History of the Spread, Community Response to, and Impact of Bubonic Plague Epidemics

1411 drawing of plague-infected people from a German-language Bible known as the Toggenburg Bible. / Wikimedia Commons

Lecture by Dr. Frank Snowden / 01.20.2010
Andrew Downy Orrick Professor of History and History of Medicine
Yale University

Pestilence as Disease

Bubonic Plague

The Triumph of Death, Pieter Bruegel the Elder, c.1562, oil on panel / Museo del Prado, Madrid

I’ll start with an overview of bubonic plague and its passage through Western society. And then we’ll look at specific features of bubonic plague, followed by community responses to the plague and its impact on society, and in particular on European culture.

Plague, in a sense, set the standard by which all other epidemics are judged. The plague was, we might call it, the worst-case scenario, and we’ll see that in later centuries, when societies experienced some new and unfamiliar disease, they waited anxiously to see if those diseases would be similar in their impact. And especially terrible diseases like cholera, in the nineteenth century, and influenza, just after the First World War, were said to be “the return of the plague.” Tuberculosis, the great killer of the nineteenth century, was known also as “the white plague.”

What were some of the distinctive features of bubonic plague? The first thing that stands out is its extreme virulence. That’s one of the first words that we may want to define as we move on. By that I mean its capacity to cause harm and symptoms in the human body. It’s a measurement of the ability of a pathogen to cause disease. Plague in that sense was highly virulent. It also struck rapidly. It caused excruciating and degrading symptoms, and it achieved a case fatality rate — another technical term, which simply means the kill rate that a disease achieved. In the case of bubonic plague, it normally killed fifty to seventy percent of the patients it infected; a rate attained by few other diseases. Its course in the human body was also terrifyingly swift. Normally it killed within about three days of the first appearance of symptoms.

Another feature that was characteristic of bubonic plague was the profile of its victims. I mean that both in terms of their age and their social class. Familiar endemic childhood diseases in a society tend to strike primarily children and the elderly. That, if you like, would be the normal experience of society with infectious diseases. But the plague was different. It struck men and women in the prime of life. And this fact, among others, made plague seem like an unnatural, or might we say supernatural, event. It also magnified the economic and social dislocations it caused. In other words, plague left in its wake vast numbers of orphans, widows and destitute families.

Furthermore, the plague, unlike most epidemic diseases, did not show a predilection for the poor. It struck universally, again magnifying a sense that this was the final day of reckoning, a divine visitation. Another feature of plague we’ll be looking at is terror as a response to it. All of the things that we’ll be saying about plague magnified the responses of the societies that were afflicted. Plague was associated with mass hysteria; with terror; with violence; with religious revivals, as people sought to assuage the divine wrath. It was associated with scapegoating and witch-hunts, for the guilty people in society responsible for the disaster. Perhaps those were the sinful, for those who saw the disease as divine retribution. Or it could be a search for the homicidal agents of some human conspiracy, for the demonic interpretation of disease. Those might be foreigners, witches, Jews or poisoners.

Then the plague was important because it generated a major societal response: the development of the first forms of public health. In part because of its very virulence, the plague inspired the first and most extreme form of public health policy to protect populations and contain the spread of this horrendous and terrible disease. Plague public health — and we’ll see this more next time — involved a military style policy carried out by the army and the navy. It involved maritime and land-based quarantines, sanitary cordons, which are military lines isolating a population. It gave rise to pest houses or lazarettos. And to new health authorities — variously called, over the centuries, health magistrates or boards of health — equipped with extraordinary powers to enforce the plague measures. In some places there were erected stocks and scaffolds to remind the population of the powers of these authorities.

Early Italian states, at the time of the Renaissance, devoted a special role — deserved a special role as the inventors of these public health measures. This was thrust upon them by their vulnerable position at the geographic center of trade routes in the Mediterranean. So, we’ll see the decisive role in the development of these measures was played by places like Florence and the great port cities like Genoa, Naples, Venice. Later centuries will see another pattern, when a new, mysterious and frightful disease strikes — say cholera, yellow fever or AIDS — one of the first responses of authorities is to return to plague measures of self-defense.

