The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time

by John Kelly

  The Hungarians were also quick to point out that Joanna had good reason to desire Andreas dead. There was the queen’s semipublic affair with the handsome Luigi, rumored to be the father of the child she was carrying at the time of the murder. Added to that was the queen’s well-known dislike for Andreas, who was said to have been a plump, dull boy, and for Andreas’s older brother King Louis, who Joanna believed to have designs on her Kingdom of Naples and Sicily. “I am a queen in name only,” she told Petrarch one day.

  For months after the murder, informed opinion in Europe was divided about the queen’s complicity. Luigi predictably insisted that Joanna was innocent, and Petrarch, a relatively unbiased observer, came to the same conclusion. Boccaccio could not make up his mind. In the first of several thinly disguised accounts of the murder, he described a Joanna-like character as a “pregnant she-wolf.” But in a later version of the story, the author changed his mind and transformed the queen’s character into a beautiful maiden in distress. Louis of Hungary suffered no such agonies of doubt. Shortly before the plague arrived, he wrote to Joanna, “Your former ill faith, your impudent assumption . . . the vengeances you have neglected to take [on Andreas’s alleged assassins], the excuses made for it, all prove you to have been accessory to the death of your husband. . . . Be sure, however, that none ever escape vengeance for such a crime.”

  When Joanna visited Genoa in March 1348, she was fleeing the armies of the avenging Louis, who had just celebrated his conquest of Naples by decapitating a cousin of Luigi’s on the balcony where Andreas was hanged.

  To Joanna’s supporters, her decision to risk the pestilential papal city to clear her name in a Church trial was

  prima facie evidence of her innocence. “To quietly triumph before the world, would for her, outweigh the risk of a hundred pestilences,” an admiring biographer wrote later. To detractors, however, the visit only proved that the queen was more afraid of ending up like Luigi’s cousin than she was of the plague. Joanna, they charged, was driven to Avignon by the need to cut a deal with Clement VI, one of the few figures powerful enough to protect her from the vengeful Hungarians. Both views would find support in the queen’s trial, which was held the same day as her arrival in Avignon, March 15, 1348, in the great Hall of the Consistory.

  As Joanna and Luigi took wine and refreshment in an antechamber, the court assembled inside the hall. Seated on a papal dais that put him two steps above everyone else was the presiding judge, Clement VI, who was wearing a bejeweled triple tiara, white robes of exquisite hand-woven silk, and linen slippers with delicate little gold crosses embroidered on the toes. Seated below the pontiff were a semicircle of cardinal-judges, and standing in front of the cardinals were Joanna’s accusers, the glowering prosecutors of the Hungarian Crown. Leaning against the walls of the consistory was the most fabulous audience in Christendom. Ignoring the plague, “prelates, princes, nobles, and ambassadors of every European power” had gathered in Avignon to witness the trial.

  The evidence against Joanna was incriminating in the extreme, and the Hungarians made the most of it. They reminded the papal court of the deep and well-known animosity that had existed between the queen and her prince consort, of the many plots Joanna’s advisers had launched against the unsuspecting Andreas, and, most incriminating of all, of the queen’s proximity to the young prince the night of the murder. Only a few inches of bedroom door had separated the royal couple; surely the queen must have heard her husband’s cries for help? Though the Hungarian case was powerful—perhaps even overwhelming, as one historian later noted—“The Queen of Naples could seduce the Areopagus itself.”

  Entering the all-male court, Joanna “came pale and slowly in her beauty, the open crown of Naples set softly upon her bright wavy hair; her long fur-fringed azure mantle . . . strewn with fleur-de-lys.” Advancing through an avenue of glittering nobles and cardinals, the Neapolitan queen fell to her knees in front of the papal dais and kissed the papal feet. Clement VI ordered Joanna to rise, kissed her on the mouth, then invited the young queen to sit by his side.

  When called upon to answer the charges against her, Joanna rose; one admirer wrote: “a woman, a mother, and a queen, three voices in one.” The queen conceded that, yes, her marriage to Andreas had been lacking in sentiment, but she insisted that shortly before the prince’s murder, a reconciliation had been effected. Joanna also reminded the court that when the prince was slain, she had lost not only a dear husband but a dear childhood companion; the royal couple had played together as boy and girl. The young queen then spoke movingly of the horrors of widowhood and exile, and passionately about the cruelties of her horrid Hungarian in-laws, who had snatched away her infant son. “Proclaim to the world at large, the innocence of a persecuted orphan and injured queen,” Joanna begged the court.

  The papal court did that and more. The judges pronounced Joanna not only innocent but “above suspicion of guilt.” Embracing the exonerated queen, Clement declared her his “blameless and beloved daughter.” As Joanna and Luigi exited the great Hall of the Consistory, church bells echoed through the pestilential streets of Avignon.

