Post-classical history

4

FRANCE: THE STATE OF MEDICAL KNOWLEDGE

THE Black Death seems to have arrived in France only a month or two after its first outbreak on the mainland of Italy; according to an anonymous Flemish cleric in one of those same ill-fated galleys which had been expelled from Italy towards the end of January 1348.1 The galley called first at Marseilles, from where it was chased, rapidly but still not rapidly enough, by the horrified authorities. Thence it continued its destructive course, spreading the plague to Spain and leaving a trail of infection along the coast of Languedoc.

France was certainly one of the most populous and should also have been the most prosperous country of Europe. Professor Lot has put its population in 1328 – the population, that is to say, of the France of its present frontiers, including part of Flanders, Burgundy, Brittany and Guienne – at between twenty-three and twenty-four million.2 Professor Renouard estimates the total twenty years later at somewhere near twenty million.3 The density of population in the countryside was more or less what it is today:4 a burden which the land was hard put to it to support since production per acre was barely a third of the present figure. On the whole the latest studies tend to indicate a total population somewhat lower5 than earlier estimates but no one would deny that the rural population was dense by medieval standards, comparable with that of Tuscany, and that the pressure of population on resources was fast becoming intolerable.

Left to itself the French countryside was probably more capable of supporting such a crowd than any other region in Europe. But where Italy had to endure its Guelphs and Ghibellines, France had the English. King Edward III had no intention of leaving France to itself or, to look at the matter in a more chauvinistic light, was justifiably outraged by French interference with his Duchy of Guienne and their support for David Bruce in Scotland. John of Bridlington, indeed, ascribed the plague in France mainly to the contumacious policy of its king.6 He pointed out that the French had been guilty of avarice, luxury, envy, gluttony, anger, sloth and conspicuous lack of devotion to the saints but that the chief crime which had called down divine vengeance was undoubtedly the failure of Philip VI to allow Edward III free and peaceful enjoyment of his inheritance. He did not go on to explain the curious circumstance that God had subsequently extended the scope of his wrath to embrace the virtuous and ill-used English.

Whether or not the policy of Philip VI provoked the plague, it certainly led to the Hundred Years War between France and England; in the long run to the detriment of both countries, in the short with disastrous consequences for his own. From 1337, when Philip VI announced that the English throne had forfeited Guienne and Edward III retorted by claiming the throne of France, the French peasant, in great areas of his country, no longer knew the meaning of the word security. A brief truce after the naval battle of Sluys quickly ended in renewed warfare. In 1346 Edward III landed in Normandy with some 15,000 men. On 25 August he won a crushing victory at Crécy. The subsequent siege of Calais lasted a year. Military casualties in the campaign, by modern standards or when viewed against the size of the French population, were insignificant but the damage to civilian morale and to the agricultural richness of the country was immeasurable. To the luckless villagers, whose few possessions had alternately been looted by French or English soldiery, the apparition of the plague seemed merely the culminating phase in a process designed by God to end in their total destruction.

*

Within a month, wrote one authority, fifty-six thousand people in Marseilles met their end.7 The figure seems improbably high but, as in many sea-ports where bubonic and pulmonary plague raged side by side, mortality was greater than in the inland regions. From the Mediterranean the epidemic advanced along two main lines. To the west it quickly reached Montpellier and Narbonne. It afflicted Carcassonne between February and May; moved on to Toulouse and Montauban and finally reached Bordeaux in August. To the north, Avignon was attacked in March, April and May; Lyons in the early summer, Paris in June and Burgundy in July and August. Flanders was exempt until 1349.

In Perpignan the plague took much the same course as in Avignon though, as was usually the case, it passed more quickly in the smaller city. The disruption of everyday commercial life is shown strikingly by statistics of loans made by the Jews of Perpignan to their Christian co-citizens. In January 1348 there were sixteen such loans, in February, twenty-five, March, thirty-two, eight in the first eleven days of April, three in the rest of the month and then no more till 12 August. Of 125 scribes and legists known to have been active shortly before the Black Death only forty-five appear to have survived – even with a reduction for natural mortality a death rate of between fifty and sixty per cent seems likely. Physicians fared even worse – only one out of eight surviving – while sixteen out of eighteen barbers and surgeons perished or, at least,8 disappeared.

‘Laura,’ wrote Petrarch in his manuscript of Virgil,

illustrious by her virtues and long celebrated in my songs, first greeted my eyes in the days of my youth, the 6th of April, 1327, at Avignon; and, in the same city, at the same hour of the same 6th of April, but in the year 1348, withdrew from life, whilst I was at Verona, unconscious of my loss …

Her chaste and lovely body was interred on the evening of the same day in the Church of the Minorites: her soul, as I believe, returned to heaven whence it came.

To write these lines in bitter memory of this event and in the place where they will most often meet my eyes has in it something of a cruel sweetness, but I forget that nothing more ought in this life to please me, which, by the grace of God, need not be difficult to one who thinks strenuously and manfully of the idle cares, the empty hopes and the unexpected end of the years that are gone …9

Avignon in 1348 had been for nearly half a century the seat of the Popes. As such it had swollen from an always considerable town to one of the great cities of Europe, Its role as papal capital ensured that it would be one of the most visited centres of Christendom; an easy prey for a plague that thrived on every kind of social intercourse. An unnamed canon writing to a friend in Bruges spoke of half the population of Avignon being dead, seven thousand houses shut up and deserted, eleven thousand corpses buried in six weeks in a single graveyard, sixty-two thousand victims in the first three months of the epidemic.10 Another record put the total of the dead at more than a hundred and twenty thousand11 while the German historian, Sticker, on still less certain authority, even ventured as far as a hundred and fifty thousand.12 It is, at least, not hard to believe that half the population died though one of the few verified facts might be taken as indicating a lower figure. The Rolls of the Apostolic Chamber show that only ninety-four out of four hundred and fifty, or 21 per cent, of the members of the Papal Curia died during the Black Death.13 But this is not much of a pointer to the overall death rate. Nobody would have expected the well-fed and well-housed senior staff of the papal establishment to perish at the rate of their fellow mortals.