It’s said of generals that they always try to fight the last war over again, often confronting new enemies with inappropriate strategies. The same might be said of public health authorities over the centuries. And this temptation is all the greater for authorities because the battery of anti-plague defenses gives an impression of taking forceful and decisive action; providing the population, in other words, with some sense of security.

A third feature of the plague is its enormous impact on society. As we’ve said, infectious diseases are not narrow, specialized interests. They’re often part of the big picture, as essential for understanding a society and its history as studying war, religion, economics, high politics and culture. I’m not trying to make a case for disease determinism, and I’m not what you might want to call a microbial Marxist. My argument instead is simply that certain diseases do have a transforming effect on society, plague being one of them. Certain others do not, even great killers such as polio or influenza. We’re going to examine why this major difference — why some diseases have a much more lasting footprint than others.

Bubonic plague was a disease that affected every aspect of society. It transformed the demography of Europe. Recurring cycles of plague, with an epidemic every generation, constituted a major break on population between the fourteenth century and the eighteenth. It had devastating effect on economic life and economic growth. It also had a major impact on religion and popular culture. It gave rise to a new piety, to cults of plague saints, to passion plays. Plague led to an outpouring of sermons and religious pamphlets, with a central theme being what we might call theodicy; that is, how do you justify God’s ways towards men?

A just and loving God could be angry and punish sinners who turned from him and disobeyed. But how were priests and ministers to explain the gruesome suffering and death of innocents, and in particular of children? Thus also we see another undertow. We talked about piety. I would argue that plague also led sometimes to its opposite; the terrifying conclusion that how could there be a good God, because a loving and all-powerful being would not take the lives of half the population of a great city, indiscriminately killing men, women and children. So, for some, the result wasn’t an act of atheism but a mute despair that was not articulated; a psychological impact that with historical hindsight we might even call post-traumatic stress.

So, plague had a major psychological impact on the relationship of human beings to their mortality, and to their god. Plague had a major impact on the arts and culture. In literature we’ll be seeing — and in fact you’re starting to see, I hope already, by reading Defoe — that there’s a whole genre of plague literature, including not only Defoe but names like Boccaccio, Camus, Manzoni; of whom more later. It affected European painting profoundly, and we’ll be looking at that. It affected architecture, with large numbers of churches dedicated to the redeemer and the plague saints. It led to sculpture, and plague columns appeared throughout Vienna and the Austrian cities. We have, even in modern times, the film that I hope you’ll be seeing, The Seventh Seal by Bergman.

Plague also had a major impact intellectually on the medical paradigm of disease. Plague profoundly tested the humoral framework of disease. And we can see this in a man I mentioned in the last lecture, Girolamo Fracastoro, who developed a theory of contagionism. Now, the humoral idea, and Hippocrates, had recognized the difficulty that epidemics pose for humoral theory. How is it possible to account for vast numbers of people experiencing the same humoral imbalance at precisely the same time? Well, Fracastoro took that idea and he eliminated the mediation of the humors, suggesting instead that the disease was caused by a poisonous chemical, transmitted in a way he didn’t understand, from one person to another. But let’s not think of Fracastoro as a modern medical scientist. He thought that plague was caused, not by a living entity, but by a chemical.

Three Western Pandemics

Manuscript illustration depicting the Justinian Plague, from the Omne Bonum by James le Palmer, 14th century / English Royal Library, MSS 1226

That’s the background, then. Let’s remember the history of three pandemics of bubonic plague that afflicted the West. Now, first maybe we should define what we mean. An outbreak — let’s talk about three terms — an outbreak, an epidemic and a pandemic. An outbreak is a small surge in morbidity and mortality in a locality. So, we might talk of an outbreak of influenza in New Haven. An epidemic is a much bigger surge, over a larger area. And a pandemic is when an epidemic goes transnational; becomes an international phenomenon, affecting whole continents, or occasionally going global. The plague struck the West in three pandemic waves.

We’ll be talking about the history, then, of three pandemics of bubonic plague. And each pandemic as a subset, if we like, had a series of recurring visitations that might even last for centuries. And in addition to being cyclical in that sense, plague had a pronounced seasonality. An epidemic of bubonic plague usually began in the spring or summer months, and faded away with the coming of winter. Especially favorable were months that were both hot and wet. The explanation for that, as we’ll see, wasn’t a humoral one. But that provides an ideal environment for fleas, which are decisive in plague, and their need for warmth and humidity, for their eggs to hatch; and they become inactive in cold or very dry climate.

