THIS BOOK BEGAN AS AN INQUIRY INTO THE FUTURE AND ENDED as an investigation of the past.
Five years ago, when I first began thinking about writing a book on the plague, I had in mind plague in the generic sense of a major outbreak of epidemic disease, and I was looking ahead to the twenty-first century, not backward toward the fourteenth. From an earlier book on experimental medicine, Three on the Edge: The Story of Ordinary Families in Search of a Medical Miracle, I had gotten a glimpse of the power of unfettered pandemic disease. One of the people I wrote about was an AIDS patient. During the two years I followed him in the early 1990s—a time when effective HIV treatments were rare—the man lost a former lover, three friends, and a colleague at work. A hallmark of pandemic disease is its ability to destroy worlds, not just individuals, but it was one thing to know that, quite another to witness it.
In 1995, the year I finished the book, Jonathan Mann, a professor at the Harvard University School of Public Health, warned that AIDS was the beginning of a frightening new era. “The history of our time will be marked by recurrent eruptions of newly discovered diseases,” he predicted. Two years later, 1997, the New England Journal of Medicine issued a similar warning when a virulent new strain of bubonic plague was identified. “The finding of multi-drug-resistant [strain of plague] reinforces the concern . . . that the threat from emerging infectious diseases is not to be taken lightly,” declared the Journal. Scarcely twenty years after the eradication of smallpox in 1979, an accomplishment widely described in the media as humanity’s ultimate triumph over infectious disease, we seemed to be slipping back into the world of our ancestors, a world of sudden, swift, and uncontrollable outbreaks of epidemic illness. The book I was thinking about would explore the nature of this threat, and in particular the danger posed by newly emerging illnesses such as Ebola fever, Marburg disease, hantavirus pulmonary syndrome, SARS, and avian flu.
The book I ended up writing is quite different, though, indirectly, it rehearses many of the same themes. Its subject is an outbreak of a particular infectious disease in a particular time and place. Seven hundred years after the fact, what we call the Black Death—and what medieval Europeans called the Great Mortality, and medieval Muslims, the Year of Annihilation—remains the greatest natural disaster in human history.
Apocalyptic in scale, the Black Death affected every part of Eurasia, from the bustling ports along the China Sea to the sleepy fishing villages of coastal Portugal, and it produced suffering and death on a scale that, even after two world wars and twenty-seven million AIDS deaths worldwide, remains astonishing. In Europe, where the most complete figures are available, in many places the plague claimed a third of the population; in others, half the population; and in a few regions, 60 percent. The affliction was not limited to humans. For a brief moment in the middle of the fourteenth century, the words of Genesis 7—“All flesh died that moved upon the earth”—seemed about to be realized. There are accounts of dogs, cats, birds, camels, even of lions being afflicted by the “boil,” the telltale bubo of bubonic plague. By the time the pestilence ended, vast stretches of the inhabited world had fallen silent, except for the sound of the wind rustling through empty, overgrown fields.
What led me from the book I planned to the book I wrote was an encounter with the literature of the Black Death. Before plunging into a book about the future of epidemic disease, I wanted to acquaint myself with its past, and the medieval plague, as the most famous example of the phenomenon, seemed the appropriate place to start. Thus, in the autumn of 2000 I began shuttling between the main reading room of the New York Public Library and Butler Library at Columbia University. I read a number of excellent academic histories, but it was the original source material, the literature of the Great Mortality—the chronicles, letters, and reminiscences written by contemporaries—that turned my gaze from the future to the past. I had approached this material with some trepidation. If, as an English writer once observed, the past is a foreign country, no part of the past seems more foreign, more “otherly,” to a modern sensibility than the Middle Ages.
My wariness proved unwarranted. Much has changed since the 1340s, the decade the Black Death arrived in Europe, but not human nature. The plague generation wrote about their experiences with a directness and urgency that, seven hundred years after the fact, retains the power to move, astonish, and haunt. After watching packs of wild dogs paw at the newly dug graves of the plague dead, a part-time tax collector in Siena wrote, “This is the end of the world.” His contemporaries provided vivid descriptions of what the end of the world looked like, circa 1348 and 1349. It was corpses packed like “lasagna” in municipal plague pits, collection carts winding through early-morning streets to pick up the previous day’s dead, husbands abandoning dying wives and parents abandoning dying children—for fear of contagion—and knots of people crouched over latrines and sewers inhaling the noxious fumes in hopes of inoculating themselves against the plague. It was dusty roads packed with panicked refugees, ghost ships crewed by corpses, and a feral child running wild in a deserted mountain village. For a moment in the middle of the fourteenth century, millions of people across Eurasia began to contemplate the end of civilization, and with it perhaps the end of the human race.
The medieval plague was one of the seminal events of the past millennium. It cast a deep shadow across the centuries that followed, and it remains part of the collective memory of the West. In discussions of AIDS and other emerging infectious diseases, the Black Death is constantly evoked as a warning from the past, something humanity must avoid at all costs. Yet, as a historical event, the medieval plague remains little known. It originated in inner Asia, somewhere in the still-remote region between Mongolia and Kirgizia, and might well have remained there, had not the Mongols unified much of Eurasia in the thirteenth century, thereby facilitating the growth of three activities that continue to play an important role in the spread of infectious disease: trade, travel, and larger and more efficient communications. In the Mongols’ case, the improvement in communication was the Yam, the Tartar version of the pony express. From inner Asia, one prong of the plague swept eastward into China, another westward across the steppe into Russia. Sometime in the mid-1340s the western wing reached Italian trading outposts in Crimea; from there, fleeing sailors carried the disease to Europe and the Middle East.
