HIST 234: Epidemics in Western Society Since 1600

Lecture 3

 - Plague (I): Pestilence as Disease


The bubonic plague is the measure by which succeeding epidemics have long been measured. Its extreme virulence, horrible symptoms, and indiscriminate victim profile all contributed to making plague the archetypical worst-case scenario. For these same reasons, the plague is also an ideal test case for the thesis that epidemic diseases play a major role in shaping human history. Over the course of its three pandemics, the plague had major economic, religious, cultural and political implications for affected societies. In its wake, religious beliefs and medical practices were questioned, public authorities tested, and the social fabric strained.

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Epidemics in Western Society Since 1600

HIST 234 - Lecture 3 - Plague (I): Pestilence as Disease

Chapter 1. Bubonic Plague [00:00:00]

Professor Frank Snowden: Well, what we’ll do this morning is to start right now. And we’ll be dealing today with the beginnings of our first major epidemic in the course. We’ll be talking about bubonic plague. This time we’ll have an overview of bubonic plague and its passage through Western society. And then in the next two classes we’ll look at specific features of bubonic plague; next time, community responses to the plague, and the time after that, the impact on society, and in particular on European culture. So, that’s where we’re headed. And this morning we’ll have a sort of overview.

Now, one of the reasons for dealing first with the plague is that it’s very important as part of testing the theme of our course; the theme being — one of the themes — that epidemic diseases aren’t just interchangeable causes of illness and death; that each one has its own particular history that is determined by a number of variables that we’ll be looking at, such as virulence, the nature of the symptoms of the disease, and a number of others. And we’ll be testing the theory too that epidemic diseases are major determinants of historical change, and have major impacts on society.

Well, plague, in a sense, set the standard by which all other epidemics are judged. The plague was, we might call it, the worst-case scenario, and we’ll see that in later centuries, when societies experienced some new and unfamiliar disease, they waited anxiously to see if those diseases would be similar in their impact. And especially terrible diseases like cholera, in the nineteenth century, and influenza, just after the First World War, were said to be “the return of the plague.” Tuberculosis, the great killer of the nineteenth century, was known also as “the white plague.”

What were some of the distinctive features of bubonic plague? The first thing that stands out is its extreme virulence. That’s one of the first words that we may want to define as we move on. By that I mean its capacity to cause harm and symptoms in the human body. It’s a measurement of the ability of a pathogen to cause disease. Plague in that sense was highly virulent. It also struck rapidly. It caused excruciating and degrading symptoms, and it achieved a case fatality rate — another technical term, which simply means the kill rate that a disease achieved. In the case of bubonic plague, it normally killed fifty to seventy percent of the patients it infected; a rate attained by few other diseases. Its course in the human body was also terrifyingly swift. Normally it killed within about three days of the first appearance of symptoms.

Another feature that was characteristic of bubonic plague was the profile of its victims. I mean that both in terms of their age and their social class. Familiar endemic childhood diseases in a society tend to strike primarily children and the elderly. That, if you like, would be the normal experience of society with infectious diseases. But the plague was different. It struck men and women in the prime of life. And this fact, among others, made plague seem like an unnatural, or might we say supernatural, event. It also magnified the economic and social dislocations it caused. In other words, plague left in its wake vast numbers of orphans, widows and destitute families.

Furthermore, the plague, unlike most epidemic diseases, did not show a predilection for the poor. It struck universally, again magnifying a sense that this was the final day of reckoning, a divine visitation. Another feature of plague we’ll be looking at is terror as a response to it. All of the things that we’ll be saying about plague magnified the responses of the societies that were afflicted. Plague was associated with mass hysteria; with terror; with violence; with religious revivals, as people sought to assuage the divine wrath. It was associated with scapegoating and witch-hunts, for the guilty people in society responsible for the disaster. Perhaps those were the sinful, for those who saw the disease as divine retribution. Or it could be a search for the homicidal agents of some human conspiracy, for the demonic interpretation of disease. Those might be foreigners, witches, Jews or poisoners.

