After the plague of the Antonines we come to the great plague of Justinian and here at last we have the evidence of an exact historian who did not run and could state what he saw in language that we can understand. Gibbon says hesitantly that Procopius was a doctor, though probably in truth he was a lawyer. Possibly he was too much afraid of the naughty little Empress Theodora, whom he was afterwards to slander, to forsake the path of duty and run away when the world seemed dying; but at any rate he has left us a remarkable account of the plague of 542, one of the most terrible recorded visitations of epidemic disease; and after reading Gibbon’s somewhat excitable account of it I think that few doctors will deny that it was real old bubonic plague that has so often made history. Justinian suffered from it and recovered; we do not know enough about the exact circumstances to estimate its exact effects upon the world; but we can be pretty certain that the bacillus pestis did not lay waste the Byzantine Empire for nothing. Gibbon estimates the total loss of life at a hundred millions; but one doubts if the population of the Roman Empire, even in its palmiest days, was ever much larger, and surely the plague could not have swept off everybody in the known world, though we do know that, if it really breaks loose in flea-bitten surroundings, plague can do an infinity of mischief, probably more than any other known disease.
We leave the dead old world that shook at Cæsar’s nod, and leap in one moment to the very beginnings of the modern world, to the Black Death of 1348; for, though the Middle Ages were still to drag their slow length along for at least a century, there can be little doubt that after the Black Death had terrified mankind all our modern problems were beginning, if only in embryo. The original source of it seems to have been China, and the epidemic proceeded with most leisurely footsteps until it took ship for Europe. Dr. Hecker[20] in 1833 wrote an exhaustive account of it from mediæval records; but since 1833 the cell-theory of Schleiden and Schwann has revolutionised medicine, and even Dr. Hecker has to be translated into modern terminology; so rapidly has medicine changed that a book written ten years ago is already obsolete. Indeed, it is not too much to say that more has been discovered in medicine within the last thirty years than in the whole previous half-million years during which man has been upon the earth; one sometimes becomes terrified at the amazing growth of knowledge. Whither is it all leading us? Are we becoming as gods? Vespasian joked about himself when he was dying; let us not really grow “pumpkinified,” to use Seneca’s words about Claudius, when we think ourselves becoming deified.
The Black Death seems to have come to Europe from Africa by ship in 1348. The harbingers of the epidemic began in 1347 with earthquakes and floods in China and Egypt; in far-away China the earth opened and swallowed men. Frightful portents appeared in the sky (of course I am simply quoting this nonsense from Hecker and his mediævalists) and the seasons changed, summer becoming winter. At that time, according to Hecker, the sheet of ice was formed which has since prevented men from looking upon the coast of Greenland; there were unequalled rains and the floodgates of heaven were opened in a more than Noachian deluge. Vast swarms of locusts appeared and died; and the want of the crops which they had devoured thrust man, whose hold upon the earth is always so feeble, to the edge of that slight precipice which generally protects him from the Valley of Starvation. The earth opened, and into the crevasses men fell, never to be seen again; from the crevasses arose a horrid stench. Into this world, even more starved and terrified by the adventure of living than was common in the Middle Ages, the rat and the bacillus pestis made their death-dealing plunge. The epidemic which they brought seems to have been carried from the sultry delta of the Nile by ship to Greece and Italy; four fugitives—and unknown numbers of rats and fleas—fled to find safety in Marseilles, carrying their own destruction with them. Thence the plague went to Avignon, at that time the residence of the pope; and ultimately to England where it landed in the southwest counties, taking half a year to crawl to London. As acutely noted by Procopius, plague always spreads inland from the shores of the sea, and we now know that it spreads just so fast as the rat can run and no faster. In 1348 they knew nothing about rats and bacteria, but attributed everything to bad air or evil spirits; and they noted that there was a continuance of southerly winds, which of course in Greece and Italy are hot winds and may possibly have spread the plague by bringing the ships and their contained rats. In Germany they had some story about a dense pestiferous fog which smelt abominably and so was obviously the cause of the Black Death. It is difficult to say how much truth there was in these stories of fog, though they are too numerous and too well attested to be utterly ignored; they have naturally been seized upon by historical novelists in search of the dramatic and anxious to show that in 1348 everything was different from things as they are to-day. Possibly they accounted for the preponderance of pneumonic plague.
John Cantacuzenos, Byzantine emperor, whose own son died of it, left a description that entirely fits in with our modern knowledge of plague, buboes, black spots and all, though there is a certain resemblance to Thucydides which makes one rather believe that he was adding to his narrative for dramatic effect. Strangely modern is his description of the dull stupor that affects so many plague patients to-day. We all noticed it in the slight epidemic that affected Sydney some years ago. Then again John specially stated that some patients were attacked by a violent pain in the chest, with difficulty of breathing and a putrid expectoration. This looks uncommonly like the pneumonic type of plague which proved so destructive in Manchuria in 1910.
