Post-classical history

Chapter Seven
The New Galenism

Paris, Summer 1348

IN PARIS, WHERE THERE WERE EIGHTY-FOUR PHYSICIANS, TWENTY-SIXgeneral surgeons, and ninety-seven barber surgeons, the plague arrived on a summer day, lingered for over a year, and prompted the forty-six masters of the Paris Medical Faculty to write one of the most renowned scientific works on the Black Death.

Medieval medicine is often regarded as a branch of medieval torture, but the plague caught the field at an important turning point. Outside the monasteries, where a few surviving classical texts on phlebotomy (bloodletting), midwifery, and the pulse were still taught, in the early Middle Ages medicine was a mixture of folk wisdom, magic, superstition, and craft. To the extent that a ninth-century medical practitioner engaged in professional reflection, he thought of himself as a craftsman like a carpenter or butcher—which he was. Specialized terms like “physician” and “surgeon” were unknown until the tenth century, and formal medical schools did not exist until almost the thirteenth century. In the early medieval period, the only remotely scientific tool available was what we might call urinalysis. A healer would sniff and eyeball a patient’s urine, then make a diagnosis. One German healer became so adept at the procedure that when the Duke of Bavaria tried to pass off the urine of a pregnant servant girl as his own, the healer announced that “within a week the Lord will perform an unheard of miracle, the Duke will give birth to a son!”

In comparison to his unlettered predecessors, the medical practitioner of the fourteenth century was a model of enlightened scientific professionalism. As Chaucer noted inThe Summoner’s Tale

. . . Nowhere a better expositioner

On points of medicine and pathology.

For he was grounded in astrology;

Treating his patients with the most modern physic

Dependent on his skill in natural magic;

He knew which times would be most propitious

For all his cures to be most expeditious . . .

Not only that, but:

Old eminent authorities he knew,

Some Greek, some Roman, some Arabian, too.

He’d read both Aesculapius the Greek

And Dioscorides, whose drug critique

Was current still. Ephesian Rufus, too

Hippocrates and Haly, all he knew.

Galen, Serapion and Rhazes, all

Their text books he could instantly recall . . .

Chaucer’s medical professional was, like the merchant and notary, a product of the new towns, where prosperity and a growing population created a brisk demand for medical care. What made the “better expositioner” something new under the medical sun was the “scientific” training Chaucer poked fun at. The New Galenism, as it was often called, was based on a reinterpretation and expansion of classical medicine by Arab physicians like Avicenna (Canon), Haly Abbas (Pantegni), and Rhazes. For European scholars accustomed to the ad hoc, craftlike structure of Western medicine, the works of the Arab master physicians, which began to be translated in the late eleventh century, were an astonishment. Drawing on Aristotle, Hippocrates, and especially Galen, the Arabs transformed medicine into a sophisticated intellectual discipline. Like the ancient Western fields of law and theology, Arab-Greco medicine had a unifying set of philosophical principles, a logical, coherent structure, and an intellectual consistency. In the hands of the masterful Arabs, the theory of the four humors created by Hippocrates and expanded and elaborated upon by Galen could explain just about anything, from ulcers to pestilences to the dangers of hot, moist air. The clever Arabs also introduced the West to a number of exciting new diagnostic techniques, including the signature tool of the medieval physician, astrology. In an early-thirteenth-century tract calledDe urina non visa—On Unseen Urines—William the Englishman told his colleagues that they could now dispense with urinalysis; astrology had made the technique obsolete. With a knowledge of the stars, declared William, you could tell what was in a patient’s urine without examining it.

For all its sophisticated intellectualism, however, the New Galenism contained some serious flaws. The most pronounced was a typically medieval reverence for authority, especially ancient authority, over observable fact. In practice, this meant that, while Chaucer’s new medical professional knew a great deal about the “old eminent authorities” and how more recent masters like “Avicenna, Averroes, Damascan John and Constantine (just dead and gone)” had intepreted them, the professional’s knowledge of medicine was, in effect, based on one- and two-thousand-year-old ideas. Medieval medical students learned very little that was new, practical, or the result of direct scientific observation. Courses in anatomy were offered in many medical schools, but since autopsies were frowned on by the Church, students had to learn about human anatomy by watching a pig being dissected.

