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

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СКАЧАТЬ all were thrown in ditches and covered with earth. And as soon as those ditches were filled, more were dug. And I, Agnolo di Tura … buried my five children with my own hands.

      Though epidemiological controversies have raged, the Black Death was almost certainly bubonic plague, caused by transmission of the bacillus Yersinia pestis from rats to humans via fleas (notably Xenopsylla cheopis). When the bacillus enters the body through the bite of an infected flea (it can disgorge up to 24,000 in one bite), the disease follows the pattern called bubonic. After a six-day incubation, victims suffer chest pains, coughing, vomiting of blood, breathing troubles, high fever and dark skin blotches caused by internal bleeding (hence the name Black Death), as well as hard, painful egg-sized swellings (buboes) in the lymph nodes in the armpit, groin, neck and behind the ears. Restlessness, delirium, and finally coma and death generally follow. Not all the features familiar in contemporary Asia match those recounted in medieval chronicles. The swift onset suggests that some direct human-to-human transmission also took place, perhaps in the form of pneumonic plague, spread by droplet infection.

      Many explanations were inevitably offered: God in His wisdom had sent plague to punish mankind for its sins; it might be the result of planetary conjunctions; amongst the ‘natural causes’, alterations in the environment could cause a ‘pestilential atmosphere’ resulting from effluvia, vapours from stagnant pools, dungheaps, decaying corpses, the breath of sufferers themselves – or poisoning of the air by ‘enemies’ such as Jews. Laymen like Boccaccio referred to contagion, but most medical theorists, loyal to their Greek learning, stood by constitutional factors: if the body was robust, illness should not result; if not, one would sicken and die.

      Responses depended upon which theory was accepted. If the plague was truly God-sent, only prayer and fasting could be effective. This encouraged flagellant bands to trudge from town to town, whipping each other, hoping by their lashings and denunciations of Jews and sinners to propitiate divine wrath; which in turn sparked persecution of Jews, who were accused of poisoning the wells. In Basel, Jews were penned up in a wooden building and burnt alive; 2000 were said to have been slaughtered in Strasbourg and 12,000 in Mainz; while in July 1349 the flagellants led the burghers of Frankfurt into the Jewish quarter for a wholesale massacre. But, however pious, the flagellants themselves posed a serious threat to public order by creating panic and challenging authority, leading Pope Clement VI to prohibit them.

      Seeking to protect themselves with long leather gowns, gauntlets, and masks with snouts stuffed with aromatic herbs, physicians put the accent on individual treatment, on the assumption that plague involved atmospheric putrefaction. They recommended sniffing amber-scented nosegays and pomanders and administering strong-smelling herbs – aloes, dittany, myrrh and pimpernel, all supposed to have cleansing properties, to say nothing of those princes of pharmacy, mithridatium and theriac. Fires should be lit and rooms fumigated with aromatic wood or vinegar. Writing in 1401, the Florentine doctor Lapo Mazzei (1350–1412) suggested ‘it would help you to drink, a quarter of an hour before dinner, a full half-glass of good red wine, neither too dry nor too sweet.’

      Faced with plague, physicians had no power to effect public-health measures; that was the magistrate’s business. In Venice a committee of three nobles laid down burial regulations, banning the sick from entering the city and jailing intruders. In Milan, the council sealed in the occupants of affected houses and left them to die (perhaps this draconian measure worked: Milan had only a 15 per cent death rate). In Florence a committee of eight was given dictatorial powers, though ordinances requiring the killing of dogs and cats ironically removed the very animals that might have contained the rats. At that time, however, no one had any reason to suspect rats.

      Secular and religious strategies were sometimes at odds. In 1469, despite the risks of congregating in large numbers, the civic authorities in Brescia allowed the Corpus Christi procession to go ahead because deliverance, hoped the pious, would come through divine intervention. By contrast, in time of plague the Venice Health Board banned preaching, processions and feast-day assemblies. Churches were locked, and in 1523 and 1529 even the shrine of St Roch, a popular intercessor against plague, was shut.

      Certain routines became standard. The committees appointed to co-ordinate public health measures began to remove the sick to leper houses beyond city limits (hence ‘lazaretto’ came to mean a plague hospital), while also establishing a system of exclusion, banning persons or goods from entering or leaving. Such measures were adopted throughout Italy. In 1377 Ragusa (Dubrovnik, Croatia) instituted a regular thirty-day isolation period on a nearby island for all arriving from plague-infected areas; in 1397 this was increased to forty, thus becoming a true quarantine (quarantenaria, forty days). Marseilles took similar action in 1383; Venice imposed quarantine measures in 1423; in 1464 Pisa followed and Genoa three years later.

      Before the fifteenth century such health boards, composed of nobles and officials, were ad hoc creations. In Milan, however, a permanent magistracy ‘for the preservation of health’ was established around 1410, with (by 1450) a staff of a physician, surgeon, notary and barber, two horsemen, three footmen and, sensibly, two grave-diggers. Doctors acted not as full members of such boards but as advisers. Other Italian cities followed; in 1486, Venice appointed a permanent Commission of Public Health, consisting of three noblemen; Florence set up a similar commission of five in 1527, and Lucca one of three in 1549. Bills of Mortality were initiated in Milan, listing names and causes of death. Health Boards extended quarantines and the closing of borders, and health passes were introduced. In these respects, north European towns lagged behind Italy by more than a century.

      The regulation of markets, streets, hospitals and cemeteries, the control of beggars, prostitutes and Jews – in short, public health measures – fell under the health boards. Resentment was expressed about their cost and powers, especially since economic disaster was almost inevitable once plague had been declared official, with commerce and travel suspended and markets closed.

      Obliquely, therefore, medical practitioners became more involved in public administration. Midwives, too, performed policing functions. Laws required them to report illegitimate births, and to press unmarried mothers for the names of the father, so as to secure financial support for the babies. The oaths sworn by English midwives seeking a bishop’s licence included promises to extract the truth about paternity and to refuse requests for secret births.

      MADNESS

      Alongside leprosy and plague, another condition of public concern was insanity. Madness remained particularly disputed. On Galen’s authority, medical writers distinguished four main categories: frenzy, mania, melancholy and fatuity, each the result of a particular humoral imbalance. Folklore believed the moon caused lunacy; theology saw it as a consequence of diabolical possession or sorcery. Some viewed it as divinely inspired, perhaps involving the gift of tongues; others praised the innocence of the village idiot; while troubadours might sing of tragic love-madness.

      Nor was there agreement over remedies. Some advocated drugs and bleeding to sedate the demented and evacuate peccant humours. Shock treatment might be tried, such as hurling a maniac into a river. For demoniacal possession, there was exorcism, while certain saints had the power to cure madness. Three shrines enjoyed a special reputation: St Mathurin at Larchant and St Acairius at Haspres (both in northern France), and St Dymphna at Geel in Flanders. A hospice built there to house the mentally ill proved too small and many were lodged in village households. From this a special ‘family colony’ developed, in which the mentally ill were tended by the villagers. The Geel community still exists.

      Public attitudes towards the insane were mixed. German municipalities sometimes expelled idiots or insane persons, whipping them out of town – though the celebrated ‘ship of fools’ is not a reality but a literary conceit, symbolizing humanity’s follies. The insane were cared for in monasteries; various towns had madmen’s towers (Narrentürme); in Paris, special cells were set aside at the Hôtel Dieu; and the Teutonic Knights’ СКАЧАТЬ