The Greatest Benefit to Mankind: A Medical History of Humanity. Roy Porter

Чтение книги онлайн.

СКАЧАТЬ to have a chamber draining into the sewers, and Milan passed ordinances for cesspools and sewers. Some German cities prohibited pig-pens facing onto the street; municipal slaughterhouses were established, and cities also tried to monitor food markets and curb river pollution. For example, tanners were not allowed to wash their skins or dyers to dump their waste in public waters. Nonetheless filth began to pose mounting threats. Plague struck in the fourteenth century (see below) and typhus from the close of the fifteenth.

      LEPROSY

      Certain diseases loomed large both in reality and in the public imagination, notably leprosy, now called Hansen’s disease after Armauer Hansen (1841–1912), the discoverer of the bacillus Mycobacterium leprae. Its physical symptoms – scaly flesh, mutilated fingers and toes and bone degeneration, in short ‘uncleanliness’ – made it seem a living death and led to deeply punitive attitudes. The disease has a puzzling history. From as early as 2400 BC Egyptian sources contain references to a skin condition interpreted as leprosy, and 900 years later, the Ebers papyrus mentions a leprous disease seemingly confirmed by Egyptian skeleton evidence. True leprosy probably existed in the Levant from biblical times, but the term was also used for various dermatological conditions producing disfiguring ulcers and sores.

      Leprosy became highly stigmatized. Authorized by ancient Levitical decrees, leper laws were strict in medieval Europe. They were forbidden all normal social contacts and became targets of shocking rites of exclusion. They could not marry, they were forced to dress distinctively and to sound a bell warning of their approach. According to the liturgical handbook, the Sarum Use, in thirteenth-century England,

      I forbid you ever to enter churches, or go into a market, or a mill, or a bakehouse, or into any assemblies of people.

      I forbid you ever to wash your hands or even any of your belongings in spring or stream of water of any kind …

      I forbid you ever henceforth to go out without your leper’s dress, that you may be recognized by others …

      I forbid you to have intercourse with any woman except your wife…

      I forbid you to touch infants or young folk, whosoever they may be, or to give them or to others any of your possessions.

      I forbid you henceforth to eat or drink in any company except that of lepers …

      They were segregated in special houses outside towns, lazarettos, following the injunction in Leviticus that the ‘unclean’ should dwell beyond the camp. There was also a leper mass, conducted with the victim in attendance, declaring the sufferer to be ‘dead among the living’, and the 1179 Lateran Council ordered them cast out from society, with their own burial places. The only consolation the Church gave was to interpret the leper’s suffering as a purgatory on earth, destined to bring swifter reward in heaven. God, proclaimed de Chauliac, loved the leper; after all, did not the Bible (Matthew 8:3) show Jesus extending his hand, saying ‘be thou clean’?

      Leprosy provided a prism for Christian thinking about disease. No less a religious than a medical diagnosis, it was associated with sin, particularly lust, reflecting the assumption that it was spread by sex. In The Testament of Cresseid by Robert Henryson (fl. 1470–1500), the heroine is punished by God with leprosy for her lust and pride. Lepers were thus scapegoated with Jews and heretics in what historians have called a ‘persecuting society’.

      From the eleventh century there was a rapid surge in the number of hospitals built to house lepers. By 1226 there may have been around 2,000 in France alone, and in England about 130. By 1225 there were a staggering 19,000 leprosaria in Europe, offering shelter while enforcing isolation. Yet by 1350 leprosy was in decline. The epidemiology of that watershed is much disputed: some have speculated that the Black Death killed so many that the disease died out, others that it might be connected with the rise of tuberculosis, which has a similar but more aggressive pathogen; the TB bacillus could have elbowed out the leprosy. But though the disease waned, its menace remained, becoming a paradigm for later diseases of exclusion, and for persecution generally. Leprosaria were used for the poor and those suspected of carrying infectious diseases. Some became hospitals: on the then outskirts of Paris, the Hôpital des Petites Maisons, near the monastery of St Germain des Prés, founded as a leprosarium, was used for the mentally disordered and for indigent syphilitics. St Giles-in-the-Fields, then just outside London, was a lazaretto and later a hospital, as were the hospitals for incurables built outside Nuremberg.

      PLAGUE

      The Black Death is the most catastrophic epidemic ever to have struck Europe, killing perhaps twenty million people in three years. Absent from Europe for eight hundred years since the plague of Justinian, it was endemic for the next three centuries. The Great Pestilence of 1347–51 probably originated in China; in 1346 it migrated from beyond Tashkent in central Asia to the Black Sea, where it broke out among the Tatars fighting Italian merchants in the Crimea. A chronicler tells how the Christians took refuge in the citadel at Kaffa (Feodosia), where they were besieged. Plague forced the Tatars to raise the siege, but before withdrawing they invented biological warfare by catapulting corpses of plague victims over the citadel walls, causing the disease to flare among the Christians. When they in turn escaped, it travelled with them into the Mediterranean, breaking out in Messina and Genoa and raging through the rest of Europe. According to Fra Michele di Piazze,

      In the first days of October 1347, twelve Genoese galleys fleeing before the wrath of our Lord over their wicked deeds, entered the port of Messina. The sailors brought in their bones a disease so violent that whoever spoke a word to them was infected and could in no way save himself from death … Those to whom the disease was transmitted by infection of the breath were stricken with pains all over the body and felt a terrible lassitude. There then appeared, on a thigh or an arm, a pustule like a lentil. From this the infection penetrated the body and violent bloody vomiting began. It lasted for a period of three days and there was no way of preventing its ending in death.

      Within a couple of years, plague killed around a quarter of Europe’s population – and far more in some towns; the largest number of fatalities caused by a single epidemic disaster in the history of Europe. This provoked a lasting demographic crisis. Thousands of villages were abandoned, and by 1427 Florence’s population had plummeted by 60 per cent from over 100,000 to about 38,000. A Europe which had been relatively epidemic-free turned into a crucible of pestilences, spawning the obsessions haunting late medieval imaginations: death, decay and the Devil, the danse macabre and the Gothic symbols of the skull and crossbones, the Grim Reaper and the Horsemen of the Apocalypse.

      Boccaccio (1313–75) gave the most graphic account of plague in the Decameron, a collection of tales related by a group of young men and women who had fled Florence to escape it (the regular advice was ‘flee early, flee far, return late’). Noting that most of the afflicted died within three days, he recorded:

      Such was the cruelty of heaven and to a great degree of man that between March [1348] and the following July it is estimated that more than 100,000 human beings lost their lives within the walls of Florence, what with the ravages attendant on the plague and the barbarity of the survivors towards the sick.

      So virulent was the plague, ‘that the sick communicated it to the healthy who came near them, just as a fire catches anything dry or oily near it’ (a sign that ordinary people regarded it as contagious). ‘How many valiant men, how many fair ladies, breakfasted with their kinsfolk and that same night supped with their ancestors in the other world.’

      Social breakdown followed. In Siena, wrote one survivor,

      Father abandoned child, wife husband, one brother another … none could be found to bury the dead for money or СКАЧАТЬ