The medical schools themselves were a by-product of the New Galenism. The first formal academic medical training was offered in the southern Italian town of Salerno, where the Arab masters were first translated; a hundred and fifty years later, Montpelier, Bologna, Oxford, Cambridge, Padua, Perugia, and Paris also had medical schools. And while each institution had its own individual style—Paris had a renowned astrology department; Montpelier, a large number of Jewish students—all the schools required five to seven years of study and taught a curriculum based on the New Galenism.

Along with extensive training, during the thirteenth century Chaucer’s new medical professional also acquired another attribute of the modern physician, a license—obtained, as today, by examination. Promoters of medical professionalization described licensure as an essential public health measure. It would—decreed the University of Paris Medical Faculty, an aggressive promoter of licensure—prevent the “shameful and brazen usurpation” of the profession by the untrained and the ill-lettered. But licensure was as much about professional and economic hegemony—it would allow physicians to dominate the old-style healers, who still provided the bulk of medical care—as it was about public health.

A small landmark in the physician’s climb to professional dominance was the 1322 trial of a Parisian healer named Jacqueline Felicie. Despite a lack of formal training, Madame Felicie, one of medieval Paris’s many female practitioners, apparently had a natural gift for medicine. During her trial, several former patients came forward to testify on her behalf, including a John of St. Omar, who told the bishop’s court that during a recent illness, Madame Felicie had visited him several times and refused payment until he had been cured. John described this as unprecedented in his experience of physicians. Other defense witnesses included a second John, John Faber, who testified that Madame Felicie had healed him with “certain potions, one green in color”; and a servant girl named Yvo Tueleu, whose fever had resisted the ministrations of several university-trained physicians. Mademoiselle Tueleu told the bishop’s court that after a careful physical examination, Madame Felicie prescribed “a glass of very clear liquid which acted as a purge.” Shortly thereafter, the young woman’s mysterious fever vanished.

The prosecution’s chief witness was John of Padua, a crusty old former medical adviser to Philip the Fair. Judging from his testimony, John seemed to think that Madame Felicie ought to be convicted on the grounds of gender alone. Women were already barred from law, John thundered; how much more urgent, then, to keep them out of a serious profession like medicine!

On November 2, 1322, Madame Felicie was convicted of violating an ordinance that prohibited unlicensed healers from visiting, prescribing medications, or performing other duties for a patient, except under the guidance of a university-trained and licensed physician. The conviction was a major victory for the Paris Medical Faculty, a principal architect of the new medical pecking order, which had a pyramidlike shape. At the pinnacle was a relatively small coterie of the university-trained physicians; they practiced what we would call internal medicine. Beneath them were the general surgeons, who usually lacked academic training, although that was changing. By the early fourteenth century surgery was beginning to find a place in the medical schools. A surgeon could treat wounds, sores, abscesses, fractures, and other disorders of the limbs and skin. Beneath the general surgeon was the barber surgeon, a kind of paramedic, who could perform minor operations, including bleeding, cupping, and applying leeches, as well as cutting hair and pulling teeth; next came the apothecary and the empiric, who usually specialized in a single condition, like hernias or cataracts. At the base of the pyramid were thousands of unlicensed healers like Madame Felicie.

To reflect their new eminence, in the decades prior to the plague, physicians began to adopt a more professional—that is, authoritative—demeanor and code of behavior. A cardinal “don’t” in the new medical etiquette was: don’t jeopardize your professional dignity by visiting patients to solicit business. “Your visit means you are putting yourself in the patient’s hands,” warned William of Saliceto, “and that is just the opposite of what you want to do, which is getting him to express a commitment to you.” A cardinal “do” in the new etiquette was to conduct a comprehensive physical exam on a first visit; the exam should include not just urinalysis, but a detailed medical history and an analysis of the patient’s breath odor, skin color, muscle tone, saliva, sweat, phlegm, and stool. Some physicians also cast a patient’s horoscope on the first visit. Another cardinal “don’t” in the new etiquette was to admit to diagnostic uncertainty. Even when in doubt, said Arnauld of Villanova, a physician should look and act authoritative and confident. For the uncertain physician, Arnauld recommended prescribing a medicine, any medicine, “that may do some good but you know can do no harm.” Another strategy was to “tell the patient and his family that [you are] prescribing this or that drug to cause this or that condition in the patient so that [they] will always be looking for something new to happen.” A third “don’t” in the new etiquette was volubility. Reticence conveyed authority, especially when combined with a grave manner; besides, said one savant, the physician who discusses his medical reasoning with the patient and his family risks letting them think that they know as much as he does, and that may tempt them to dispense with his services.

