In the Wake of the Plague

The Black Death and the World It Made

Norman F. Cantor

• Publisher: Simon & Schuster
• Year: 2014
• ISBN:
  9781439136027
• Topic: History
• Subtopic: European Medieval History
• Index: History

Much of what we know about the greatest medical disaster ever, the Black Plague of the fourteenth century, is wrong. The details of the Plague etched in the minds of terrified schoolchildren -- the hideous black welts, the high fever, and the final, awful end by respiratory failure -- are more or less accurate. But what the Plague really was, and how it made history, remain shrouded in a haze of myths.Norman Cantor, the premier historian of the Middle Ages, draws together the most recent scientific discoveries and groundbreaking historical research to pierce the mist and tell the story of the Black Death afresh, as a gripping, intimate narrative. In the Wake of the Plague presents a microcosmic view of the Plague in England (and on the continent), telling the stories of the men and women of the fourteenth century, from peasant to priest, and from merchant to king. Cantor introduces a fascinating cast of characters. We meet, among others, fifteen-year-old Princess Joan of England, on her way to Spain to marry a Castilian prince; Thomas of Birmingham, abbot of Halesowen, responsible for his abbey as a CEO is for his business in a desperate time; and the once-prominent landowner John le Strange, who sees the Black Death tear away his family's lands and then its very name as it washes, unchecked, over Europe in wave after wave.Cantor argues that despite the devastation that made the Plague so terrifying, the disease that killed more than 40 percent of Europe's population had some beneficial results. The often literal demise of the old order meant that new, more scientific thinking increasingly prevailed where church dogma had once reigned supreme. In effect, the Black Death heralded an intellectual revolution. There was also an explosion of art: tapestries became popular as window protection against the supposedly airborne virus, and a great number of painters responded to the Plague. Finally, the Black Death marked an economic sea change: the onset of what Cantor refers to as turbocapitalism; the peasants who survived the Plague thrived, creating Europe's first class of independent farmers.Here are those stories and others, in a tale of triumph coming out of the darkest horror, wrapped up in a scientific mystery that persists, in part, to this day. Cantor's portrait of the Black Death's world is pro-vocative and captivating. Not since Barbara Tuchman's A Distant Mirror have medieval men and women been brought so vividly to life. The greatest popularizer of the Middle Ages has written the period's most fascinating narrative.

PART I

Biomedical Context

CHAPTER ONE

All Fall Down

IN THE SIXTH MONTH OF the new millennium and new century, the American Medical Association held a conference on infectious diseases. Pronouncements by scientists and heads of medical organizations at the conference were scary in tone. Infectious disease was the leading cause of death worldwide and the third leading cause in the U.S.A., it was stressed. The situation could soon become much worse.

As the world becomes more of a global village, said one expert, infectious disease could by natural transmission become more threatening in the United States. Here monitoring is lax because of a mistaken belief that the threat of infectious disease has been almost wiped out by antibiotics.

Bioterrorism presented a further and much greater possibility of terrible outbreaks of pandemic in the United States. The New York Times reported: “A speaker at the meeting warned that the healthcare system in the United States was not prepared for a bioterrorist attack, in which hundreds or thousands of people might flood hospitals, needing treatment for diseases: anthrax, plague, or smallpox, which most doctors in this country have never seen.”

In the same week as this AMA conference and its Cassandra-like speeches, the NBC Nightly News featured a brief segment showing American biochemists helping their Russian counterparts clean up and close down a large germ warfare factory. The TV correspondent remarked that the Russian plant had been capable of producing far more than the minimum required for effective biochemical warfare. He did not pursue the obvious questions of whether the Russians had been exporting the plants’ surplus to Iraq, or if this was only one of several Russian germ warfare factories and whether the others may still be operating.

That The New York Times report was tucked away on page fifteen of its National Edition and that NBC News devoted all of four minutes to the Russian disease factory indicate that the problem of infectious disease and its pandemic threat to American wellbeing is still regarded as a marginal matter. By the time the next president of the United States finishes his term, it could be the most visible problem facing American society, similar to the biomedical crisis of late medieval Europe, England in particular.

In the England of 1500 children were singing a rhyme and playing a game called “Ring Around the Rosies.” When I grew up in Canada in the 1940s children holding hands in a circle still moved around and sang:

Ring around the rosies

A pocketful of posies

Ashes, ashes

We all fall down

The origin of the rhyme is the flulike symptoms, skin discoloring, and mortality caused by bubonic plague. The children were reflecting society’s efforts to repress memory of the Black Death of 1348–49 and its lesser aftershocks. Children’s games were—or used to be—a reflection of adult anxieties and efforts to pacify feelings of fright and concern at some devastating event. So say the folklorists and psychiatrists.

