The Epidemics of the Middle Ages

by J. F. C. Hecker; John Caius

It is evident that in such a condition of affairs, the effect which the plague produced on civil society must have been different from that of former times. Pernicious influences which, during the middle ages, had endangered the health of the inhabitants of towns, and had often rendered disorders, naturally slight, in the highest degree malignant, were for ever removed. Under this head may be mentioned more particularly the ill-contrived construction of the houses and streets, which even yet, in large cities, destroys the comfort of the inhabitants of whole districts, and those not of the poorest class only. As people acquired confidence in the security of peace, it ceased to be necessary to protect every country town by fortifications. The walls were thrown down, the stagnant moats were filled up, and as people were no longer limited to a narrow space, they built more convenient houses in airy streets; the dark alleys and damp dwellings under ground were gradually abandoned, and a more comfortable mode of living superseded the former misery. By this means the mortality was considerably diminished, and the power of epidemics was checked; nor can it be doubted, that the better administration of the laws greatly obviated the dissolution of social ties in times of plague, and the effects of superstition and religious animosity, which had formerly been so frightful. These inestimable national improvements, however, took place but gradually, and were not a little retarded for a time by the new evil of the employment of mercenaries. For as the germs of vice were scattered in all directions by the wandering Lansquenets, so also the infection of noxious diseases found easier entrance into the towns and villages through the medium of this dissolute and widely spread class of men. The Lansquenets of the sixteenth century, as spreaders of contagion, supplied the place of the former Romish pilgrims and flagellants; they even proved a more permanent scourge than those wanderers of the middle ages, who only made their appearance on extraordinary occasions. We need here only call to mind the malignant and beyond measure noisome lues which at the end of the fifteenth century spread with the rapidity of lightning over all Europe. It was not an importation from the innocent inhabitants of the New World, nor was it bred by the ill-treated Marrani[59], the victims of the Spanish Inquisition. It was the mercenary army of Charles the VIIIth in Naples (1495), whose excesses gave to the already existing poison a malignity till then unknown, and prepared for the deeply rooted depravity, a scourge at which all the world shuddered with horror. It is, moreover, in place here to observe that, in the larger armies which the new military system now brought into the field, the ordinary camp diseases, to which another very fatal one was added[60], were of course much more extensively propagated than in the less numerous forces of preceding centuries, and consequently that the peaceful inhabitants of the towns and of the country at large were thereby exposed to much danger.

Sect. 3.—Sweating Sickness.

Meantime Europe was frequently and very severely visited by the epidemics of the middle ages, the terrors of the constantly recurring plague being borne with gloomy resignation to the inevitable evil with which, as a merited chastisement, the anger of God, according to the notion of the times, afflicted the human race. Even the English were not exempt from this fearful visitation, which, in the year 1499, carried off 30,000 people in London alone, so that the king found it advisable to retire with all his court to Calais[61]. Thus the recollection of the Sweating Sickness of 1485 was gradually obliterated. No one thought of its possible return, and all the world was occupied with other matters, when the old enemy unexpectedly again raised his head in the summer of 1506, and scared away this comfortable state of false security. The renewed eruption of the epidemic was not, on this occasion, connected with any important occurrence, so that contemporaries have not even mentioned the month in which it began to rage. Towards the autumn it had again disappeared, and as no new symptoms were added to the disease, the form of which was identified by a reference to the old descriptions, it was immediately treated by the same means, the efficacy of which those who had witnessed the epidemic of 1485 lauded with so much reason[62]. Every exposure to heat or cold was, as at that time, avoided, and the malignant fever was left to the curative powers of nature, the patient being kept moderately warm in bed; and no powerful medicines being administered. The result was beyond all expectation favourable, for in few houses did any fatal cases occur. The victory over this dreaded enemy was now, by a pardonable error, attributed more to human skill than to the mildness of the malady on this occasion, which, even under a less judicious treatment of the sick, would certainly not have been marked by any considerable degree of severity.

The disease broke out in London, but whether it penetrated to the west or not, contemporary writers, being soon convinced of its slight character, have left us no intelligence. However widely it may have spread, it certainly was confined to England, and nowhere occasioned any great mortality.

Sect. 4.—Accompanying Phenomena.

As the epidemic was on this occasion so very mild, it was not accompanied by any remarkable phenomena in England, but the case was otherwise in the rest of Europe, as will be proved by the following details. After a wet summer, in the year 1505, a severe winter set in[63]. Comets were seen in this as in the following year. An eruption of Vesuvius also took place in 1506[64], which may be mentioned, although it is well established that volcanic commotions are to be taken into account only in great pestilences, not in less extensive epidemics. In England there blew a violent storm from the south-west, from the 15th till the 26th of January, 1506, which drove the king of Castille, Philip of Austria, with his consort Johanna, from the Netherlands to Weymouth; and as, some days before, a golden eagle falling from St. Paul’s church, in London, had crushed a black eagle which ornamented some lower building, evil predictions were promulgated among the people respecting the fate of this son of the emperor[65]. This event, however, could not be considered as at all connected with the pestilence which broke out about half a year afterwards. More consideration is due to the gloom and anxiety which at that time depressed the spirit of the English nation. The reckless avarice of Henry the VIIth, named the English Solomon[66], gave just ground for doubts regarding the security of property; and the pious foundations—those accustomed means of softening the dreaded wrath of heaven, which the king, who became gradually more and more broken down by disease, established, could not efface the recollection of the arbitrary violence and extortions of his corrupt servants[67]. Although these extortions principally affected the wealthy nobility, who were much in need of restraint, yet dark mistrust was general, and all cheerfulness was banished from the minds of the people. This state of feeling might have been favourable to the propagation of the returning disease, but the genius of the year 1506 would not suffer it to be more than a slight and transient reminiscence of a mystically hidden danger, the import of which was not apparent to any medical inquirer of the 16th century.