What made the university-trained physician such an impressive figure to laymen, however, was not only his authoritative bedside manner but his mastery of the arcanae of the New Galenism. Its signature principle was the theory of the four humors. For the ancient Greeks, whose thinking shaped so much medieval medicine, the number four was, like the atom, a universal building block. Everything, the Greeks believed, was made out of four of something. In the case of the physical world, the four elements were earth, wind, water, and fire; in the case of the human body, the four humors were blood, black bile, yellow bile, and phlegm. An important element in the humoral theory were the four qualities of all matter: hot and cold, wet and dry. Thus, blood was said to be hot and moist; black bile, cold and dry; yellow bile, hot and dry; and phlegm, cold and wet.

InOn the Nature of Man,Hippocrates wrote that “health is primarily that state in which [the four] constituent elements [that is, the four humors] are in correct proportion to each other, both in strength and quality, and are well mixed. Pain occurs when one of the substances presents either a deficiency or excess or is separated from the body and not mixed with others.”

The theory of corrupt or infected air also played an important part in the New Galenism. Bad air was dangerous because it could disrupt the balance of bodily humors, and particularly dangerous was hot and humid air because both heat and humidity corrupted the life force around the heart. Contagion was a by-product of this corruption. People became ill by inhaling not airborne germs but the corrupt vapors emanating from diseased bodies.

In the new medical schools like the University of Paris, students also learned that earthquakes, unburied corpses, decaying crops, stagnant water, poor ventilation, and even poisons could infect the air; but in the case of epidemics, which affected hundreds of thousands of people in widely separated places, infection was thought to result from a global disturbance, like an unfavorable planetary alignment. The movement of the moon clearly controlled tides; ergo, reasoned medieval (and ancient) man, air quality must also be affected by planetary movements and cycles.

TheCompendium de epidemia per Collegium Facultatis Medicorum Parisius,the plague treatise of the Paris medical masters, offers an example of how the new medicine used the theories of astrology and infected air to explain the origins of the pestilence.

According to theCompendium,“the first cause of this pestilence was and is [the] configuration of the heavens [which occurred] in 1345, at one hour after noon on 20 March, [when] there was a major conjunction of three planets in Aquarius.” In the masters’ view, the conjunction caused “a deadly corruption in the air,” and Mars and Jupiter, two of the three planets in the conjunction, played a particularly important role in the corruption. “For Jupiter, being wet and hot draws up evil vapors from the earth and Mars, because it is immoderately hot and dry, then ignites the vapors and as a result there were lightning sparks, noxious vapors and fires throughout the air.”

The second chapter of theCompendiumexplains how these astrological changes led to the plague. “What happened,” explained the masters, “was that many of the vapors . . . corrupted at the time of the conjunction . . . then mixed with the air and [were] spread abroad by frequent gusts of wind in the wild southerly gales. . . . This corrupted air, when breathed in, necessarily penetrates to the heart and corrupts the substance of the spirit there and the heat thus destroys the life force.”

Like many contemporaries, the Paris masters believed that the extraordinary ecological upheavals of the 1330s and 1340s—the succession of earthquakes, floods, tidal waves, heavy rains and winds, and unseasonable weather—played an important role in the plague. “Experience,” declared the masters, “tells us that for some time the seasons have not succeeded each other in the proper way. Last winter was not as cold as it should have been with a great deal of rain. . . . Summer was late, not as hot as it should have been and extremely wet. . . . Autumn, too, was very rainy and misty. It is because the whole year here—or most of it—was warm and wet that the air is pestilential. For it is a sign of pestilence for the air to be warm and wet at unseasonable times.”

How could people protect themselves against the plague?

Facing its first great public health crisis, the New Galenism was not lacking in ideas. Between 1348 and 1350, twenty-four plague tracts were written, most by university-trained medical professionals. Like theCompendiumof the Paris masters, some of the tracts took a big- picture view; others dispensed practical advice on how to stay healthy; two examples of the latter areDescription and Remedy for Avoiding the Disease in the Future,by Ibn Khatimah, a Muslim physician who lived in Grenada, andConsilia contra pestilentium,the tract of the Italian master physician Gentile da Foligno. One plague work, Simon of Covino’sConcerning the Judgment of the Sun at the Banquet of Saturn,was written in verse, while others, such asA Very Useful Inquiry into the Horrible SicknessandIs It from Divine Wrath That the Mortality of These Years Proceeds?convey some of the terror of the time.