On the whole the churchmen of Avignon seem to have behaved creditably during the plague; churchmen in the widest sense that is, from papal councillor to penniless and itinerant monk. ‘Of the Carmelite friars at Avignon,’ wrote Knighton uncharitably,14‘sixty-six died before the citizens knew the cause of the calamity; they thought that these friars had killed each other. Of the English Austin Friars at Avignon not one remained, nor did men care.’ Knighton had all the contempt of a Canon Regular for these turbulent and often embarrassing colleagues. ‘At Marseilles, of one hundred and fifty Franciscans, not one survived to tell the tale; and a good job too!’ was another of his still harsher comments. Yet in fact there is no reason to doubt that the mendicant orders behaved at Avignon with as much courage and devotion as they did elsewhere and that their reputation rose accordingly.15

Pope Clement VI himself played a slightly less forthright part. There is no doubt that he was preoccupied by the horrors of the plague and genuinely disturbed and distressed for his people. Though by no means celebrated as an ascetic he was good-hearted and honourable, anxious to do what was best for his flock. He did all he could to ease the path of the afflicted by relaxing the formalities needed to obtain absolution and ordered ‘devout processions, singing the Litanies, to be made on certain days each week’. Unfortunately such processions tended to get out of hand; at some, two thousand people attended, ‘amongst them, many of both sexes were barefooted, some were in sack cloth, some covered with ashes, wailing as they walked, tearing their hair, and lashing themselves with scourges even to the point where blood was drawn’16 At first the Pope made a habit of being present at these processions, at any rate when they were within the precincts of his palace, but excesses of this kind revolted his urbane and sophisticated mind. He also realized that large concourses, attended by the devout from all over the region, were a sure means of spreading the plague still further, as well as providing a breeding ground for every kind of hysterical mob outburst. The processions were abruptly ended and the Pope from then onwards sought to discourage any kind of public demonstration.

Not unreasonably, Pope Clement VI calculated that nothing would be gained by his death and that, indeed, it was his duty to his people to cherish them as long as possible. He therefore made it his business to stay alive. On the advice of the papal physician, Gui de Chauliac, he retreated to his chamber, saw nobody, and spent all day and night sheltering between two enormous fires. For a time he took refuge in his castle on the Rhône near Valence but by the autumn he was again at his post in Avignon. It does not seem that the Black Death died out in the papal capital much before the end of 1348.

*

‘Fish, even sea fish, are commonly not eaten’ the horrified clerics of Bruges heard from their compatriots at Avignon, ‘as people say that they have been infected by the bad air. Moreover, people do not eat, nor even touch spices, which have not been kept a year, since they fear that they may have lately arrived in the aforesaid ships. And, indeed, it has many times been observed that those who have eaten these new spices and even some kinds of sea fish have suddenly been taken ill.’

As the Black Death moved across Europe it was inevitable that a host of theories would be generated on the best methods of avoiding, preventing and curing the disease. The growing threat to France induced King Philip VI to appeal to the Medical Faculty at Paris to prepare a considered report on the subject. Their response17 provided the most prestigious, though neither the best informed nor the most intelligent, of the many studies of the Black Death in action. The plague literature as a whole, drawn from some half-dozen countries, was voluminous, repetitious and of little value to the unfortunate victims of the epidemic. Before considering it, however, it is worth taking a quick look at the growth of medical knowledge before and during the Middle Ages so that the disadvantages and limitations under which the medieval physician laboured can be better understood.

Modern medical science, if a gross over-generalization may be forgiven, began with Hippocrates. It was he who first conceived ill health, not as a series of unrelated and essentially inexplicable catastrophes but as an orderly process calling on each occasion for examination of symptoms, diagnosis of malady and prescription of cure. For any study of the Black Death his importance is paramount since he was the first student of epidemiology and the first to distinguish between epidemic and endemic diseases. In his First and Third Books of Epidemics and the four volumes of notes compiled either by Hippocrates himself or by his son he set out to analyse the factors which led to a disease settling in any given area and becoming endemic. The next stage was to define and explain the causes, climatic, meteorological or latent within the body of man himself, which provoked a subsequent epidemic outburst. It was his particular concern to work out a relationhip between each type of epidemic and the different environmental conditions in which it flourished. This ‘katastasis’, as he called it, was, it seemed to him, best established on astronomical evidence – a red herring which Hippocrates himself might in time have transcended but which was to bedevil medical research for many centuries.

The main flaw in the monumental labour of Hippocrates was that he had insufficient data from which to draw valid conclusions. He deduced, for instance, that spells of warm, moist weather were, in themselves, conducive to ill health; a thesis reasonable enough where malarial regions were concerned but irrelevant if not positively misleading when applied to England. His great achievement was to have provided a blue-print for research on which subsequent generations should have worked. The tragedy is that the vast compilation of case histories, on which a serious study of epidemiology could alone have been based, was not made by his successors. After the death of Hippocrates in 377BC, medical science slumbered for five hundred years; it awoke only to find itself rigidified by the misplaced formalizing genius of Galen of Pergamos.