  A few months later, it was announced that Clement had purchased Avignon from the queen, who, as countess of Provence, held title to the city. The selling price, eighty thousand gold florins, was deemed very reasonable by most observers—indeed, perhaps even a bit low for what was, after all, the capital of Christendom. Nonetheless, rumors persisted for years that no money ever changed hands in the sale.*

  As March turned to April and April to May, Avignon continued to die. Shops and businesses shut down; people fled to the countryside; astrologers warned that the pestilence would last a decade. In April Heyligen told friends that the departure of the pope was expected daily, and if Clement left Avignon, he would leave, too. “They say that my lord [Cardinal Colonna] follows the Pope and that I am to go with him. Since that place looks towards Mount Ventoux, where the plague has not yet come, it is the best place to be, or—anyways—so they say.”

  Clement’s departure in May did not arouse much public comment. Almost anyone who could was fleeing the city, and the pope had done what he could for Avignon. He had bought the city a new cemetery, granted a blanket absolution to the dying, waived the ban on autopsies so that physicians could explore the cause of the disease, condemned the attacks on the Jews in a strongly worded bull, even appointed a commission to calculate the number of plague fatalities worldwide—the commission came up with a figure of almost twenty-four million dead. But the pestilence wore Clement down, as it did nearly everyone else. Between Joanna’s trial in March and late spring, when he fled to the papal retreat at Etoile-sur-Rhône, the pope spent a great deal of time seated between two roaring fires in the papal chambers. The fires were the idea of surgeon de Chauliac, who believed heat would cleanse the papal chambers of infected air, thought to be the cause of the pestilence. And the treatment worked, though for reasons that would have surprised the surgeon: the fires kept the papal chambers free of infected fleas.

  It would be unfair to heap obloquy on Clement; if he can be accused of anything, it is the sin of being ordinary in an extraordinary time. The pope did what he thought he ought to do, and some of what he did was meritorious. He marched with the fearful and purchased cemeteries for the dead. It can even be argued that Clement was a bolder defender of the Jews than Pius XII, the pope who presided over the Church during World War II. However, in a situation that called for a leader with a Gandhi-like spiritual authority—someone who could both give comfort and inspire—Clement acted like a head of state. He was responsible but, in the end, unimaginative and self-preserving. Surgeon de Chauliac is a more inspiring figure. When the pope fled to Etoile-sur-Rhône, taking Cardinal Colonna and Heyligen with him, the surgeon chose to stay behind in Avignon. One sees Guigo walking through the wintry streets, a big lumbering man, calm of manner, with observant eyes and oversized peasant hands so gentle they could make a feverish child stop trembling. “To avoid infamy
I dared not absent myself,” de Chauliac wrote of his decision to remain in Avignon, but he never explained whose infamy he feared. Indeed, the surgeon was generally reticent about his personal experiences during the plague. “Toward the end of the mortality,” he says, he was stricken himself. “I fell into a continuous fever, with a tumor in the groin. I was ill for nearly six weeks and in such great danger that all my associates thought I would die, but the tumor being ripened and treated . . . I survived.”

  Surgeon de Chauliac’s only other reference to his personal experience comes in the context of a scientific observation. He noted that between winter and spring, the plague changed character in Avignon, altering from a pneumonic to a bubonic form. “The mortality,” he wrote, “began with us in January and lasted for seven months. It had two phases. The first was for two months and with continuous fever and the spitting of blood, from which victims died within three days. The second phase lasted for the remainder of the period [that is, spring and early summer] and patients also had continuous fever. In addition, abscesses and carbuncles—i.e., buboes—formed in the extremities, namely in the armpits and groin.”

  It is only a conjecture, but perhaps the infamy the surgeon feared was the infamy of scientific conscience, of failing to stand in the whirlwind and try to understand and tame it with human reason.

  How many people died in Avignon?

  A contemporary puts the mortality in the city at 120,000, but this figure is as suspect as Marseille’s death toll of 56,000. Whenever a medieval observer used large numbers, what he meant to say was not, “This is the how many bodies were counted,” but “A great many people died.” Given the lethality of pneumonic plague and the number of contemporary accounts that describe Avignon’s losses as severe, Philip Ziegler’s estimate of a mortality in the 50 percent range sounds about right.

  In

  On Thermonuclear War, another landmark of Cold War literature, theorist Herman Kahn describes a casualty rate of 50 percent in a nuclear exchange as unacceptably high. In little Avignon in the year of 1348, one out of every two people died.

  Chapter Seven

  The New Galenism

  Paris, Summer 1348

  IN PARIS, WHERE THERE WERE EIGHTY-FOUR PHYSICIANS, TWENTY-SIX gene

  ral surgeons, and ninety-seven barber surgeons, the plague arrived on a summer day, lingered for over a year, and prompted the forty-six masters of the Paris Medical Faculty to write one of the most renowned scientific works on the Black Death.

  Medieval medicine is often regarded as a branch of medieval torture, but the plague caught the field at an important turning point. Outside the monasteries, where a few surviving classical texts on phlebotomy (bloodletting), midwifery, and the pulse were still taught, in the early Middle Ages medicine was a mixture of folk wisdom, magic, superstition, and craft. To the extent that a ninth-century medical practitioner engaged in professional reflection, he thought of himself as a craftsman like a carpenter or butcher—which he was. Specialized terms like “physician” and “surgeon” were unknown until the tenth century, and formal medical schools did not exist until almost the thirteenth century. In the early medieval period, the only remotely scientific tool available was what we might call urinalysis. A healer would sniff and eyeball a patient’s urine, then make a diagnosis. One German healer became so adept at the procedure that when the Duke of Bavaria tried to pass off the urine of a pregnant servant girl as his own, the healer announced that “within a week the Lord will perform an unheard of miracle, the Duke will give birth to a son!”

