The Black Death

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Introduction…………………………………………………………………….…3

The disease………………………………………………………………………..4

Mortality………………………………………………………………………….8

Physicians………………………………………………………………………..11

Effects of The Black Death………………………………………………………14

Introduction

Plague has a remarkable place in history. For centuries, plague represented disaster for those living in Asia, Africa and Europe, where, it has been said, populations were so affected that sometimes there were not enough people left alive to bury the dead. Because the cause of plague was unknown, plague outbreaks contributed to massive panic in cities and countries where it appeared. The disease was believed to be delivered upon the people by the displeasure of the gods, by other supernatural powers or, by heavenly disturbance. Innocent groups of people were blamed for spreading plague and were persecuted by the panicked masses. Numerous references in art, literature and monuments attest to the horrors and devastation of past plague epidemics. So imprinted in our minds is the fear of plague that, even now, entering into the 21st century, a suspected plague outbreak can incite mass panic and bring much of the world's economy to a temporary standstill. The number of human plague infections is low when compared to diseases caused by other agents, yet plague invokes an intense, irrational fear, disproportionate to its transmission potential in the post-antibiotic/vaccination era.

The disease

The most memorable example of what has been advanced is afforded by a

great pestilence of the fourteenth century, which desolated Asia, Europe, and Africa, and of which the people yet preserve the remembrance in gloomy traditions. It was an oriental plague, marked by inflammatory boils and tumours of the glands, such as break out in no other febrile disease. On account of these inflammatory boils, and from the black spots, indicatory of a putrid decomposition, which appeared upon the skin, it was called in Germany and in the northern kingdoms of Europe the Black Death, and in Italy, _la mortalega grande_, the Great Mortality.

Few testimonies are presented to us respecting its symptoms and its course, yet these are sufficient to throw light upon the form of the malady, and they are worthy of credence, from their coincidence with the signs of the same disease in modern times.

The imperial writer, Kantakusenos, whose own son, Andronikus, died of this plague in Constantinople, notices great imposthumes of the thighs and arms of those affected, which, when opened, afforded relief by the discharge of an offensive matter. Buboes, which are the infallible signs of the oriental plague, are thus plainly indicated, for he makes separate mention of smaller boils on the arms and in the face, as also in other parts of the body, and clearly distinguishes these from the blisters, which are no less produced by plague in all its forms. In many cases, black spots broke out all over the body, either single, or united and confluent.

These symptoms were not all found in every case. In many, one alone was sufficient to cause death, while some patients recovered, contrary to expectation, though afflicted with all. Symptoms of cephalic affection were frequent; many patients became stupefied and fell into a deep sleep, losing also their speech from palsy of the tongue; others remained sleepless and without rest. The fauces and tongue were black, and as if suffused with blood; no beverage could assuage their burning thirst, so that their sufferings continued without alleviation until terminated by death, which many in their despair accelerated with their own hands.

Contagion was evident, for attendants caught the disease of their relations and friends, and many houses in the capital were bereft even of their last inhabitant. Thus far the ordinary circumstances only of the oriental plague occurred. Still deeper sufferings, however, were connected with this pestilence, such as have not been felt at other times; the organs of respiration were seized with a putrid inflammation; a violent pain in the chest attacked the patient; blood was expectorated, and the breath diffused a pestiferous odour.

In England the malady appeared with spitting of blood, and with the same fatality, so that the sick who were afflicted either with this symptom or with vomiting of blood, died in some cases immediately, in others within twelve hours, or at the latest two days. The inflammatory boils and buboes in the groins and axillae were recognised at once as prognosticating a fatal issue, and those were past all hope of recovery in whom they arose in numbers all over the body. It was not till towards the close of the plague that they ventured to open, by incision, these hard and dry boils, when matter flowed from them in small quantity, and thus, by compelling nature to a critical suppuration, many patients were saved. Every spot which the sick had touched, their breath, their clothes, spread the contagion; and, as in all other places, the attendants and friends who were either blind to their danger, or heroically despised it, fell a sacrifice to their sympathy. Even the eyes of the patient were considered a sources of contagion, which had the power of acting at a distance, whether on account of their unwonted lustre, or the distortion which they always suffer in plague, or whether in conformity with an ancient notion, according to which the sight was considered as the bearer of a demoniacal enchantment. Flight from infected cities seldom availed the fearful, for the germ of the disease adhered to them, and they fell sick, remote from assistance, in the solitude of their country houses.