Galen was one of the outstanding intellects of his age and a great experimental physiologist. But, when it came to epidemiology, rather than work from the Hippocratic base and accumulate fresh data from which empirically to establish new and constructive theses, he instead elected to devise an inflexible theoretical pattern which left no room for further research or original thought. He lived through a major epidemic of bubonic plague but the phenomenon was in no way reflected in his work. To attempt to summarize Galen’s complicated and, within his own terms of reference, logically faultless theorizing would be to reduce it to a parody. Suffice it to say that he believed ill health to depend on the interaction of temperament, the constitution of the atmosphere and certain other factors such as excessive or ill-judged eating and drinking. Temperament and constitution in their turn depended on the blending of the elementary qualities and any failure to achieve perfect balance led to one of a number of possible discords. The permutations on these factors were developed into an intricate mathematical pattern: a computer into which the details of any case could be fed and a logically satisfactory explanation provided.

Unfortunately, though the logic might be impeccable, its relevance to anything so mundane as the prevention or cure of plague was sadly tenuous. What was worse, the medieval physician believed that Galen had said the last word on epidemics and that any further research was unnecessary if not positively disrespectful to the teachings of the master. And yet the teachings of the master themselves were in doubt since the original texts had been largely lost and doctors in the West for several centuries worked almost exclusively from inadequate Latin versions of Arabic translations of Hippocrates and Galen. The result was an Arabic-Latin literature, in Dr Singer’s description,

… generally characterized by the qualities most often associated with the words ‘medieval’ and ‘scholastic’. It is extremely verbose and almost wholly devoid of the literary graces. An immense amount of attention is paid to the mere arrangement of the material, which often occupies its author more than the ideas that are to be conveyed. Great stress is laid on argument, especially in the form of syllogism, while observation of nature is entirely in the background…. Lip-service is often paid to Hippocrates, but his spirit is absent from these windy discussions.18

Nurtured on such material it is hardly surprising that medical science did not flourish in the Middle Ages. ‘The Dark Ages for Medicine,’ wrote Dr Singer, ‘began at the death of Bede in 753’.19 They did not end until long after the Black Death had run its course. But the failings of the fourteenth-century doctors should not be exaggerated nor their limitations presented as grotesque extravagances. Ill-informed and unimaginative they might have been but there was, on the whole, surprisingly little of the:

Watres rubifiying, and boles galle,

Arsenyk, sal armonyak, and brymstoon,

And herbes koude I telle eek many oon,

As egremoyne, valerian, and lunarie.*

which were the stock-in-trade of Chaucer’s alchemist.

The situation of medicine was not helped by the stern determination of the medieval churchman to keep the physician in his place. What Professor Gurlt described as ‘that fatal exaggeration which enthroned theology not merely as mother but as Queen of all the sciences’,20 ensured that the doctor would play a secondary  role. In the sick room it was the priest who took the lead and the doctor who humbly offered his services once the praying was over. Before he even treated a patient the doctor was supposed to establish whether he had first confessed; if he had not, then medicine would have to wait its turn. Sometimes the doctor would manage to assert himself but, in general, the more eminent the invalid, the more likely it was that he would find himself thrust into the back row behind a bevy of churchmen and courtiers. When the disease worked quickly a doctor might not even be admitted to his patient’s bedside until death was imminent or had actually occurred.

But the Church, by the stranglehold which it had on every field of education, ensured that the invalid would have gained little even if the doctor had been given a freer hand. All medical teaching at the universities was on lines laid down by the Church and consisted mainly of the reading of outmoded texts with a brief and usually misleading ‘interpretation’ by the professor. Surgery was the poor relation of an anyhow impoverished science. In 1300, Boniface VIII published a Bull forbidding the mutilation of corpses. His object was to check the excesses of relic hunters but, incidentally, he dealt a crippling blow to would-be anatomists. Soon afterwards the Medical Faculty of Paris formally declared itself an opponent of surgery. At Montpellier, supposed to be among the most enlightened of the medical schools, there was one practical anatomy lesson every two years. This long and eagerly awaited occasion consisted merely of the opening of an abdomen and a cursory exposition of its contents. It was not till the end of the fifteenth century that Sixtus IV authorized the practice of dissection and even then specific authority had to be obtained on each occasion.

Given such handicaps it would have been miraculous if the medical profession had met the Black Death with anything much more useful than awe-struck despair. Their efforts were as futile as their approach was fatalistic. Not only were they well aware that they could do little or nothing to help but they considered it self-evident that an uncharitable Deity had never intended that they should. ‘The plague’, wrote Gui de Chauliac, one of their most distinguished and, incidentally, successful practitioners, was ‘shameful for the physicians, who could give no help at all, especially as, out of fear of infection, they hesitated to visit the sick. Even if they did they achieved nothing, and earned no fees, for all those who caught the plague died, except for a few towards the end of the epidemic who escaped after the buboes had ripened.’21A doctor not prepared to visit the sick must, of course, labour under a singular disadvantage but de Chauliac was certainly right in his contention that, from the point of view of the infected, it made little difference. Nothing in the medical literature which survives suggests that the treatment of the doctors, though it may sometimes have eased a patient’s sufferings, can have been directly responsible for a single cure.

