The first notice on this subject is due to a very celebrated teacher in Perugia, Gentilis of Foligno, who, on the 18th of June, 1348, fell a sacrifice to the plague, in the faithful discharge of his duty. Attached to Arabian doctrines, and to the universally respected Galen, he, in common with all his contemporaries, believed in a putrid corruption of the blood in the lungs and in the heart, which was occasioned by the pestilential atmosphere, and was forthwith communicated to the whole body. He thought, therefore, that everything depended upon a sufficient purification of the air, by means of large blazing fires of odoriferous wood, in the vicinity of the healthy as well as of the sick, and also upon an appropriate manner of living, so that the putridity might not overpower the diseased. In conformity with notions derived from the ancients, he depended upon bleeding and purging, at the commencement of the attack, for the purpose of purification; ordered the healthy to wash themselves frequently with vinegar or wine, to sprinkle their dwellings with vinegar, and to smell often to camphor, or other volatile substances. Hereupon he gave, after the Arabian fashion, detailed rules, with an abundance of different medicines, of whose healing powers wonderful things were believed. He had little stress upon super-lunar influences, so far as respected the malady itself; on which account, he did not enter into the great controversies of the astrologers, but always kept in view, as an object of medical attention, the corruption of the blood in the lungs and heart. He believed in a progressive infection from country to country, according to the notions of the present day; and the contagious power of the disease, even in the vicinity of those affected by plague, was, in his opinion, beyond all doubt. On this point intelligent contemporaries were all agreed; and, in truth, it required no great genius to be convinced of so palpable a fact. Besides, correct notions of contagion have descended from remote antiquity, and were maintained unchanged in the fourteenth century. So far back as the age of Plato a knowledge of the contagious power of malignant inflammations of the eye, of which also no physician of the Middle Ages entertained a doubt, was general among the people; yet in modern times surgeons have filled volumes with partial controversies on this subject. The whole language of antiquity has adapted itself to the notions of the people respecting the contagion of pestilential diseases; and their terms were, beyond comparison, more expressive than those in use among the moderns.
Arrangements for the protection of the healthy against contagious diseases, the necessity of which is shown from these notions, were regarded by the ancients as useful; and by man, whose circumstances permitted it, were carried into effect in their houses. Even a total separation of the sick from the healthy, that indispensable means of protection against infection by contact, was proposed by physicians of the second century after Christ, in order to check the spreading of leprosy. But it was decidedly opposed, because, as it was alleged, the healing art ought not to be guilty of such harshness. This mildness of the ancients, in whose manner of thinking inhumanity was so often and so undisguisedly conspicuous, might excite surprise if it were anything more than apparent. The true ground of the neglect of public protection against pestilential diseases lay in the general notion and constitution of human society—it lay in the disregard of human life, of which the great nations of antiquity have given proofs in every page of their history. Let it not be supposed that they wanted knowledge respecting the propagation of contagious diseases. On the contrary, they were as well informed on this subject as the modern; but this was shown where individual property, not where human life, on the grand scale was to be protected. Hence the ancients made a general practice of arresting the progress of murrains among cattle by a separation of the diseased from the healthy. Their herds alone enjoyed that protection which they held it impracticable to extend to human society, because they had no wish to do so. That the governments in the fourteenth century were not yet so far advanced as to put into practice general regulations for checking the plague needs no especial proof. Physicians could, therefore, only advise public purifications of the air by means of large fires, as had often been practised in ancient times; and they were obliged to leave it to individual families either to seek safety in flight, or to shut themselves up in their dwellings, a method which answers in common plagues, but which here afforded no complete security, because such was the fury of the disease when it was at its height, that the atmosphere of whole cities was penetrated by the infection.