To varying degrees, most plague authors agreed with the Muslim physician Ibn al-Khatib, who described the pestilence as “an acute disease, accompanied by fever in its origin, poisonous in its material, which primarily reaches the vital principal [the heart] by means of the air, spreads in the veins and corrupts the blood, and changes certain humors into a poisonous character, whence follow fever and blood spitting.”

There was also agreement that the best defense against plague was to remain healthy, and above all, this meant avoiding infected air. But how? One way, said the Paris masters, was to avoid marshes, swamps, and other bodies of stagnant water where the air is dense and turgid; another way was by keeping windows with a northern exposure open to let in good air—that is, cool and dry air—and keeping windows with a southern exposure shut to keep out bad air—that is, warm, humid air. To be extra safe, the Paris masters further recommended glazing, or putting a wax cloth over windows with a southern exposure. According to Ibn Khatimah, in plague as in real estate, location was everything. Bad to live in, said the Muslim physician, were cities with a southern coast. The reason? The rays of the sun and other stars bounced off the sea, blanketing such cities in warm, damp air. Also to be avoided were cities facing the south pole, particularly if unprotected on the south side. Cities with an eastern or western exposure occupied a middle ground in the risk spectrum, though a western exposure, which favors dampness, was more dangerous than an eastern exposure.

A physician named John Colle emerged as a particularly innovative thinker on the question of corrupt air. Noting that the “attendants who take care of latrines and those who serve in hospitals and other malodorous places are nearly all to be considered immune,” John argued that the best antidote to bad air was more bad air. One of the most surreal images to emerge from the Black Death is of knots of people crouched at the edge of municipal latrines inhaling the noxious fumes.

For Muslims like Ibn Khatimah and his fellow Spanish Arab Ibn al-Khatib, the issue of contagion posed a special problem. According to Islam, God’s will determined who lived and who died in an epidemic. Choosing to play it safe, Ibn Khatimah described contagion as a phenomenon “in which the Arabs in their ignorance” [in other words, before Islam] used to believe but no longer do.” Ibn Khatimah probably did not believe what he wrote, but he knew it would keep him out of trouble. Braver, Ibn al-Khatib said what he thought: contagion’s role in the spread of plague was “firmly established by experience, research, mental perception, autopsy and authentic knowledge of fact.” In 1374, when Ibn al-Khatib was dragged from a prison cell and murdered by a Muslim mob, there were those who said that one factor in the physician’s undoing was his disregard of Islamic teaching during the plague.

Untroubled by theological dilemmas, Christian writers were free to concentrate their energies on preventive stratagems. To protect against infection indoors, a number of authors recommended burning dry and odiferous woods, such as juniper and ash, vine and rosemary, oak and pine. In winter, this regimen could be supplemented with aromatic substances, such as wood of aloes, amber, musk, laurel, and cypress, and in summer with fragrant flowers and plants sprinkled with vinegar and rosewater. Out of doors, people were advised to carry a smelling apple, a kind of personal scent that, like a gas mask, would protect against noxious fumes. A physician named John Mesue said a very good smelling apple could be made from black pepper, red and white sandal, roses, camphor, and four parts of bol armeniac (Armenian bole). Gentile da Foligno, who liked to keep things simple, said a pleasant-smelling herb—of the type many Florentines used during the plague’s visit—would do. Gentile also recommended streetcorner bonfires, a public health measure already in use in Avignon and other cities.

Changes in lifestyle could also protect against infected air. The Swedish bishop Bengt Knutsson, for example, recommended avoiding both sex and bathing because “where bodies have open pores as is the case of men who abuse themselves with women or often have baths . . . they are the more disposed to this great sickness.” What if abstinence proved impossible? Ibn Khatimah recommended regular bleedings to purge excess heat and impurities from the body. An energetic self-bleeder himself, the Muslim lost eight pounds via phlebotomy. Also to be avoided—or taken in moderation—was exercise, another pore opener.