The meaning of the rhyme is that life is unimaginably beautiful—and the reality can be unbearably horrible.

In the late fourteenth century a London cleric, who previously served in a rural parish and who is known to us as William Langland, made severe reference to the impact of infectious diseases “pocks” (smallpox) and “pestilence” (plague) in Piers Plowman, a long, disorganized, and occasionally eloquent spiritual epic. As translated by Siegfried Wenzel:

So Nature killed many through corruptions,

Death came driving after her and dashed all to dust,

Kings and knights, emperors and popes;

He left no man standing, whether learned or ignorant;

Whatever he hit stirred never afterwards.

Many a lovely lady and their lover-knights

Swooned and died in sorrow of Death’s blows. . . .

For God is deaf nowadays and will not hear us,

And for our guilt he grinds good men to dust.

The playing children, arms joined in a circle and singing “Ring Around,” and the gloomy, anguished London priest were each in their distinctive ways trying to come to psychological terms with an incomparable biomedical disaster that had struck England and most of Europe.

The Black Death of 1348–49 was the greatest biomedical disaster in European and possibly in world history. Its significance was immediately perceived by the wise Arab historian Ibn Khaldun, writing a few years later: “Civilization both in East and West was visited by a destructive plague which devastated nations and caused populations to vanish. It swallowed up many of the good things of civilization and wiped them out in the entire inhabited world.” A contemporary Florentine writer referred to “the exterminating of humanity.”

A third at least of Western Europe’s population died in what contemporaries called “the pestilence” (the term the Black Death was not invented until after 1800). This meant that somewhere around twenty million people died of the pestilence from 1347 to 1350. The so-called Spanish influenza epidemic of 1918 killed possibly fifty million people worldwide. But the mortality rate in proportion to total population was obviously relatively small compared to the impact of the Black Death—between 30 percent and 50 percent of Europe’s population.

The Black Death affected most parts of the Mediterranean world and Western Europe. Ingmar Bergman’s 1957 film The Seventh Seal depicts the impact of the Black Death on Sweden. In Bergman’s view the Black Death, which reached Sweden by 1350, caused an era of intense pessimism and widespread feelings of dread and futility.

But the great medical devastation hit no country harder than England in 1348–49 and because of the rich documentation surviving on fourteenth-century England it is in that country that we can best examine its personal and social impact in detail. Furthermore, there were at least three waves of the Black Death falling upon England over the century following 1350, nowhere near as severe as the cataclysm of the late 1340s, whose severity was unique in human history. But the succeeding outbreaks generated a high mortality nonetheless.

The population of England and Wales in the thirteenth century had doubled. Unusually warm weather together with adequate moisture produced bumper crops and the generous food supply moderated the death rate. Then the downswing of the Malthusian cycle common to premodern rural societies set in.

Due to famines in the second decade of the fourteenth century the English population had begun to recede from its medieval peak of six million in 1300. But it was the Black Death that principally caused the demographic crash and the road back was slow and very long. When the English population began to rise significantly in the later seventeenth century there was yet another and final outbreak of the terrible pestilence in 1665 as graphically imagined by the journalist Daniel Defoe (author of Robinson Crusoe) in his Journal of the Plague Year (1722).

The level of English and Welsh population attained in 1300, close to six million people, was not reached again until the mid–eighteenth century.

Recently there have appeared in scientific journals and in the press articles and stories about diseases and pandemics in modern times that raise remarkable parallels with or connections to the Black Death and offer new perspectives on the fourteenth-century devastation. But there will likely always be a degree of uncertainty about the clinical history of the Black Death because of severe limitations of the fourteenth-century medical profession in diagnosing the ailments of its patients.

Fourteenth-century medicine was not without accomplishment. It could amputate limbs and normally cauterize the wounds in an effective manner. It had precious knowledge of herbal remedies for headache, minor stomachaches, menstrual cramps, and other marginal afflictions, possibly including psychological depression. But it was impotent in the face of an epidemic.

Medieval physicians still followed the theories of the second-century Greek doctor Galen, which attributed disease to imbalance in the bodily conditions, or “humours,” of an individual. The main instrument of diagnosis was eyeballing the color and consistency of urine.

The prime remedies for illnesses involved restoration of putative bodily balance through purgation (enemas) or bloodletting. Drawing blood from a sick patient was considered a credible remedy until the nineteenth century. Cleaning the bowels was thought to have a curative effect. Enemas are still a popular home remedy. Nineteenth-century medicine introduced antiseptic surgery and anesthesia and smallpox inoculation but in the face of a pandemic outbreak was not much better off than the physicians of fourteenth-century England.

