THE DISEASE.
The most memorable example of what has been advanced, is afforded
by a great pestilence of the fourteenth century, which desolated
Asia, Europe, and Africa, and of which the people yet preserve the
remembrance in gloomy traditions. It was an oriental plague, marked by
inflammatory boils and tumors of the glands, such as break out in no
other febrile disease. On account of these inflammatory boils, and from
the black spots, indicatory of a putrid decomposition, which appeared
upon the skin, it was called in Germany and in the northern kingdoms
of Europe, _the Black Death_, and in Italy, la Mortalega Grande, _the
Great Mortality_.[1]
[1] La Mortalega Grande. _Matth. de Griffonibus._ Muratori. Script.
rer. Italicar. T. XVIII. p. 167. D. They were called by others
Angumalgia. _Andr. Gratiol._ Discorso di peste. Venet. 1576,
4to. Swedish: _Diger-döden. Loccenii_ Histor. Suecan L. III. p.
104.--Danish: _den sorte Dod. Pontan_. Rer. danicar Histor. L. VIII.
p. 476.--Amstelod: 1631, fol. Icelandic: _Svatur Daudi_. Saabye,
Tagebuch in Grönland. Introduction XVIII. _Mansa_, de Epidemiis
maxime momorabilibus, quae in Dania grassatae sunt, &c. Part. I.
p. 12. Havniae, 1831, 8.--In Westphalia the name of _de groete Doet_
was prevalent. Meibom.
Few testimonies are presented to us respecting its symptoms and its
course, yet these are sufficient to throw light upon the form of the
malady, and they are worthy of credence, from their coincidence with
the signs of the same disease in modern times.
The imperial writer, Kantakusenos,[2] whose own son, Andronikus, died
of this plague in Constantinople, notices great imposthumes[3] of
the thighs and arms of those affected, which, when opened, afforded
relief by the discharge of an offensive matter. Buboes, which are the
infallible signs of the oriental plague, are thus plainly indicated,
for he makes separate mention of smaller boils on the arms and in the
face, as also in other parts of the body, and clearly distinguishes
these from the blisters,[4] which are no less produced by plague in all
its forms. In many cases, black spots[5] broke out all over the body,
either single, or united and confluent.
[2] _Joann Cantacuzen_ Historiar, L. IV. c. 8. Ed. Paris, p. 730. 5.
The ex-emperor has indeed copied some passages from Thucydides, as
_Sprengel_ justly observes, (Appendix to the Geschichte der Medicin.
Vol. 1. H. I. S. 73.) though this was most probably only for the
sake of rounding a period. This is no detriment to his credibility,
because his statements accord with the other accounts.
[3] Αποσάσεις μεγάλαι.
[4] Μελαίναι φλυχτίδες.
[5] ὤσπερ σιγματα μέλανα.
These symptoms were not all found in every case. In many, one alone was
sufficient to cause death, while some patients recovered, contrary to
expectation, though afflicted with all. Symptoms of cephalic affection
were frequent; many patients became stupified and fell into a deep
sleep, losing also their speech from palsy of the tongue; others
remained sleepless and without rest. The fauces and tongue were black,
and as if suffused with blood; no beverage would assuage their burning
thirst, so that their sufferings continued without alleviation until
terminated by death, which many in their despair accelerated with their
own hands. Contagion was evident, for attendants caught the disease of
their relations and friends, and many houses in the capital were bereft
even of their last inhabitant. Thus far the ordinary circumstances only
of the oriental plague occurred. Still deeper sufferings, however,
were connected with this pestilence, such as have not been felt at
other times; the organs of respiration were seized with a putrid
inflammation; a violent pain in the chest attacked the patient; blood
was expectorated, and the breath diffused a pestiferous odour.
In the West, the following were the predominating symptoms on the
eruption of this disease.[6] An ardent fever, accompanied by an
evacuation of blood, proved fatal in the first three days. It appears
that buboes and inflammatory boils did not at first come out at all,
but that the disease, in the form of carbuncular (_anthraxartigen_)
affection of the lungs, effected the destruction of life before the
other symptoms were developed.
[6] _Guidon de Cauliaco_ Chirurgia. Tract 11. c. 5. p. 113. Ed.
Lugdun, 1572.
Thus did the plague rage in Avignon for six or eight weeks, and the
pestilential breath of the sick, who expectorated blood, caused a
terrible contagion far and near; for even the vicinity of those
who had fallen ill of plague was certain death;[7] so that parents
abandoned their infected children, and all the ties of kindred were
dissolved. After this period, buboes in the axilla and in the groin,
and inflammatory boils all over the body, made their appearance; but it
was not until seven months afterwards that some patients recovered with
matured buboes, as in the ordinary milder form of plague.