The first pandemic, when was that? That lasted for two centuries after 541 A.D., and is called the Plague of Justinian. It was the first appearance of bubonic plague as a major player in world history, and there are estimates that it afflicted Africa, Asia and Europe with — people are guessing, but there are figures bandied about of perhaps a hundred million victims. There are few accounts, or records that have survived, and there’s some debate about whether this so-called Plague of Justinian was even bubonic plague at all, or whether it was some other disease. But as we speak, paleopathologists are at work exhuming bodies from ancient cemeteries in order to find conclusive DNA evidence to support a firm diagnosis, and the latest news is that they’re pretty certain that it was bubonic plague.

The second pandemic occurred from the 1330s, in the Middle East, until the 1830s. So, we have — what’s that? — five centuries of bubonic plague in the second pandemic. It began with what was called the Black Death. This erupted in Central Asia in the 1330s, and first invaded Europe in 1347. And the early years, from 1347 into the 1350s, were usually called the Black Death, which referred to the first wave of the second pandemic; after which it’s usually referred to simply as bubonic plague, plague, or pestilence. It may well — and this is the common theory — have arrived aboard a Genoese merchant ship that had sailed from the Black Sea in the summer of 1347.

In any case, Italy was the first land to be invaded by the disease; again, as I say, not by chance, because Italy was at the center of the trade routes of the Mediterranean, and therefore was always, at this time, permanently at risk. About a third of the population of Europe is estimated to have perished. And after the 1350s, after the Black Death, the plague returned more or less once in a generation, for a number of centuries, with some famous local epidemics. Let me just remember some of the worst cases. Florence in 1348, when the disease killed half the population — and that’s portrayed vividly in Boccaccio’s Decameron; 1576 to 1577, Milan; 1630, again Milan — and there are two major plague works of literature: Manzoni’s novel The Betrothed, and his work The Column of Infamy — 1656 in Naples; and 1665 and 1666 in London, which you’re reading about in Dafoe’s Journal of the Plague Year.

Then for reasons we’re going to return to, the plague was vanquished in Western Europe between the end of the seventeenth century and the middle of the eighteenth. The last outbreaks in Western Europe, of the second pandemic, were 1720 to 1722, at Marseilles in France, the last on the Western European mainland; and in 1743 at Messina and Sicily. Interestingly, Messina is a convenient bookend; the very first place in Western Europe to be afflicted by the plague, and also the last, during the second pandemic. Now, don’t make the mistake of assuming that the virulence of the plague declines over these centuries. In many cases the last epidemics of the seventeenth or eighteenth century were the most devastating of all, including the experience of London that you’re reading about.

Then we come to the third pandemic, which lasted from about 1855 until 1959, more or less, when it fades away. It began in earnest, and attracted world attention in China, when it attacked Hong Kong and Canton in 1894. And, as I said, it lasted until the middle of the twentieth century. Now, this pandemic ravaged India and affected five countries, but mostly not the industrial West, apart from a brief flare-up in Naples in 1899, and an also limited outbreak in San Francisco in the early years of the twentieth century. That’s the topic of Marilyn Chase’s work that you’ll be reading, The Barbary Plague. It was the steamship that enabled plague to reach the New World for the first time in the twentieth century. It had limited impact on humans, but it did establish a stable reservoir of infection among wild rodents in the southwest of the United States, where it persists to this very day and causes an ongoing trickle of cases of bubonic plague in this country.

The great disaster was India from 1898 to 1908, which experienced some 13 million deaths from the bubonic plague. Present day plague — and I think a number of you may have the idea that plague is something medieval that doesn’t have anything to do with the modern world, and I want to make it clear that plague is not extinct. Indeed, I have a friend myself who is a survivor of bubonic plague, which she contracted in Arizona in the southwest. As I said, it continues to cause a trickle of cases every year in the United States, because it persists in the wild animal population, and there are occasional flare-ups.

We also need to remember there’s a somber background threat, then, of bubonic plague even today, which is made more vivid by the threat possibly of bubonic plague as an instrument of bio-terror. And just to show the sort of modern — here’s a modern image of the grim reaper as still with us. Now, our focus here in our class will be instead firmly on the second pandemic, and especially its last terrible century in Europe, the seventeenth.