Then the plague was important because it generated a major societal response: the development of the first forms of public health. In part because of its very virulence, the plague inspired the first and most extreme form of public health policy to protect populations and contain the spread of this horrendous and terrible disease. Plague public health — and we’ll see this more next time — involved a military style policy carried out by the army and the navy. It involved maritime and land-based quarantines, sanitary cordons, which are military lines isolating a population. It gave rise to pest houses or lazarettos. And to new health authorities — variously called, over the centuries, health magistrates or boards of health — equipped with extraordinary powers to enforce the plague measures. In some places there were erected stocks and scaffolds to remind the population of the powers of these authorities.

Early Italian states, at the time of the Renaissance, devoted a special role — deserved a special role as the inventors of these public health measures. This was thrust upon them by their vulnerable position at the geographic center of trade routes in the Mediterranean. So, we’ll see the decisive role in the development of these measures was played by places like Florence and the great port cities like Genoa, Naples, Venice. Later centuries will see another pattern, when a new, mysterious and frightful disease strikes — say cholera, yellow fever or AIDS — one of the first responses of authorities is to return to plague measures of self-defense.

It’s said of generals that they always try to fight the last war over again, often confronting new enemies with inappropriate strategies. The same might be said of public health authorities over the centuries. And this temptation is all the greater for authorities because the battery of anti-plague defenses gives an impression of taking forceful and decisive action; providing the population, in other words, with some sense of security.

A third feature of the plague is its enormous impact on society. As we’ve said, infectious diseases are not narrow, specialized interests. They’re often part of the big picture, as essential for understanding a society and its history as studying war, religion, economics, high politics and culture. I’m not trying to make a case for disease determinism, and I’m not what you might want to call a microbial Marxist. My argument instead is simply that certain diseases do have a transforming effect on society, plague being one of them. Certain others do not, even great killers such as polio or influenza. We’re going to examine why this major difference — why some diseases have a much more lasting footprint than others.

Bubonic plague was a disease that affected every aspect of society. It transformed the demography of Europe. Recurring cycles of plague, with an epidemic every generation, constituted a major break on population between the fourteenth century and the eighteenth. It had devastating effect on economic life and economic growth. It also had a major impact on religion and popular culture. It gave rise to a new piety, to cults of plague saints, to passion plays. Plague led to an outpouring of sermons and religious pamphlets, with a central theme being what we might call theodicy; that is, how do you justify God’s ways towards men?

A just and loving God could be angry and punish sinners who turned from him and disobeyed. But how were priests and ministers to explain the gruesome suffering and death of innocents, and in particular of children? Thus also we see another undertow. We talked about piety. I would argue that plague also led sometimes to its opposite; the terrifying conclusion that how could there be a good God, because a loving and all-powerful being would not take the lives of half the population of a great city, indiscriminately killing men, women and children. So, for some, the result wasn’t an act of atheism but a mute despair that was not articulated; a psychological impact that with historical hindsight we might even call post-traumatic stress.

So, plague had a major psychological impact on the relationship of human beings to their mortality, and to their god. Plague had a major impact on the arts and culture. In literature we’ll be seeing — and in fact you’re starting to see, I hope already, by reading Defoe — that there’s a whole genre of plague literature, including not only Defoe but names like Boccaccio, Camus, Manzoni; of whom more later. It affected European painting profoundly, and we’ll be looking at that. It affected architecture, with large numbers of churches dedicated to the redeemer and the plague saints. It led to sculpture, and plague columns appeared throughout Vienna and the Austrian cities. We have, even in modern times, the film that I hope you’ll be seeing, The Seventh Seal by Bergman.

Plague also had a major impact intellectually on the medical paradigm of disease. Plague profoundly tested the humoral framework of disease. And we can see this in a man I mentioned in the last lecture, Girolamo Fracastoro, who developed a theory of contagionism. Now, the humoral idea, and Hippocrates, had recognized the difficulty that epidemics pose for humoral theory. How is it possible to account for vast numbers of people experiencing the same humoral imbalance at precisely the same time? Well, Fracastoro took that idea and he eliminated the mediation of the humors, suggesting instead that the disease was caused by a poisonous chemical, transmitted in a way he didn’t understand, from one person to another. But let’s not think of Fracastoro as a modern medical scientist. He thought that plague was caused, not by a living entity, but by a chemical.