Antidotes were also a popular preventive. For those who liked tasty antidotes, a prebreakfast snack of fig, filbert, and rue was suggested. Pills of aloe, myrrh, and saffron were also recommended by many physicians; but theriac, mithridate, bol armeniac, and terra sigillata—all traditional poison remedies—were the most popular antidotes. In Gentile da Foligno’s view, however, no antidote could rival the power of an emerald ground into a powder; Gentile’s assertion that the remedy could “crack a toad’s eyes” suggests that the “prince of physicians,” a university-trained professional, harbored a secret weakness for black magic.

Since a good diet kept the four humors in balance, many tracts also stressed the importance of proper eating. Specific dietary recommendations varied according to age, sex, season, and circumstance, but in general, wise to avoid were foods that spoiled easily, like milk, fish, and meat. If meat was one’s choice, then fowl, lamb, and kid were best, and should be tender and digestible. As for preparation, the Paris masters took a firm stand for roasting and against boiling. A little cheese helped digestion, said Ibn Khatimah. The Moor’s stand on eggs, like his stand on contagion, was subtle. Good were eggs dipped in vinegar, bad were eggs dipped in garlic. The anonymous author ofFirst About the Epidemiccould barely contain himself on the subject of hard-boiled eggs; they were a garden of dangers, he fulminated.

Everyone liked bread, though good flour and proper baking were important. Wine was another universal recommendation. Best against the pestilence, said Gentile da Foligno, was white wine, preferably, old, light, and aromatic, mixed with water. However, fruits and vegetables produced finger-pointing and argument. The Paris masters took a dim view of lettuce, but Gentile da Foligno was unshakable in his defense of the vegetable. “Cabbage is good for you,” said the anonymous author ofFirst About the Epidemic—but not if eaten with eggplant and garlic, warned Ibn Khatimah. Some agreement emerged on figs, dates, raisins, and pomegranates, but the only universally recommended fruit was the filbert.

The six non-naturals, factors such as personal habits, behaviors, and emotional states were also stressed by the authors of many plague tracts. Thus, the Paris masters urged people to avoid “accidents of the soul,” a far more felicitous description of emotional upset than our dreary modern clinical terms. To be especially eschewed were fear, worry, weeping, speaking ill of others, excessive cogitation, and wrath, which, according to Gentile da Foligno, “overheated the members.” Sadness, which cools the body, dulls the mind, and deadens the spirit, also predisposed a person toward plague. Good, in Ibn Khatimah’s view, was stupidity, which lowered the risk of pestilence; bad was intelligence, which raised it.

Galen, who lived through the third-century Plague of Antonine* (a devastating outbreak of measles or smallpox) believed that little could be done to cure the pestilence once a person was infected, and his pessimism was reflected in the plague tracts of his medieval disciples. Only a handful of authors even suggested cures, and aside from symptomatic relief, most suggestions revolved around bleeding, which was thought to draw poisons and corrupt humors away from vital organs such as the heart, liver, and brain. With phlebotomy, said John of Penna, a professor at the University of Naples, speed was essential. At the first sign of plague symptoms, the patient should be bled on the same side of the body as the pain; even better than bleeding, said John, were purges. Gentile da Foligno, another advocate of bleeding, recommended a venesection of the median vein when the course of the disease was unclear. If the bubo was on the neck, Gentile advised a venesection of the cephalic vein; if under the arms, of the pulmonary vein. Gentile said the bleeding should continue until faintness developed.

Ibn Khatimah, who, unlike many tract authors, seems to have actually treated plague patients, believed that in the bubonic form of the disease, the crisis point arrived on the fourth day. After that, the evil vapors begin to detach from the heart, he said. In the recovery period, the Muslim recommended applying an ointment to the buboes to hasten ripening and then surgical excision on the seventh day.

How did the New Galenism perform against the plague?

Some of the advice in the plague tracts was plainly sensible, but, alas, not a great deal—and usually what worked, worked for reasons that would have surprised the tracts’ authors. Diet, for example, was useful because it enhanced immune system function, not because it balanced the four humors, fire because it drove away fleas. For all his careful training and his command of the Arab and Greek masters, the best advice Chaucer’s new medical professional could offer his patients was the commonsensical admonition to “run far and run fast.” And by the time the plague neared Paris in the summer of 1348, even that advice was becoming ineffective since the pestilence was now everywhere, from the Mongolian Plateau to the coast of Greenland.