The views and activities of the doctors are reasonably well known through the plague tractates which they left behind them. Sudhoff’s Archives22 already reproduce well over two hundred and eighty of these. Many relate to other phases of the great pandemic but seventy-seven were written before 1400 and at least twenty before 1353. The majority of the most important studies relating to the Black Death have been analysed by Dr Anna Campbell in her invaluable work, The Black Death and Men of Learning.23 The preamble to the Report of the Faculty of Medicine at Paris demonstrates admirably the vague, hopeless search for arcane solutions which appeared again and again in the tractates: ‘Upon seeing effects whose cause is concealed even from the most highly trained of intellects, the mortal mind must ask itself, especially as there is in it an innate desire for appreciation of the good and of the true, for what reason everything seeks good and desires knowledge …’

But the windy nothingness of this somewhat unhelpful speculation was by no means typical. There was much shrewd observation and a certain amount of common sense and sound judgement in the recommendation of measures which, though no more than palliatives, still did more good than harm. Certainly there was a depressing readiness to stress that flight was the only possible defence against the plague or to argue that, if flight were impossible, there had better be immediate recourse to prayer. But the patient was also given a certain amount of guidance on how he should conduct himself. It seems unlikely that much confidence was inspired among those threatened or afflicted by the plague but some people must at least have been given a ray of hope and a feeling that they were not entirely helpless in the face of destiny.

Differences of opinion between the experts were frequent. Simon of Covino24 considered that the pregnant woman and, even more, ‘those of fragile nature’ would succumb and that no doctor could help them. The undernourished pauper would be the first to go – a reasonable conclusion which the Medical Faculty, however, rejected, claiming that those ‘whose bodies are replete with humours’ were the most vulnerable. Ibn Khātimah25 agreed with the Faculty. People of ‘hot, moist temperament’ were the most exposed; the ultimate in peril was to be a stout young woman with a taste for lechery.

There was more agreement on the best place to live so as to avoid the plague. Seclusion, obviously, must be a first priority. After that, the problem was how to keep out of the way of the dreadful miasma, the infected air which, borne generally by the south wind, carried death from land to land. A low site, sheltered from the wind, was of course desirable. The coast was to be shunned; with good reason because of the threat from shipborne rats though the danger was visualized by the tractators as corrupt mists creeping lethally across the surface of the sea. Marsh lands were not to be recommended for here too rose the killing mist. Houses should face north; windows preferably be glazed or covered with waxcloth.

Even in the most prosperous practices – and where there was no prosperity there was generally no doctor – the doctor recognized that many of his clients would not be able to flee to remote spots where they might hope to escape the plague. Rules had to be laid down for the conduct of life in a plague-stricken area. If infection was carried by corrupted atmosphere then what was needed was something to build up counter-bodies within the air. Dry and richly scented woods were to be burnt: juniper, ash, vine or rosemary. Anything aromatic was of value: wood of aloes, amber, musk, or, for the less prosperous, cyprus, laurel and mastic. A typical recipe for a powder to throw on the fire26 was one ounce each of choice storax, calamite and wood of aloes mixed in a mortar with rose-water of Damascus and made into small, oblong briquettes. The house was to be filled, whenever possible, with pleasant smelling plants and flowers and the floors sprinkled with vinegar and rose-water. If one was unfortunate enough to have to leave one’s house a prudent precaution would be to carry an amber or smelling apple. If amber was too expensive a cheaper but efficacious substitute could be contrived from equal portions of black pepper and red and white sandal, two portions of roses and a half portion of camphor. The resulting blend was then pounded for a week in a solution of rose-water and moulded into apples with paste of gum arabic.

It is doubtful if these precautions did anything to reduce the risk of infection with the possible exception of one recipe of Dionysius Colle for a powder, used for throwing on the fire, which contained sulphur, arsenic and antimony.27 The first of these is now recognized as being destructive to bacteria as well as to rats and fleas. The other compounds, in most cases, had the minor merit of making the usually smelly medieval house a little more agreeable to live in.

Vegetable inactivity was the ideal posture in which to meet the plague. If one had to move, at least move slowly; exercise introduced more air into the body and, with the air, more poison. Hot baths, which opened pores in the skin, were to be shunned for the same reason, though it was beneficial to bathe the face and hands from time to time in vinegar or the inevitable rose-water.

There was general agreement also on the best kinds of preventive medicine. A fig or two with some rue and filberts taken before breakfast was a useful start to the day. Pills of aloes, myrrh and saffron were popular. One authority28 placed his confidence in ten-year-old treacle blended with some sixty elements, including chopped-up snakes, and mixed with good wine. Rhubarb and spikenard was a compound easier to manufacture and to swallow. Witchcraft joined herbalism in the works of Gentile of Foligno29 who recommended powdered emerald; a remedy so potent that, if a toad looked at it, its eyes would crack. Gentile also suggested etching on an amethyst the figure of a man bowing, girded with a serpent whose head he held in his right hand and whose tail in his left. To be fully operative the stone had first to be set in a gold ring.

Bleeding was generally held to be a useful preventive device; Ibn Khātimah,30 for instance, feeling that it could only be beneficial to lose up to eight pounds. Diet was important. Anything which quickly went bad in hot weather was to be avoided. So was fish from the infected waters of the sea. Meat should be roast rather than boiled. Eggs were authorized if eaten with vinegar31 but should never be taken hard-boiled.32 Anyone trying to follow the advice of every expert would have been sadly perplexed. Ibn Khātimah approved of fresh fruit and vegetables but no one else agreed. Gentile of Foligno recommended lettuce, the Faculty of Medicine at Paris forbade it. Ibn Khātimah had faith in egg plant, another expert deplored its use.

