Guy De Chauliac

• 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

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

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

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. Online Lecture Library Even frescoes (1412) and woodcuts (1482) of later date bear witness to the fact that physicians approached the sick with their faces uncovered.

© by author ESCMID Online Lecture Library When the priest ©was by shriving author a dying person, everyone else had to leave the room so that ESCMIDthe dying man Online could speakLecture out loudLibrary without the confessor having to approach him. Malta, Mdina dungeons

In Malta, victims were administered Holy Communion by priests using long pincers to avoid contact. © by author ESCMID Online Lecture Library How many of the clergy died?

The death rate in the Church was particularly high. Priests visited the sick to comfort them, so were likely to catch the plague. Once the plague got into a monastery it would© by author easily spread to all the monks. In some monasteriesESCMID nearly Online all the Lecture Library monks died. How many died?

It is difficult to know exactly how many died. Nowadays every death has to© be by registered. author There were no such registers in the Middle Ages. ESCMIDThe Church was Online the only organisationLecture toLibrary keep accurate records. Bishops noted down when a new priest was appointed to a parish church. In many areas half the churches had new priests in 1348 or 1349. The Apothecary's shop

Plants and naturally occurring juices were the mainstay of Medieval medical art, and apothecaries used to make and invent their own medicines from natural ingredients. © by author The shops were full of strangeESCMID preserved Online animal Lecture Library flesh and strong spices. Theriaca

Theriaca or theriac was a medical concoction originally formulated by the Greeks in the first century AD and had become popular © by author throughout the ancient worldESCMID as a universal Online Lecture Library panacea.

The production of a proper theriac took months with all the collection and fermentation of herbs and other ingredients, the total number of which was sixty- four, including a mashed© by author decoction of viper flesh. ESCMID Online Lecture Library Modus vivendi tempore pestilentialis

The famous treatise Modus vivendi tempore pestilentialis lists many recommendations, that were meant for everybody and were not specifically written for doctors. This book was written by Giovanni Dondi (1385©-88 by ca.), author professor of Medicine and Astrology at the University of Padua.ESCMID Online Lecture Library Modus vivendi tempore pestilentialis

• The treatise of Giovanni Dondi extensively deals with ‘how to live in the plague time’, and it includes all sorts of measures stemming from the belief that plague is a result of air corruption. • People had to flee from any eastern or southern wind, never expose themselves to the sun, nor settle in either hot or damp localities. • The air had to be purified© by by author burning all manner of incense: juniper, laurel, pine, beech, lemon leaves, rosemary, camphor, sulphur and others. • ESCMIDHandkerchiefs Onlinewere dipped Lecture in aromatic oils,Library to cover the face when going out.

Frequent bathing was proscribed as dangerous by medieval medicine, since it opened your pores to the airborne© by author disease. ESCMID Online Lecture Library Physical exercise as well as sexual intercourse were also dangerous because they caused excessive heating and ‘forced’ inhalation© by author of miasmas. ESCMID Online Lecture Library Controlling health and the masses

Mostly in the early modern Italian city-states, the idea of plague as a contagion© bywent authorfrom strength to strength. The governments took more and more ad hoc measures ESCMIDdesigned to combat Online the spread Lecture of infection. Library These measures often included an element of social control, not necessarily related to the plague itself. The plague in Milan

Milan, which Barnabò Visconti governed more despotically than either the Venetian or the Florentine republics, enforced very strong measures. City officials immediately walled up houses found to have the plague, isolating the© healthy by author in them along with the sick. All doctors were asked to notify ESCMIDthe names of the Online sick patients Lecture Library in their care. Marchionne di Coppo Stefani

In his already-cited Florentine Chronicle, Marchionne di Coppo Stefani reports: When somebody took ill to his bed, the other occupants in panic told him: 'I'm going for the doctor'; and quietly locked the door from the outside and didn't come back. © by author Many were those who begged their families not to abandon them; but when evening came, and ESCMIDwhen the patient Online fell asleep, Lecture the relatives Library went off and did not return. Lorenzo de Monacis

If in Florence and Milan the sick were locked up in their homes and left to die, the chronicler Lorenzo de Monacis portrays a very different, but no less disquieting,© by author picture of what was ESCMIDhappening in Online Venice. Lecture Library The Islands of the Dead