In May 1348, as the plague slithered north through a misty French countryside, Paris was enveloped in a sense of déjà vu. Scarcely two years earlier the English king, Edward III, desiring “nothing so much as a deed of arms,” had landed a force of ten thousand archers and four thousand foot solders on the windswept Cotentin Peninsula, next door to the D-day beaches of 1944; within a month, the English were standing astride the approaches to Paris. The enemy “could be seen by anyone . . . who could mount a turret,” wrote the chronicler Jean de Venette, who described Parisians as “stupefied [with] amazement” by the proximity of the danger.

But the English threat at least had been comprehensible, and the spectacle and glamour of war had provided a tonic for turbulent souls and unquiet minds. Paris in the summer of 1346, like Paris in the summer of 1914, crackled with electricity: shouts and cheers echoed through streets and squares and marketplaces as thearrière-ban—the general summons to arms—was read. On August 15, there had been the thrilling spectacle of the greatest knights in the realm, led by the dashing Count of Alençon, the king’s brother, rushing out to meet the enemy, accompanied by a brigade of Genoese bowmen and by blind King John of Bohemia. All day long, the thunderous sound of horse hooves had echoed across the cobblestoned Grand Rue. There was also the thrilling news that the king, Philip VI, had challenged Edward to personal combat (Edward refused), and the heartening sight of Philip, sitting on his horse like a simple knight, addressing the humble folk of Paris before marching out to battle. “My good people,” the portly Philip declared, “doubt ye not, the Englishmen will approach you no nearer than they be.”*

Paris in the summer of 1346 had flags to put out, trumpets to blare, war drums to beat. Paris in the summer of 1348 had nothing to do but visit churches, light candles, listen to rumors, think, and wait. “Everyone in our neighborhood, all of us, everyone in Paris is frightened,” wrote the physician Peter Damouzy, who lived to the north of the city. Damouzy, a former member of the Paris medical faculty, tried to occupy his mind by writing a treatise on the pestilence, but the approach of the plague kept breaking into his thoughts. “I write without benefit of time,” he scribbled at one point, and, later, with even more urgency, “I have no time beyond the present to say or write more.”

Physician Damouzy’s account is one of the few reports we have of what, by the summer of 1348, was becoming a common experience—waiting. Though the plague was moving with great swiftness, often advancing several miles in a single day, the sense of shock had evaporated. Most localities had several days’ to several weeks’ advance notice of its arrival. Enough time to think and wonder and worry.

Eight months later, a waiting Strasbourg would vent its anxiety by killing Jews, nine hundred of them. “They were led to their own cemetery into a house prepared for their burning and on their way were stripped naked by the crowd which ripped off their clothes and found much money that had been concealed,” wrote a local chronicler. Paris had no Jews to burn, having banished them all; but in the long rainy weeks of May, June, and July 1348, there were prayers to be said and rumors to listen to, many of them filled with “stupefied amazements.” From Normandy in the west, from Avignon in the south, and from points between came stories of church bells echoing through deserted streets, of black plague flags flying above villages, of abandoned countryside, where the only sound to be heard was the banging of a farmhouse door in the wind. The pestilence’s magisterial pace also gave Parisians ample time to contemplate the meaning of love and duty and honor in a time of plague. What would they do if a loved one was afflicted? What would the loved one do iftheywere afflicted? The fear of contagion makes the psychology of plague different from the psychology of war. In plague, fear acts as a solvent on human relationships; it makes everyone an enemy and everyone an isolate. In plague every man becomes an island—a small, haunted island of suspicion, fear, and despair.

“In August, a very large and bright star was seen in the west over Paris,” wrote chronicler de Venette, who believed the brilliance of the star “presaged the incredible pestilence which soon followed . . .” However, since no one is sure when the plague arrived in Paris—estimates range from May to August, with June being the most probable date—its start must have been less spectacular than the chronicler’s brilliant star.

On a summer morning when the sky was again heavy with black-bottomed rain clouds and the streets were full of watery light, perhaps a young housewife awoke with a terrible pain in her abdomen. Pulling up her nightshirt, she saw a tumor the size of an almond a few inches above her pubic hair. A few days later, when the almond had become the size of an egg, one of her children developed a mass behind the ear; then the old woman who lived above the afflicted family fell ill with a terrible fever, and the young father who lived below them began to vomit violently; and then a prostitute the father had slept with awoke with pain in her abdomen and then . . .