It was bad to sleep by day or directly after meals. Gentile believed that it was best to keep steady the heat of the liver by sleeping first on the right side and then on the left. To sleep on one’s back was disastrous since this would cause a stream of superfluities to descend on the palate and nostrils. From thence these would flow back to the brain and submerge the memory.

Bad drove out bad and a school of thought maintained that to imbibe foul odours was a useful if not infallible protection. According to John Colle: ‘Attendants who take care of latrines and those who serve in hospitals and other malodorous places are nearly all to be considered immune.’ It was not unknown for apprehensive citizens of a plague-struck city to spend hours each day crouched over a latrine absorbing with relish the foetid smells.

A tranquil mind was one of the surer armours against infection. Ideally one should retreat to Boccaccio’s enchanted glade, live beautifully, pass one’s time in dalliance and in practising the art of conversation. But dalliance should not be carried too far: sex, like wrath, heated the members and disturbed the equilibrium. One’s mind should be resolutely closed to the agonies of one’s fellow men; sadness cooled the body, dulled the intelligence and deadened the spirit.

It seems unlikely that the intelligent and enlightened men who worked out these preventive measures had any great faith in their efficacy. Essentially they were a morale-building exercise: the morale of the physician, in that they made him feel at least remotely in control of the situation, and of the patient, in that they offered a slight hope of escape from death. But if the doctors lacked confidence in their capacity to keep the plague at bay, still more did they doubt their ability to cure it once it had struck. They knew too well how few of the sick recovered. But this knowledge of their helplessness did not stop them putting forward a host of remedies.

Bleeding was an even more important part of the cure than it had been of prevention. The blood that emerged from the infected would normally be thick and black; it boded even worse for the victim if a thin green scum rose to the surface. If the patient fainted, instructed Ibn Khātimah somewhat heartlessly, pour cold water over him and continue as before. Most surgeons bled for the sake of bleeding, not worrying much where the incision was made. John of Burgundy33was more scientific. He believed in the existence of emunctories, from which the poison could be expelled by bleeding. The evil vapours, having entered by the pores of the skin, were carried by the blood either to the heart, the liver or the brain. ‘Thus, when the heart is attacked, we may be sure that the poison will fly to the emunctory of the heart, which is the armpit. But if it finds no outlet there it is driven to seek the liver, which again sends it to its own emunctory in the groin. If thwarted there, the poison will next seek the brain, when it will be driven either under the ears or to the throat.’ Each emunctory had a surface vein which corresponded to it and a skilled surgeon could there intercept the poison on its devil’s progress around the body and draw it off before it did more mischief. A common and disastrous mistake was to make the incision on the wrong side of the body; this not only wasted good blood but meant that healthy limbs were corrupted by the degraded liquid which poured in to make up the loss.

As well as bleeding, it was useful to open and cauterize the plague boils or buboes. Various curious substances were applied to the boils to draw off the poison. Gentile used a plaster made from gum resin, the roots of white lilies and dried human excrement, while Master Albert was in favour of an old cock cut through the back. Ibn Khātimah believed that an operation on the bubo was possible between the fourth and seventh day of the disease when the poison was flowing from the heart to the boils. But even a slight mistake in timing could lead to the escape of the vital principle from the heart and the immediate death of the patient.

Various soothing potions were prescribed, in particular a blend of apple-syrup, lemon, rose-water and peppermint. This must at least have been pleasant to drink. Even this consolation was removed when powdered minerals were added to the mixture. There was some belief in the virtues of emeralds and pearls and the medicinal qualities of gold were taken for granted by most authorities. Take one ounce of best gold – was Gentile’s recipe – add eleven ounces of quicksilver, dissolve by slow heat, let the quicksilver escape, add forty-seven ounces of water of borage, keep airtight for three days over a fire and drink until cure or, more probably, death supervened. At least the high price of gold ensured that not many invalids could afford to be poisoned by such medicines.

Just how little the doctors learned from the Black Death is shown by the Tractate of John of Burgundy or John à la Barbe, published in 1365.34 It is true that the author had gained much of his experience and no doubt devised his treatments in 1348 and 1349 but he had lived through a second great epidemic in 1361 and, at the time he wrote, was distilling what should have been a lifetime’s learning. The same sterile analysis of causes appeared, the same catalogue of futile preventive methods and still more futile cures. Given the state of medical learning no great leap forward was possible but if Hippocrates had been alive he would at least have discarded a lot of dead wood of proven uselessness and made some sensible and valuable deductions about the conditions in which the epidemic seemed to thrive and the best means of removing them. Of this there was nothing; only the regurgitation of long discredited dogmas and, from time to time, the addition of some new mineral or vegetable gimmick to give the technique of the writer a flavour of modernity.

I pray to God, so save thy gentil cors

And eek thyne urynals and thy jurdones,

Thyn ypocras and eek thy galiones.

And every boyste ful of thy letuarie.

