The Black Death

by Philip Ziegler

  The inhabitants reacted violently when they realized the cargo that their visitors were bringing with them. They sought to drive the danger away and, in so doing, ensured that it spread more rapidly. ‘In January of the year 1348,’ wrote a Flemish chronicler,

  three galleys put in at Genoa, driven by a fierce wind from the East, horribly infected and laden with a variety of spices and other valuable goods. When the inhabitants of Genoa learnt this, and saw how suddenly and irremediably they infected other people, they were driven forth from that port by burning arrows and divers engines of war; for no man dared touch them; nor was any man able to trade with them, for if he did he would be sure to die forthwith. Thus, they were scattered from port to port…{13}

  But by the time that the Genoese authorities reacted, it was too late. The infection was ashore and nothing was to stop it. By the spring of 1348 the Black Death had taken a firm grasp in Sicily and on the mainland.

  * * *

  At this point, with the plague poised to strike into the heart of Europe, it seems appropriate to pause and consider what the epidemic really was and how far it was something entirely new. Today there is little mystery left about the origins and nature of the Black Death; a few points remain to be clarified but all the essential facts are known. But in the Middle Ages the plague was not only all-destroying, it was totally incomprehensible. Medieval man was equipped with no form of defence – social, medical or psychological – against a violent epidemic of this magnitude. His baffled and terrified helplessness in the face of disaster will be above all the theme of this book.

  One of the minor mysteries which does still persist over the Black Death is the genesis of its name. The traditional belief is that it was so called because the putrefying flesh of the victims blackened in the final hours before death supervened. The trouble about this otherwise plausible theory is that no such phenomenon occurred. It is true that, in cases of septicaemic plague, small black or purple blotches formed on the bodies of the sick and this symptom must have made a vivid impression on beholders. But if the name of the epidemic had been derived primarily from the appearance of its victims, one would have expected it to have been used at the time. Of this there is no evidence. Indeed, it seems that such a title was not generally heard until the eighteenth century, though similar expressions had often been applied to other epidemics in the past.{14} The first recorded use of the term for the epidemic of 1348 is in a reference to the swarta döden in Sweden in 1555. About fifty years later it emerged in Denmark as the sorte død.{15} Cardinal Gasquet believed that, in England at least, the name began to be used some time after 1665 to distinguish the fourteenth-century epidemic from the ‘Great Plague’ which ravaged Carolean London.{16}

  The fact that the title ‘Black Death’ was not used by contemporaries similarly makes it hard to credit those other explanations which attributed the name to a black comet seen before the arrival of the epidemic, to the number of people who were thrown into mourning as a result of the high mortality{17} or to the popular images of the plague as a man on a black horse or as a black giant striding across the countryside.{18}

  The most likely explanation seems to be that it originally stemmed from an over-literal translation into the Scandinavian or the English of the Latin pestis atra or atra mors. Even in the fourteenth century the word ‘atra’ could connote ‘dreadful’ or ‘terrible’ as well as ‘black’. But once the mistranslation had been established then all the other reasons for associating ‘Black’ with ‘Death’ must have contributed to give it general currency. In France it was once called the morte bleue. The superior dreadfulness of the accepted phrase is obvious and today no other style would be acceptable.

  Contemporary records are remarkably consistent in their descriptions of the physical appearance of the disease. The most commonly noted symptom is, of course, also the most dramatic; the buboes or boils, sometimes also described as knobs, kernels, biles, blaines, blisters, pimples or wheals which are the invariable concomitants of bubonic plague. Boccaccio’s description will do for all the rest:

  …in men and women alike it first betrayed itself by the emergence of certain tumours in the groin or the armpits, some of which grew as large as a common apple, others as an egg, some more, some less, which the common folk called gavocciolo. From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. And as the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they shewed themselves….{19}

  Medically the only questionable detail in this account is the reference to the bubo as an ‘infallible token of approaching death’. Other contemporary records{20} as well as observation of subsequent epidemics show that it was by no means unheard of for the buboes to discharge and the patient recover. But certainly this happened in a very small minority of cases. To most of its victims the bubo meant inevitable death and it would not be surprising if Boccaccio had never heard of an instance to the contrary.

  It was Gui de Chauliac, physician to the Papal Court at Avignon, who saw most clearly that these buboes were by no means an invariable symptom and that a distinct, still more violent variant of the plague existed.{21} ‘The mortality… lasted seven months,’ he wrote. ‘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 apostumes and carbuncles on the external parts, principally on the armpits and groin. From this one died in five days.’

  The first form, de Chauliac had no doubt, was the more deadly. Even those doctors who failed to perceive the significance of the different symptoms, associated the coughing of blood with certain death: ‘…men suffer in their lungs and breathing and whoever have these corrupted, or even slightly attacked, cannot by any means escape nor live beyond two days.’