[7] Et fuit tantae contagiositatis specialiter quae fuit cum
sputo sanguinis, quod non solum morando, sed etiam inspiciendo
unus recipiebat ab alio: intantum quod gentes moriebantur sine
servitoribus, et sepeliebantur sine sacerdotibus, pater non visitabat
filium, nec filius patrem: charitas erat mortua, spes prostrata.
Such is the report of the courageous Guy de Chauliac, who vindicated
the honor of medicine, by bidding defiance to danger; boldly and
constantly assisting the affected, and disdaining the excuse of
his colleagues, who held the Arabian notion, that medical aid was
unavailing, and that the contagion justified flight. He saw the plague
twice in Avignon, first in the year 1348, from January to August, and
then twelve years later, in the autumn, when it returned from Germany,
and for nine months spread general distress and terror. The first time
it raged chiefly among the poor, but in the year 1360, more among the
higher classes. It now also destroyed a great many children, whom it
had formerly spared, and but few women.
The like was seen in Egypt.[8] Here also inflammation of the lungs was
predominant, and destroyed quickly and infallibly, with burning heat
and expectoration of blood. Here too the breath of the sick spread a
deadly contagion, and human aid was as vain as it was destructive to
those who approached the infected.
[8] _Deguignes_, Histoire générale des Huns, des Turcs, des Moguls,
&c. Tom. IV. Paris 1758. 4to. p. 226.
Boccacio, who was an eye-witness of its incredible fatality in
Florence, the seat of the revival of science, gives a more lively
description of the attack of the disease than his non-medical
contemporaries.[9]
[9] Decameron Giorn. I. Introd.
It commenced here, not as in the East, with bleeding at the nose, a
sure sign of inevitable death; but there took place at the beginning,
both in men and women, tumours in the groin and in the axilla, varying
in circumference up to the size of an apple or an egg, and called
by the people, pest-boils (gavoccioli). Then there appeared similar
tumours indiscriminately over all parts of the body, and black or blue
spots came out on the arms or thighs, or on other parts, either single
and large, or small and thickly studded. These spots proved equally
fatal with the pest-boils, which had been from the first regarded as
a sure sign of death.[10] No power of medecine brought relief--almost
all died within the first three days, some sooner, some later, after
the appearance of these signs, and for the most part entirely without
fever[11] or other symptoms. The plague spread itself with the greater
fury, as it communicated from the sick to the healthy, like fire among
dry and oily fuel, and even contact with the clothes and other articles
which had been used by the infected, seemed to induce the disease. As
it advanced, not only men, but animals fell sick and shortly expired,
if they had touched things belonging to the diseased or dead. Thus
Boccacio himself saw two hogs on the rags of a person who had died of
plague, after staggering about for a short time, fall down dead, as
if they had taken poison. In other places, multitudes of dogs, cats,
fowls and other animals, fell victims to the contagion;[12] and it is
to be presumed that other epizootes among animals likewise took place,
although the ignorant writers of the fourteenth century are silent on
this point.
[10] From this period black petechiæ have always been considered as
fatal in the plague.
[11] A very usual circumstance in plague epidemics.
[12] _Auger de Biterris_, Vitae Romanor. pontificum, _Muratori_
Scriptor. rer. Italic. Vol. III. Pt. II. p. 556.
In Germany there was a repetition in every respect of the same
phenomena. The infallible signs of the oriental bubo-plague with
its inevitable contagion were found there as everywhere else; but the
mortality was not nearly so great as in the other parts of Europe.[13]
The accounts do not all make mention of the spitting of blood, the
diagnostic symptom of this fatal pestilence; we are not, however,
thence to conclude that there was any considerable mitigation or
modification of the disease, for we must not only take into account
the defectiveness of the chronicles, but that isolated testimonies are
often contradicted by many others. Thus, the chronicles of Strasburg,
which only take notice of boils and glandular swellings in the axillæ
and groins,[14] are opposed by another account, according to which the
mortal spitting of blood was met with in Germany;[15] but this again is
rendered suspicious, as the narrator postpones the death of those who
were thus affected, to the sixth, and (even the) eighth day, whereas,
no other author sanctions so long a course of the disease; and even in
Strasburg, where a mitigation of the plague may, with most probability,
be assumed, since in the year 1349, only 16,000 people were carried
off, the generality expired by the third or fourth day.[16] In Austria,
and especially in Vienna, the plague was fully as malignant as any
where, so that the patients who had red spots and black boils, as well
as those afflicted with tumid glands, died about the third day;[17]
and lastly, very frequent sudden deaths occurred on the coasts of the
North Sea and in Westphalia, without any further development of the
malady.[18]
[13] Contin. altera Chronici _Guillelmi de Nangis_ in _d’Acher_,
Spicilegium sive Collectio Veterum Scriptorum, &c. Ed. de la _Barre_,
Tom. iii. p. 110.