Yersina pestis (plague) / Wikimedia Commons

Let’s talk about some of the features of bubonic plague, and we’ll begin with its etiology. Again a bit of jargon, and by that I simply mean the causes or origins of the disease. And the plague is a disease with a complex history of four protagonists. First there’s the bacterium — and there it is above — Yersinia pestis, sometimes called, in a more old-fashioned way, Pasteurella pestis. It was discovered in Hong Kong by Alexander Yersin, a Swiss student of Louis Pasteur, and at the same time by his rival the Japanese physician, Shibasaburo Kitasato, a protégé instead of Robert Koch.

So, the first protagonist is this bacterium, Yersinia pestis. And then there are two vectors. The vector is normally another bit of jargon: An animal or insect responsible for conveying a disease to human beings. And in this case there are two vectors or carriers that convey the disease to human beings: fleas and rodents, especially rats. And then there’s the fourth protagonist, you and me. By between 1894 and 1898, Yersin and his colleague, Paul-Louis Simond, unraveled the complex relationship among rats, fleas and humans, and the bacterium, that governs the epidemiology of bubonic plague.

Normally the plague began as an infection, an epidemic among animals and especially wild rodents: hamsters, gerbils, prairie dogs, chipmunks, squirrels in their burrows, where underground catastrophes, unknown to humans, took place. A particularly important moment was when it inflicted this particular creature and friend, that lives not so distant from us,Rattus rattus, the black rat or ship rat; and as you see, extremely cute it is. Unlike his cousin, the brown rat, that took over its ecological niche later on, and is more familiar in modern times, the black rat was definitely not shy, but lived in close proximity to people, with whom they shared the same dietary preferences. So, the rat was extremely important.

The bacterium was spread in a third major character, the flea, a highly efficient vector for bubonic plague. The flea is naturally parasitic on warm-blooded animals. In a single feed it sucks up an amount of blood equal to its own weight. I’m talking about something like a billion bacteria at a time. And here we’re looking at the slide of a flea engorged with blood after a meal. Now, once infected — and here you’ll feel sorry for the poor flea — the flea does not survive the plague either. The bacterium blocks the gut of the flea, causing it to starve to death. Poor thing. But before dying, in a frenzied bid to survive, the flea feeds repeatedly, and in each bite inoculates perhaps a hundred thousand bacteria into the bloodstream of its warm-blooded victim.

So, when a rodent host of fleas sickens and dies, the fleas leap to the warm body of another mammal that passes within leaping radius. And the flea also is capable of hibernating for as much as a couple of months, lying in wait. Now, how did human beings come to be involved in this catastrophe? Well, it might be sometimes that the remote steppes where wild rodents lived had their ecological systems disrupted, perhaps by floods or droughts, that sent animals scurrying over long distances, and then they encountered other rodents who lived in close proximity to man, and especially our friend the black rat. Alternatively, human beings invaded rodents’ habitats, exposing themselves to infection; soldiers perhaps, or refugees in times of war, or hunters and shepherds.

So, the first foci — that is, the first locuses where infections sprang up amongst human beings — were the first infected men and women which shared their fleas and infection with other members of their household. The plague would then begin, not as a disease so much of isolated individuals, but of households. Housing conditions were important. Overcrowding, with whole families sleeping in a single bed, facilitated the exchange of fleas. And there were particular moments that were especially dangerous, such as the laying out and final attentions to the dead. As the body cooled, the fleas infesting it became desperate to escape to the next warm body that approached; quite possibly you and me.

Then there was the wider spread; and this was dependent on networks of trade and commerce. It was not an accident that plague emerged when it did in European history. It spread overland and along river valleys, by river traffic. Now, fleas obviously are severely restricted in their range, but rats are really wonderful travelers. They hide in the shipments of wheat and are transported overland. They travel by barge down waterways. But the garments of victims were also important, because they were recycled. Remember how precious an item of clothing was in the early modern world. And, so, the clothing of dead men and women was packed in crates, and sold in markets and fairs, often with fleas intact among their folds.