Thus did the plague spread over England with unexampled rapidity, afterit had first broken out in the county of Dorset, whence it advanced through the counties of Devon and Somerset, to Bristol, and thence reached Gloucester, Oxford and London. Probably few places escaped, perhaps not any; for the annuals of contemporaries report that throughout the land only a tenth part of the inhabitants remained alive.

From England the contagion was carried by a ship to Bergen, the capital of Norway, where the plague then broke out in its most frightful form, with vomiting of blood; and throughout the whole country, spared not more than a third of the inhabitants. The sailors found no refuge in their ships; and vessels were often seen driving about on the ocean and drifting on shore, whose crews had perished to the last man.

Thus much, from authentic sources, on the nature of the Black Death. The descriptions which have been communicated contain, with a few unimportant exceptions, all the symptoms of the oriental plague which have been observed in more modern times. No doubt can obtain on this point. The facts are placed clearly before our eyes. We must, however, bear in mind that this violent disease does not always appear in the same form, and that while the essence of the poison which it produces, and which is separated so abundantly from the body of the patient, remains unchanged, it is proteiform in its varieties, from the almost imperceptible vesicle, unaccompanied by fever, which exists for some time before it extends its poison inwardly, and then excites fever and buboes, to the fatal form in which carbuncular inflammations fall upon the most important viscera.

Such was the form which the plague assumed in the fourteenth century, for the accompanying chest affection which appeared in all the countries whereof we have received any account, cannot, on a comparison with similar and familiar symptoms, be considered as any other than the inflammation of the lungs of modern medicine, a disease which at present only appears sporadically, and, owing to a putrid decomposition of the fluids, is probably combined with hemorrhages from the vessels of the lungs. Now, as every carbuncle, whether it be cutaneous or internal, generates in abundance the matter of contagion which has given rise to it, so, therefore, must the breath of the affected have been poisonous in this plague, and on this account its power of contagion wonderfully increased; wherefore the opinion appears incontrovertible, that owing to the accumulated numbers of the diseased, not only individual chambers and houses, but whole cities were infected, which, moreover, in the Middle Ages, were, with few exceptions, narrowly built, kept in a filthy state, and surrounded with stagnant ditches. Flight was, in consequence, of no avail to the timid; for even though they had sedulously avoided all communication with the diseased and the suspected, yet their clothes were saturated with the pestiferous atmosphere, and every inspiration imparted to them the seeds of the destructive malady, which, in the greater number of cases, germinated with but too much fertility. Add to which, the usual propagation of the plague through clothes, beds, and a thousand other things to which the pestilential poison adheres--a propagation which, from want of caution, must have been infinitely multiplied; and since articles of this kind, removed from the access of air, not only retain the matter of contagion for an indefinite period, but also increase its activity and engender it like a living being, frightful ill- consequences followed for many years after the first fury of the pestilence was past.

Mortality

We have no certain measure by which to estimate the ravages of the Black Plague, if numerical statements were wanted, as in modern times. Let us go back for a moment to the fourteenth century. The people were yet but little civilised. The Church had indeed subdued them; but they all suffered from the ill consequences of their original rudeness. The dominion of the law was not yet confirmed. Sovereigns had everywhere to combat powerful enemies to internal tranquillity and security. The cities were fortresses for their own defence. Marauders encamped on the roads. The husbandman was a feudal slave, without possessions of his own. Rudeness was general, humanity as yet unknown to the people. Witches and heretics were burned alive. Gentle rulers were contemned as weak; wild passions, severity and cruelty, everywhere predominated. Human life was little regarded. Governments concerned not themselves about the numbers of their subjects, for whose welfare it was incumbent on them to provide. Thus, the first requisite for estimating the loss of human life, namely, a knowledge of the amount of the population, is altogether wanting; and, moreover, the traditional statements of the amount of this loss are so vague, that from this source likewise there is only room for probable conjecture.

Most of the great cities suffered incredible losses; above all, Yarmouth, in which 7,052 died; Bristol, Oxford, Norwich, Leicester, York, and London, where in one burial ground alone, there were interred upwards of 50,000 corpses, arranged in layers, in large pits. It is said that in the whole country scarcely a tenth part remained alive; but this estimate is evidently too high. Smaller losses were sufficient to cause those convulsions, whose consequences were felt for some centuries, in a false impulse given to civil life, and whose indirect influence, unknown to the English, has perhaps extended even to modern times.