  In comparison to his unlettered predecessors, the medical practitioner of the fourteenth century was a model of enlightened scientific professionalism. As Chaucer noted in

  The Summoner’s Tale

  . . . Nowhere a better expositioner

  On points of medicine and pathology.

  For he was grounded in astrology;

  Treating his patients with the most modern physic

  Dependent on his skill in natural magic;

  He knew which times would be most propitious

  For all his cures to be most expeditious . . .

  Not only that, but:

  Old eminent authorities he knew,

  Some Greek, some Roman, some Arabian, too.

  He’d read both Aesculapius the Greek

  And Dioscorides, whose drug critique

  Was current still. Ephesian Rufus, too

  Hippocrates and Haly, all he knew.

  Galen, Serapion and Rhazes, all

  Their text books he could instantly recall . . .

  Chaucer’s medical professional was, like the merchant and notary, a product of the new towns, where prosperity and a growing population created a brisk demand for medical care. What made the “better expositioner” something new under the medical sun was the “scientific” training Chaucer poked fun at. The New Galenism, as it was often called, was based on a reinterpretation and expansion of classical medicine by Arab physicians like Avicenna (

  Canon), Haly Abbas (

  Pantegni), and Rhazes. For European scholars accustomed to the ad hoc, craftlike structure of Western medicine, the works of the Arab master physicians, which began to be translated in the late eleventh century, were an astonishment. Drawing on Aristotle, Hippocrates, and especially Galen, the Arabs transformed medicine into a sophisticated intellectual discipline. Like the ancient Western fields of law and theology, Arab-Greco medicine had a unifying set of philosophical principles, a logical, coherent structure, and an intellectual consistency. In the hands of the masterful Arabs, the theory of the four humors created by Hippocrates and expanded and elaborated upon by Galen could explain just about anything, from ulcers to pestilences to the dangers of hot, moist air. The clever Arabs also introduced the West to a number of exciting new diagnostic techniques, including the signature tool of the medieval physician, astrology. In an early-thirteenth-century tract called

  De urina non visa—On Unseen Urines—William the Englishman told his colleagues that they could now dispense with urinalysis; astrology had made the technique obsolete. With a knowledge of the stars, declared William, you could tell what was in a patient’s urine without examining it.

  For all its sophisticated intellectualism, however, the New Galenism contained some serious flaws. The most pronounced was a typically medieval reverence for authority, especially ancient authority, over observable fact. In practice, this meant that, while Chaucer’s new medical professional knew a great deal about the “old eminent authorities” and how more recent masters like “Avicenna, Averroes, Damascan John and Constantine (just dead and gone)” had intepreted them, the professional’s knowledge of medicine was, in effect, based on one- and two-thousand-year-old ideas. Medieval medical students learned very little that was new, practical, or the result of direct scientific observation. Courses in anatomy were offered in many medical schools, but since autopsies were frowned on by the Church, students had to learn about human anatomy by watching a pig being dissected.

  The medical schools themselves were a by-product of the New Galenism. The first formal academic medical training was offered in the southern Italian town of Salerno, where the Arab masters were first translated; a hundred and fifty years later, Montpelier, Bologna, Oxford, Cambridge, Padua, Perugia, and Paris also had medical schools. And while each institution had its own individual style—Paris had a renowned astrology department; Montpelier, a large number of Jewish students—all the schools required five to seven years of study and taught a curriculum based on the New Galenism.

  Along with extensive training, during the thirteenth century Chaucer’s new medical professional also acquired another attribute of the modern physician, a license—obtained, as today, by examination. Promoters of medical professionalization described licensure as an essential public health measure. It would—decreed the University of Paris Medical Faculty, an aggressive promoter of licensure—prevent the “shameful and brazen usurpation” of the profession by the untrained and
the ill-lettered. But licensure was as much about professional and economic hegemony—it would allow physicians to dominate the old-style healers, who still provided the bulk of medical care—as it was about public health.

  A small landmark in the physician’s climb to professional dominance was the 1322 trial of a Parisian healer named Jacqueline Felicie. Despite a lack of formal training, Madame Felicie, one of medieval Paris’s many female practitioners, apparently had a natural gift for medicine. During her trial, several former patients came forward to testify on her behalf, including a John of St. Omar, who told the bishop’s court that during a recent illness, Madame Felicie had visited him several times and refused payment until he had been cured. John described this as unprecedented in his experience of physicians. Other defense witnesses included a second John, John Faber, who testified that Madame Felicie had healed him with “certain potions, one green in color”; and a servant girl named Yvo Tueleu, whose fever had resisted the ministrations of several university-trained physicians. Mademoiselle Tueleu told the bishop’s court that after a careful physical examination, Madame Felicie prescribed “a glass of very clear liquid which acted as a purge.” Shortly thereafter, the young woman’s mysterious fever vanished.