The Time Traveler's Guide to Medieval England: A Handbook for Visitors to the Fourteenth Century
Page 25
Diseases
The differences between medieval and modern personal hygiene account for relatively little physical suffering. Far more serious are such factors as inadequate diet, poor sanitation (particularly the proximity to feces and rotting meat), parasites, and shared living space. No matter how often you wash your body, simply being around other people is going to lead to the spread of illnesses, as it does in modern times. Even withdrawing from the world and residing in a monastery might not save you. In fact it might make things worse because monks eat, pray, sing, sleep, and work very near to one another. The average life expectancy for monks entering the urban monasteries at Westminster and Canterbury is about five years less than those living outside a monastery23 Being a monk in or near a town might actually shorten your life, despite the good sanitation and the much better diet.
PLAGUE
You have no idea what destruction a disease can wreak upon society. When you see people consumed from within, as if they are being eaten alive by some invisible creature—when you look at the faces of mothers and fathers staring at their feverish blood-vomiting infants, lying in their own beds, in the very places where they parted with a kiss the previous evening, then you might get an inkling. When you are there in 1348, and have been relieved of any complacent assumptions that anyone will survive this hideous calamity, and have come face-to-face with the very real prospect that it will annihilate the whole of humanity, and that God has deserted mankind, then you will start to realize how destructive the plague is.
The Great Plague—the term “Black Death” is not invented until the nineteenth century—is one of the most horrific events in human history, comparable only with those traumas which people have inflicted on one another in modern times. Arriving at the eastern end of the Mediterranean in 1347; spreading along the sea-lanes to France, southern Spain, and Italy; and making its way up across the Continent to England by August 1348, it shakes society in every conceivable respect. It destroys large portions of the population and leaves parts of the country completely empty of people. It starkly reveals the limits of both professional and amateur medical assistance. No doctor of medicine can help the victims; no one can attend the dying with any feeling but revulsion and despair. It reveals the inadequacy of a concept of society based on the “three estates.” Frankly, if “those who pray” cannot protect the population, and “those who fight” simply run away, why should “those who work” feed them? Similarly, the plague forces men to reappraise the fundamental relationship between themselves and God. This horrific disease does not just affect the sinful; it kills the innocent too. If this is the work of God, then He is indiscriminate in his judgments.
According to the papal physician Guy de Chauliac, the first two months of an outbreak see it at its most virulent, with a continuous fever and spitting of blood. This will kill you within three days, sometimes within hours. This phase of the infection passes and a second, less virulent stage takes over. This too is marked by continuous fever but it also gives rise to the boils and black buboes of bubonic plague in the groin and armpits. Catching the disease in this phase will kill you within five days.24 For those affected in the first waves of the plague, death can occur overnight. Some people go to bed and never wake up. These are the lucky ones. If you feel something is wrong, and you are beginning to feel feverish, lift up your arm and start tapping around in your armpit: if something makes you wince, prepare for your final hours of life.
The often-quoted figure of one-third dead—”a third of all the people in the world” as the contemporary chronicler Froissart declares—may lead you to believe that two-thirds of the population survive the disease. This is misleading. If you catch it you will very probably die of it. Those who survive are predominantly those who do not catch it, having some natural or genetic defense against the infection, or just being plain lucky. When it gets into a monastery, normally half the monks die, if not more. At Peterborough in Northamptonshire, thirty-two of the sixty-four monks perish. At Henwood in Warwickshire, only three nuns are left out of the original fifteen. Scare stories spread—of how in some towns tens of thousands of people are dying, and how in Bristol nine-tenths of the population are already dead. There is utter panic. No one can tell really how many people are dying up and down the country. In London two hundred are buried every day. Those clerks who compile episcopal registers have the best measure of the scale of the mortality: they at least can see how many clergymen are dying. In the dioceses of York and Lincoln, 40 percent of all the beneficed clergy die in 1348-49, some of them infected while administering to their dying parishioners. In the far southwest and Herefordshire, the figure is higher, almost 50 percent. The peasantry fare little better: half the population of a manor dying is not unusual. Fifty-five percent of the tenants of twenty-two manors belonging to Glastonbury Abbey die; 43 percent of tenants on three manors in Essex; 39 percent of those holding land from the bishop of Winchester.25 To put these figures in proportion, remember that less than 6 percent of the adult male population of the United Kingdom perish over the whole four years of the First World War, and the overall mortality figure is just 1.55 percent.26
Guy de Chauliac’s advice to those wishing to avoid infection is as follows: “Go quickly, go far, and return slowly.” It is good advice but most cannot follow it. Among those who can—the gentry and esquires—the death rate is a little lower, at 27 percent. But even if you survive the 1348-49 outbreak, you are not safe. The Great Plague is just the first of several waves of plague that sweep across Europe. Miss it in England in 1348-49 and you can catch it later in 1361-62, 1368-69, 1375 (with various minor outbreaks in subsequent years) and 1390-91. The 1361-62 and 1390-91 outbreaks are particularly distressing, as they kill many children. Twenty-three percent of all young heirs of estates die in the 1361-62 plague.27 Overall, the death rate from the second visitation probably kills about 15 percent of the population, and the third, in 1369, about 10 percent. Although the mortality rate is thus in decline, the population continues to shrink further with each outbreak. By 1400 about half of all those born over the previous seventy years have died of plague.