But the most interesting feature of the Black Death was its attack upon Avignon, where Guy de Chauliac was physician to the pope. It lasted eight months, with the usual concomitants of numbers of dead so huge that the living could not bury them. As trench after trench became filled, no matter how hard the living worked, the pope blessed the Rhone and had the bodies hurled into that rushing stream, doubtless to the joy of the rats. Guy himself showed the courage that one expects in a modern doctor, and has left us a perfectly recognisable description, which is commented upon by both Dr. Hecker and Dr. Crawfurd. It is in Guy himself that our interest dwells; for at last Medicine had found its soul. His colleagues, being trained in Arabian medicine, all told him that the plague was inevitably fatal, that medicine could do nothing, and that he was only courting destruction by staying to comfort those whom he knew that he could not save. Guy himself had a theory that strong purgation would cure the disease, though he knew that the only real safety was in flight. He stayed; though whether he was prevented from running by the medicines that he prescribed or by sheer courage no one can say. His own words were “As for me I did not dare absent myself, though I was in constant fear.” To be feared of a thing and yet to do it—that is what makes the prettiest kind of a man; and to be afraid only of his own conscience makes a man a hero. Guy was afraid of his own conscience, not of the plague, and therefore he has become one of the heroes of medicine. No doubt he donned his quaint mediæval anti-infection costume with its beaky vizor, and went from door to door trying to bring a little hope to the gloomy death-beds of the frightened people; no doubt he had himself to clean up the mess caused by his treatment, which must have been calamitous. But he lives in the memory of his colleagues, for we are all proud to belong to the profession of that simple-minded doctor of Provence, and try to act like him though with less messy treatment. He was a brave man.
The epidemic endured at Avignon for eight months, and Guy tells us that for the first three it took the form, in our terminology, of pneumonic plague and was intensely infectious, but for the other five it seems to have been the ordinary bubonic that was so fatal in London in 1665. Guy remained in Avignon for the Black Death, and faced its return twelve years later. In the first visitation the poor suffered, but in the second the rich; but, rich or poor, Guy remained at his post with his ample store of aloes to win the love of the dying whom he could not save. We know now some results of crude aloes which are not very pleasant, and I wonder whether Master Guy de Chauliac ever noticed them, or whether his patients ever came running to him to cure them of the effects of his aloes.
To sum up, it is probable that the series of epidemics that we call the Black Death were all different varieties of the plague; bubonic, pneumonic, septicæmic, hæmorrhagic, etc. The sentimental and journalistic Nordic nations, such as the English and Germans, muttered the horrified name “Black Death,” afraid to give the thing a name, just as to-day they talk about the “Red Plague” or “a certain loathsome disease” when they mean to say syphilis; but the more clear-sighted and logical Mediterranean peoples knew that the thing certainly killed them, though they did not know what it was, so they simply called it La Grande Mortelaga—the Great Mortality, which it assuredly was. We prosaic moderns simply call it the plague, whose dread name even to-day makes us shudder. We do not fear it, because we know exactly how it is spread, and that, to use Osler’s epigrammatic words, all that one needs to defeat an epidemic of plague is a stout heart and a long purse. During the fourteenth century men’s hearts, being very ignorant, were not very stout, and their purses were atrociously short. It would hardly be too much to say that during the Middle Ages, and up till about 1700, the greatest cause of death in cities was the plague. After 1700 people slowly began to become rich, and to build better houses which would keep the rat at a distance, so that man conquered the plague without knowing how he had done it. But the conditions in the Middle Ages must have been frightful. Listen to the words of Dr. Abram in English Life and Manners in the Later Middle Ages about the overcrowding, which would put even Glasgow to shame. He is referring to the Miller of Trumpington in Chaucer’s Reve’s Tale; and the miller cannot have been a very poor man; he was prosperous and on edge for his dignity. But in his house there was only one bedroom, where slept he himself, his wife, his baby, his grown-up daughter, and two undergraduates from Cambridge all at once.
No wonder the rats and fleas were rampant and the plague swept over the land. And as for the personal cleanliness of these crowded peoples, there was none.[21] If I wished to use another jargon than medical I would say it was a minus quantity, but personally I prefer the medical, because that means something and is exact.
The Black Death revived that strange and mournful sect of the flagellants, the Brotherhood of the Cross. The spirit of man, which is capable of such wonders, must needs bow before that shadow of itself which it has projected into the infinite, and ask pardon of its anthropomorphic fourteenth-century God for the fancied sins which had brought these horrors upon the world. The quaint figures of the flagellants wandered, cross on breast, in doleful procession all over Europe, chanting dolorous hymns of misery that bore the seeds of rebellion against that very God whom they affected to supplicate. They would reach a church, lie down in circles, strip off their clothing and flog each other with scourges of nails. People crowded to watch the blood flow, while doubtless the rats and fleas rejoiced if rejoicing be possible to beings so lowly. In these flagellants probably lay the real seeds of the Reformation which was to come. They sometimes seized upon a church and rebelliously conducted Mass without an authorised priest, although the pope, Clement VI, who was a brave man and faced the plague like a hero, had given absolution in advance to every patient who should be taken sick. Man wanted his own priest, and sometimes when he sent in his last extremity his priest would not come, or was dead of the plague, so that when the epidemic had abated, and the world was struggling to recover itself and reap the neglected harvests, men were only too ready to believe the stories about the priests and their women which were even then paving the way for the Reformation. The Statute of Labourers, in England, was the herald of many of our modern political ideas. Those unhappy men who died, stupefied by plague, were really dying for humanity.
We cannot make an accurate guess even at the actual number of people lost during the Great Mortality. Hecker, after taking the utmost trouble, thought that at least a fourth of the people of Europe perished, but in some places far more; thus in Avignon, of which we have the most exact information, about nine-tenths. This vast mortality in Avignon was not caused by de Chauliac and his aloes, any more than it was due to Pope Clement and his blessing. Probably de Chauliac’s treatment had no influence one way or the other; neither did the question of pope and anti-pope nor the great schism. But we know more about what happened at Avignon than anywhere else, because de Chauliac was a brave doctor who told the truth.