The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time

by John Kelly

  There were also a number of innovations in the medical profession, which like the Church emerged from the plague with its prestige damaged. One was a greater emphasis on practical, clinically oriented medicine, a change reflected in the growing influence of the surgeon and the declining influence of the university-trained physician, who knew a great deal about Aristotle but not much about hernias and hangnails. Anatomy texts also began to become more accurate as autopsies became more common. In the new medical schools, there was a shift in emphasis toward the practical physical sciences.

  These changes helped to set the stage for what today is called the scientific method. Increasingly after the Black Death, the physician—rather than deducing a conclusion from pure reason—posited a theory, tested the theory against observable fact, and rigorously analyzed the results to see if they supported the theory.

  In the post–Black Death era, the hospital also began to move toward its modern form. The chief purpose of the preplague hospital was to isolate the sick—to remove them from society so that they would neither offend nor infect. “When a sick person entered the hospital he was treated as if he were dead,” says Professor Gottfried. “His property was disposed of and, in many regions, a quasi-requiem mass was said for his soul.” After the plague, hospitals at least attempted to cure the ill, though any patient fortunate enough to emerge from a hospital of the late Middle Ages in sound health probably owed more to good genes and good luck than to his medical treatment. One noteworthy post–Black Death innovation was the ward system: patients with specific maladies began to be housed together. Patients with broken bones were put in one ward, those with degenerative diseases in another.

  The Black Death also played a major role in the birth of public health. One early innovation in the field was the municipal health board, such as those Florence and Venice established in 1348 to oversee sanitation and the burial of the dead. Later the boards would grow more sophisticated. In 1377 Venice established the first public quarantine in its Adriatic colony of Ragusa (Dubrovnik). The lazaretto, or plague house, a Florentine creation, was another early public health landmark. These were part hospital, part nursing home, and, not uncommonly, part prison.

  Post–Black Death Europe also began to develop new ideas about how illness spread. It probably was not happenstance that the first systematic theory of contagion was developed by Giovanni Fracastoro, a practicing public health physician in Florence.

  The plague also changed medieval higher education. Cambridge established four new colleges: Gonville Hall in 1348, Trinity Hall in 1350, Corpus Christi in 1352, and Clare Hall in 1362, while Oxford created two new schools, Canterbury and New College. Post– Black Death Florence, Prague, Vienna, Cracow, and Heidelberg also established new universities. In many cases, the charters of the schools reflected their tortured beginnings. Many mention the decay of learning and the shortage of priest-educators after the plague as the reason for their founding.

  The long century of death that followed the medieval plague also had a profound effect on religious sentiment. People began to long for a more intense, personal relationship with God. One expression of the new mood was what Professor Norman Cantor has called the “privatization of Christianity.” Chantries (private chapels), which were always common among the nobility, now became common among well-to-do merchants, professional families, and even artisans, who began to build private chapels through their craft guilds. Another expression of the “privatization” was the growing popularity of mysticism. In an age of “arbitrary, inexplicable tragedy,” many people sought to create their own private pipeline to God.

  As religious feeling intensified, the wills of the rich began to resemble celestial corporate reports. Few ventured as far into the field of “heavenly accounting” as Sir Walter Manny, whose good works included the purchase of a London cemetery and the construction of a chapel on one of its acres for monks to pray for the plague dead. (In a later iteration, the chapel became one of London’s most famous landmarks, the Charterhouse.) However, rare was the wealthy man who died without leaving behind enough money to fund several lifetimes’ worth of prayer for the repose of his immortal soul.

  The upswing in religious feeling was accompanied by a deepening disillusionment with the Church. In the greatest crisis of the Middle Ages, the Church had proved as ineffective as every other institution in medieval society. In addition, it had lost many of its best priests, and those who survived often behaved in ways that brought shame to religious life. In 1351, as the first wave of plague was lifting, a critic wrote a blistering indictment of the clergy. “About what can you preach to the people?” he asked. “If on humility, you yourselves are the proudest of the world, arrogant and given to pomp. If on poverty, you are the most grasping and covetous, . . . if on chastity—but we will be silent on that.” The critic was the sitting pope, Clement VI, a man whose own worldliness made him hard to shock. In the decades after 1351, the ordination of ill-trained boys—the ordination age was dropped from twenty-five to twenty—and ill-suited widowers further damaged the clergy’s reputation. As William Langland observed in

  Piers Plowman, the only outstanding characteristic of the new clerical recruits seemed to be cupidity.

  Parsons and parish priests complained to the Bishop

  That their parishes were poor since the pestilence time

  And asked leave and license in London to dwell

  And sing requiems for stipends, for silver is sweet . . .