Certain professions were also highly at risk: street vendors, market-stall-holders, washerwomen, gravediggers, physicians, priests, and also millers and bakers, because of the dietary preferences of your friend the black rat. But the disease also went further afield, and it did so by sea. And shipping was essential to the spread of the plague over long distance, and helps to explain its epidemiology; its tendency, that is, to arrive in a country first by striking port cities, and only then moving inland by road and river traffic. Infected rats would clamor aboard ships, by ropes and gangplanks, or they could be lifted aboard in crates of grain or shipments of clothes.

Istanbul was a great hub of trade in the Middle East, and it linked the rest of the Mediterranean world by trade overland across the Balkans, and by ship to Venice, Naples, Genoa, Marseilles, Valencia. Sometimes there was havoc at sea when a whole crew and its passengers would be killed by the plague before they arrived at port, and there were ghost ships that floated on the Mediterranean. Once reaching a port, however, the ship would dock and rats would disembark, in crates, or by rope, or by the gangplank again, and at the same time infected passengers and crew could go ashore, together with their fleas. Normally the first indication of plague — one that’s dramatically apparent in Camus’s novel The Plague, but we’ll also see in some of the paintings that we’ll look at time after next — an important indication was a sudden and massive die-off of rats. And there would be pictures like this of rats killed by an epidemic of bubonic plague; in this case Sydney, Australia.

So, ports are crucial in epidemics, and in the development of public health measures to counter them. Almost invariably in Western Europe the plague arrived in port cities and then spread inland, following roads and rivers. In the large cities, the disease typically would arrive in the spring, reach a peak of ferocity after a few weeks, then continue as a violent outbreak for two to four months, and then decline with the coming of colder, dry weather, either to disappear entirely, or to be rekindled when favorable climatic conditions returned.

Symptomatology and Pathology

Well, that’s the etiology, in a nutshell, of the plague. I’d like to turn now to its symptomatology and pathology; that is, how does it affect the individual human body? And the study of the symptoms of the epidemics we study isn’t just a matter of ghoulish curiosity. I’m going to argue that the history of each epidemic disease is distinct. That’s one of the reasons that I will be showing slides, to fix the image of a particular disease in your mind. Because it’s important not to confuse them, because each has its own history. And a crucial variable is the differing way in which each of these diseases affected its victims.

A feature of the plague, I would argue, is that it seemed almost purposefully designed to maximize terror. I will be showing you some vivid material, and I’m sorry that it’s just before lunch. And indeed a couple of years ago in this class someone in the front row fainted with some of the pictures. So, if you don’t wish to look at them, I can tell you in advance it’s not compulsory. You can simply close your eyes. In any case, Yersinia pestis is exceptionally virulent because of its ability to overwhelm the immune system of the body. After an infective bite, there’s an incubation period, usually of one to six days, and then the classic symptoms appear — the first beginning — launching the first stage of bubonic plague.

Stage 1: Flea bite / Wikimedia Commons

That is, at the site of the flea bite, there’s what’s called a carbuncle or gangrenous black blister, surrounded by red pot marks. And this will be familiar to you because it’s been immortalized in the nursery rhyme, “The Ring a Ring o’ Roses.” But also, along with it, there’s high temperature and shivering, violent headache, nausea and vomiting, and general flu-like symptoms; after which the patient passes on to the second stage of bubonic plague, when it invades — the bacteria invade the lymph system and drain into the lymph nodes.

Stage 2: Buboes / http://theblackdeathmb.blogspot.com

A couple of days later a so-called bubo — which gives the symptom that gives the disease its name, bubonic plague — the plague of buboes appears. This is an infected swelling of the lymph nodes, a hard mass the size of an orange beneath the skin. The site of the bubo varies, according to the location of the infective bite. If a flea bites the legs, the bubo is usually in the groin, and would look like that. If the fleas instead were to bite the arms, the bubo would appear in the armpit or on the neck, and there would be symptoms — would look like this, or like that. In any case, Daniel Defoe imagined, and he writes in our book, that the agony was so violent from the bubo that victims hurled themselves from roofs, or into the Thames to escape it. And there was a general consensus that the body and all of its excretions — urine, sweat, the breath — had an overpowering stench.