[14] “The people all died of boils and inflamed glands which appeared
under the arms and in the groins.” _Jac. v. Königshoven_, the oldest
chronicle of Alsace and Strasburg, and indeed of all Germany.
Strasburg, 1698. 4. cap. 5, § 86. p. 301.
[15] _Hainr. Rebdorff_, Annals, _Marq. Freher_. Germanicarum. rerum
Scriptores. Francof, 1624. fol. p. 439.
[16] _Königshoven_, in loc. cit.
[17] Anonym. Leobiens. Chron. L. VI. in _Hier. Pez_, Scriptor.
rer. Austriac. Lips. 1721. fol. Tom. 1, p. 970. The above named
appearances are here called, _rote sprinkel_, _swarcze erhubenn_ und
_druesz under den üchsen und ze den gemächten_.
[18] _Ubb. Emmiie_ rer. Frisiacar. histor. L. XIV. p. 203. Lugd. Bat.
1616. fol.
To France, this plague came in a northern direction from Avignon, and
was there more destructive than in Germany, so that in many places not
more than two in twenty of the inhabitants survived. Many were struck,
as if by lightning, and died on the spot, and this more frequently
among the young and strong than the old; patients with enlarged glands
in the axillæ and groins scarcely survived two or three days; and no
sooner did these fatal signs appear, than they bid adieu to the world,
and sought consolation only in the absolution which Pope Clement VI.
promised them in the hour of death.[19]
[19] _Guillelmus de Nangis._
In England the malady appeared, as at Avignon, with spitting of blood,
and with the same fatality, so that the sick who were afflicted
either with this symptom or with vomiting of blood, died in some cases
immediately, in others within twelve hours, or at the latest, in two
days.[20] The inflammatory boils and buboes in the groins and axillæ
were recognised at once as prognosticating a fatal issue, and those
were past all hope of recovery in whom they arose in numbers all over
the body. It was not till towards the close of the plague that they
ventured to open, by incision, these hard and dry boils, when matter
flowed from them in small quantity, and thus, by compelling nature to
a critical suppuration, many patients were saved. Every spot which the
sick had touched, their breath, their clothes, spread the contagion;
and, as in all other places, the attendants and friends who were either
blind to their danger or heroically despised it, fell a sacrifice
to their sympathy. Even the eyes of the patient were considered as
sources of contagion,[21] which had the power of acting at a distance,
whether on account of their unwonted lustre or the distortion which
they always suffer in plague, or whether in conformity with an ancient
notion, according to which the sight was considered as the bearer of a
demoniacal enchantment. Flight from infected cities seldom availed the
fearful, for the germ of the disease adhered to them, and they fell
sick, remote from assistance, in the solitude of their country houses.
[20] _Ant. Wood_, Historia et Antiquitates Universit. Oxoniens. Oxon.
1764, fol. L. 1. p. 172.
[21] _Mezeray_, Histoire de France, Paris, 1685. fol. T. 11 p. 418.
Thus did the plague spread over England with unexampled rapidity,
after it had first broken out in the county of Dorset, whence it
advanced through the counties of Devon and Somerset, to Bristol, and
thence reached Gloucester, Oxford and London. Probably few places
escaped, perhaps not any; for the annals of contemporaries report, that
throughout the land only a tenth part of the inhabitants remained
alive.[22]
[22] _Barnes_, who has given a lively picture of the black plague, in
England, taken from the Registers of the 14th century, describes the
external symptoms in the following terms: knobs or swellings in the
groin or under the arm-pits, called kernels, biles, blains, blisters,
pimples, wheals or plague-sores. The Hist. of Edw. III. Cambridge.
1688. fol. p. 432.