  Given the amount of criticism leveled at the Church, it is perhaps unsurprising that several new heretical movements became active in the post–Black Death era, including the anticlerical Lollards, an English sect that attacked the ecclesiastical leadership and even questioned the spiritual benefit of the Mass. However, it would be an oversimplification to claim, as a few scholars have, that the Church’s failures during the Black Death led inexorably to the Reformation. The establishment of Protestantism in northern Europe, like other large, complex historical movements, was multicausal in origin. Everything from Henry VIII’s libido to the political goals of the German princes who supported Martin Luther contributed to the Reformation. The safest conclusion one can make about the plague’s contribution is that, by promoting dissatisfaction with the Church, it created fertile ground for religious change.

  There is a surer link between the recurrent plagues and epidemics of 1350 to 1450 and the death-obsessed culture of the late Middle Ages. Some of the motifs of the era, such as the dance of death and the

  transi tomb, predate the plague. But it required an era of mass death to transform these exercises in the macabre into major cultural phenomena. As historian Johan Huizinga observed in his classic work,

  The Waning of the Middle Ages, “no other epoch has laid as much stress . . . on the thought of death.” Huizinga might have added that no other epoch has also done so little to soften the image of death. Late medieval man not only expected to die, he expected to die hard and ugly. A case in point is the sculpture that adorns of the

  transi tomb (from the Latin verb

  transire, meaning “to pass away”) of Cardinal Jean de Lagrange in Avignon. It depicts the dying cardinal without pity; his mouth is agape, his eyes hollow, his cheeks sunken; his rib cage rises out of his withered lower body like a mountainous coastline. The inscription beneath the sculpture reminds the passerby: “We are a spectacle to the world. Let the great and humble, by our example, see to what state they shall be inexorably reduced, whatever their condition, age, or sex. Why then, miserable person, are you puffed up with pride? Dust you are, unto dust you return, rotten corpse, morsel and meal to worms.”

  Life’s impermanence was also the theme of

  The Three Living and the Three Dead, a story that resonates through much late medieval art and literature. The tale, which came in several versions, centers on an encounter between the living and the dead. After the meeting, each of the three living participants comes away drawing a different moral. One man is reminded
that the true purpose of this life is to repent and prepare for the next. Another, shaken by the sight and smell of death, loses himself in thoughts of the here and now; while the third man, like the first, chastened by the encounter, delivers a sermon on the transitory nature of earthly glories.

  The Dance of Death, another popular cultural motif of the period, offered a different message. It presents death as a great social leveler—a jolly, ghoulish, jitterbugging democrat who insists on dancing with everyone at the party no matter how rich or poor, how highborn or lowborn.

  The Dance of Death’s dramatic possibilities made it a favorite theme of contemporary painters, poets, and dramatists, who often used the theme to make points about the late medieval social order. Thus, in several renditions, a laborer is depicted as welcoming Death as relief from his toil, while the rich and powerful, wedded to earthly pleasures, recoil in horror from the smiling hooded figure when he extends his hand for a dance. Unlike

  transi tombs and the

  Three Living and the Three Dead, The Dance of Death may have originated during the mortality. One source, the

  Grands-Chroniques of the Abbey of St. Denis, Paris, suggests that the theme arose from a 1348 encounter between two monks from the abbey and a group of dancers. When asked why they danced, one man replied, “We have seen our neighbors die and see them die daily, but since the plague has not entered our town, we hope our merrymaking will keep it away and that is why we dance.”

  Another story dates the origins of the dance of death to a recurrence of the plague along the Rhine in 1374. According to a German chronicler, during the outbreak, groups of the afflicted, some five hundred strong, would perform dances that concluded with the dancers falling to the ground and begging onlookers to trample on their bodies. The trampling was supposed to effect a cure. However, since plague victims often had difficulty just standing unassisted, the story has the whiff of the apocryphal about it.

  For all the terrible suffering the plague inflicted, it may have saved Europe from an indefinite future of subsistence existence.

  In the autumn of 1347, when the Black Death arrived in Europe, the continent was caught in a Malthusian deadlock. After two and a half centuries of rapid demographic growth, the balance between people and resources had become very tight. Nearly everywhere, living standards were either falling or stagnating; poverty, hunger, and malnutrition were widespread; social mobility rare; technological innovation stifled; and new ideas and modes of thinking denounced as dangerous heresies. The autumn morning that the Genoese plague fleet sailed into Messina harbor, a thick layer of congealed gel lay over an immobilized Europe.