Faced with a worldwide outbreak of what was arbitrarily called Spanish influenza in 1918, which killed fifty million people within a year, the early twentieth-century medical profession was not much more effective in terms of diagnosis and cure than its medieval counterpart facing the Black Death. Essentially the flu pandemic of 1918 came and went without anyone knowing why, in spite of the capacity to see under a microscope some viruses and bacteria that were totally invisible to the physicians of the fourteenth century. Recently, DNA analysis has begun on cell tissue taken from 1918 graves in Spitzbergen and Alaska.

After surveying what recent biomedical science tells us about the Black Death, this book studies the Black Death in two ways. It aims to show how the great biomedical devastation affected particular individuals, both victims and survivors, families, institutions, cultures, and social groups. It tries existentially to communicate the experience of this terrible ordeal, which may have some parallels in human society in coming decades.

This is a microcosmic closeup perspective on the Black Death. The second perspective is at the macrocosmic level. This book places the fourteenth century in context of the long history of such fearsome outbreaks of infectious disease, drawing upon our increasing knowledge of the history of medicine.

On the microcosmic level we will learn what happened to key individuals in a society overwhelmed by biomedical devastation. On the macrocosmic level, we will gain insight into the history of the human race from its beginning millions of years ago into the third Christian millennium.

CHAPTER TWO

Rodents and Cattle

IN SPITE OF THE INCAPACITY of the medieval medical profession to describe securely the symptoms and course of the Black Death, historians of medicine and society have been able to determine that it involved at least bubonic plague, the same pandemic that had devastated the East Roman or Byzantine Empire in the sixth century A.D. and invaded the whole Mediterranean world in the third century or even earlier. The only big question on the medical side of the Black Death is whether bubonic plague was exclusively the cause of the devastation of the 1340s or whether another disease was simultaneously occurring in some parts of Europe, and particularly in England.

Bubonic plague is a bacillus carried by parasites on the backs of rodents, principally but not exclusively in the Middle Ages, the species of black rat. The black rats and the plague parasites residing on them could have been disseminated by shipping in international trade. The port of Bristol was the major initial point of entry for the pestilence into England.

It is this provocative picture of these rodents scurrying inland from port cities and making long journeys through the countryside at great speed so that most of Western Europe was in pandemic conditions within a year of initial contact that raises skepticism about the conventional account of the Black Death’s exclusive identification with bubonic plague.

When a human contracts bubonic plague without antidote (not available until the applications of antibiotics in the 1940s), there is a four out of five probability that he will die within two weeks. The first stage is marked by flulike symptoms, normally accompanied by high fever. In the second stage, buboes—that is, black welts and bulges—appear in the groin or near the armpits. (Except about 10 percent of plague victims. In these unfortunate men and women the buboes develop intra-abdominally—that is, internally—and are only seen in autopsies.)

The buboes first grow as dark accretions on the skin. They vary in size from one to ten centimeters, but are all extremely ugly and extremely painful. Diarrhea and vomiting also accompany this, the crisis stage of the plague. Its incubation period, marked by fever, runs from two to eight days.

The third—and often fatal—stage of the plague is respiratory failure (pneumonia).

Today a patient is likely to recover if treated with antibiotics during the first two stages; if the disease reaches the third stage, antibiotics may not work.

Forty years ago historians believed that bubonic plague stopped affecting Europe in the eighteenth century because one species of rodent, the black rat, was replaced by another species, the gray rat. Even if this were true, which is not likely, it would not account for the disappearance of the plague, because the disease can be carried by any rodent and, today’s scientists believe, by cats, of which there were plenty in the eighteenth century.

Moreover, there are peculiarities about the spread of the Black Death if it was exclusively bubonic plague that was involved. In 1984 the British zoologist Graham Twigg pointed out that the plague’s impact, at least in England, was as severe in some thinly populated rural areas as in thickly settled areas. The pestilence produced almost as high a level of mortality in the winter months as in summer. These qualities do not easily conform to the view that the Black Death was exclusively bubonic plague: parasites on the backs of rats in thinly settled areas and severe impact in cold weather are not in keeping with the common activity of fleas.

Medical historians such as Twigg also noted that mortality tales of the period around 1350 frequently described a death that occurred within three or four days of incubation, much too rapid for the much longer three-phase course of the bubonic plague. Some patients died without fever and without the buboes or welts on groins or around armpits, and to explain their deaths it was proposed, in what is still a minority opinion—although one rapidly gaining strength—that the Black Death involved or was even exclusively a rare virulent antihumanoid form of cattle disease, namely anthrax.

Both anthrax and bubonic plague begin with similar flulike symptoms, and the two diseases could have been conflated by contemporary doctors. And it is not hard to perceive how this anthrax-based plague—if Twigg’s theory is correct—could have ...