From England the contagion was carried by a ship to Bergen, the capital
of Norway, where the plague then broke out in its most frightful form,
with vomiting of blood; and throughout the whole country, spared not
more than a third of the inhabitants. The sailors found no refuge in
their ships; and vessels were often seen driving about on the ocean and
drifting on shore, whose crews had perished to the last man.[23]
[23] _Torfaeus_, Historia rerum Norvegicarum. Hafn. 1711. fol. L. ix.
c. 8. p. 478. This author has followed _Pontanus_ (Rerum Danicar.
Historia. Amstelod. 1631. fol.) who has given only a general account
of the plague in Denmark, and nothing respecting its symptoms.
In Poland the infected were attacked with spitting of blood, and died
in a few days in such vast numbers, that, as it has been affirmed,
scarcely a fourth of the inhabitants were left.[24]
[24] _Dlugoss_, S. Longini Histor. polonic. L. xii. Lips. 1711. fol.
T. 1. p. 1086.
Finally, in Russia the plague appeared two years later than in Southern
Europe; yet here again, with the same symptoms as elsewhere. Russian
contemporaries have recorded that it began with rigor, heat, and
darting pain in the shoulders and back; that it was accompanied by
spitting of blood, and terminated fatally in two, or at most, three
days. It is not till the year 1360, that we find buboes mentioned as
occurring in the neck, in the axillæ and in the groins, which are
stated to have broken out when the spitting of blood had continued some
time. According to the experience of Western Europe, however, it cannot
be assumed that these symptoms did not appear at an earlier period.[25]
[25] _W. M. Richter_, Geschichte der Medicin in Russland. Moskwa,
1813. 8. p. 215. _Richter_ has taken his information on the black
plague in Russia, from Authentic Russian MSS.
Thus much, from authentic sources, on the nature of the Black Death.
The descriptions which have been communicated contain, with a few
unimportant exceptions, all the symptoms of the oriental plague which
have been observed in more modern times. No doubt can obtain on this
point. The facts are placed clearly before our eyes. We must, however,
bear in mind, that this violent disease does not always appear in the
same form, and that while the essence of the poison which it produces,
and which is separated so abundantly from the body of the patient,
remains unchanged, it is proteiform in its varieties, from the almost
imperceptible vesicle, unaccompanied by fever, which exists for some
time before it extends its poison inwardly, and then excites fever and
buboes, to the fatal form in which carbuncular inflammations fall upon
the most important viscera.
Such was the form which the plague assumed in the 14th century, for
the accompanying chest affection which appeared in all the countries
whereof we have received any account, cannot, on a comparison with
similar and familiar symptoms, be considered as any other than the
inflammation of the lungs of modern medicine,[26] a disease which at
present only appears sporadically, and, owing to a putrid decomposition
of the fluids, is probably combined with hemorrhages from the vessels
of the lungs. Now, as every carbuncle, whether it be cutaneous or
internal, generates in abundance the matter of contagion which has
given rise to it, so, therefore, must the breath of the affected
have been poisonous in this plague, and on this account its power
of contagion wonderfully increased; wherefore the opinion appears
incontrovertible, that owing to the accumulated numbers of the
diseased, not only individual chambers and houses, but whole cities
were infected, which, moreover, in the middle ages, were, with few
exceptions, narrowly built, kept in a filthy state, and surrounded with
stagnant ditches.[27] Flight was, in consequence, of no avail to the
timid; for even though they had sedulously avoided all communication
with the diseased and the suspected, yet their clothes were saturated
with the pestiferous atmosphere, and every inspiration imparted to
them the seeds of the destructive malady, which, in the greater number
of cases, germinated with but too much fertility. Add to which, the
usual propagation of the plague through clothes, beds, and a thousand
other things to which the pestilential poison adheres,--a propagation,
which, from want of caution, must have been infinitely multiplied;
and since articles of this kind, removed from the access of air, not
only retain the matter of contagion for an indefinite period, but also
increase its activity and engender it like a living being, frightful
ill-consequences followed for many years after the first fury of the
pestilence was past.
[26] Compare on this point, _Ballings_ treatise “Zur Diagnostik der
Lungenerweichung.” Vol. XVI. ii. 3. p. 257 of lit. Annalen der ges.
Heilkunde.
[27] It is expressly ascertained with respect to Avignon and Paris,
that uncleanliness of the streets increased the plague considerably.