Chapter 2. Three Western Pandemics [00:14:03]

That’s the background, then. Let’s remember the history of three pandemics of bubonic plague that afflicted the West. Now, first maybe we should define what we mean. An outbreak — let’s talk about three terms — an outbreak, an epidemic and a pandemic. An outbreak is a small surge in morbidity and mortality in a locality. So, we might talk of an outbreak of influenza in New Haven. An epidemic is a much bigger surge, over a larger area. And a pandemic is when an epidemic goes transnational; becomes an international phenomenon, affecting whole continents, or occasionally going global. The plague struck the West in three pandemic waves.

We’ll be talking about the history, then, of three pandemics of bubonic plague. And each pandemic as a subset, if we like, had a series of recurring visitations that might even last for centuries. And in addition to being cyclical in that sense, plague had a pronounced seasonality. An epidemic of bubonic plague usually began in the spring or summer months, and faded away with the coming of winter. Especially favorable were months that were both hot and wet. The explanation for that, as we’ll see, wasn’t a humoral one. But that provides an ideal environment for fleas, which are decisive in plague, and their need for warmth and humidity, for their eggs to hatch; and they become inactive in cold or very dry climate.

The first pandemic, when was that? That lasted for two centuries after 541 A.D., and is called the Plague of Justinian. It was the first appearance of bubonic plague as a major player in world history, and there are estimates that it afflicted Africa, Asia and Europe with — people are guessing, but there are figures bandied about of perhaps a hundred million victims. There are few accounts, or records that have survived, and there’s some debate about whether this so-called Plague of Justinian was even bubonic plague at all, or whether it was some other disease. But as we speak, paleopathologists are at work exhuming bodies from ancient cemeteries in order to find conclusive DNA evidence to support a firm diagnosis, and the latest news is that they’re pretty certain that it was bubonic plague.

The second pandemic occurred from the 1330s, in the Middle East, until the 1830s. So, we have — what’s that? — five centuries of bubonic plague in the second pandemic. It began with what was called the Black Death. This erupted in Central Asia in the 1330s, and first invaded Europe in 1347. And the early years, from 1347 into the 1350s, were usually called the Black Death, which referred to the first wave of the second pandemic; after which it’s usually referred to simply as bubonic plague, plague, or pestilence. It may well — and this is the common theory — have arrived aboard a Genoese merchant ship that had sailed from the Black Sea in the summer of 1347.

In any case, Italy was the first land to be invaded by the disease; again, as I say, not by chance, because Italy was at the center of the trade routes of the Mediterranean, and therefore was always, at this time, permanently at risk. About a third of the population of Europe is estimated to have perished. And after the 1350s, after the Black Death, the plague returned more or less once in a generation, for a number of centuries, with some famous local epidemics. Let me just remember some of the worst cases. Florence in 1348, when the disease killed half the population — and that’s portrayed vividly in Boccaccio’s Decameron; 1576 to 1577, Milan; 1630, again Milan — and there are two major plague works of literature: Manzoni’s novel The Betrothed, and his work The Column of Infamy — 1656 in Naples; and 1665 and 1666 in London, which you’re reading about in Dafoe’s Journal of the Plague Year.

Then for reasons we’re going to return to, the plague was vanquished in Western Europe between the end of the seventeenth century and the middle of the eighteenth. The last outbreaks in Western Europe, of the second pandemic, were 1720 to 1722, at Marseilles in France, the last on the Western European mainland; and in 1743 at Messina and Sicily. Interestingly, Messina is a convenient bookend; the very first place in Western Europe to be afflicted by the plague, and also the last, during the second pandemic. Now, don’t make the mistake of assuming that the virulence of the plague declines over these centuries. In many cases the last epidemics of the seventeenth or eighteenth century were the most devastating of all, including the experience of London that you’re reading about.