Despite the enormous size of Eurasia and the slowness of medieval travel—in 1345 it took eight to twelve months to travel from the Crimea to China overland—the plague spread to almost every corner of the continent within a matter of decades. It seems to have erupted in inner Asia sometime in the first quarter of the fourteenth century, and by the autumn of 1347 it was in Europe. In late September Sicily was infected by a fleet of Genoese galleys. One chronicler reported that the Genoese tumbled off the infected ships with “sickness clinging to their very bones.” From Sicily the pestilence moved swiftly northward to continental Europe. By March of 1348 much of central and northern Italy was or soon would be infected, including Genoa, Florence, and Venice, where gondolas slipped through wintery canals to collect the dead; by spring the plague was in Spain, southern France, and the Balkans, where one contemporary reports that packs of wolves came down from the hills to attack the living and feed on the dead. By summer the disease had reached northern France, England, and Ireland, where it took a great toll among the English in port towns like Dublin, but left the native Irish in the hills relatively unscathed. By the late autumn of 1348 the plague was in Austria and menacing Germany, and by 1349 and 1350 it had infected the regions along the European periphery: Scotland, Scandinavia, Poland, and Portugal. In a century when nothing moved faster than the fastest horse, the Black Death had circumnavigated Europe in a little less than four years.
To many Europeans, the pestilence seemed to be the punishment of a wrathful Creator. In September 1349, as the disease raced toward an anxious London, the English king Edward III declared that “a just God now visits the sons of men and lashes the world.” To many others, the only credible explanation for death on so vast a scale was human malfeasance. Evildoers were using poisons to spread the plague, warned Alfonso of Cordova. To many of Alfonso’s contemporaries, that could only mean one thing. The Great Mortality occasioned the most violent outburst of anti-Semitism in the Middle Ages, a period already marked by violent anti-Semitic outbursts.
Few events in history have evoked such extremes of human behavior as the medieval plague. There was the horrendous brutality of the Flagellants, who trampled the roads of Europe, flailing their half-naked bodies and murdering Jews, and the sweet selflessness of the sisters of Hôtel-Dieu, who sacrificed their own lives to care for the plague victims of Paris. There was the fearfulness of Pope Clement VI, who fled Avignon, seat of the medieval Church, a few months after the pestilence arrived, and the fearlessness of his chief physician, Gui de Chauliac, who stayed in the afflicted city until the bitter end, so as “to avoid infamy.” The Great Mortality produced many examples of great cunning and compassion, charity and greed, and, in a testimonial to the stubbornness—some would say the irredeemable wickedness— of human character, it also provided a backdrop for both the most notorious royal murder trial and greatest comic opera of the Middle Ages, the former featuring, as defendant, the beautiful Queen Joanna of Naples; the latter, the Roman tribune Cola di Rienzo, possibly the silliest man in Europe. Throughout the worst months of the plague, somewhere in Europe men were always waging war on one another.
The Great Mortality attempts to bring alive the world described in the letters, chronicles, and reminiscences of contemporaries. It is a narrative of a supreme moment in human history told through the voices, personalities, and experiences of the men and women who lived through it. However, since it is impossible to understand the pestilence without understanding its historical context, it is also a book about a time as well as an event. As the British historian Bruce Campbell has observed, the decades preceding the plague were “exceptionally hazardous and unhealthy for both humans and domesticated animals.” Almost everywhere in Europe there was war, overpopulation (relative to resources), economic stagnation and decline, filth, overcrowding, epidemic (nonplague) disease, and famine, as well as climatic and ecological instability.
In retrospect, contemporaries interpreted the reign of woe as a portent of the coming apocalypse, and in a sense it was. The economic and social conditions of the early fourteenth century, and the environmental instability of the period, made Europe an unhealthy place to live.
The Great Mortality also looks at new theories about the nature of the medieval plague. For well over a century, it has been considered settled fact that the pestilence was a catastrophic outbreak of bubonic plague and a variant called pneumonic plague, which attacks the lungs. However, since in modern settings neither form of plague looks or acts much like the illness described in the Black Death literature, a number of historians and scientists have recently begun to argue that the mortality was caused by a different infectious illness, perhaps anthrax, perhaps an Ebola-like ailment.
While history may never repeat itself, “man,” as Voltaire once observed, “always does.” The factors that allowed the Black Death to escape the remoteness of inner Asia and to savage the cities of medieval Europe, China, and the Middle East still operate. Except, of course, today they operate on a vastly larger scale. Trade and human expansion, the twin anthems of modern globalization, have opened up ever more remote areas of the globe, while transportation has enhanced the mobility of both men and microbes incalculably. A journey that took the plague bacillus decades to complete in the fourteenth century today takes barely a day. And for all the triumphs of modern science, infectious disease retains the ability to render us as impotent as our medieval ancestors.
In the spring of 2001 English journalist Felicity Spector was reminded of that fact when an epidemic of hoof-and-mouth disease spun out of control and the British government, helpless to contain the outbreak, was forced to resort to methods that made Britain seem “suddenly, shockingly medieval.” We thought, wrote Spector in the New York Times, that “modern medicine had brought us beyond the days when the only solution to an infectious disease was to burn entire herds of livestock, to close vast swaths of countryside, to soak rags and spread them on the roads. . . . [M]odernity, it seems, is a very fragile thing.”