The deaths in 1348-49 are so numerous that the statistics are much easier to talk about than the individual tragedies. Looked at from the safe distance of the twenty-first century, one can see its beneficial effects—how the Great Plague cauterizes feudalism, frees up capital, and allows society to develop in a more democratic way. But a visit to the time reminds you, with a sharp shock, of both the reality and the scale of the suffering. If anything, it proves the value of virtual history—of understanding historical events as lived experiences, as opposed to impersonal facts. Imagine a disease were to wipe out 40 percent of the modern population of the UK—more than 25 million people. Now imagine a historian in the future discussing the benefits of your death and the deaths of your partner, your children, and your friends .. . You would want to cry out, or hang your head in despair, that historians could blithely comment on the benefits of such suffering. There is no shadow of a doubt that every one of these people you see in 1348—whether they will die or survive—deserves your compassion. When you see women dragging their parents’ and children’s corpses into ditches, weeping and screaming—when you listen to a man who has buried all five of his sons with his own hands, and, in his distress, he tells you that there was no divine service when he did so, and that the death bell did not sound—you know that these people have entered a chasm of grief beyond description.28 In the fields lie dead and rotting sheep, five thousand in one field alone, according to Henry Knighton. As you look around and see ravens flying through deserted streets, and half-wild dogs and pigs eating the corpses abandoned on the edge of a village, you will see something which no historian will ever see. The doors of houses left blackly open, thus to remain as night comes and day dawns, until someone enters and finds the cold body of the owner. The passing bells are banned by the church, the traditional laments thrown away. Even prayer fades into a mere whisper of horror
.
Beyond this, although one could say a great deal, there is little which needs to be said. What you will see is just too shocking.
LEPROSY
Put plague in a category of its own as a cataclysm beyond human understanding but do not regard it as the only horrific disease. Before 1348 leprosy is the most terrifying illness which people can imagine. Leprosy is known to us as Hansen’s disease but in the fourteenth century it can include all manner of skin ailments, including eczema, psoriasis, and lupus. Basically if you have a skin disease which results in long-term disfiguration you need to cover it up for as long as possible. If it is seen, and if it is judged by other people to be possibly leprous, then in line with the decree of the Third Lateran Council (of 1179) you will be shunned by society, forced to wear a covering cloak and to ring a bell wherever you go, and be regarded as one of the living dead.
Your leprous breath will be considered to be of a similar quality as the miasma around a cesspit, and likely to lead to leprosy in others, so no one will tolerate your presence. Perhaps some people will pity you in your ailing condition and look upon your situation charitably. Many will not, seeing your affliction as divine judgment on you for your sinful life and your suffering as nothing more than an opportunity to atone for your sins, and thereby purify your soul, before you die.
Leprosy is not uncommon in 1300. If you catch it you will find that it progresses very slowly through your body, removing first the sensations in your hands and feet, and later paralyzing your extremities, leaving them badly ulcerated. After a few years your fingers and toes will melt off. You will probably bleed from your palms. Your body hair and eyelashes will fall out. You might suffer from claw-foot or claw-hand. Men will see their penises putrefy. At some point the bridge of your nose will collapse and you will be left with a smelly liquid constantly running from the gaping wound where your nose was. The ulcers in your larynx will grow and give your voice a coarse, croaking quality. You will probably lose some teeth, your eyeballs may become ulcerated, and your skin will be marked with large nodules. Ultimately you will be wholly deformed, stinking, repulsive, and blind. That is why it is called the “living death.” That is why people are absolutely terrified of it. And that is why, if you catch it, very few people will dare to come near you.
The good news is that leprosy is on the wane. By 1400 there are very few lepers in leper hospitals, and increasingly the beds are being occupied by tuberculous patients and, in a number of cases, even travelers. When Edward III throws the lepers out of London in 1346, a number of hospitals are set up for them. There is one in Kent Street, Southwark, another between Mile End and Stratford Bow, another at Kingsland (between Shoreditch and Stoke Newington), and another at Knightsbridge. All around the rest of the country leper hospitals are set up on the roads out of towns. Therein, it is supposed, the lepers are fornicating furiously, in line with their supposedly sinful natures, and so most lepers do not actually go to these places until forced to do so. Wearing the cloak and the bell is a preferable alternative. Most communities want nothing to do with those poor souls who suffer from the disease. Given how important it is to an individual to belong somewhere, to throw him or her out of the community is no small thing. You can understand why the London baker John Mayn repeatedly refuses to leave the city when ordered to do so by the mayor in 1372. That order to abjure the city amounts to his loss of income, possessions, home, protectors, friends, and family. And who is to say he really has leprosy? Perhaps it is just some eczematous skin on his hands and arms, an occupational hazard of medieval baking.29
TUBERCULOSIS
As leprosy declines, tuberculosis is on the rise. It is a case of out of the frying pan and into the fire. Tuberculosis is an infectious disease which comes in many shapes and sizes, and none of them are pleasant. One common version is scrofula, or the King’s Evil, which is a tuberculous infection of the lymph nodes in the neck. If you catch it, you can expect your neck to swell up until it resembles that of a pig.