Then we come to the third pandemic, which lasted from about 1855 until 1959, more or less, when it fades away. It began in earnest, and attracted world attention in China, when it attacked Hong Kong and Canton in 1894. And, as I said, it lasted until the middle of the twentieth century. Now, this pandemic ravaged India and affected five countries, but mostly not the industrial West, apart from a brief flare-up in Naples in 1899, and an also limited outbreak in San Francisco in the early years of the twentieth century. That’s the topic of Marilyn Chase’s work that you’ll be reading, The Barbary Plague. It was the steamship that enabled plague to reach the New World for the first time in the twentieth century. It had limited impact on humans, but it did establish a stable reservoir of infection among wild rodents in the southwest of the United States, where it persists to this very day and causes an ongoing trickle of cases of bubonic plague in this country.

The great disaster was India from 1898 to 1908, which experienced some 13 million deaths from the bubonic plague. Present day plague — and I think a number of you may have the idea that plague is something medieval that doesn’t have anything to do with the modern world, and I want to make it clear that plague is not extinct. Indeed, I have a friend myself who is a survivor of bubonic plague, which she contracted in Arizona in the southwest. As I said, it continues to cause a trickle of cases every year in the United States, because it persists in the wild animal population, and there are occasional flare-ups.

We also need to remember there’s a somber background threat, then, of bubonic plague even today, which is made more vivid by the threat possibly of bubonic plague as an instrument of bio-terror. And just to show the sort of modern — here’s a modern image of the grim reaper as still with us. Now, our focus here in our class will be instead firmly on the second pandemic, and especially its last terrible century in Europe, the seventeenth.

Chapter 3. Etiology [00:23:39]

Let’s talk about some of the features of bubonic plague, and we’ll begin with its etiology. Again a bit of jargon, and by that I simply mean the causes or origins of the disease. And the plague is a disease with a complex history of four protagonists. First there’s the bacterium — and there it is — Yersinia pestis, sometimes called, in a more old-fashioned way, Pasteurella pestis. It was discovered in Hong Kong by Alexander Yersin, a Swiss student of Louis Pasteur, and at the same time by his rival the Japanese physician, Shibasaburo Kitasato, a protégé instead of Robert Koch.

So, the first protagonist is this bacterium, Yersinia pestis. And then there are two vectors. The vector is normally another bit of jargon: An animal or insect responsible for conveying a disease to human beings. And in this case there are two vectors or carriers that convey the disease to human beings: fleas and rodents, especially rats. And then there’s the fourth protagonist, you and me. By between 1894 and 1898, Yersin and his colleague, Paul-Louis Simond, unraveled the complex relationship among rats, fleas and humans, and the bacterium, that governs the epidemiology of bubonic plague.

Normally the plague began as an infection, an epidemic among animals and especially wild rodents: hamsters, gerbils, prairie dogs, chipmunks, squirrels in their burrows, where underground catastrophes, unknown to humans, took place. A particularly important moment was when it inflicted this particular creature and friend, that lives not so distant from us,Rattus rattus, the black rat or ship rat; and as you see, extremely cute it is. Unlike his cousin, the brown rat, that took over its ecological niche later on, and is more familiar in modern times, the black rat was definitely not shy, but lived in close proximity to people, with whom they shared the same dietary preferences. So, the rat was extremely important.

The bacterium was spread in a third major character, the flea, a highly efficient vector for bubonic plague. The flea is naturally parasitic on warm-blooded animals. In a single feed it sucks up an amount of blood equal to its own weight. I’m talking about something like a billion bacteria at a time. And here we’re looking at the slide of a flea engorged with blood after a meal. Now, once infected — and here you’ll feel sorry for the poor flea — the flea does not survive the plague either. The bacterium blocks the gut of the flea, causing it to starve to death. Poor thing. But before dying, in a frenzied bid to survive, the flea feeds repeatedly, and in each bite inoculates perhaps a hundred thousand bacteria into the bloodstream of its warm-blooded victim.