Stage 3: Systemic spread / AP Photo, The Gaylord Family, 2012

This led — I want us to remember how dehumanizing the symptoms of plague were, and that’s tremendously important to the way that societies experienced its outbreak. In the third stage, the bacteria releases a powerful toxin, and this circulates throughout the bloodstream, and it’s the toxin that kills. It attacks tissues, causing blood vessels to hemorrhage, and giving rise to purpurous, subcutaneous spots, the so-called tokens of plague. Another bit of jargon to remember. The plague is associated with tokens and these — let’s have a look at — which look like this. They gain their name because they were thought by many to be the signs, that is the tokens, of God’s anger, the anger that led him to smite his people with the plague.

The toxin initiates the septic phase of this disease, causing rapid degeneration of the muscles of the heart, of the kidneys, of the nerves and the central nervous system, and this leads to such symptoms as bloodshot eyes, general prostration, fever, nausea, severe headache, and progressive neurological damage that’s manifested by slurred speech, a staggering gait, psychic disturbances and derangement. We again see how this disease is terrifyingly dehumanizing and agonizing. And it leads then to delirium and coma. Sometimes it also causes gangrene of the extremities — and I will also have a picture of that — and this may, in fact, be the origin of the term Black Death.

Now, in terms of the symptomatology — let me pass on from that to this. This is a Franciscan friar, Michael of Piazza, a chronicler — you’ll remember I said Messina was the first place to be afflicted by bubonic plague in 1347. He wrote this terrifying description of how it afflicted a sufferer. He wrote: “Not only did the burned blisters appear, but there developed in different parts of the body gland boils; in some on the sexual organs. In others” — whoops, sorry, there we go — “In others on the arms or the neck. At first these were the size of a hazelnut and developed accompanied by violent shivering fits that soon rendered those attacked so weak they could no longer stand upright, but were forced to lie in their beds, consumed by violent fever and overcome by great tribulation. Soon the boils grew to the size of a walnut, then a hen’s egg, and they were exceedingly painful and irritated the body, causing it to vomit blood by vitiating the juices. The blood rose from the affected lungs to the throat, producing on the whole body a putrefying and decomposing effect. The sickness lasted three days, and on the fourth, at the latest, the patient succumbed.”

So, as soon as anyone was seized with headache and shivering, he knew that he was bound to pass away within the specified time, and first confessed his sins to the priest, and then made his will. Death occurred in about half of cases within a few days, though some of the afflicted lingered in agony for as long as three to four weeks, and then a minority slowly recovered.

The symptoms of bubonic plague are agonizing. They’re terrifying, dehumanizing, as suffers succumb to hallucinations and delirium. Now, there are three forms of bubonic plague, and I want to mention what those are immediately. These are not three separate diseases. They’re one disease in three separate manifestations. The first is what we’ve been describing as classic bubonic plague, the most common and historically most important form. Then there’s septicemic plague, which is an overwhelming infection in which the patient frequently dies, even before developing a bubo. But this, as I said, is not a separate disease; simply a fulminant form of plague; and it’s most common among the elderly.

Then there’s pneumonic plague, which again is the same disease, but clinically and epidemiologically distinct. It begins with an ordinary case of plague, complicated by pneumonia, and can then give rise to a secondary catastrophe, within the general disaster; that is, the disease is then spread by bacteria coughed out in the sputum of the victim and spread person to person when inhaled by those near him or her. This form of plague is not dependent on fleas. It’s highly infectious, and as far as is known is one hundred percent fatal. And even today, in the antibiotic era, there’s no cure for pneumonic plague. And pneumonic plague is also recorded in your favorite nursery rhyme. This is the, “ah-choo, ah-choo, we all fall down.”

Now, what did doctors do? What were treatments historically? There was a continuity of strategy from the Black Death, through the eighteenth century, based on Galenic principles of dealing with the a disequilibrium of the humors. So, the main indication of treatment was to assist the body in expelling what was called the peccant humor responsible, or the morbific poison. The physician regarded his task as one of assisting Nature, as the body was already clearly attempting to expel the poison. After all, it was vomiting, there was diarrhea and sweating. So, physicians attempted to assist the body in its fight; perhaps directly by bleeding, a very popular therapy, although there were intense debates about timing, about the best veins to be opened, and the amount of blood to be drawn.