Sect. 5.—Petechial Fever in Italy, 1505.

Thus, if we paid attention, as usual, only to the palpable occurrences which take place on the earth and beneath its surface, the Sweating Sickness of the above-mentioned year might appear to be unconnected with more considerable commotions of organic life. The powers of nature, however, are in their operations too subtle to be comprehended by our dull senses and by the coarse mechanism of our organs; nay, precisely at a time when neither the one nor the other indicate any alteration around us, those operations bring to light the most extraordinary phenomena in the human frame—that most sensitive index of secret influences on life. This observation was fully confirmed at the time of the first return of the sweating fever. For whilst this disease remained confined to England, there appeared in the southern and central parts of Europe a new and fatal epidemic, which thenceforth visited these nations almost continually with intense malignity. This was the petechial fever, a disease unknown to the older physicians, which was first observed in 1490, in Granada, where it threatened to annihilate the army of Ferdinand the Catholic, and made great havoc also among the Saracens[68]. The bubo plague had immediately preceded it, (1483, 1485, 1486, 1488, 1489, and 1490[69],) and it may with no small probability be assumed that the petechial fever had resulted from this as a peculiar variety, since in other countries also, fifteen years later, the bubo plague degenerated in various ways, and examples are not wanting in which particular forms or constituent parts of great epidemics thus branch off from them, in the same manner as, under favourable circumstances, these will combine together, and united into one destructive whole, multiply the sources of danger.

Yet some contemporaries were of opinion that the petechial fever had been brought over to Granada[70] by Venetian mercenaries from Cyprus, where they had fought against the Turks, and where this disorder was said to have been indigenous. Notwithstanding some good works[71] already existing, this matter has need of a more thorough examination, which might bring to light important and instructive results, respecting the rise and spread of the petechial fever, and especially respecting its relation to other plagues. Whatever may be held with regard to the true origin of this fever, thus much is established, that it was at first an independent European disease, and that, at the commencement, having occupied the southern part of this quarter of the world, it then became connected, in a manner as extraordinary as it was worthy of observation, with the sweating sickness of the north; since the nearly simultaneous eruption of the sweating fever in England, with the great epidemic petechial fever in the year 1505, may be justly attributed to an influence common to both, although unquestionably of greater power in the latter.

The epidemic petechial fever, of which we are now treating, prevailed principally in Italy, and is described by Fracastoro as the first plague of this kind which ever appeared in that country. Of this new disease[72], which was placed by this great physician midway between the bubo plague and the non-pestilential fever, the contagious quality showed itself from the beginning; yet it was plainly perceived, that the contagion did not take effect so quickly as in the bubo plague, that it was not conveyed so easily by means of clothing and other articles, and that physicians and attendants on the sick were the only persons who incurred much danger of infection. The fever began insidiously, and with very slight symptoms, so that the sick in general did not so much as seek medical aid. Many persons, and even physicians among the number, suffered themselves to be deceived by this circumstance, and thus, not being aware of the danger, they hoped to effect an easy cure, and were not a little astonished at the sudden development of malignant phenomena. The heat was inconsiderable, in proportion to the fever, yet those affected felt a certain inward indisposition, a general depression of all the vital powers, and a weariness as if after great exertion. They lay upon their backs with an oppressed brain, their senses were blunted, and in most cases delirium and gloomy muttering, with bloodshot eyes, commenced from the fourth to the seventh day. The urine was usually clear and copious at the beginning, it then became red and turbid, or resembling pomegranate wine, (granatwein,) the pulse was slow and small, the evacuations putrid and offensive, and either on the fourth or seventh day red or purple spots, like flea-bites, or larger, or resembling lentils, (lenticulæ,) which also gave a name to the disorder, broke out on the arms, the back, and the breast. There was either no thirst at all, or very little; the tongue was loaded, and in many cases a lethargic state came on. Others, on the contrary, suffered from sleeplessness, or from both these symptoms alternately. The disease reached its height on the seventh or on the fourteenth day, and in some cases still later. In many there existed a retention of urine with very unfavourable prognosis. Women seldom died of this fever, elderly people still more rarely, and Jews scarcely ever. Young people, on the other hand, and children died in great numbers, and especially from among the higher ranks, while the plague, on the contrary, used generally to commit its ravages only among the poorer classes. An inordinate loss of power in the commencement betokened death, as also a too violent effect from mild aperient means, and a failure in alleviation after a complete crisis. Patients were seen to die who had lost to the extent of three pounds of blood from the nose. It was also a very bad sign when the spots disappeared, or broke out tardily, or were of a blackish-blue colour. Phenomena of an opposite character, on the contrary, afforded hope of recovery.