Of the astral influence which was considered to have originated the “Great Mortality,” physicians and learned men were as completely convinced as of the fact of its reality. A grand conjunction of the three superior planets, Saturn, Jupiter, and Mars, in the sign of Aquarius, which took place, according to Guy de Chauliac, on the 24th of March, 1345, was generally received as its principal cause. In fixing the day, this physician, who was deeply versed in astrology, did not agree with others; whereupon there arose various disputations, of weight in that age, but of none in ours. People, however, agree in this—that conjunctions of the planets infallibly prognosticated great events; great revolutions of kingdoms, new prophets, destructive plagues, and other occurrences which bring distress and horror on mankind. No medical author of the fourteenth and fifteenth centuries omits an opportunity of representing them as among the general prognostics of great plagues; nor can we, for our part, regard the astrology of the Middle Ages as a mere offspring of superstition. It has not only, in common with all ideas which inspire and guide mankind, a high historical importance, entirely independent of its error or truth—for the influence of both is equally powerful—but there are also contained in it, as in alchemy, grand thoughts of antiquity, of which modern natural philosophy is so little ashamed that she claims them as her property. Foremost among these is the idea of general life which diffuses itself throughout the whole universe, expressed by the greatest Greek sages, and transmitted to the Middle Ages, through the new Platonic natural philosophy. To this impression of an universal organism, the assumption of a reciprocal influence of terrestrial bodies could not be foreign, nor did this cease to correspond with a higher view of nature, until astrologers overstepped the limits of human knowledge with frivolous and mystical calculations.
Guy de Chauliac considers the influence of the conjunction, which was held to be all-potent, as the chief general cause of the Black Plague; and the diseased state of bodies, the corruption of the fluids, debility, obstruction, and so forth, as the especial subordinate causes. By these, according to his opinion, the quality of the air, and of the other elements, was so altered that they set poisonous fluids in motion towards the inward parts of the body, in the same manner as the magnet attracts iron; whence there arose in the commencement fever and the spitting of blood; afterwards, however, a deposition in the form on glandular swellings and inflammatory boils. Herein the notion of an epidemic constitution was set forth clearly, and conformably to the spirit of the age. Of contagion, Guy de Chauliac was completely convinced. He sought to protect himself against it by the usual means; and it was probably he who advised Pope Clement VI. to shut himself up while the plague lasted. The preservation of this Pope’s life, however, was most beneficial to the city of Avignon, for he loaded the poor with judicious acts of kindness, took care to have proper attendants provided, and paid physicians himself to afford assistance wherever human aid could avail—an advantage which, perhaps, no other city enjoyed. Nor was the treatment of plague-patients in Avignon by any means objectionable; for, after the usual depletions by bleeding and aperients, where circumstances required them, they endeavoured to bring the buboes to suppuration; they made incisions into the inflammatory boils, or burned them with a red-hot iron, a practice which at all times proves salutary, and in the Black Plague saved many lives. In this city, the Jews, who lived in a state of the greatest filth, were most severely visited, as also the Spaniards, whom Chalin accuses of great intemperance.
Still more distinct notions on the causes of the plague were stated to his contemporaries in the fourteenth century by Galeazzo di Santa Sofia, a learned man, a native of Padua, who likewise treated plague-patients at Vienna, though in what year is undetermined. He distinguishes carefully pestilence from epidemy and endemy. The common notion of the two first accords exactly with that of an epidemic constitution, for both consist, according to him, in an unknown change or corruption of the air; with this difference, that pestilence calls forth diseases of different kinds; epidemy, on the contrary, always the same disease. As an example of an epidemy, he adduces a cough (influenza) which was observed in all climates at the same time without perceptible cause; but he recognised the approach of a pestilence, independently of unusual natural phenomena, by the more frequent occurrence of various kinds of fever, to which the modern physicians would assign a nervous and putrid character. The endemy originates, according to him, only in local telluric changes—in deleterious influences which develop themselves in the earth and in the water, without a corruption of the air. These notions were variously jumbled together in his time, like everything which human understanding separates by too fine a line of limitation. The estimation of cosmical influences, however, in the epidemy and pestilence, is well worthy of commendation; and Santa Sofia, in this respect, not only agrees with the most intelligent persons of the fourteenth and fifteenth centuries, but he has also promulgated an opinion which must, even now, serve as a foundation for our scarcely commenced investigations into cosmical influences. Pestilence and epidemy consist not in alterations of the four primary qualities, but in a corruption of the air, powerful, though quite immaterial, and not cognoscible by the senses—(corruptio aëris non substantialis, sed qualitativa) in a disproportion of the imponderables in the atmosphere, as it would be expressed by the moderns. The causes of the pestilence and epidemy are, first of all, astral influences, especially on occasions of planetary conjunctions; then extensive putrefaction of animal and vegetable bodies, and terrestrial corruptions (corruptio in terra): to which also bad diet and want may contribute. Santa Sofia considers the putrefaction of locusts, that had perished in the sea and were again thrown up, combined with astral and terrestrial influences, as the cause of the pestilence in the eventful year of the “Great Mortality.”
