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Guy De Chauliac © by author ESCMID Online Lecture Library Methodological issues for a medical history of the Black Death • The Middle Ages span approximately 1,000 years ! • Many other major events in the 14th century • Many different countries involved • Scarce historical accuracy of many sources • More familiar aspects© of by the plagueauthor in 16th -17th centuries • More documents of the plague in 16th-17th centuries • BlackESCMID Death scholars Online focus Lectureon socio-econom Libraryic changes rather than on medical aspects Who’s Who in Europe in 1347 © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library Caffa, 1346 © by author ESCMID The disease Online broke Lecture out in Library1346 in a Mongol army laying siege to the trading station of Caffa in the Crimea. According to the chronicles, huge catapults lobbed the infected corpses of plague victims over the walls of Caffa, thus spreading the disease inside the besieged city. The Italian merchants fled on their ships,© by author unknowingly carrying theESCMID Black Death. Online Lecture Library © by author It ESCMIDwas not until 1894 Online that scientists Lecture discovered Library the cause of the plague. It came from a germ (Yersinia pestis) infecting the fleas (Xenopsylla cheopis) that lived on Black Rats. © by author ESCMID Online Lecture Library Messina, 1347 At the beginning of October, in the year of the incarnation of the© Son by of author God 1347, twelve Genoese galleys . entered the harbour of Messina. In their bones they bore so virulent a diseaseESCMID that anyone Online who Lecture only spoke Library to them was seized by a mortal illness and in no manner could evade death. (from Michael Platiensis, 1357) Buboes © by author Plague manifested itself dramatically in its ‘buboes’, i.e. painfulESCMID swellings Online in the groin, Lecture armpit, or neckLibrary that formed when the infection reached the lymphatic system. Death often resulted within a week of the infection. © by author Plague also spread among humans through airborne ESCMIDtransmission Online (such as Lecture coughs and sneezes).Library Pulmonary plague required no vector, but its almost invariably rapid fatality (death through asphyxiation within one day) limited its power as an epidemic. Whereas other countries would have been able to face up to the Black Death with some experience, the epidemic hit Sicily like a mighty scourge and© by from author there was free to spread outESCMID of control. Online Lecture Library © by author ESCMID Online Lecture Library There was a lot of rubbish for the rats to feed on. Most people had fleas anyway, so they had no idea that it was the fleas© bythat author carried the plague germ. ESCMID Online Lecture Library © by author ESCMID Online Lecture Library Wood and thatch, the characteristic materials of house building in the XIV century, made comfortable homes for rats, lice and fleas.© by author ESCMID Online Lecture Library © by author In 1348-49 London was one of the largest towns in Europe. TheESCMID black rats feastedOnline on the Lecture city's rubbish Library and loved the filth and warmth of the ramshackle wooden houses crammed together inside the city walls. Two hundred people per day were dying at the peak of the plague. By then the bodies were not being buried in coffins, but just tipped into huge pits. © by author Two new cemeteries had to beESCMID made outside Online the city. Lecture Library © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library Letter from King Edward III to the Lord Mayor of London, 1349 "You are to make sure that all the human excrement and other filth lying in the street of the city is removed. You are to cause the© cityby toauthor be cleaned from all bad smells so that no more ESCMID Onlinepeople Lecture will die from Library such smells" The smell of the plague Also Boccaccio says that the air in Florence was ‘tainted by the scent of dead bodies’ and people went about ‘carrying in their hands, some flowers, … and others some diverse kind of species, which they set to their noses’. © by author According to some sources, it is theESCMID origin of the Onlinepractice of Lecture Library sending flowers at funerals. Boccaccio and his Decameron Giovanni Boccaccio provided the most famous description of what happened during the Black Death in Italy. In the introduction to his collection of 100 tales entitled the Decameron, he relates in precise© by author detail how the disease disrupted all forms of ESCMIDnormal human Onlinerelations. Lecture Library © by author ESCMID‘But … almost Onlineincredible wasLecture the fact that Library fathers and mothers refused to nurse and assist their own children, as though they did not belong to them.’ Medieval medicine facing the Black Death © by author During the 1300's nothing was known about the plague, ESCMIDother Online than that itLecture was contagious. Library There were no real drugs, sanitation was inadequate and knowledge of public and personal health and hygiene was virtually nonexistent. Galen and his theory At the head of the list of immediate causes was ‘bad air’, the official doctrine of some universities, where it was integrated with Galen’s theory of the four© humours. by author Medical prescriptions were ESCMIDdesigned to assistOnline the bodyLecture in restoring Library balance, rather than to combat specific diseases. Miasma © by author It was assumed that the plague was spread through the air asESCMID a miasma (Greek Online language: Lecture ‘pollution’), Library i.e. a poisonous atmosphere or ‘influence’ thought to rise from swamps and putrid matter and to cause disease. Doctors and the plague Mediaeval doctors could not help the victims of the plague. In fact many were so scared that they would not treat patients© by author suffering from it, and ESCMIDthey often fled. Online Lecture Library Until well into© theby lateauthor Middle Ages, no European physicians were bound by oath to any code of ethics, and the fact that many of ESCMIDthem viewed Online their professionLecture Librarymainly as a lucrative source of income is borne out by the parodies of the doctor figure in numerous novellas. Boccaccio also confirmed© by author that the epidemic was a particularly favourable occurrence for doctors that didn’t use common, conventional methods ESCMIDand for charlatans Online who Lecture‘had never Libraryreceived the slightest instruction in medicine’. © by author With us ther was a Doctour of Phisik, ESCMIDIn al this world Online ne was Lecture ther noon Library hym lik, … He kepte that he wan in pestilence. For gold in phisik is a cordial, Therfore he lovede gold in special. The main instrument of diagnosis was examining the colour and consistency of© by author ESCMIDurine. Online Lecture Library © by author ESCMID Online Lecture Library Guy de Chauliac Guy de Chauliac, physician to Pope Clement VI and the most eminent surgeon of the Middle Ages, was© by author the most successful ESCMIDin curing the Online plague. Lecture Library • Guy de Chauliac was the first to distinguish between bubonic and pneumonic plague, and to realise that he could not help victims of pneumonic plague. • Guy would cut open the buboes and burn the wounds with a red hot iron. • Chauliac also recommends purification of the air,© by author venesection, and having the sick maintain a healthy diet ESCMIDto combat the disease. Online Lecture Library Therapeutic measures © by author ESCMID Online Lecture Library Pope Clement VI sat in his apartment at Avignon between two large bonfires to breath ‘purified’ air. Rats and lice actually shun strong heat, so © by authorthis was one of the few truly effective ESCMID Online Lecturemeasures Library taken. Gentile da Foligno In his Consilium, Gentile da Foligno advised people to keep blazing fires burning in the rooms of their homes. Gentile also established that all food should be steeped in wine. Acid foods were © by author considered optimal (“There can be no doubt thatESCMID everything thatOnline has Lecture Library been acidified will combat putrefaction”). A plague-preventive diet The choice of food was strictly disciplined: • Meat was regarded as fairly safe, while fish was dangerous. • Milk needed to be avoided because of its innate corruptibility. • Bread had to be well baked and yeasted to avoid fermentation in the stomach. © by author • Wine and beer were expressly advised, as was dried fruit, whereasESCMID fresh fruit –Online easily Lecture Library perishable – had to be avoided. All food had to be seasoned with highly aromatic substances, and vinegar was the basis of a plague-preventing diet. A few precautions… In his Florentine Chronicle, Marchionne di Coppo Stefani reports: No doctors were to be found, because they were dying like everybody else; those who could be found wanted exorbitant fees cash-in- hand before entering the house, and having entered, they took the patient's pulse with their heads turned away, and assayed the urine samples from afar, with aromatic herbs held© to by their author noses. A professor at Montpellier, France’s first and most important school of medicine, advised his colleagues toESCMID close their patients’ Online eyes Lecture or cover them Library with a cloth so as to avoid contagion through eye-to-eye contact. Protective clothing Nowadays, plague doctors are invariably imagined as wearing hoods/masks with sweet-smelling herbs in the long 'beak', and© by also author covering themselves headESCMID to foot inOnline robes. Lecture Library In actual fact, in the fourteenth century the treatises on the Black Death only advised people to wear clothing that did not retain the miasmas of infection. Precautions regarding the purification of© the by air author and the use of sponges soaked in vinegar were ESCMIDsuggested.
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