Symptoms and Type of the Black Death.
This sweeping pestilence was part of a great wave of infection which passed over Europe from the remote East, and of which we shall trace the antecedents in the latter part of this chapter. The type and symptoms of the disease are sufficiently well-known from foreign descriptions—by Guy de Chauliac and Raymond de Chalin, both of Avignon, by Boccaccio, and by the Villani of Florence. It was the bubo-plague, a disease which is known to have existed in Egypt in the time of the Ptolemies, and made its first great incursion from that country into Europe in the reign of Justinian in the year 543 (see Chapter I.). Its second great invasion, but from a new direction, was the Black Death of 1347-9; and from that time it remained domesticated in the soil of Europe for more than three hundred years as “the plague.” The first medical descriptions of it by native British writers are comparatively late. Manuscript treatises or “ordinances” on the plague circulated in England from the reign of Richard II., most of them being copies of a short work of no great value by one John of Burgoyne or John of Bordeaux. There is also extant an English translation in manuscript, assigned to the 14th century (but belonging to the end of it, if not to the 15th), of a really good work on the plague by the bishop of Aarhus, in Denmark, of which I shall have more to say in the next chapter. But none of these give English experience; and the earliest of our 16th century plague-books, by Phaer, is a compilation mostly, if not entirely, from the Danish bishop’s treatise, the latter having been printed in its English form in or near 1480. It is not until we come to the work of Dr Gilbert Skene of Edinburgh, printed in 1568, that we find a treatise on plague showing traces of first-hand observation and reflection. Then follow the essay of Simon Kellwaye on the London plague of 1593, and that of the well-known Elizabethan poet and physician Thomas Lodge, on the plague of 1603. Thus the reign of the plague in Britain was approaching an end before the native medical profession began to write upon it. Its eventful history from its arrival in 1348 down to a comparatively late period has to be constructed from other materials than the records or systematic writings of the faculty.
The type of the Black Death in England is sufficiently indicated by Le Baker, who was probably living at Osney, near Oxford, when the infection began, and indubitably by friar Clyn of Kilkenny. Le Baker mentions the apostemata or swellings in diverse parts, their sudden eruption, and their extreme hardness and dryness, so that hardly any fluid escaped when they were lanced according to the usual method of treating them[225]. He speaks also of a peculiarly fatal form, from which few or none recovered; it was characterised by “small black pustules” on the skin, probably the livid spots or “tokens” which came to be considered the peculiar mark of the plague, and were certainly the index of a malignant type of it, just as the corresponding haemorrhages are in pestilential fever (or typhus) and in yellow fever. The disease, he adds, was swift in doing its work: one day people were in high health and the next day dead and buried. Knighton also says, with special reference to Bristol, that the attack was fatal sometimes within twelve hours, and usually within three days at the most. The treatment, which would have been, according to all subsequent experience, the privilege only of those who could pay for it, would appear to have consisted in lancing the risings or botches in the armpits, neck, or groins; these were the lymph-glands enlarged to the size of a walnut or of a hen’s egg, and of a livid colour,—the most striking and certain of all the plague-signs.
Clyn’s account of the disease, as he saw it at Kilkenny in 1349, is important for including one remarkable symptom on which great importance has been laid as distinctive of the Black Death among the epidemics of bubo-plague, namely haemorrhage from the lungs: “For many died from carbuncles, and boils, and botches which grew on the legs and under the arms; others from passion of the head, as if thrown into a frenzy; others by vomiting blood[226].” It was so contagious, he says, that those who touched the dead, or even the sick, were incontinently infected that they died, and both penitent and confessor were borne together to the same grave. Such was the fear and horror of it that men scarce dared exercise the offices of pity, namely, to visit the sick and bury the dead. Clyn’s list of symptoms includes all the most prominent features of the plague as we shall find them described for the great epidemics of the Stuart period—the botches in the armpits or groins, the carbuncles, the boils (or blains), and the frenzy or delirium, as well as the special symptom of the great mortality—vomiting of blood.
Of the botch, which was the most striking sign of the plague, the following description, by Woodall (1639), may be introduced here, to supplement the more meagre accounts of the bubo-plague on its first appearance. Woodall had himself suffered from the bubo or botch on two occasions, in its comparatively safe suppurating form; his description relates to the hard, tense, and dry botch, especially mentioned by Le Baker for 1349, and always the index of great malignity:
“But the pestilential bubo or boyle commeth ever furiously on, and as in a rage of a Feaver, and as being in haste; sometimes it lighteth on or near the inguen thwart, but more often lower upon the thigh, pointing downward with one end, the upper end towards the belly being commonly the biggest or the fullest part of the bubo, the whole thigh being also inflamed[227].”
Of this disease, says Le Baker, few of the first rank died, but of the common people an incalculable number, and of the clergy and the cleric class a multitude known to God only. It was mostly the young and strong who were cut off, the aged and weakly being commonly spared. No one dared come near the sick, and the bodies of the dead were shunned. Both Le Baker and Knighton speak of whole villages and hamlets left desolate, and of numbers of houses, both great and small, left empty and falling to ruin. It was not merely one in a house that died, says friar Clyn of Kilkenny, but commonly husband, wife, children and domestics all went the same way of death; the friar himself wrote as one inter mortuos mortem expectans. Without naming the locality, Avesbury says that in a single day, twenty, forty, sixty or more corpses were buried in the same trench[228]. The stereotyped phrase in the monastic chronicles is that not more than a tenth part of the people were left alive. However, the author of the Eulogium, a monk of Malmesbury who brought his history down to 1366, gives a numerical estimate at the other extreme. He says that the plague entered England at Melcumbe, destroyed innumerable people in Dorset, Devon and Somerset, and, having left few alive in Bristol, proceeded northwards, leaving no city, nor town, nor hamlet, nor scarcely a house, in which it did not cut off the greater part of the people, or the whole of them; but he adds, somewhat inconsequently, “so that a fifth part of the men, women and children in all England were consigned to the grave[229].” These are the vague contemporary estimates of the mortality—ranging from nine-tenths to one-fifth of the whole population. It is possible, however, to come much nearer to precision by the systematic use of documents; and in that exercise we shall now proceed, in an order from the more general to the more particular.