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 tumours 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.
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, whose own son, Andronikus, died of
this plague in Constantinople, notices great imposthumes 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,
which are no less produced by plague in all its forms. In many cases,
black spots broke out all over the body, either single, or united and
confluent.
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 stupefied 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 could 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. 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 (_anthrax-artigen_) affection of the
lungs, effected the destruction of life before the other symptoms were
developed.
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; 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.
Such is the report of the courageous Guy de Chauliac, who vindicated the
honour 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. 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.
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.
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. No power of medicine 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 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; 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.
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. 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 axillae and groins, are opposed by another account,
according to which the mortal spitting of blood was met with in Germany;
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 the year 1349, only 16,000 people
were carried off, the generality expired by the third or fourth day. In
Austria, and especially in Vienna, the plague was fully as malignant as
anywhere, so that the patients who had red spots and black boils, as well
as those afflicted with tumid glands, died about the third day; and
lastly, very frequent sudden deaths occurred on the coasts of the North
Sea and in Westphalia, without any further development of the malady.
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
axillae and groins scarcely survive 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.
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 two days.
The inflammatory boils and buboes in the groins and axillae 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 a sources of contagion, 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.
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 annuals of contemporaries report that throughout
the land only a tenth part of the inhabitants remained alive.
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.
In Poland the affected were attacked with spitting 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.
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 axillae, 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.
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 fourteenth 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, 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. 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.
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 the 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.
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 back spots of plague
patients more satisfactorily than any of his contemporaries. 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 as late as the
fourteenth day. 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.