could be administered. With such daily contact with the stricken, it is not surprising that the death rate among the clergy was particularly high.

  The Arab doctor Ibn al-Khatib (1313–1374) was almost alone in believing that the plague was contagious.176 He noted how waves of infection always seemed to coincide with ‘the arrival of contaminated merchants and goods from foreign lands where plague was raging’.177 In contrast, Ibn al-Khatib pointed out that the tent-dwelling nomads of the desert remained healthy during the pandemic.178

  Ibn Khâtimah, who disputed with Ibn al-Khatib over the contagion theory, witnessed the effects of the plague at first hand in his home town of Almeria, where he noted something that inadvertently supported the theory of contagion: in Suq-al-Khalq, a market area with lively trade in blankets, clothes and bedding, the mortality rate was almost 100 per cent. It was, in other words, a place with a very active flea population. The Byzantine historian Nicephorus Gregoras was one of the few contemporary writers to mention rats, noting that they too were dying in the houses they frequented.

  Estimates of mortality by modern scholars put the death rate at approximately 30 per cent. In some places, such as Florence, it was higher – probably 50 to 60 per cent. Some smaller communities were wiped out altogether. In England, the country with the best records, we read of higher mortality in certain areas. At Carlisle, the castle lands were left untenanted for 18 months, due to all previous tenants dying, while at West Thickley, Co. Durham, the ecclesiastical roll read simply ‘they are all dead’.

  The Effects of the Black Death

  One immediate effect of the pandemic was the invention of quarantine. Wages rose across Europe, due to the lack of a full workforce. People travelled in search of work, weakening feudal ties. Such was the movement of labour that the manorial system never recovered. Needing the workers, but fearing the power shift that higher pay might bring about, Europe’s monarchs and nobles capped wages in an effort to maintain the status quo. Unrest began to simmer, finally coming to the boil in England in 1381 with the Peasants’ Revolt. Similar popular uprisings occurred in France and Low Countries. Although the revolts were quelled, the damage was done: the Black Death had helped the feudal system to its grave.

  The church also suffered. The huge numbers of clergy who perished tending their flocks were hurriedly replaced, but often the incoming incumbents were not as well trained. Some were less than eloquent in Latin, leading to a rise in the vernacular. It is not a coincidence that groups like the Lollards came to prominence in the years after the Black Death, advocating worship in the common tongue of the people, rather than the Latin of the elites. It was a mere half a dozen generations from John Wycliffe and his (illegal) Bible translated into Middle English to Martin Luther.

  One of the puzzles about the pandemic is its virulence. What made it the worst pandemic in history, if judged in terms of proportion of population killed? The natural disasters that had afflicted China in the 1330s helped make the population more vulnerable to disease. Much of Europe had been similarly stricken in the first decades of the fourteenth century. There had been no major earthquakes, granted, but repeated crop failures, heavy rains and famine, saw Europeans weakened by malnutrition, starvation and poverty. In a sense, Europe was the victim of its own success: the High Middle Ages had seen the general standard of living improve; the economy grew, wages rose. And so did the population. By 1300, Europe’s population was outstripping its resources. Intensive farming was weakening the soil.

  That being said, the Black Death was much more virulent than the Plague of Justinian. Plague chronicles recount that the plague was just as active in the winter months, suggesting that pneumonic plague was raging alongside its bubonic form, which usually does most of its work in warmer months. Pneumonic plague, like TB, can be spread from person to person through coughing and expectorating. It’s also possible that the third form of plague, septicaemic, was also at work. This form of the disease goes straight into the blood, where it causes septic shock. No buboes form. Death can come within twenty-four hours. This might account for the stories of people going to bed healthy and being found dead the next day.

  Yet none of these three main forms of plague can explain why the Black Death spread quickly in sparsely populated countries, such as Norway. Theories have since been put forward to try and explain this, claiming that another disease such as anthrax must have been working alongside plague.179 Anthrax spores have been found in plague pits but to date there is not enough conclusive evidence.

  Historian GM Trevelyan argued that the Black Death was at least as important as the industrial revolution, while David Herlihy argued that the Black Death was ‘the great watershed’, without which there were would have been no Renaissance, and with no Renaissance, no industrial revolution.180 The prevailing view now is that the pandemic accelerated changes that would have happened anyway, such as the end the feudal system, while at the same time delaying other transformations, such as the Renaissance, which had already started in Italy by 1347, but then went into enforced hiatus for around a century while the pandemic did its work.

  As the Plague of Justinian can be seen to close Antiquity, so the Black Death brought the Middle Ages to an end. The plague would continue to recur in Europe into the Renaissance, a world haunted by its danse macabre.

  4

  The New World

  When Christopher Columbus reached the New World on 12 October 1492, he noted in his journal that the native people – the Arawaks – were friendly and peaceful. ‘With fi
fty men we could subjugate them all and make them do whatever we wish.’181 He was so impressed by their gold jewellery that he took a number of them prisoner, insisting they take him to the source of the gold. Columbus began to make plans to sell them as slaves, and to make good Christians out of them. (He wasn’t averse to his crew raping the women, either, nor was that seen as incompatible with Christianity.182) And so began one of the most disastrous episodes in history: the arrival of the Old World in the New.

  The disaster was not just cultural and political: Columbus’s belief that he could ‘subjugate them all’ with fifty men proved to be an uncannily accurate prediction of what actually happened. The Spanish conquistador Hernando Cortes landed in Mexico in 1518 with only a few hundred men. The Aztecs, like the Arawaks before them, were peaceful and offered the Spanish gifts of gold; Cortes himself was regarded as a minor deity. (Or at least, that’s what he told the King of Spain in a letter home.) His forces bolstered by other indigenous peoples who effectively acted as Spanish mercenaries, Cortes managed to conquer the Aztec empire (modern-day Mexico) in just a few short years following his arrival. He was greatly aided by smallpox. In fact, the disease did most of the work for him.

  Smallpox had in fact been present in the New World for around a dozen years by that time. It was introduced into Newfoundland by Portuguese explorers in 1506 (who also brought tuberculosis with them). The following year, an outbreak occurred on Hispaniola – probably courtesy of the Spanish – where ‘whole tribes were exterminated’,183 as the German medical historian August Hirsch matter-of-factly put it. In 1515, it appeared in Puerto Rico, introduced by African slaves; the native Arawak and Calusa population was reduced from 50,000 to 600 within 25 years.184 When considering such a catastrophic fatality rate, it comes as no surprise to learn that smallpox was nicknamed the ‘cruel disease,’ the ‘Angel of Death’, and the ‘Destroying Angel’.