Moving through the gray, rainy city like a fever, the plague slithered from house to house, street to street, neighborhood to neighborhood. It visited the crowded mercantile quarter on the Right Bank, where the Sienese and Florentine bankers lived; the Grand Rue, where the French cavalry had dashed out to meet the English two years earlier; Les Halles, where local farmers brought their produce on Fridays; St. Jacques-la Boucherie, the butchers’ quarter, where the fierce Paris wind made little ripples in the pools of animal blood; and the Right Bank, where crowds assembled each morning to buy goods from the arriving barges.

Crossing the Grand Pont to the Ile de la Cité, the pestilence visited the Hôtel-Dieu, where patients slept three and four to a bed and the clothes of the dead were sold at monthly auctions; the Cathedral of Notre Dame, built on the site of a Roman temple of Jupiter; the rue Nouvelle Notre Dame, begun the same year as the cathedral, 1163, and built wide and straight to accommodate the heavy wagons that carried construction materials to the cathedral; and the exquisite Sainte Chapelle, where Louis IX—saint, anti-Semite, and patron of William of Rubruck—kept his relics, among them the Crown of Thorns and fragments of the True Cross.

On the Left Bank, already a student quarter, the plague found lodgments in the Sorbonne, established a hundred years earlier by the theologian Robert de Sorbon, and destined, a hundred years hence, to become a fierce enemy of Joan of Arc; the College de Navarre, site of the first public theater in Paris; and, of course, the University of Paris, which vied with Bologna for the title of Europe’s oldest university (Paris dated its origins to the twelfth-century schools of disputation attached to Notre Dame). Contemporary records indicate that the pestilence took a terrible toll on the university faculty; in 1351 and 1352, some disciplines were so short of teachers, the administration had to relax academic qualifications. Remarkably, however, all the authors of theCompendiumseem to have survived the pestilence in good health. A 1349 university roll shows that, as in 1347, there were still forty-six masters on the medical faculty. Another notable survivor of the pestilence was the man who commissioned the faculty to write theCompendium,King Philip VI.

Corpulent and insecure, Philip was a man of profound contradictions. Though he fought like a lion at Crécy and planned a Viking funeral for himself—the royal heart was to be sent to a church in Bourgfontaine; the royal entrails to a monastic house in Paris so as to double the number of prayers offered up in repose of the royal soul—Philip fled Paris almost as soon as the pestilence arrived. Over the next year, one catches glimpses of him at Fontainebleau, at Melun, and at the casket of his plague-dead queen, the ill-tempered Jeanne of Burgundy, but Philip does not emerge into full public view again until the early 1350s, when he shocked Paris with a heinous betrayal. The high-minded moralist who hated to hear the Lord’s name taken in vain—in Philip’s France blasphemers had their upper lip cut off—stole his eldest son’s bride-to-be, the beautiful Blanche of Navarre, a few months before the couple were to be married.

Jean Morellet, unlike his king, chose to remain in Paris, and because he did, we have something more fine-grained than the usual chroniclers’ estimates with which to measure the city’s mortality. Morellet was attached to the parish of St. Germain l’Auxerrois as canon or priest—contemporary records are unclear. Today the parish sits in one of the most congested areas of Paris, surrounded by scores of famous neighbors including the Louvre and the Place de la Concorde, but in 1340, when Morellet became director of St. Germain’s building fund, the only landmark of any import nearby was the cobblestoned Grand Rue. From his office at the church, the director would have had an unobstructed view of the windmills, boatmen, and rickety piers along the still unembanked Seine.

Morellet’s duties as director of the building fund were not very taxing. When a deceased parishioner left a bequest, he would make a record of it. In the first eight years of his tenure, roughly mid-1340 to mid-1348—the fund received a total of seventy-eight bequests—not enough to keep the director busy. Indeed, the pace of death was so slow in the parish, most of the time Morellet seems to have kept track of the donations in his head. Fund records indicate that he would update the donor list only once or twice a year. However, in the summer of 1348, this pattern changed.

The plague’s arrival in St. Germain is announced with a donation of twenty-four sous. At a time when six sous could buy a man a good horse, twenty-four sous was a significant sum. Even more unusual was the purpose of the bequest. Heretofore, all bequests had gone toward maintenance of the parish church and for future building projects. The twenty-four sous were used to purchase burial shrouds for parishioners. Around the same time, the number of bequests suddenly explodes. For most of the 1340s, annual donations to the fund remained in the single digits. In the nine months between June 1348 and April 25, 1349, a total of 445 were received, roughly a forty-five-fold increase.