  The question of how long the sick could be expected to survive caused much confusion to the contemporary chroniclers; confusion that could never be cleared up because of their failure to identify the second and, as we now know, the third distinct form of the plague. Most reports agreed with Boccaccio that, in those cases where there were only buboes, death was likely to come in five or six days but that, when there was coughing of blood, either by itself or as an additional symptom, the course of the disease was more rapid and the patient died within two or three days. But there were other, by no means infrequent references to the disease killing almost instantaneously or within a few hours. Geoffrey the Baker wrote{22} of people who went peacefully to bed and were dead the next morning, while Simon of Covino described priests or doctors who ‘were seized by the plague whilst administering spiritual aid; and, often by a single touch, or a single breath of the plague-stricken, perished even before the sick person they had come to assist.’{23}

  Through almost every account breathes the revulsion as well as the fear which the plague inspired in all who encountered it. Disease rarely respects human dignity and beauty but the Black Death seemed peculiarly well equipped to degrade and humiliate its victims. Everything about it was disgusting, so that the sick became objects more of detestation than of pity: ‘…all the matter which exuded from their bodies let off an unbearable stench; sweat, excrement, spittle, breath, so foetid as to be overpowering; urine turbid, thick, black or red…’{24}

  All these phenomena were observed with horrified accuracy by contemporary writers and reported with care and objectivity. Little or no effort was made, however, to explain them logically or to work them into a coherent pattern; the background of knowledge against which such an attempt could have been made was woefully inadequate and the will to try rarely present. One subject which proved something of an exception was the problem of how the dise
ase passed from man to man and country to country. To this much thought was given and many esoteric theories were put forward. Fundamentally there were two, by no means mutually exclusive, schools of thought: those who believed in person-to-person infection and those who pinned their faith in the existence of a ‘miasma’ or poison cloud.

  The medieval doctor was confronted with a situation where a large number of people died suddenly and inexplicably in a given area. This zone of mortality shifted constantly but gradually, conquering new territory and abandoning old. Any rational being, faced with such a phenomenon but totally unversed in medical lore, would be likely to arrive at the same explanation. There must be some vicious property in the air itself which travelled slowly from place to place, borne by the wind or impelled by its own mysterious volition. There were many different points of view as to the nature of this airborne menace, its origin, its physical appearance. But almost every fourteenth-century savant or doctor took it for granted that the corruption of the atmosphere was a prime cause of the Black Death.

  Debate generally centred on the degree of harm which this corruption might do to the atmosphere which it affected. Ibn Khātimah, the Arab philosopher and physician from Granada, took an extreme line when he argued that corruption might in certain cases be absolute; that is to say that the very nature of the air might be permanently changed by putrefaction.{25} In such air no light would burn, still less could a man hope to live. Such conditions existed only in the very heart of a plague-ridden area, all around was to be found a zone of partial corruption where the danger of death, though still great, was no longer inescapable. A change in the composition of the air might be caused by the movement of the stars or the putrid fumes of decaying matter; in the case of the Black Death, however, Ibn Khātimah believed that the cause was to be found in the vagaries of the weather over the previous few years.

  Not many people agreed with the theory that the air could be altered in its very composition. Even Ibn Khātimah’s colleague and friend, Ibn al Khatīb, could not accept that there was more than a temporary poisoning caused by the addition of something noxious to the atmosphere.{26} What that something was and where it came from was similarly a topic for hot debate. Alfonso of Cordoba, like most men of learning at the time, considered that movements of the planets probably started the mischief but held that, if the poisoning of the atmosphere went on for any length of time, then some human agency must be behind it:

  since air can also be infected artificially, as when a certain confection is prepared in a glass flask, and when it is well fermented, the person who wishes to do that evil waits till there is a strong, slow wind from some region of the world, then goes into the wind and rests his flask against some rocks opposite the city or town which he wishes to infect and, making a wide detour and going further into the wind lest the vapours infect him, pulls his flask violently against the rocks. When it breaks the vapour pours out and is dispersed in the air, and whoever it touches will die…{27}

  The anonymous author of another plague tractate rejected all such fantasies of medieval gas warfare and made the great earthquakes of 1347 the villains of the piece.{28} Even before this date, pressure had been building up underground and a few noxious currents of air which had escaped had started minor epidemics. But now poisonous fumes poured forth through cracks in the earth, escaped into the atmosphere and drifted around the face of Europe killing all who encountered them.

  It is curious that, though every doctor paid lip-service to the teachings of Galen, the relatively prosaic explanation of the corruption of the atmosphere which he had advanced several hundred years before was almost ignored by commentators on the Black Death. Infection, he propounded, arose mainly from ‘Inspiration of air infected with a putrid exhalation. The beginning of the putrescence may be a multitude of unburned corpses, as may happen in war; or the exhalations of marshes and ponds in the summer…’ Perhaps the monstrous dimensions of the disaster which overtook Europe in the fourteenth century forced its victims to seek some proportionately monstrous explanation.