So, when a rodent host of fleas sickens and dies, the fleas leap to the warm body of another mammal that passes within leaping radius. And the flea also is capable of hibernating for as much as a couple of months, lying in wait. Now, how did human beings come to be involved in this catastrophe? Well, it might be sometimes that the remote steppes where wild rodents lived had their ecological systems disrupted, perhaps by floods or droughts, that sent animals scurrying over long distances, and then they encountered other rodents who lived in close proximity to man, and especially our friend the black rat. Alternatively, human beings invaded rodents’ habitats, exposing themselves to infection; soldiers perhaps, or refugees in times of war, or hunters and shepherds.

So, the first foci — that is, the first locuses where infections sprang up amongst human beings — were the first infected men and women which shared their fleas and infection with other members of their household. The plague would then begin, not as a disease so much of isolated individuals, but of households. Housing conditions were important. Overcrowding, with whole families sleeping in a single bed, facilitated the exchange of fleas. And there were particular moments that were especially dangerous, such as the laying out and final attentions to the dead. As the body cooled, the fleas infesting it became desperate to escape to the next warm body that approached; quite possibly you and me.

Then there was the wider spread; and this was dependent on networks of trade and commerce. It was not an accident that plague emerged when it did in European history. It spread overland and along river valleys, by river traffic. Now, fleas obviously are severely restricted in their range, but rats are really wonderful travelers. They hide in the shipments of wheat and are transported overland. They travel by barge down waterways. But the garments of victims were also important, because they were recycled. Remember how precious an item of clothing was in the early modern world. And, so, the clothing of dead men and women was packed in crates, and sold in markets and fairs, often with fleas intact among their folds.

Certain professions were also highly at risk: street vendors, market-stall-holders, washerwomen, gravediggers, physicians, priests, and also millers and bakers, because of the dietary preferences of your friend the black rat. But the disease also went further afield, and it did so by sea. And shipping was essential to the spread of the plague over long distance, and helps to explain its epidemiology; its tendency, that is, to arrive in a country first by striking port cities, and only then moving inland by road and river traffic. Infected rats would clamor aboard ships, by ropes and gangplanks, or they could be lifted aboard in crates of grain or shipments of clothes.

Istanbul was a great hub of trade in the Middle East, and it linked the rest of the Mediterranean world by trade overland across the Balkans, and by ship to Venice, Naples, Genoa, Marseilles, Valencia. Sometimes there was havoc at sea when a whole crew and its passengers would be killed by the plague before they arrived at port, and there were ghost ships that floated on the Mediterranean. Once reaching a port, however, the ship would dock and rats would disembark, in crates, or by rope, or by the gangplank again, and at the same time infected passengers and crew could go ashore, together with their fleas. Normally the first indication of plague — one that’s dramatically apparent in Camus’s novel The Plague, but we’ll also see in some of the paintings that we’ll look at time after next — an important indication was a sudden and massive die-off of rats. And there would be pictures like this of rats killed by an epidemic of bubonic plague; in this case Sydney, Australia.

So, ports are crucial in epidemics, and in the development of public health measures to counter them. Almost invariably in Western Europe the plague arrived in port cities and then spread inland, following roads and rivers. In the large cities, the disease typically would arrive in the spring, reach a peak of ferocity after a few weeks, then continue as a violent outbreak for two to four months, and then decline with the coming of colder, dry weather, either to disappear entirely, or to be rekindled when favorable climatic conditions returned.

Chapter 4. Symptomatology and Pathology [00:34:10]

Well, that’s the etiology, in a nutshell, of the plague. I’d like to turn now to its symptomatology and pathology; that is, how does it affect the individual human body? And the study of the symptoms of the epidemics we study isn’t just a matter of ghoulish curiosity. I’m going to argue that the history of each epidemic disease is distinct. That’s one of the reasons that I will be showing slides, to fix the image of a particular disease in your mind. Because it’s important not to confuse them, because each has its own history. And a crucial variable is the differing way in which each of these diseases affected its victims.