During the second half of l349, donations to the fund remained at record levels. In September, fifteen months after the plague’s arrival in Paris and seven months after the municipal cemetery, Holy Innocents, had to be closed for lack of burial space, bequests to the building fund reached an all-time high. Morellet, who was now forced to update the fund records monthly because of the volume of donations, notes that the parish received forty-two bequests; in October, the number dipped, but only slightly, to thirty-six bequests.

Director Morellet’s figures, which represent a single stream of deaths in a single Paris parish, can’t be extrapolated to the entire city. Nonetheless, they show that something unparalleled was happening in Paris, an impression substantiated by chronicler de Venette’s account of events at the Hôtel-Dieu. Like most medieval hospitals, including La Pigonette in Avignon, the hôtel was a retirement home for the elderly, and a shelter for the homeless and indigent as well as medical facility. All three roles put it on the front line during the pestilence.

“For a considerable period,” says the chronicler, “more than 500 bodies a day were being taken in carts from the Hôtel-Dieu [on the Ile de la Cité] . . . for burial at the cemetery of the Holy Innocents [on the Grand Rue].” Many of the caravans carried the bodies of thefilles blanches,the young novitiates who nursed the ill. “The saintly sisters of Hôtel-Dieu,” wrote de Venette, “. . . worked sweetly and with great humility, setting aside consideration of earthly dignity. A great number of [them] were called to a new life and now rest, it is piously believed, with Christ.”

Several historians have called de Venette’s mortality figures into question, but they do not seem out of line with the estimates of other contemporaries. TheGrandes Chroniques de France,kept by the monks of nearby St. Denis, speaks of eight hundred people dying “from one day to the next” in the city. An Italian merchant reports that “on March 13th, [1349] 1573 noblemen were buried not counting petty officials.” Another resident claims that “1328 [people] were buried in a single day.” During the eighteen months between June 1348 and December 1349, Paris seems to have lost the equivalent of a good-sized village almost every day, and on bad days, a good-sized town. According to Richard the Scot, 50,000 residents died during the plague. “Nothing like it has been heard or seen or read about,” wrote a contemporary.

The constancy of the death seems to have dispirited director Morellet. As the year 1349 drew to a close, a certain listlessness becomes apparent in his manner. The director’s record keeping becomes intermittent again, and his work shows an uncharacteristic sloppiness; he no longer bothers to write down the names of new donors, just the sums contributed to the fund; it is as if the dead have lost all meaning for him, as if he can no longer envision them as anything but a pile of corpses in one of the little death carts shuttling back and forth in the rain to the cemetery of Holy Innocents. Historian George Deaux believes that this kind of indifference became common later in the mortality as the monotony of death replaced the terror of death. Deaux compares the survivors to “soldiers . . . who have been in the line so long they no longer know or care if their side is winning or losing or even what the terms mean anymore. . . . [W]ar has become an endless course of terror and fatigue, mutated to a sort of boredom that destroys everything but the body’s motor functions.”

From Paris—and from Normandy, which was also struck in the summer of 1348—the plague spread northward to Rouen, where a new cemetery had to be consecrated to accommodate the dead; to La Graverie, where “bodies . . . decayed in putrefaction on the pallets where they had breathed their last”; to La Leverie, where the family of a noblewoman was unable to find a priest to bury her because the local clergy were all dead and priests from other villages refused to visit one that was flying the black plague flag. At Amiens, burial space was also a problem, until the wandering Philip graciously authorized the mayor to open a new cemetery. In his proclamation, the king declared, “The mortality . . . is so marvelously great that people are dying . . . as quickly as between one evening and the following morning, and often quicker than that.”

In the fall of 1348, as the plague approached Tournai on the Flemish border, a local abbot, Gilles li Muisis, recalled a fifty-year-old prophecy and wondered if still worse was to come. “I have been thinking [recently] about . . . Master Jean Haerlebech,” wrote the seventy-eight-year-old li Muisis. “When I was a young monk he would often speak to me in secret of things, which afterward came to pass.

“. . . He predicted that in 1345 major wars would begin in various places . . . and that in 1346 and 1347 . . . people would not know where to go or where to turn for safety. . . . But he didn’t want to tell me anything about 1350 and I was not able to wring anything out of him.”

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