Medical Evidence of the Continuance of Plague.
The plague was called “the botch” down to the Elizabethan and Stuart periods; and the “botches” in Langland’s poem, or, as he writes it, “boches,” were the familiar risings, under the arms and elsewhere, which had given the disease its popular name when it began to recur time after time. Apart from this verbal or philological evidence, there is a clear proof of the prevalence of true bubo-plague during the latter part of the fourteenth century, in the manuscript ordinances or rules of prevention and treatment which were in circulation. Most of the extant copies bear the name of one John of Burgoyne, or John of Bordeaux[394]. A fragment in comparatively late handwriting purports to be the ordinance of “a great Clark, Mr John Cordewe, at the prayer of King Richard and other the Lords, for pestilence[395]”; from which it may be concluded that this, the commonly used ordinance, dates from the time of Richard II. The names used in the text are “pestilence” and “pestilential sores,” and the handling of the subject is the conventional one for the plague. The ordinance contains exceedingly little that is of practical interest, and it is difficult to believe that it can have been of real use to anyone. We are introduced to the subject with a few empty common-places; but whenever we come to business, we are plainly told to go and consult those who know—and this, be it observed, in a disease which was remarkably uniform in its type and circumstances:
“Wherefore they that have not dronken of that swete drynke of Astronomye may putte to these pestilentiall sores no fit remedies; for, because that they know not the cause and the quality of the sickness, they may not hele it, as sayeth the prince of physic Avicenna: ‘How shouldest thou hele a sore and yknowe not the cause?’ He that knoweth not the cause, it is impossible that he hele the sickness.”
If there were any doubt about the date of John of Burgoyne, or John of Bordeaux[396], it ought to be set at rest by the discovery that he corresponds in the closest way with the physician in the Prologue of the Canterbury Tales. Chaucer’s doctor of physic stands for the well-grounded practitioner of the time—“grounded in astronomie,” it is true, but at all events academically grounded, in contrast to the charlatans and pretenders who had not been to Paris or Bologna, probably knew no Latin, to say nothing of “astronomy,” and therefore knew not how to let a patient die (or recover) secundum artem. The doctor of physic uses his astrological knowledge so much in the manner of John of Bordeaux, that one suspects Chaucer to have seen the passage quoted above, and to have condensed it into the two following lines:
“The cause yknowne, and of his harm the rote,
Anon he gave to the sick man his bote.”
It was in the pestilence that this practitioner had made the money which he kept so tightly. Richly clad he was;
“And yet he was but easy of dispense;
He kept that he wan in the pestilence.
For gold in physic is a cordial:
Therefore he loved gold in special.”
This is John of Burgoyne all over; it would have been an anachronism in England by more than two hundred years to have represented a physician as caring for any but paying patients, or as regarding an epidemic sickness from any other point of view than as a source of income.
Besides the “ordinance” of John of Burgoyne, which may be assigned to the reign of Richard II., there was another essay on the plague circulating in England in an English translation, of which the copy among the Sloane manuscripts is assigned to the fourteenth century[397]. The importance attached to this manuscript work is shown in the fact that it was chosen among the very first to be printed at an English press, probably in the year 1480[398]. It was reprinted in 1536, and the substance of it was copied into nearly all the English books on plague (from one to another) as late as the seventeenth century, much of its original matter passing under the name of one Phaer, or Phayre or Thayre, who was a compiler about the middle of the sixteenth century. Writers on early English printing have made much of the printed book of 1480; but they do not appear to have known of the manuscript which was used as the printer’s “copy[399].” If one happens to use the latter first, and comes later to the printed book, he will observe the identity not merely in the words and spelling but even in the very form in which the type had been cut. The authorship of a manuscript which is thus invested with a various interest may deserve a few lines of inquiry.
The author of it describes himself in the (translated) introduction as “I the bisshop of Arusiens, Doctour of phisike,” that is to say, bishop of Aarhus, in Denmark. In the text, he claims to have practised physic at Montpellier:
“In the Mount of Pessulane I might not eschewe the company of people, for I went from house to house, because of my poverty, to cure sick folk. Therefore bread or a sponge sopped in vinegar I took with me, holding it to my mouth and nose, because all aigre things stoppen the ways of humours and suffereth no venomous thing to enter into a man’s body; and so I escaped the pestilence, my fellows supposing that I should not live. These foresaid things I have proved by myself[400].”
The fact that this medieval treatise, whatever its exact date, was turned into English and circulated in manuscript, and that it was chosen for printing almost as soon as English printing began, in the reign of Edward IV., is sufficient evidence, if more were needed, that the English had to reckon with bubo-plague as one of their standing diseases throughout the latter part of the medieval period. Before we come to the chronology of English plagues in that period, from the Black Death to the accession of the Tudor dynasty in 1485, it will be convenient to consider here, with the help of the above treatise, how the endemic plague was viewed in those days,—what it was ascribed to in its origin, in its incidence upon houses and persons, and in its propagation, what was advised for its avoidance or prevention, and what was prescribed for its treatment. As the bishop’s essay was the source of most that was taught on these matters in England for the next two or three hundred years, it will be an economy to give a brief account of it here once for all.