A feature of the plague, I would argue, is that it seemed almost purposefully designed to maximize terror. I will be showing you some vivid material, and I’m sorry that it’s just before lunch. And indeed a couple of years ago in this class someone in the front row fainted with some of the pictures. So, if you don’t wish to look at them, I can tell you in advance it’s not compulsory. You can simply close your eyes. In any case, Yersinia pestis is exceptionally virulent because of its ability to overwhelm the immune system of the body. After an infective bite, there’s an incubation period, usually of one to six days, and then the classic symptoms appear — the first beginning — launching the first stage of bubonic plague.

That is, at the site of the flea bite, there’s what’s called a carbuncle or gangrenous black blister, surrounded by red pot marks. And this will be familiar to you because it’s been immortalized in the nursery rhyme, “The Ring a Ring o’ Roses.” But also, along with it, there’s high temperature and shivering, violent headache, nausea and vomiting, and general flu-like symptoms; after which the patient passes on to the second stage of bubonic plague, when it invades — the bacteria invade the lymph system and drain into the lymph nodes.

A couple of days later a so-called bubo — which gives the symptom that gives the disease its name, bubonic plague — the plague of buboes appears. This is an infected swelling of the lymph nodes, a hard mass the size of an orange beneath the skin. The site of the bubo varies, according to the location of the infective bite. If a flea bites the legs, the bubo is usually in the groin, and would look like that. If the fleas instead were to bite the arms, the bubo would appear in the armpit or on the neck, and there would be symptoms — would look like this, or like that. In any case, Daniel Defoe imagined, and he writes in our book, that the agony was so violent from the bubo that victims hurled themselves from roofs, or into the Thames to escape it. And there was a general consensus that the body and all of its excretions — urine, sweat, the breath — had an overpowering stench.

This led — I want us to remember how dehumanizing the symptoms of plague were, and that’s tremendously important to the way that societies experienced its outbreak. In the third stage, the bacteria releases a powerful toxin, and this circulates throughout the bloodstream, and it’s the toxin that kills. It attacks tissues, causing blood vessels to hemorrhage, and giving rise to purpurous, subcutaneous spots, the so-called tokens of plague. Another bit of jargon to remember. The plague is associated with tokens and these — let’s have a look at — which look like this. They gain their name because they were thought by many to be the signs, that is the tokens, of God’s anger, the anger that led him to smite his people with the plague.

The toxin initiates the septic phase of this disease, causing rapid degeneration of the muscles of the heart, of the kidneys, of the nerves and the central nervous system, and this leads to such symptoms as bloodshot eyes, general prostration, fever, nausea, severe headache, and progressive neurological damage that’s manifested by slurred speech, a staggering gait, psychic disturbances and derangement. We again see how this disease is terrifyingly dehumanizing and agonizing. And it leads then to delirium and coma. Sometimes it also causes gangrene of the extremities — and I will also have a picture of that — and this may, in fact, be the origin of the term Black Death.

Now, in terms of the symptomatology — let me pass on from that to this. This is a Franciscan friar, Michael of Piazza, a chronicler — you’ll remember I said Messina was the first place to be afflicted by bubonic plague in 1347. He wrote this terrifying description of how it afflicted a sufferer. He wrote: “Not only did the burned blisters appear, but there developed in different parts of the body gland boils; in some on the sexual organs. In others” — whoops, sorry, there we go — “In others on the arms or the neck. At first these were the size of a hazelnut and developed accompanied by violent shivering fits that soon rendered those attacked so weak they could no longer stand upright, but were forced to lie in their beds, consumed by violent fever and overcome by great tribulation. Soon the boils grew to the size of a walnut, then a hen’s egg, and they were exceedingly painful and irritated the body, causing it to vomit blood by vitiating the juices. The blood rose from the affected lungs to the throat, producing on the whole body a putrefying and decomposing effect. The sickness lasted three days, and on the fourth, at the latest, the patient succumbed.”