Morals were deteriorated everywhere, and the service of God was in a great measure laid aside; for, in many places, the churches were deserted, being bereft of their priests. The instruction of the people was impeded; covetousness became general; and when tranquillity was restored, the great increase of lawyers was astonishing, to whom the endless disputes regarding inheritances offered a rich harvest. The want of priests too, throughout the country, operated very detrimentally upon the people (the lower classes being most exposed to the ravages of the plague, whilst the houses of the nobility were, in proportion, much more spared), and it was no compensation that whole bands of ignorant laymen, who had lost their wives during the pestilence, crowded into the monastic orders, that they might participate in the respectability of the priesthood, and in the rich heritages which fell in to the Church from all quarters. The sittings of Parliament, of the King's Bench, and of most of the other courts, were suspended as long as the malady raged. The laws of peace availed not during the dominion of death. Pope Clement took advantage of this state of disorder to adjust the bloody quarrel between Edward III and Philip VI; yet he only succeeded during the period that the plague commanded peace. Philip's death (1350) annulled all treaties; and it is related that Edward, with other troops indeed, but with the same leaders and knights, again took the field. Ireland was much less heavily visited that England. The disease seems to have scarcely reached the mountainous districts of that kingdom; and Scotland too would perhaps have remained free, had not the Scots availed themselves of the discomfiture of the English to make an irruption intotheir territory, which terminated in the destruction of their army, by the plague and by the sword, and the extension of the pestilence, through those who escaped, over the whole country.

At the commencement, there was in England a superabundance of all the necessaries of life; but the plague, which seemed then to be the sole disease, was soon accompanied by a fatal murrain among the cattle. Wandering about without herdsmen, they fell by thousands; and, as has likewise been observed in Africa, the birds and beasts of prey are said not to have touched them. Of what nature this murrain may have been, can no more be determined, than whether it originated from communication with plague patients, or from other causes; but thus much is certain, that it did not break out until after the commencement of the Black Death. In consequence of this murrain, and the impossibility of removing the corn from the fields, there was everywhere a great rise in the price of food, which to many was inexplicable, because the harvest had been plentiful; by others it was attributed to the wicked designs of the labourers and dealers; but it really had its foundation in the actual deficiency arising from circumstances by which individual classes at all times endeavour to profit. For a whole year, until it terminated in August, 1349, the Black Plague prevailed in this beautiful island, and everywhere poisoned the springs of comfort and prosperity.

Physicians

If we now turn to the medical talent which encountered the "Great Mortality," the Middle Ages must stand excused, since even the moderns are of opinion that the art of medicine is not able to cope with the Oriental plague, and can afford deliverance from it only under particularly favourable circumstances. We must bear in mind, also, that human science and art appear particularly weak in great pestilences, because they have to contend with the powers of nature, of which they have no knowledge; and which, if they had been, or could be, comprehended in their collective effects, would remain uncontrollable by them, principally on account of the disordered condition of human society. Moreover, every new plague has its peculiarities, which are the less easily discovered on first view because, during its ravages, fear and consternation humble the proud spirit.

The physicians of the fourteenth century, during the Black Death, did what human intellect could do in the actual condition of the healing art; and their knowledge of the disease was by no means despicable. They, like the rest of mankind, have indulged in prejudices, and defended them, perhaps, with too much obstinacy: some of these, however, were founded on the mode of thinking of the age, and passed current in those days as established truths; others continue to exist to the present hour.

Their successors in the nineteenth century ought not therefore to vaunt too highly the pre-eminence of their knowledge, for they too will be subjected to the severe judgment of posterity--they too will, with reason, be accused of human weakness and want of foresight.