Other key practices were administering powerful purgatives or emetics, so the poison could pour forth more copiously; or to cause the patient to sweat, piling him or her high with clothes, even mattresses, so the poison would pass out through the pores; and forbidding the sufferer to drink; and of course lancing or cauterizing the bubo itself, so that it too could discharge its load of poison directly. Some doctors applied hot compresses. There were also internal medicines that were administered, as they were thought to raise the buboes, or to hasten recovery by fortifying what was called the flagging animal energy of the victim; things like brandy or opium. But in practice, treatment was pitifully rare for plague sufferers.

Physicians, priests and attendants recognized that they were powerless; that they were too few in number to cope with the catastrophe that engulfed them. And they perished too in great numbers during the outbreaks. And many, overcome with terror like everyone else, simply fled. So, one of the terrors of the plague was that it broke the common bonds of humanity, and the common plight of plague victims was often to be abandoned, to face agony and death alone. Let’s listen to the famous and awful testimony of Boccaccio in The Decameron, describing Florence. Sorry for a momentary technological glitch, but we’ll get there. There we are.

This is Boccaccio describing Florence in 1348. “Let us omit that one Citizen fled after another, and one neighbor had not any care of another, Parents nor kindred ever visiting them, but utterly they were forsaken on all sides: this tribulation pierced into the hearts of men, and with such a dreadful terror, that one brother forsook another, the Uncle, the Nephew, the Sister, the Brother, and the Wife the Husband: nay a matter much greater, and almost incredible; Fathers and Mothers fled from their own Children, even as if they no way appertained to them. In regard whereof, it could not be otherwise, but that a countless multitude of men and women fell sick; finding no charity among their friends, except a very few, and were subject to the avarice of servants.”

So, this is our first overview of plague in its three pandemics. Next time what I’d like to do is to talk about the response of communities to this catastrophe, and to look in particular at public health measures designed to protect communities. That’s where we’re heading next.

Responses and Measures

Responses to the Plague and Miasmatism

A representation by Robert Seymour of the cholera epidemic of the 19th century depicts the spread of the disease in the form of poisonous air. / National Library of Medicine

Now we move on to community responses to bubonic plague, first in terms of unorganized, spontaneous responses. And then I’d like to look at something really decisive, which was organized community responses; that is, the first form of successful public health ever devised, and the first victory over a human disease, over bubonic plague.

And just so you’ll remember, plague is not a disease entirely of the past. The third pandemic reached these shores, and I wanted to remind you that plague is still with us. These are the areas in the United States where plague, at the present day, is endemic among wild rodents, and it causes every year a small trickle of cases of bubonic plague, usually in the southwest of the United States. Well, in terms of community responses, probably the first and most spontaneous of all was flight. Panic and fear of sudden death led people to depart in haste. As Defoe makes clear, those who were the first to flee were people of means, and those often included the authorities, and physicians themselves, and clergymen, thereby increasing disruption and chaos, and magnifying the sense of terror.

I imagine you could — for an equivalent, if you were to wake up tomorrow morning and hear that there was something terrible on the medical front happening in New Haven, and that DeStefano and Rick Levin had taken the last train out, I can imagine some of the responses that you might have. In any case, let’s remember the atmosphere in a city visited by the plague. Last time you heard a description of Florence in 1348, provided by Boccaccio, and you’re now reading about Defoe and London in 1665. So, let me give you a different and also dramatic example. And that was Naples in 1656.

Naples, one of the largest cities in Europe, especially vulnerable because of its urban poverty and overcrowding, and its status as one of Europe’s great port cities. It had, in 1656, the year of this terrible visitation, a population of 500,000 — an enormous city by seventeenth century standards — and 300,000 people died no less in this visitation. Every activity in Naples ceased at the time. There was general unemployment and universal hunger. The living — as in the cliché — weren’t sufficiently numerous to bury the dead, and I mean that literally. Cadavers were left, not only in doors, but in all public places. In the end, some 60,000 bodies were burned in pyres, and 20,000 more were unceremoniously dumped into the sea.

Imagine a great city, then, with the intolerable stench of decomposition, with dogs, vultures and ravens picking at cadavers, and a total breakdown of law and order in every public service. Imagine too the flight of people, the sense that the end of the world was at hand. And indeed one of the popular images of the plague in art was a black figure on horseback, one of the dread horsemen of the Apocalypse who had come on this final day of reckoning. So, it was from places like this that everyone who could took to the roads, often with the fear in their hearts that God and his anger were in hot pursuit.