So, as soon as anyone was seized with headache and shivering, he knew that he was bound to pass away within the specified time, and first confessed his sins to the priest, and then made his will. Death occurred in about half of cases within a few days, though some of the afflicted lingered in agony for as long as three to four weeks, and then a minority slowly recovered.

The symptoms of bubonic plague are agonizing. They’re terrifying, dehumanizing, as suffers succumb to hallucinations and delirium. Now, there are three forms of bubonic plague, and I want to mention what those are immediately. These are not three separate diseases. They’re one disease in three separate manifestations. The first is what we’ve been describing as classic bubonic plague, the most common and historically most important form. Then there’s septicemic plague, which is an overwhelming infection in which the patient frequently dies, even before developing a bubo. But this, as I said, is not a separate disease; simply a fulminant form of plague; and it’s most common among the elderly.

Then there’s pneumonic plague, which again is the same disease, but clinically and epidemiologically distinct. It begins with an ordinary case of plague, complicated by pneumonia, and can then give rise to a secondary catastrophe, within the general disaster; that is, the disease is then spread by bacteria coughed out in the sputum of the victim and spread person to person when inhaled by those near him or her. This form of plague is not dependent on fleas. It’s highly infectious, and as far as is known is one hundred percent fatal. And even today, in the antibiotic era, there’s no cure for pneumonic plague. And pneumonic plague is also recorded in your favorite nursery rhyme. This is the, “ah-choo, ah-choo, we all fall down.”

Now, what did doctors do? What were treatments historically? There was a continuity of strategy from the Black Death, through the eighteenth century, based on Galenic principles of dealing with the a disequilibrium of the humors. So, the main indication of treatment was to assist the body in expelling what was called the peccant humor responsible, or the morbific poison. The physician regarded his task as one of assisting Nature, as the body was already clearly attempting to expel the poison. After all, it was vomiting, there was diarrhea and sweating. So, physicians attempted to assist the body in its fight; perhaps directly by bleeding, a very popular therapy, although there were intense debates about timing, about the best veins to be opened, and the amount of blood to be drawn.

Other key practices were administering powerful purgatives or emetics, so the poison could pour forth more copiously; or to cause the patient to sweat, piling him or her high with clothes, even mattresses, so the poison would pass out through the pores; and forbidding the sufferer to drink; and of course lancing or cauterizing the bubo itself, so that it too could discharge its load of poison directly. Some doctors applied hot compresses. There were also internal medicines that were administered, as they were thought to raise the buboes, or to hasten recovery by fortifying what was called the flagging animal energy of the victim; things like brandy or opium. But in practice, treatment was pitifully rare for plague sufferers.

Physicians, priests and attendants recognized that they were powerless; that they were too few in number to cope with the catastrophe that engulfed them. And they perished too in great numbers during the outbreaks. And many, overcome with terror like everyone else, simply fled. So, one of the terrors of the plague was that it broke the common bonds of humanity, and the common plight of plague victims was often to be abandoned, to face agony and death alone. Let’s listen to the famous and awful testimony of Boccaccio in The Decameron, describing Florence. Sorry for a momentary technological glitch, but we’ll get there. There we are.

This is Boccaccio describing Florence in 1348. “Let us omit that one Citizen fled after another, and one neighbor had not any care of another, Parents nor kindred ever visiting them, but utterly they were forsaken on all sides: this tribulation pierced into the hearts of men, and with such a dreadful terror, that one brother forsook another, the Uncle, the Nephew, the Sister, the Brother, and the Wife the Husband: nay a matter much greater, and almost incredible; Fathers and Mothers fled from their own Children, even as if they no way appertained to them. In regard whereof, it could not be otherwise, but that a countless multitude of men and women fell sick; finding no charity among their friends, except a very few, and were subject to the avarice of servants.”

So, this is our first overview of plague in its three pandemics. Next time what I’d like to do is to talk about the response of communities to this catastrophe, and to look in particular at public health measures designed to protect communities. That’s where we’re heading next.

[end of transcript]

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