In March 1348, the Grand Council in Venice entrusted three ‘Sages’ with the task of devising an emergency plan “pro conservatione sanitatis”. It was decided to employ porters to go round collecting the dead and dying and taking them to the © by author islands of San Marco in Boccalama or San Leonardo in Fossamala,ESCMID where Online they Lecture Library were then buried in mass graves. It is a spine-chilling thought that “many breathed their last on these boats and many who still had breath in their bodies survived only to yield up their souls in these mass graves”. Members of the family were cynically allowed to accompany the dying, that is to say, to travel © by author voluntarily, despite being healthy, to these islands. ESCMID Online Lecture Library Venice and the Lazzareto

In 1431, a further fundamental© by author institution was created in Venice - the Lazzareto, an Island in the lagoon, where the AugustinianESCMID Monastery Online of Saint Lecture Mary of NazarethLibrary used to stand and where carers of the sick used to come from the lagoon leper hospital dedicated to San Lazzaro.

Quarantine

In 1377 Ragusa decreed that ships from infected localities could only enter the port after a period of isolation. The teachings of Hippocrates establish that the fortieth day is the© last by author day that an acute disease such as the plague can manifestESCMID itself. Online Lecture Library © by author ESCMID Online Lecture Library Psychology

The psychological trauma originated by the contagion scare was huge. People were used to death in the Middle Ages. Babies often died, people were old at 45, wars were frequent, medicine was often impotent,© and by aauthor poor harvest meant starvation and death. ESCMID Online Lecture Library But the Black Death was far worse. The thing that was most dreaded in the Middle Ages was sudden death (called “the bad death”) because it gave you no time to confess and therefore you© by author risked damnation. ESCMID Online Lecture Library Escaping the plague

© by author The prevalent reaction was to get away. ESCMIDSo many men Online and women Lecture (or, at Libraryleast, those who could afford it) abandoned their houses and their relations and fled to the country. © by author ESCMID Online Lecture Library Dancing mania swept through Europe during the Black Death. Danse macabre, The Dance of Death

The medieval artistic© by and author literary form known as the Danse macabre or Dance of the Dead originated before 1348, but mediaeval artists found the iconic image a ESCMIDuseful means Onlineto express theLecture morbid and Library anxious views of death prevalent in the later mediaeval and early modern periods. Fears and violence

© by author But anxiety and fears invested all those that looked in any way ‘different’ or disturbing, ESCMIDranging from Online lepers Lecture to witches, Library and from foreigners to Jews. The Jews

Everyone suffered© during by author the plague, but the Jews had to suffer the ferocity of their fellow men, too. ESCMIDLiving in cleaner Online conditions Lecture than their Library neighbours, they were less vulnerable to the plague - which probably gave rise to the belief that they poisoned the wells of the Gentiles. © by author ESCMID Online Lecture Library Pope Clement VI was a collector of Hebrew manuscripts, and his personal physicians were Jewish. His Bull of July 6, 1348, protected the Jews in Avignon and the surrounding area, but could not hope to be© effective by author across the whole of Western ESCMIDEurope. Online Lecture Library Witches

According to popular mediaeval belief, the benevolent ‘white’ witch was capable of curing disease with her potions and knowledge. The persecution of witches was so ferocious, perhaps because they threatened to undermine the authority of the Church and official medicine. It was believed that “whenever© by a author woman attempts to cure the sick without studying, that woman is a witch and should be condemned ESCMIDto death”. Online Lecture Library The Flagellants

© by author Large groups of people walked around the country, stopping at towns and villages. They sang hymns at the ESCMIDtops of their voices Online and flayed Lecture each other Library with whips. Pope Clement VI denounced the flagellants as heretical, but their popularity persisted in times of plague outbreaks. © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library Plague and Renaissance Europe

• The coming of the Black Death marks a watershed in Mediaeval and Renaissance European History, virtually no aspect of European society being unaffected. • The popular responses are often treated as irrational or superstitious. Yet there is clear evidence that most Europeans tried to find, within the medieval world view, rational explanations© for by what author was happening. • Plague stimulated chroniclers, poets and authors, and physicians to write about what might have caused the ESCMIDplague, and it alsoOnline affected Lecture the general understandingLibrary of public health. © by author ESCMID Online Lecture Library