THE BLACK DEATH* ITS SOCIAL AND ECONOMIC RESULTS By HERMAN B. ALLYN, M.D. PHILADELPHIA, PA. THE spectacle of a pestilence march­ After they had suffered seven months of ing steadily on from East to West, pestilence they were advised to send the claiming thousands of victims, ark back with a trespass offering of five unchecked by anything that man golden tumors and five golden mice, can do, inspires horror, and in proportion “images of your tumors and images of to the degree of ignorance and helplessness your mice that mar the land.” The emerods that prevails, an angry resentment, with (tumors) were evidently swellings that the demand that something be done, even to might easily have been buboes. After the the extent of human sacrifice. If in the story Philistines had sent the ark back the pesti­ of the spread of the plague in the Middle lence abated among them, but seems to Ages, with its processions, its futile worship have attacked the Israelites, ostensibly of this god or its vain offerings at that because some of them profaned the ark shrine, its torture and wholesale slaughter of by looking into it. It is certainly suspicious Jews, its burnings of suspected poisoners, of bubonic plague that those who were we are appalled at the ignorant brutishness attacked died very quickly: if they survived of mankind, let us remember that they long enough to develop tumors recovery were only just a little removed from pagan­ was possible. ism, and that even we have not yet, in our As we shall see later the pneumonic and day, acquired in full measure the conviction septicemic forms are extremely fatal in that all men are brothers. Moreover, it is from one to three days; if the victim lives only within the memory of some of us that four to seven days buboes develop. It is we have learned the causes and prevention quite probable that bubonic plague existed of typhoid, of cholera, of typhus, of malarial sporadically for many centuries. We know fevers, of yellow fever and of plague. that there are endemic centers today in Since more has been accomplished in the Yunnan, southern China; in Kurdistan; past fifty years by medical men in the in southwestern Arabia; in central Africa discovery of the causes of disease and in (Uganda) and doubtless also in India, their prevention than in all the previous in central Asia and in Siberia. It is charac­ centuries, it may be interesting historically teristic of all great epidemic diseases that to review the progress and consequences they come in waves and then recede; that of the Black Death, which swept over when they attack a virgin population the Europe like a hurricane, causing many mortality is very great (for example, measles more deaths than the World War. We shall in the Faroe Islands); the same extreme at least be the more thankful for living in fatality is noted when the disease recurs the twentieth century. after an absence long enough to enable a Whether or not the plague that affected new generation of susceptibles to be born the Philistines after they had captured the and grow up. Ark of the Covenant was bubonic plague Whatever opinion may be held as to the affords a chance for an interesting discus­ antiquity of the disease, W. Bulloch and sion. You will recall that the men that Capt. S. R. Douglas are probably right in did not die were smitten with the tumors. saying: * Read before the Section of Medical History of the College of Physicians of Philadelphia, May, The first historical notice of a disease like 1925. bubonic plague records its occurrence in Libya in the third century before Christ, or earlier; inclined to cast it in the phrases of Thucy­ but this notice is only contained in a fragment dides. There is some excuse for this, inasmuch from the writings of a much later physician, as the disastrous effects upon a com­ Rufus of Ephesus [about ioo a.d.], who also munity of any great pestilence are much the speaks of its occurrence in his own time in same: fear, paralyzing effort and abolishing Libya, Egypt and Syria. Whether it was clearly reason, justice, mercy and morality; heaps known to the classical Greek writers on medi­ of dead with too few living to bury them; cine is doubtful, but Aretaeus speaks of the survivors thinking only of their own pestilential buboes. The plague of Athens pleasure and profit: “Eat, drink and be described by Thucydides was apparently not this disease; nor was the destructive pestilence merry, for tomorrow' we die” being their in the reign of Marcus Aurelius alluded to by motto. Thucydides says: Galen. We meet with bubonic plague again, however, in the great plague of Justinian, The season was admitted to have been w’hich started from Egypt, 542 a.d., and spread remarkably free from ordinary sickness; and if over a large part of Europe; it was described anybody was already ill of any other disease, it in Gaul as lues inguinaria. Epidemics succeeded was absorbed in this. Many who were in perfect one another in this and the succeeding century. health, all in a moment, and without any At the end of the seventh century bubonic apparent reason, were seized with violent heats plague prevailed in Italy and is unmistakably in the head and with redness and inflammation recorded by Bede in England. But after that of the eyes. Internally the throat and the tongue time it is difficult to follow the track of plague. were quickly suffused with blood, and the Many European pestilences are spoken of in breath became unnatural and fetid. There mediaeval histories, which may or may not have followed sneezing and hoarseness; in a short been bubonic plague, though no sufficiently time the disorder, accompanied by a violent clear record remains.1 cough, reached the chest; then fastening lower Classical and medical literature is full down, it would move the stomach and bring on all the vomits of bile to which physicians of references to the plague. The word have ever given names; and they were very signifies a stroke or blow, an allusion both distressing. An ineffectual retching producing to the suddenness as well as to the severity of violent straining attacked most of the sufferers; the attack, particularly when the disease some as soon as the previous symptoms had assumes epidemic form. While gradually abated, others not until long afterwards. the word plague has come to be limited The body externally was not so very hot to the specifically to bubonic plague, due to the touch, nor yet pale; it was of a livid colour bacillus pestis, in earlier times it was inclining to red, and breaking out in pustules applied loosely to a number of different and ulcers. But the internal fever was intense: diseases with the common characteristics The sufferers could not bear to have on them of widespread distribution and great mortal­ even the finest linen garment. They insisted on ity. The best description of a plague in being naked, and there was nothing which they longed for more eagerly than to throw early times is that recorded by Thucydides, themselves into cold water. And many of those who writes of the plague in Athens in 430 who had no one to look after them actually b.c. Thucydides was himself attacked and plunged into cisterns, for they were tormented he witnessed the sufferings of others. So by unceasing thirst, which was not in the least vivid was the description given by this assuaged whether they drank little or much. classic writer that it has influenced unduly They could not sleep: a restlessness which was the writings of many others, notably Boccac­ intolerable never left them. While the disease cio, who have not been content to describe was at its height the body, instead of wasting objectively what they saw, but have been away, held out amid these sufferings in a marvel­ 1 Bullock, W., and Douglas, Capt. S. R. In lous manner, and either they died on the seventh Allbutt, Sir C. System of Medicine, Lond., 1912, or ninth day, not of weakness, for their strength ix, Part n, 358. was not exhausted, but of internal fever, which was the end of most; or, if they survived, angry or neglected gods. In the Middle then the disease descended into the bowels and Ages religious hatred added fury to igno­ there produced violent ulceration; severe diar­ rance. Crawfurd describes the persecution rhoea at the same time set in, and at a later of the Jews in the following language: stage caused exhaustion, which finally with few exceptions carried them off. For the disorder Amid all the panic of the Black Death, perse­ which had originally settled in the head passed cution of the Jews broke out with even greater gradually through the whole body, and, if a ferocity than during the Crusades in the twelfth person got over the worst, would often seize the century. Some victim was needed to appease the extremities and leave its mark, attacking the maddened populace: so the Jews were accused of privy parts and the fingers and the toes; and poisoning the wells, and even of infecting the some escaped with the loss of these, some with air. Circumstantial accounts were circulated the loss of their eyes. Some again had no sooner throughout Europe of secret operations directed recovered than they were seized with a forget­ from Toledo. The concoction of poisons from fulness of all things and knew neither themselves spiders, owls, and other supposed venomous nor their friends.2 animals was described, and its mode of distribu­ tion made known.