Fourteenth-century men seem to have regarded their doctor in rather the same way as twentieth-century men are apt to regard their priest, with tolerance for someone who was doing his best and the respect due to a man of learning but also with a nagging and uncomfortable conviction that he was largely irrelevant to the real and urgent problems of their lives. They were, of course, ready to believe almost anything which was told them with authority but their faith had been undermined by the patent lack of confidence on the part of the doctors themselves. Sometimes, under intolerable stress, scepticism would give way to something more primitive and violent, tolerance would crack and the doctor find himself execrated as the architect of the disease which he had proved so signally ill-qualified to check. But such moments of revulsion were rare and in general the doctor preserved a privileged position. Chaucer’s mockery and the occasional abuse of an aggrieved patient was the worst that he had to bear.

*

However little use the doctors may have been, the average Parisian at least had the comfort of knowing that he was far better provided with medical attention than his contemporaries. There were more doctors, predominantly Jewish, in Paris than in any other city of Europe and all surgeons had passed an examination and had been licensed by a panel of master surgeons trained at the Châtelet.35 The fashionable course for study was based on the works of the Arab surgeon Razi and an ointment called ‘Blanc de Razès’ was on sale at apothecaries as a cure recommended for virtually any ailment. But no amount of ointments nor the wisdom of the august Faculty of Medicine itself could do much to help the Parisian when the Black Death broke about him.

It seems that the first authenticated cases of plague in the capital were noted in May or June 1348, though the full force of the epidemic was not felt until several months later. It did not die out until the winter of 1349. The chronicler of St Denis put the death roll at about fifty thousand,36 a surprisingly conservative estimate for a city that may well have had more than two hundred thousand inhabitants.37 Certainly there is no reason to think the figure exaggerated. An analysis based on church warden accounts for the parish of St Germain l’Auxerrois showed that seventy-eight legacies were bequeathed to the church between Easter 1340 and 11 June 1348.38 In the next nine months the number rose to four hundred and nineteen – a rate forty times as high. ‘It seems,’ commented Mollat, ‘that the plague sent men to their lawyers as fast as to their confessors.’ On this, admittedly somewhat slender basis, he calculated that the plague was at its worst almost at the end, in September and October 1349, and that it ran an unusually protracted course. The Bishop, Foulque de Chanac, died in July 1349; the Duchess of Normandy, Bonne de Luxembourg, in October and her mother-in-law, Jeanne de Bourgogne, when the danger must have seemed almost over, on 12 December.

‘There was,’ wrote the best-known chronicler of the Black Death in Paris, ‘so great a mortality among people of both sexes, of the young rather than of the old, that it was hardly possible to bury them.’39 This is not the only reference to the plague striking the young rather than the old, the strong before the weak. Statistically, as will be seen more clearly in the case of England,40 there seems no reason to credit such a theory. The position is, of course, complicated by the tendency of the old to die from other causes without a major epidemic to speed them on their way, but, even after allowing for this, the young and fit, as was to be expected, proved the more likely to resist the disease. The death of a strong young man is naturally more shocking and more likely to be remembered: to this, perhaps, is due the conviction on the part of certain chroniclers that his chances of death were unfairly high.

‘In the Hôtel-Dieu at Paris,’ continued the chronicler, ‘so great was the mortality that for a long time more than five hundred corpses were carted daily to the churchyard of St Innocent to be buried.’ Cardinal Gasquet has suggested that this is a misprint for fifty.41 Certainly the latter figure is probably nearer reality but there seems little reason to doubt that William of Nangis would have preferred the larger, more imposing total. ‘And those holy sisters,’ he continued, ‘having no fear of death, tended the sick with all sweetness and humility, putting all honour [sic ?fear] behind their back. The greater number of these sisters, many times renewed by death, now rest in peace with Christ, as we must piously believe.’ Such examples of self-abnegation were rare enough to deserve special mention; for the most part, in Paris as in every other city, the rule of the day was sauve-qui-peut. Charity, if it was to be found at all, began at home and ended there. Even the priests ‘retired through fear’, leaving the sick to shrive themselves or, if they were lucky, to gain the attention of a mendicant friar.

When the pastors set such an example it was hardly surprising that their flocks should follow suit. In the benighted city, where it seemed death to wander abroad, only those servants of death, the grave-diggers, felt themselves free to travel where they would. The rich and privileged fled, the poor remained to drown their fear in looted liquor and die in their hovels. Under the surface scum of terror and disorder ordinary decent men continued to behave in an ordinary, decent way; the life of the city fitfully continued. But to the casual visitor it must have seemed that society had disintegrated, that the plague must rage until there was not a home inviolated, not a Parisian alive. If it was not to be the end of the world, it seemed at least the end of the established order.

*

From Paris the plague moved northwards to the coast, which it reached in or a little before August 1348. In this area, exceptionally, the winter checked the violence of the epidemic but with the spring it returned, evidently in its more virulent pulmonary form. The King had fled from Paris to Normandy but the plague was quick to follow him. At Rouen, where an over-excited contemporary calculated the dead at a hundred thousand, the Duke of Normandy donated land for a new graveyard. At Bayeux the Bishop and many canons died. At La Graverie, about four miles from Vire, ‘the bodies of the dead decayed in putrefaction on the pallets where they had breathed their last.’ A black flag flew above the church as it did in all the worst affected villages of Normandy.42

La Léverie was a village within the parish of La Graverie. The lady of the manor died and her relatives wished to bury her in the churchyard. But no priest of La Graverie remained alive to conduct the service and there was no sign of a new incumbent being appointed. The relatives appealed to the priest of neighbouring Coulonces who was happy to bury the deceased but drew the line at visiting La Graverie, because of the danger of infection, and was equally reluctant to accept the corpse in Coulonces for fear of contaminating his so far inviolate village. So this lady was buried in the park of her own manor and the grateful relatives arranged the transfer of La Léverie from the parish of La Graverie to the parish of Coulonces.