_Raim. Chalin de Vinario._
The affection of the stomach, often mentioned in vague terms, and
occasionally as a vomiting of blood, was doubtless only a subordinate
symptom, even if it be admitted that actual hematemesis did occur. For
the difficulty of distinguishing a flow of blood from the stomach, from
a pulmonic expectoration of that fluid, is, to non-medical men, even in
common cases, not inconsiderable. How much greater then must it have
been in so terrible a disease, where assistants could not venture to
approach the sick without exposing themselves to certain death? Only
two medical descriptions of the malady have reached us, the one by the
brave _Guy de Chauliac_, the other by _Raymond Chalin de Vinario_, a
very experienced scholar, who was well versed in the learning of his
time. The former takes notice only of fatal coughing of blood; the
latter, besides this, notices epistaxis, hematuria and fluxes of blood
from the bowels, as symptoms of such decided and speedy mortality, that
those patients in whom they were observed, usually died on the same or
the following day.[28]
[28] _De Peste_ Libri tres, opera _Jacobi Dalechampii_ in lucem
editi. Lugdani, 1552. 16. p. 35. _Dalechamp_ has only improved the
language of this work, adding nothing to it but a preface in the
form of two letters. _Raymond Chalin de Vinario_ was contemporary
with _Guy de Chauliac_ at Avignon. He enjoyed a high reputation,
and was in very affluent circumstances. He often makes mention of
cardinals and high officers of the papal court, whom he had treated;
and it is even probable, though not certain, that he was physician
to Clement VI. (1342--1352), Innocent VI. (1352--) and Urban the V.
(1362--1370). He and _Guy de Chauliac_ never mention each other.
That a vomiting of blood may not, here and there, have taken
place, perhaps have been even prevalent in many places, is, from a
consideration of the nature of the disease, by no means to be denied;
for every putrid decomposition of the fluids, begets a tendency to
hemorrhages of all kinds. Here, however, it is a question of historical
certainty, which, after these doubts, is by no means established. Had
not so speedy a death followed the expectoration of blood, we should
certainly have received more detailed intelligence respecting other
hemorrhages; but the malady had no time to extend its effects further
over the extremities of the vessels. After its first fury, however,
was spent, the pestilence passed into the usual febrile form of the
oriental plague. Internal, carbuncular inflammations no longer took
place, and hemorrhages became phenomena, no more essential in this
than they are in any other febrile disorders. Chalin, who observed
not only the _great mortality_ of 1348, and the plague of 1360, but
also that of 1373 and 1382, speaks moreover of _affections of the
throat_, and describes the _black spots_ of plague patients more
satisfactorily than any of his cotemporaries. The former appeared but
in few cases, and consisted in carbuncular inflammation of the gullet,
with a difficulty of swallowing, even to suffocation, to which, in
some instances, was added inflammation of the ceruminous glands of
the ears, with tumours, producing great deformity. Such patients, as
well as others, were affected with expectoration of blood; but they
did not usually die before the sixth, and sometimes, even so late as
the fourteenth day.[29] The same occurrence, it is well known, is not
uncommon in other pestilences; as also blisters on the surface of the
body, in different places, in the vicinity of which, tumid glands and
inflammatory boils, surrounded by discoloured and black streaks,
arose, and thus indicated the reception of the poison. These streaked
spots were called, by an apt comparison, _the girdle_, and this
appearance was justly considered extremely dangerous.[30]
[29] _Dalechamp_, p. 205--where, and at pp. 32–36, the
plague-eruptions are mentioned in the usual indefinite terms:
Exanthemata viridia, cærulea, nigra, rubra, lata, diffusa, velut
signata punctis, &c.
[30] “Pestilentis morbi gravissimum symptoma est, quod zonam vulgo
nuncupant. Ea sic fit: Pustulæ nonnunquam per febres pestilentes
fuscæ, nigræ, lividæ existunt, in partibus corporis a glandularum
emissariis sejunctis, ut in femore, tibia, capite, brachio, humeris,
quarum fervore et caliditate succi corporis attracti, glandulas
in trajectione replent, et attollunt, unde bubones fiunt atque
carbunculi. _Ab iis tanquam solidus quidam nervus in partem vicinam
distentam ac veluti convulsione rigentem producitur, puta Brachium
vel tibiam, nunc rubens, nunc fuscus, nunc obscurior, nunc virens,
nunc Iridis colore, duos vel quatuor digitos latus._ Hujus summo, qua
desinit in emissarium, plerumque tuberculum pestilens visitur, altero
vero extremo, qua in propinquum membrum porrigitur, carbunculus. Hoc
scilicet malum vulgus zonam cinctumve nominat, periculosum minus, cum
hic tuberculo, illic carbunculo terminatur, quam si tuberculum in
capite solum emineat.” p. 198.