Arrangements for the protection of the healthy against contagious diseases, the necessity of which is shown from these notions, were regarded by the ancients as useful; and by man, whose circumstances permitted it, were carried into effect in their houses. Even a total separation of the sick from the healthy, that indispensable means of protection against infection by contact, was proposed by physicians of the second century after Christ, in order to check the spreading of leprosy. But it was decidedly opposed, because, as it was alleged, the healing art ought not to be guilty of such harshness. This mildness of the ancients, in whose manner of thinking inhumanity was so often and so undisguisedly conspicuous, might excite surprise if it were anything more than apparent. The true ground of the neglect of public protection against pestilential diseases lay in the general notion and constitution of human society--it lay in the disregard of human life, of which the great nations of antiquity have given proofs in every page of their history. Let it not be supposed that they wanted knowledge respecting the propagation of contagious diseases. On the contrary, they were as well informed on this subject as the modern; but this was shown where individual property, not where human life, on the grand scale was to be protected. Hence the ancients made a general practice of arresting the progress of murrains among cattle by a separation of the diseased from the healthy. Their herds alone enjoyed that protection which they held it impracticable to extend to human society, because they had no wish to do so. That the governments in the fourteenth century were not yet so far advanced as to put into practice general regulations for checking the

plague needs no especial proof. Physicians could, therefore, only advise public purifications of the air by means of large fires, as had often been practised in ancient times; and they were obliged to leave it to individual families either to seek safety in flight, or to shut themselves up in their dwellings, a method which answers in common plagues, but which here afforded no complete security, because such was the fury of the disease when it was at its height, that the atmosphere of whole cities was penetrated by the infection.

 Of the astral influence which was considered to have originated the "Great Mortality," physicians and learned men were as completely convinced as of the fact of its reality. A grand conjunction of the three superior planets, Saturn, Jupiter, and Mars, in the sign of Aquarius, which took place, according to Guy de Chauliac, on the 24th of March, 1345, was generally received as its principal cause. In fixing the day, this physician, who was deeply versed in astrology, did not agree with others; whereupon there arose various disputations, of weight

in that age, but of none in ours. People, however, agree in this—that conjunctions of the planets infallibly prognosticated great events; great revolutions of kingdoms, new prophets, destructive plagues, and other occurrences which bring distress and horror on mankind. No medical author of the fourteenth and fifteenth centuries omits an opportunity of representing them as among the general prognostics of great plagues; nor can we, for our part, regard the astrology of the Middle Ages as a mere offspring of superstition. It has not only, in common with all ideas which inspire and guide mankind, a high historical importance, entirely independent of its error or truth--for the influence of both is equally powerful--but there are also contained in it, as in alchemy, grand thoughts of antiquity, of which modern natural philosophy is so little ashamed that she claims them as her property. Foremost among these is the idea of general life which diffuses itself throughout the whole universe, expressed by the greatest Greek sages, and transmitted to the Middle Ages, through the new Platonic natural philosophy. To this impression of an universal organism, the assumption of a reciprocal influence of terrestrial bodies could not be foreign, nor did this cease to correspond with a higher view of nature, until astrologers overstepped the limits of human knowledge with frivolous and mystical calculations.

Effects of The Black Death

Religion

The Black Death led to cynicism toward religious officials who could not keep their promises of curing plague victims and banishing the disease. No one, the Church included, was able to cure or accurately explain the reasons for the plague outbreaks. One theory of transmission was that it spread through air, and was referred to as miasma, or 'bad air'. This increased doubt in the clergy's abilities. Extreme alienation with the Church culminated in either support for different religious groups such as the flagellants, which from their late 13th century beginnings grew tremendously during the opening years of the Black Death, or to a pursuit of pleasure and hedonism.

The Black Death hit the monasteries very hard because of their close proximity with the sick, who sought refuge there, so that there was a severe shortage of clergy after the epidemic cycle. This resulted in a mass influx of hastily-trained and inexperienced clergy members, many of whom knew little of the discipline and rigor of the veterans they replaced. This led to abuses by the clergy in years afterwards and a further deterioration of the position of the Church in the eyes of the people.

Other effects

After 1350, European culture in general turned very morbid. The general mood was one of pessimism, and contemporary art turned dark with representations of death.

In retrospect, it seemed like everything the people thought to do at the time simply made the problem worse; For example, since many equated the plague with God's wrath against sin, and that cats were often considered in league with the Devil, cats were killed en masse. Had this bias toward cats not existed, local rodent populations could have been kept down, lessening the spread of plague-infected fleas from host to host.

The practice of alchemy as medicine, previously considered to be normal for most doctors, slowly began to wane as the citizenry began to realize that it seldom affected the progress of the epidemic and that some of the potions and "cures" used by many alchemists only served to worsen the condition of the sick. Liquor, originally made by alchemists, was commonly applied as a remedy for the Black Death, and, as a result, the consumption of liquor in Europe rose dramatically after the plague. The Church often tried to meet the medical need.