St Marie Laumont in the same area lost four hundred people, or over half the population. The epidemic there raged for three months and had ended by September 1348. Amiens, it seems, must have suffered a second attack or perhaps, as occasionally happened in the larger cities, wasted away gradually over a year or more rather than succumbed to a brief but shattering epidemic. As late as June 1349 the King authorized the Mayor to open a new cemetery on the grounds that: ‘The mortality … is so marvellously great that people are dying there suddenly, as quickly as between one evening and the following morning and often quicker than that.’43 Meanwhile the Black Death seeped across every corner of France. Bordeaux it had reached in August 1348 and there caught and killed Princess Joan, daughter of King Edward III of England, on her way to marry the son of the King of Castile. The news of her death reached England at much the same time as the plague itself.

To the North East the Black Death moved slowly on towards Flanders and the Low Countries. ‘It is almost impossible,’ wrote Gilles Li Muisis44 ‘to credit the mortality throughout the whole country. Travellers, merchants, pilgrims and others who have passed through it declare that they have found cattle wandering without herdsmen in the fields, towns and waste-lands; that they have seen barns and wine-cellars standing wide open, houses empty and few people to be found anywhere…. And in many different areas, both lands and fields are lying uncultivated.’

Professor Renouard says that, though mortality in the French towns was terrifyingly high, the country escaped comparatively lightly.45 In many areas this was certainly true but, though Li Muisis’s account may well have been embellished in the interests of the picturesque, there are too many descriptions like it to accept Renouard’s statement as invariably valid. At Givry, a large Burgundian village near Chalon-sur-Saône of between twelve and fifteen hundred inhabitants, the average death rate in the years before the plague was thirty each year. Between 5 August and 19 November 1348 six hundred and fifteen people died. In Saint-Pierre-du-Soucy, a rural parish in Savoy, the number of households dwindled from one hundred and eight in 1347 to sixty-eight at the end of 1348 and fifty-five in 1349. In the seven neighbouring parishes, all farming communities with small and scattered populations, the number of households fell from three hundred and three to one hundred and forty-two.46 In areas such as these, at least, something close to half the population must have perished.

In the summer of 1349, the Black Death reached Li Muisis’s own city of Tournai. The Bishop, John de Pratis, was one of the first to die; then came a lull during which the citizens told themselves that they had been let off lightly. But by August the plague was raging with renewed strength:

Every day the bodies of the dead were borne to the churches, now five, now ten, now fifteen, and in the parish of St Brice sometimes twenty or thirty. In all parish churches the curates, parish clerks and sextons, to get their fees, rang morning, evening and night the passing bells, and by this the whole population of the city, men and women alike, began to be filled with fear.

The Town Council acted firmly to restore public confidence and check the collapse in moral standards which was likely, they feared, to bring down upon the city a still more ferocious measure of divine vengeance. Men and women who, although not married, were living together as man and wife were ordered either to marry at once or to break off their relationship. Swearing, playing dice and working on the Sabbath were prohibited. No bells were to be rung at funerals, no mourning worn and there were to be no gatherings in the houses of the dead. New graveyards were opened outside the city walls and all the dead, irrespective of their standing in the city or the grandeur of their family vaults, were in future to be buried there.

The measures seem to have been successful; if not in checking the Black Death then at least in raising the moral tone of the community. Li Muisis reported that the number of people living in sin dwindled rapidly, swearing and work on the Sabbath almost ended, the dice manufacturers became so discouraged with their sales-figures that they turned their products into ‘round objects on which people told their Pater Nosters.’ But gratifying though this must have been, the death roll was still terrifyingly high. ‘It was strange,’ said the chronicler, that ‘the mortality was especially great among the rich and powerful.’ Strange indeed, especially since he went on to comment: ‘Deaths were more numerous about the market places and in poor, narrow streets than in broader and more spacious areas.’ There seems no reason to doubt that in Tournai, as in every other city, the rich man who remained prudently secluded had a better chance of survival than the poor man who, like it or not, was forced to live cheek-by-jowl with his neighbours. But his chance was not necessarily a high one: ‘… no one was secure, whether rich, in moderate circumstances or poor, but everyone from day to day waited on the will of the Lord.’

*

The Middle Ages were described by Koyré, the great historian of science, as the period of à peu près. Everything is seen through a glass darkly; though here and there it may be possible to identify detail with fair certainty, for the most part a bold, impressionistic picture is the best that can be hoped for. No more in France than in Italy can it be said what proportion of the population died. Gui de Chauliac spoke of three quarters, other chroniclers of half; Professor Renouard, who has studied the subject as closely as anyone, can do no better than estimate that the death rate varied from an eighth to two-thirds according to the area.

But even if such details were known to us we would still be very far from understanding what the Black Death meant to medieval man. Some hazy outline of the reactions of the French emerges from the records of the chroniclers. Men seem to have taken refuge in frenetic gaiety. It was not only in Tournai that dice and lechery were the order of the day. ‘It is a curious fact,’ observed Papon,47 ‘that neither the flail of war nor of plague can reform our nation. Dances, festivals, games and tournaments continued perpetually; the French danced, one might say, on the graves of their kinsmen….’ The standards of society were relaxed; debauchery was common; thrift and continence forgotten; the sacred rules of property ignored; the ties of family and friendship denied; let us eat and drink, for tomorrow we shall die.