  But the idea that the disease might be passed directly from man to man was not ruled out by belief in a corrupted atmosphere. A few, mainly among the Arabs, rejected the possibility of infection on religious grounds but for most people the evidence of their own eyes was too strong. Some effort was made to establish a link between the two theories, as by those who argued that a victim of the plague might radiate infection in his immediate vicinity by generating a form of personal and highly localized miasma which he carried, like a halo, around his head.{29} But such refinements of logic were not much considered and, in general, people were content to note that the disease could pass from victim to victim with terrifying speed and did not worry too much about the philosophical or scientific basis for such a phenomenon. The evidence was overwhelming. It is noteworthy that it was an Arab, Ibn al Khatīb, who defied his religion’s teaching and stated flatly: ‘The existence of infection is firmly established by experience, research, mental perception, autopsy and authentic knowledge of fact…’

  It does indeed appear that, to the medieval mind, the speed with which the Black Death passed from man to man was its most alarming feature. ‘The contagious nature of the disease,’ wrote one chronicler,{30} ‘is indeed the most terrible of all the terrors, for when anyone who is infected by it dies, all who see him in his sickness, or visit him, or do any business with him, or even carry him to the grave, quickly follow him thither, and there is no known means of protection.’

  Boccaccio was particularly struck by the perils of infection:

  Moreover, the virulence of the pest was the greater by reason that intercourse was apt to convey it from the sick to the whole, just as fire devours things dry or greasy when they are brought close to it. Nay, the evil went yet further, for not merely by speech or association with the sick was the malady communicated to the healthy with consequent peril of common death, but any that touched the clothes of the sick or aught else that had been touched or used by them, seemed thereby to contract the disease.

  Boccaccio himself claims to have seen a couple of pigs in the street digging their snouts into the rags of a poor man who had just died. They smelt them, tossed them to and fro between their teeth, then almost immediately ran round and round, and, without more ado, tumbled dead to the ground. The inevitable result of this well-founded if somewhat exaggerated terror of infection was that the victims of the plague more often than not found themselves abandoned to their fate and even those who had endured some slight brush with the disease were likely to be shunned by their fellow-men. Security lay only in total isolation. If this were impracticable then at least contact with the plague-struck should be avoided.

  It was quickly realized that there was no need to touch a sick man to be infected. Most people believed that the disease passed by breath but other theories existed. Looks, according to a physician from Montpellier, could kill.{31} ‘Instantaneous death occurs when the aerial spirit escaping from the eyes of the sick man strikes the eyes of a healthy person standing near and looking at the sick, especially when the latter are in agony; for then the poisonous nature of that member passes from one to the other, killing the other.’ But swift and terrible though the infection might be, it was also evident that it varied in its dreadfulness from place to place and time to time. On one occasion a whole community would be obliterated, on another there would only be one or two victims and the rest would survive unscathed; here a family would die within twenty-four hours, there the father would die one day, a child three weeks later, another child after a month and then there would be no further victim. In general this was accepted apathetically as yet another of those inexplicable phenomena of which the Black Death was composed. A few doctors noted that the infection seemed more virulent where there was spitting of blood. Only Gui de Chauliac went on to deduce that, of the two forms of the disease which were apparent, one was notably more infectious than the other.

  * * *

  Enjoyin
g as we do the immense superiority of a generation which has devised means of mass destruction more effective even than those inflicted by nature on our ancestors, it is easy and tempting to deride their inability to understand the calamity which had overtaken them. It would, perhaps, be more fitting to wonder at the courage and wisdom of men like Gui de Chauliac who saw their civilization apparently doomed by a hideous and inexplicable calamity and could still observe its development with scientific objectivity, draw reasonable deductions about its habits and likely course and do their best to curb its ravages. It is also sobering to reflect that only within the last century have we learned enough to detect the origins and plot the course of the epidemics and that, even today, quick and expensive action is necessary if they are to be checked before they do great damage. It is much less than a hundred years since the sophisticated and immensely learned Dr Creighton concluded positively that the source of the Black Death lay in the mounds of dead left unburied by the successive disasters which had overtaken China. He invoked cadaveric poisoning as the reason for the high death rate among priests and monks: priests tended to live near the village churchyard while: ‘Within the monastery walls were buried not only generations of monks, but often the bodies of princes, of notables of the surrounding country, and of great ecclesiastics.’{32}

  Today we smile politely at Dr Creighton’s blunders; it is reasonable to wonder whether a hundred years from now the theories of today may not seem equally ridiculous. On the whole it is unlikely that they will. Undoubtedly further discoveries will be made, dark corners illuminated, concepts amended or refined. But the techniques of scientific investigation are now sufficiently evolved to have established as a fact the main elements of the Black Death and to explain authoritatively the cycle of its activity.{33}