  The high mortalities of the Black Death and the era of recurrent disease helped to end the paralysis and allow the continent to recapture its momentum. Smaller population meant a larger share of resources for survivors—and, often as well, a wiser use of resources. After the plague, low-yielding farmland was used more productively as pasturage, and mills, once used largely to grind grain, were now put to a wider range of purposes, including fulling cloth and cutting wood. Human ingenuity also flowered, as people sought ways to substitute machine power for manpower. “A more diversified economy, a more intensive use of capital, a more powerful technology and standard of living—these seem the salient characteristics of the late medieval economy,” says historian David Herlihy. “Plague, in sum, broke the Malthusian deadlock . . . , which threatened to hold Europe in its traditional ways for an indefinite future.”

  Horrific as a century of unremitting death had been, Europe emerged from the charnel house of pestilence and epidemic cleansed and renewed—like the sun after rain.

  Afterword

  The Plague Deniers

  FOR THE LAST TWENTY YEARS, A SMALL BUT VOCAL GROUP OF scholars has been challenging the traditional view of the Black Death as a plague pandemic. The “origins” controversy, as it might be called, was ignited in 1984 when Graham Twigg, a respected British zoologist, published The Black Death: A Biological Reappraisal. Since then, works such as The Biology of Plagues, by Susan Scott, a British sociologist, and her colleague, biologist Christopher J. Duncan; and The Black Death Transformed, by Samuel K. Cohn, a professor of medieval history at the University

  of Glasgow, have kept the controversy roiling. For lack of a better term, these authors—and their supporters—might be called the Plague Deniers, since they believe that the Black Death was caused by a disease other than plague.

  The Deniers’ case against

  Y. pestis can be reduced to two basic points. The first and weaker part of their argument involves their pet theories about what else could have caused the medieval plague. Anthrax, zoologist Twigg’s candidate, has never struck a human community in epidemic form and does not produce buboes (although anthrax victims do develop black boils). Professor Cohn’s candidate is a mysterious Disease X, which he does not name, but believes has probably gone extinct. Scott and Duncan go furthest of all, arguing improbably that many of the worst epidemics in Western history, from the fifth century b.c. Plague of Athens to the Black Death, were caused by an by an Ebola-like illness they call hemorrhagic plague.

  The second part of the Deniers’ case against

  Y. pestis is far more substantial. Our modern understanding of plague is based on the comprehensive studies that were done during the Third Pandemic. In the hinge decades between the nineteenth and twentieth centuries, Alexandre Yersin identified the plague bacillus; Paul-Louis Simond, a French scientist, the rat-flea mechanism that drives the disease; and the Indian Plague Commission, a creation of the British Raj and one of the great achievements of Victorian medicine, compiled an unprecedentedly detailed profile of

  Y. pestis. Commission officials studied the role climate, sanitation, population density, and—in a few commission reports—nutritional status played in the spread of the plague bacillus and its vectors, the rat and rat flea. The commissioners also looked at which transportation facilities and goods were most often associated with the movement of the disease—grain unsurprisingly proved to be a big magnet for rats.

  As the Plague Deniers are quick to point out, the disease that emerged from the commission’s findings bears little resemblance to the disease described in the Black Death chronicles. A case in point already mentioned is the widely different dissemination rates of the two pandemics. While the Black Death virtually leaped across Europe, sometimes traveling two to two and a half miles a day, the plague of the Third Pandemic moved at a relatively sluggish ten to twenty miles per year. Another key difference is the astonishing variation in mortality rates. How could a disease that killed at least a third of the population in one appearance (the Black Death) kill under 3 percent of the population in a later outing? Some of the other discrepancies the Plague Deniers cite include:

  • Differences in symptoms. Cardinal Francis Aidan Gasquet, the great Victorian scholar of the Black Death in England, was among the first experts to call attention to this difference. Writing at the time of the Third Pandemic, the cardinal noted that contemporary accounts of the “ordinary eastern or bubonic plague” rarely mentioned four symptoms that Black Death chroniclers referred to frequently. The four were: a “(1) Gangrenous inflammation of the throat and lungs, (2) violent pains in the region of the chest, (3) vomiting and spitting of blood, and (4) the pestial odor coming from the bodies and breath of the sick.”

  Add contagion to the cardinal’s list of symptoms, and you have an almost perfect description of the disease Friar Michele da Piazza described tumbling off the Genoese galleys at Messina. “Breath spread the infection . . . , and it seemed as if victims were struck all at once by the affliction . . . and so to speak, shattered by it. . . . [They] violently coughed up blood and after three days of incessant vomiting for which there was no cure, they died.”

  Louis Heyligen’s description of the Black Death also contains the cardinal’s symptom list. “The disease is threefold in its infection,” Heyligen wrote,” . . . firstly men suffer in their lungs and
breathing, and whoever have these corrupted or even slightly attacked cannot by any means escape nor live beyond two days. . . . Many dead bodies have been . . . dissected and it is found that all that die, thus . . . have had their lungs infected and spat blood. . . .”