It is dangerously easy to allow the prejudiced records of a handful of priestly and conservative chroniclers to delude one into a vision of Europe studded with Sodoms and Gomorrahs and echoing from end to end with the rattle of dice and the laughter of tipsy courtesans. But it would be hardly less foolish to let one’s rejection of such fantasies blind one to the very real degeneracy of life during the plague. The great nobles and churchmen, the richest merchants, withdrew from the city; those who were left drank, fornicated or skulked in cellars according to their inclinations. To none of them could it have seemed likely that his life would drag on for more than a few painful weeks. With no future to await and the threat of annihilation hanging over all he cared for, how could medieval man be expected to behave with responsibility? Honesty, decency and sobriety were by no means dead but they must, at times, have been uncommonly hard to find. In Paris at least there had been something not far removed from a complete collapse of public and private morality. This was not the least of the penalties which the Black Death exacted from its victims.

Notes

1 De Smet, Vol. II, Breve Chronicon, p. 15.

2 M. E. Lot, ‘L’état des paroisses et des feux de 1328’, Bibliothèque de L’École. de Chartes, Tome XC, 1929.

3 Y. Renouard, Population, Tome III, 1948.

4 J. R. Strayer, ‘Economic Conditions in the Country of Beaumont-le-Roger’, Speculum, XXVI, 1951, p.282.

5 For the best resumé of the debate see E. Carpentier and J. Glénisson, ‘La Démographie françhise en XTVe Siècle’, Annales E.S.C., Tome XVII, 1962, No. 1, p.109.

6 T. Wright, Political Poems and Songs relating to English History, p.169.

7 C. Anglada, Étude sur les Maladies Étientes, p.432.

8 R. Emery, ‘The Black Death of 1348 in Perpignan’, Speculum, Vol. XLII, 1967, No. 4, p.611.

9 cit. Crawfurd, Plague and Pestilence in Literature and Art, pp.115–16.

10 De Smet, Vol. 11, Breve Chronicon, pp.16–17.

11 Storie Pistoresi, Muratori, 11, v. p.235.

12 Die Geschichte der Pest, Giessen, 1908, p.57.

13 Y. Renouard, ‘La Peste Noire’, Revue de Paris, March 1950, p.111.

14 Knighton, Chronicon, R.S. 92, II, p.59.

15 See, e.g. Lea, History of the Inquisition, Vol. I, p.290.

16 De Smet, op. cit., Vol. II, p.17.

17 op. cit., p.38, n.24 above.

18 C. Singer, Short History of Medicine, p.69.

19 C. Singer, ‘Review of the Medical Literature of the Dark Ages’, Proc. Roy. Soc. Med., Vol. X, 1917, p.107.

20 Geschichte der Chirurgie, Berlin, 1878, Vol. 1, p.673.

21 La Grande Chirurgie, op. cit., p. 171.

22 Archiv für Geschichte der Medizin, 1910 onwards.

23 New York, 1931.

24 Bibl. de l’École des Chartes, (1840–41), Sér. 1, Vol. 2, p.240.

25 Sudhoff, XIX, p.49.

26 Primo de Epydimia, Sudhoff, V, p.43.

27 D. J. Colle, De Pestilentia, Pisa, 1617, p.570.

28 Compendium de Epydimia, op. cit, p. 60.

29 cit. Campbell, p.71. [Not in Sudhoff.]

30 Sudhoff XIX, pp.76–7.

31 d’Irsay, Annals of Medical History, IX, 1927, p. 174.

32 Gentile da Foligno, Sudhoff, V, p.83.

33 ed. D. W. Singer, Proc. Roy. Soc. Med. (Hist. Med.), Vol. 9, 1916, p.159.

34 ibid.

35 Siméon Luce, Bertrand de Guescelin, pp.69–73.

36 cit. H. Martin, Histoire de France, Vol. V, p.111.

37 E. Carpentier and J. Glénisson, op. cit., p.109.

38 M. Mollat, ‘La Mortalité à Paris’, Moyen Age, Vol. 69, 1963, p.505.

39 ‘Continuatio Chronici Guillelmi de Nangiaco’, Soc, de L’Histoire de France, Vol. II, 1844, pp.211–17.

40 p.169 below.

41 Black Death, p.55, basing himself on Géraud.

42 L. Porquet, La Peste en Normandie, Vire, 1898, p.77.

43 Thierry, Recueil des Monuments inédits de L’Histoire du Tiers État, Vol. I, p.544.

44 ‘Chronicon majus Aegidii li Muisis’, De Smet, Receuil des Chroniques de Flandres, Vol. II, p.280.

45 Y. Renouard, Population, Vol. III, 1948, p.459.

46 E. Carpentier, ‘Autour de la Peste Noire’, op. cit, p. 1065.

47 De la Peste …, op. cit., Vol. 1. p. 123.

* For this and subsequent extracts from The Canterbury Tales I append as a footnote Professor Coghill’s admirable rendering published by Penguin Books.

Water in rubefaction; bullock’s gall,

Arsenic, brimstone, sal ammoniac,

And herbs that I could mention by the sack,

Moonwort, valerian, agrimony and such.

God’s blessing on you, Doctor, not forgetting

Your various urinals and chamber pots,

Bottles, medicaments and cordial tots

And boxes brimming all with panaceas.

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