The particularly interesting thing about this disease is that it has a supposed cure. The person of the king has the power to alleviate the suffering, or so it is thought, by touching the sufferer or, rather, by touching a coin passed to the unfortunate person. Thousands of people queue up to benefit in this way. Edward I undertakes touching up to two thousand individuals each year. Edward III touches about four hundred individuals every year in the 1330s and 1340s, giving each one Id, only ending the practice in 1344.30 From that date onward he prefers to have all those pennies melted down underneath the Neith Cross (a reliquary holding a piece of the True Cross), which then can be fashioned into cramp rings for the cure of epilepsy. Later monarchs revive the touching for scrofula: it is a good way to demonstrate their divine right.
Although you can get tuberculosis from drinking infected cows’ milk—many children get it this way, with fatal results—most adults are infected by human-to-human contact. This does not require them to touch or even be in the same room as one another. Aerial transmission of the bacillus can take place as a result of talking, coughing, spitting, sneezing, breathing, or just singing. Once the droplets containing the bacilli have dried out, they can rest in the dust of the house or the parish church (an important place for spreading disease) and remain infectious for up to eight weeks. Once in the body, the bacillus remains dormant until the body’s resistance fails, but further bacilli may be spat or breathed out, spreading the disease further. Of course, medieval people do not know this. They just see the results. If you catch pulmonary tuberculosis you will find you are affected by an increasingly frequent and violent cough. After a short while your sputum will be flecked with blood. In addition you may experience fatigue, anorexia, weight loss, lethargy, anxiety, chills, muscular aches, irregular periods, sweating, and fever; ultimately you will die. Given that hundreds of men and women suffering from this infectious disease are brought before the king each year, it is a wonder that the royal family survives.
As you may imagine from these sources of infection, tuberculosis is a particularly urban problem. This is another reason why living with monks in a dormitory is a dangerous thing to do. Once one monk is infected, the whole dormitory goes down. Sufferers need to be taken to a hospital—or a monastic infirmary, in the case of monks—to be given good food and fresh water and allowed to rest. Keeping up your strength is about the only effective remedy, unless you include the psychosomatic value of going to see the king. Other remedies have a certain antiquarian charm but you would not want to undergo them. John Mirfield’s handbook for physicians at St. Bartholomew’s Hospital recommends that women’s milk should be used as a cure, and that it should be sucked directly from the breast. However, before any tuberculous men rush off to St. Bartholomew’s, they should note that Mirfield adds that if no lactating women are available, then asses’ or goats’ milk should be used, and this too should be taken directly from the udder. In addition, the patient should take a medicinal bath. For this the physician’s assistant should “take blind puppies, remove the viscera and cut off the extremities, then boil them in water, and bathe the patient in this water four hours after he has eaten.” While he is in this bath, he needs to keep his head entirely covered and his chest completely wrapped in the skin of a small goat, as a preservation against a sudden chill.
OTHER DISEASES
There are myriad other diseases in medieval England which you may end up catching. Many of them will cease to exist before the advent of the modern world. Several ailments described by the chronicler Henry Knighton do not correspond with anything known to modern medical science. Similarly there are afflictions such as “styche” and “ipydyme” which have no modern equivalent.31 Some diseases have simply become less common: malaria is endemic in marshy areas, such as Romney Marsh in Kent and the Fens of Lincolnshire and Norfolk. On the other hand, fourteenth-century England is free from a number of diseases which affect us in later centuries: you will not find cholera or syphilis.32 In some cases this is due to barriers o
f travel. In others, it is because our vulnerability to specific infections alters with our living conditions. Diseases change as they circulate around the pool of humanity. Rodent carriers of diseases are replaced by different rodents carrying different diseases. Certain illnesses which are initially lethal grow progressively less dangerous as the decades go by. The entire medical landscape is slightly different—the diseases being as changeable as the remedies.
Childbirth is an exception. The problems of babies presenting themselves the wrong way up, or with umbilical cords wrapped around their necks, or developing within mothers whose pelvises are too small to give birth to them, are timeless. What alters is the level of medical help available. There are no forceps in fourteenth-century England. There is no vacuum extraction. A Cesarean birth is a last resort, as it is always fatal for the mother. In fact, giving birth is often fatal, whether or not it ends with a Cesarean: 2 percent of all confinements result in the mother’s death.33 That statistic—one in fifty—does not sound a high proportion, but most married women give birth more than once, and many loyal wives do so more than a dozen times. Every single pregnancy is thus like a game of Russian roulette, played with a fifty-barrel gun. A dozen children is like firing that fifty-barrel gun a dozen times. Twenty-two percent of women will not survive that number of pregnancies. Often it is not the birth itself which is fatal but the blood loss afterwards. As for the babies, a much greater proportion do not survive the ordeal. The exact rate is unknown but more than 10 percent are stillborn. Of those who do survive the birth, and live long enough to be baptized, one in six will be dead before their first birthday34