All the fevers which were called forth by the pestilence are, according to him, of the putrid kind; for they originate principally from putridity of the heart’s blood, which inevitably follows the inhalation of infected air. The Oriental Plague is, sometimes, but by no means always occasioned by pestilence (?), which imparts to it a character (qualitas occulta) hostile to human nature. It originates frequently from other causes, among which this physician was aware that contagion was to be reckoned; and it deserves to be remarked that he held epidemic small-pox and measles to be infallible forerunners of the plague, as do the physicians and people of the East at the present day.
In the exposition of his therapeutical views of the plague, a clearness of intellect is again shown by Santa Sofia, which reflects credit on the age. It seemed to him to depend, 1st, on an evacuation of putrid matters by purgatives and bleeding; yet he did not sanction the employment of these means indiscriminately and without consideration; least of all where the condition of the blood was healthy. He also declared himself decidedly against bleeding ad deliquium (venæ sectio eradicativa). 2nd, Strengthening of the heart and prevention of putrescence. 3rd, Appropriate regimen. 4th, Improvement of the air. 5th, Appropriate treatment of tumid glands and inflammatory boils, with emollient, or even stimulating poultices (mustard, lily-bulbs), as well as with red-hot gold and iron. Lastly, 6th, Attention to prominent symptoms. The stores of the Arabian pharmacy, which he brought into action to meet all these indications, were indeed very considerable; it is to be observed, however, that, for the most part, gentle means were accumulated, which, in case of abuse, would do no harm: for the character of the Arabian system of medicine, whose principles were everywhere followed at this time, was mildness and caution. On this account, too, we cannot believe that a very prolix treatise by Marsigli di Santa Sofia, a contemporary relative of Galeazzo, on the prevention and treatment of plague, can have caused much harm, although perhaps, even in the fourteenth century, an agreeable latitude and confident assertions respecting things which no mortal has investigated, or which it is quite a matter of indifference to distinguish, were considered as proofs of a valuable practical talent.
The agreement of contemporary and later writers shows that the published views of the most celebrated physicians of the fourteenth century were those generally adopted. Among these, Chalin de Vinario is the most experienced. Though devoted to astrology still more than his distinguished contemporary, he acknowledges the great power of terrestrial influences, and expresses himself very sensibly on the indisputable doctrine of contagion, endeavouring thereby to apologise for many surgeons and physicians of his time who neglected their duty. He asserted boldly and with truth, “that all epidemic diseases might become contagious, and all fevers epidemic,” which attentive observers of all subsequent ages have confirmed.
He delivered his sentiments on blood-letting with sagacity, as an experienced physician; yet he was unable, as may be imagined, to moderate the desire for bleeding shown by the ignorant monks. He was averse to draw blood from the veins of patients under fourteen years of age; but counteracted inflammatory excitement in them by cupping, and endeavoured to moderate the inflammation of the tumid glands by leeches. Most of those who were bled, died; he therefore reserved this remedy for the plethoric; especially for the papal courtiers and the hypocritical priests, whom he saw gratifying their sensual desires, and imitating Epicurus, whilst they pompously pretended to follow Christ. He recommended burning the boils with a red-hot iron only in the plague without fever, which occurred in single cases; and was always ready to correct those over-hasty surgeons who, with fire and violent remedies, did irremediable injury to their patients. Michael Savonarola, professor in Ferrara (1462), reasoning on the susceptibility of the human frame to the influence of pestilential infection, as the cause of such various modifications of disease, expresses himself as a modern physician would on this point; and an adoption of the principle of contagion was the foundation of his definition of the plague. No less worthy of observation are the views of the celebrated Valescus of Taranta, who, during the final visitation of the Black Death, in 1382, practised as a physician at Montpellier, and handed down to posterity what has been repeated in innumerable treatises on plague, which were written during the fifteenth and sixteenth centuries.
Of all these notions and views regarding the plague, whose development we have represented, there are two especially, which are prominent in historical importance:—1st, The opinion of learned physicians, that the pestilence, or epidemic constitution, is the parent of various kinds of disease; that the plague sometimes, indeed, but by no means always, originates from it: that, to speak in the language of the moderns, the pestilence bears the same relation to contagion that a predisposing cause does to an occasional cause; and 2ndly, the universal conviction of the contagious power of that disease.