Plague doctors visited victims verify whether they had been afflicted or not, take their pay, and leave. Surviving records of contracts drawn up between cities and plague doctors offered the plague doctor often gave the plague doctor enormous latitude, and financial compensation. However, most plague doctors were essentially volunteers, as the qualified doctors had (usually) already fled, knowing they could do nothing for those affected by the plague. Considered an early form of hazmat suit, a plague doctor's clothing consisted of:

A wide-brimmed black hat worn close to the head. At the time, a wide-brimmed black hat would have been identified a person as a doctor, much the same as how nowadays a hat may identify a chefs, soldiers, and workers. The wide-brimmed hat may have also been used as partial shielding from infection.

A primitive gas mask in the shape of a bird's beak. A common belief at the time was that the plague was spread by birds. There may have been a belief that by dressing in a bird-like mask, the wearer could draw the plague away from the patient and onto the garment the plague doctor wore. The mask also included red glass eyepieces, which were thought to make the wearer impervious to evil. The beak of the mask was often filled with strongly aromatic herbs and spices to overpower the miasmas or "bad air" which was also thought to carry the plague. At the very least, it may have served a dual purpose of dulling the smell of unburied corpses, sputum, and ruptured bouboules in plague victims.

A long, black overcoat. The overcoat worn by the plague doctor was tucked in behind the beak mask at the neckline to minimize skin exposure. It extended to the feet, and was often coated head to toe in suet or wax. A coating of suet may have been used with the thought that the plague could be drawn away from the flesh of the infected victim and either trapped by the suet, or repelled by the wax. The coating of wax likely served as protection against respiratory droplet contamination, but it was not known at the time if coughing carried the plague. It was likely that the overcoat was waxed to simply prevent sputum or other bodilly fluids from clinging to it.

A wooden cane. The cane was used to both direct family members to move the patient, other individuals nearby, and possibly to examine the patient with directly. Its precise purpose with relation to the plague victim isn't known.

Leather breeches. Similar to waders worn by fishermen, leather breeches were worn beneath the cloak to protect the legs and groin from infection. Since the plague often tended to manifest itself first in the lymph nodes, particular attention was paid to protecting the armpits, neck, and groin.

The plague doctor's clothing also had a secondary use -- To both intentionally warn and frighten onlookers. The bedside manner common to doctors of today did not exist at the time; part of the appearance of the plague doctor's clothing was meant to frighten onlookers, and to communicate that something very, very wrong was nearby, and that they too might become infected. It's not known how often or widespread plague doctors were, or how effective they were in treatment of the disease. It's likely that while offering some protection the wearer, they may have actually contributed more to spreading the disease.

Although the Black Death highlighted the shortcomings of medical science in the medieval era, it also led to positive changes in the field of medicine. As described by David Herlihy in The Black Death and the Transformation of the West, more emphasis was placed on “anatomical investigations” following the Black Death. How individuals studied the human body notably changed, becoming a process that dealt more directly with the human body in varied states of sickness and health. Further, at this time, the importance of surgeons became more evident.

A theory put forth by Stephen O'Brien says the Black Death is likely responsible, through natural selection, for the high frequency of the CCR5-Δ32 genetic defect in people of European descent. The gene affects T cell function and provides protection against HIV, smallpox, and possibly plague, though for the latter, no explanation as to how it would do that exists.

The Black Death also inspired European architecture to move in two different directions; there was a revival of Greco-Roman styles that, in stone and paint, expressed Petrarch's love of antiquity and a further elaboration of the Gothic style. Late medieval churches had impressive structures centered on verticality, where one's eye is drawn up towards the high ceiling for a religious experience bordering on the mystical. The basic Gothic style was revamped with elaborate decoration in the late medieval period. Sculptors in Italian city-states emulated the work of their Roman forefathers while sculptors in northern Europe, no doubt inspired by the devastation they had witnessed, gave way to a heightened expression of emotion and an emphasis on individual differences. A tough realism came forth in architecture as in literature. Images of intense sorrow, decaying corpses, and individuals with faults as well as virtues emerged. North of the Alps, paintings reached a pinnacle in precise realism with the Flemish school of Jan Van Eyck (c. 1385-1440). The natural world was reproduced in these works with meticulous detail bordering on photography.