The remote causes, or warnings of the approach of pestilence, are given under seven heads, including the kind of weather, swarms of flies, shooting stars, comets, thunder and lightning out of the south, and winds out of the south; this list was reproduced, with little or no change, by the Elizabethan writers of popular health-manuals. The second section of the essay is on the “causes of pestilence.” There are three causes:—
“Sometime it cometh from the root beneath; other while from the root above, so that we may feel sensibly howwith change of the air appeareth unto us; and sometime it cometh of both together, as well from the root above as from the root beneath, as we see a siege or privy next to a chamber, or of any other particular thing which corrupteth the air in his substance and quality, which is a thing may happen every day. And thereof cometh the ague of pestilence (and about the same many physicians be deceived, not supposing this ague to be a pestilence). Sometimes it cometh of dead carrion, or corruption of standing waters in ditches or sloughs and other corrupt places. These things sometime be universal, sometime particular.” Then follow sentences on the “root above” which are somewhat transcendental. When both “roots” work together, when, by “th’ ynp‘ffyons[401]” above, the air is corrupt and by the putrefaction or rotten carrion of the vile places beneath,—an infirmity is caused in man. “And such infirmity sometimes is an ague, sometimes a posthume or a swelling, and that is in many things. Also the air inspired sometimes is venomous and corrupt, hurting the heart, that nature many ways is grieved, so that he perceiveth not his harm....
“These things written before are the causes of pestilence. But about these things, two questions be mooted. The first is, wherefore one dieth and another dieth not, in a town where men be dead in one house and in another house there dieth none. The second question is, whether pestilence sores be contagious.
“To the first question, I say it may hap to be of two causes: that is to say, of that thing that doth, and of that thing that suffereth. An ensample of that thing that doth: The influence of the bodies above beholdeth that place or that place, more than this place or this place. And one patient is more disposed to die than another. Therefore it is to be noted that bodies be more hot disposed, of open pores, than bodies infect having the pores stopped with many humours. Where bodies be of resolution or opening, as men which abusen them selfe with wymmen, or usen often times bathis; or men that be hot with labour or great anger—they have their bodies more disposed to this great sickness.
“To the second question I say, that pestilence sores be contagious by cause of infect humoures bodies, and the reek or smoke of such sores is venomous and corrupteth the air. And therefore it is to flee from such persons as be infect. In pestilence time nobody should stand in great press of people, because some man of them may be infect. Therefore wise physicians, in visiting sick folk, stand far from the patient, holding their face toward the door or window. And so should the servants of sick folk stand. Also it is good to a patient every day for to change his chamber, and often times to have the windows open against the North and East, and to spar the windows against the South. For the south wind hath two causes of putrefaction. The first is, it maketh a man, being whole or sick, feeble in their bodies. The second cause is, as it is written in the Third of Aphorisms, the south wind grieveth the hearing and hurteth the heart, because it openeth the pores of man and entereth into the heart. Wherefore it is good to an whole man in time of pestilence, when the wind is in the South, to keep within the house all the day. And if it shall need a man to go out, yet let him abide in his house till the sun be up in the East passing southward.”
These explanations of the incidence of plague are in part repeated in the section of the essay where the author gives directions for avoiding it. After enjoining penance, he proceeds:
“It is a good remedy to void and change the infect place. But some may not profitably change their places. Therefore as much as to them is possible, it is to be eschewed every cause of putrefaction and stinking, and namely every fleshly lust with women is to be eschewed. Also the southern wind, which wind is naturally infective: therefore spar the windows, etc. Of the same cause, every foul stink is to be eschewed—of stable, stinking fields, ways, or streets, and namely of stinking dead carrion; and most of stinking waters, where in many places water is kept two days or two nights, or else there be gutters of water casten under the earth which caused great stink and corruption. And of this cause some die in that house where such things happen, and in another house die none, as it is said afore. Likewise in that place where the worts and coles putrefied, it maketh noifull savour and stinking. For in like wise as by the sweet odour of bawme the heart and spirits have recreation, so of evil savours they be made feeble. Therefore keep your house that an infect air enter not in. For an infect air most causeth putrefaction in places and houses where folk sleep. Therefore let your house be clean, and make clear fire of wood flaming: let your house be made with fumigation of herbs, that is to say, with leaves of bay-tree, juniper, yberiorgam—it is in the apothecary shops—wormwood etc.... For a little crust corrupteth all the body.
“Also in the time of the pestilence it is better to abide within the house; for it is not wholesome to go into the city or town. Also let your house be sprinkled, specially in summer, with vinegar and roses, and with the leaves of vine tree. Also it is good to wash your hands ofttimes in the day with water and vinegar, and wipe your face with your hands, and smell to them. Also it is good always to savour aigre things.”
Then follows his own Montpellier experience, already quoted.
The diagnostics come in casually along with the treatment:
“But some would understand how may a man feel when he is infect. I say that a man which is infect, that day eateth not much meat for he is replenished with evil humours; and forthwith after dinner he hath lust to sleep, and feeleth great heat under cold. Also he hath great pain in the forehead.... He shall feel a swelling under the arm, or about the share, or about the ears.... When a man feeleth himself infect, as soon as he may, let him be let blood plenteously till he swoon: then stop the vein. For a little letting of blood moveth or stirreth venom.”
Then follow directions for bleeding, according to the position of the bubo—in the armpit, groin or neck, the direction “if on the back” probably having reference to the carbuncle[402]. The section on treatment, which is the last, ends with a prescription for a medicine “that the sooner a swelling be made ripe.”
These are sufficiently clear indications of the bubonic nature of the disease called pestilence. At the same time the writer includes an ague as also pestilential, due to similar causes and arising on similar occasions. This is a use of the name ague which should not be mistaken for its common application to intermittent fever. Ague was simply (febris) acuta; and pestilential ague was a name for typhus fever in the sixteenth century (as in Jones’ Dyall of Agues), as well as in Ireland until a much later period. This early association of acute pestilential fever with true bubo-plague means the same relationship of typhus to plague which was systematically taught by Sydenham, Willis, and Morton in the seventeenth century; typhus in their time was the frequent attendant of plague,—a pestis mitior; and it would appear to have been its attendant and congener in the fourteenth century also.