The Black Death in the Fourteenth Century

by J. F. C. Hecker

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[175] at the present day.

In the exposition of his therapeutical views of the plague, a clearness of intellect is again shewn 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). 2d, Strengthening of the heart and prevention of putrescence. 3d, 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,[176] a contemporary relative of Galeazzo, on the prevention and treatment of plague, can have caused much harm, although, perhaps, even in the 14th 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, shews that the published views of the most celebrated physicians of the 14th 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 apologize for many surgeons and physicians of his time, who neglected their duty.[177] He asserted boldly, and with truth, “that all epidemic diseases might become contagious,[178] 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 shewn 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.[179] 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.[180] He recommended burning the boils with a red-hot iron, only in the plague without fever, which occurred in single cases;[181] and was always ready to correct those over-hasty surgeons, who, with fire and violent remedies, did irremediable injury to their patients,[182] 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.[183] 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 15th and 16th centuries.[184]

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 2dly, the universal conviction of the contagious power of that disease.

Contagion gradually attracted more notice: it was thought that in it, the most powerful occasional cause might be avoided; the possibility of protecting whole cities by separation, became gradually more evident; and so horrifying was the recollection of the eventful year of the “Great Mortality,” that before the close of the 14th century, ere the ill effects of the Black Plague had ceased, nations endeavoured to guard against the return of this enemy, by an earnest and effectual defence.

The first regulation which was issued for this purpose, originated with Viscount Bernabo, and is dated the 17th Jan. 1374. “Every plague patient was to be taken out of the city into the fields, there to die or to recover. Those who attended upon a plague patient, were to remain apart for ten days, before they again associated with any body. The priests were to examine the diseased, and point out to special commissioners, the persons infected; under punishment of the confiscation of their goods, and of being burned alive. Whoever imported the plague, the state condemned his goods to confiscation. Finally, none except those who were appointed for that purpose, were to attend plague-patients, under penalty of death and confiscation.[185]

These orders, in correspondence with the spirit of the 14th century, are sufficiently decided to indicate a recollection of the good effects of confinement, and of keeping at a distance those suspected of having plague. It was said that Milan itself, by a rigorous barricado of three houses in which the plague had broken out, maintained itself free from the “Great Mortality,” for a considerable time;[186] and examples of the preservation of individual families, by means of a strict separation, were certainly very frequent. That these orders must have caused universal affliction from their uncommon severity, as we know to have been especially the case in the city of Reggio, may be easily conceived; but Bernabo did not suffer himself to be frightened from his purpose—on the contrary, when the plague returned in the year 1383, he forbad the admission of people from infected places into his territories, on pain of death.[187] We have now, it is true, no account how far he succeeded; yet it is to be supposed that he arrested the disease, for it had long lost the property of the Black Death, to spread abroad in the air the contagious matter which proceeded from the lungs, charged with putridity, and to taint the atmosphere of whole cities by the vast numbers of the sick. Now that it had resumed its milder form, so that it infected only by contact, it admitted being confined within individual dwellings, as easily as in modern times.

Bernabo’s example was imitated; nor was there any century more appropriate for recommending to governments strong regulations against the plague, than the 14th; for when it broke out in Italy, in the year 1399, and still demanded new victims, it was for the 16th time; without reckoning frequent visitations of measles and small-pox. In this same year, Viscount John, in milder terms than his predecessor, ordered that no stranger should be admitted from infected places, and that the city gates should be strictly guarded. Infected houses were to be ventilated for at least eight or ten days, and purified from noxious vapours by fires, and by fumigations with balsamic and aromatic substances. Straw, rags, and the like, were to be burned; and the bedsteads which had been used, set out for four days in the rain or the sunshine, so that, by means of the one or the other, the morbific vapour might be destroyed. No one was to venture to make use of clothes or beds out of infected dwellings, unless they had been previously washed and dried either at the fire or in the sun. People were, likewise, to avoid, as long as possible, occupying houses which had been frequented by plague-patients.[188]