So, the first spontaneous reaction was to escape. But remember what we said about humoralism, Hippocrates and Galen. And if you’ll remember then, looking back, medical theory at the time sanctioned this particular reaction, or led to it logically. Because epidemics and humoral theory, as you now know, were caused by an imbalance in the humors, triggered by a poisoned air, one of the “six unnaturals,” a miasma. In other words, the disease was tied to the air around a given locality, and so it made perfect good sense, by the medical theory that people had inherited, that they should escape the locale and therefore the poisonous miasma.

The response of populations was mediated by the ideas that people had in their heads, by the ways an epidemic was understood, or — in a fashionable modern phrase — how it was socially constructed. Now, orthodoxy was spawned in particular with an idea of what’s called miasmatism; that is to say there was a miasma, which is derived from the Greek word for corrupted or defiled. A miasma was a corruption, a defilement or poisoning of the air. Poisonous atoms, emitted by rotting organic matter of infected people and the objects they had touched, were released, became an effluvia in the air, which was poisoned thereby. And once the air had been made poisonous, it could be absorbed by anyone in a locality — through the pores in the skin, perhaps, or by being inhaled. So, the body would then be poisoned like the air.

And, so, the search in the city was for a corrupting agent. What did people who had this idea, this medical philosophy of bubonic plague — where would their suspicious alight? Well, first they would fall on foul odors; and these were plentiful in an early modern city. There was the night soil that people hurled from their windows and doors, the offal that butchers swept into the streets. There were the products, the noxious products, of stinking trades, like metal or leatherworking, or the retting of hemp and so on. This meant that the logical consequence would be urban cleanups. And, so, authorities ordered cleanups. They collected refuse, closed down certain workshops and trades, cleansed the streets, halted work in abattoirs, and ordered the prompt burial of cadavers.

Furthermore, in Christian Europe water had a symbolic, if we like, ritual cleansing attached to it. It was a purifying quality because of its role in baptism, where it cleansed the soul. So, throughout Europe, cities ordered their streets cleansed with water in times of plague. They did more though than just cleanse the streets. They tried also to cleanse the air directly. There were bonfires that were set, especially with aromatic wood like pine, or with sulfur. And there was the firing of cannon, with the idea that this too would purify the air. Those were authorities who took those measures.

Individual Measures of Self-Protection and Scape-Goating

Medieval plague protection costume illustration / Wikimedia Commons

There were also ideas of individual self-protection. And since the cause of the plague was this horrible poisoned air around you, it was a good idea to have a little vial of aromatic spices around your neck, or it might be vinegar; and tobacco had a certain popularity, as people smoked their way to health in the seventeenth century. It was also wise to shut up windows and doors, if you were indoors, to prevent the poison from entering your home. The garments of people who were infected also fell under suspicion, because the miasmatic poison was held to cling to them, just as you know in your own experience that the scent of tobacco or perfume can cling to a dress, a sweater, a shirt.

Well, for this reason, people also tried to protect themselves with special plague costumes. You can see you’d be very handsome dressed like that. And the idea was that the costume would be waxed, because that would prevent anything from adhering to it. In this case they weren’t thinking about fleas, they were thinking about the atoms of the corrupted, defiled atmosphere. And you’ll note that there’s a prominent feature; is the beak here. And it’s not because it’s a bird. The idea was that in the beak you would fill it with herbs that were spicy and would protect you that way.

And you’ll notice that the person is carrying a rod. That’s not for instructive purposes. That’s to keep people away, at a safe distance from you. So, what better way than to be a bit like a verger? Or let me show you another example. And here you might have your own brazier of coal that’s burning, and you might have sulfur or something else that would scent the atmosphere around you. And always, of course, you would have your stick to keep people at a good safe distance to you.

You also took other precautions. You would approach a plague victim, if you suspected that you were encountering one, upwind, and it was said that plague victims could be approached if you stayed upwind and kept your distance. But for those who approached downwind, illness was likely, and the outcome would depend on a body’s susceptibility, on its organic disposition, that would determine the balance of the four bodily humors. If the balance was precarious, any small influence that disturbed the equilibrium could be fatal, such as fear, a dissolute lifestyle, a sudden chill.

But this idea of cleansing, in early modern Europe, could also have more sinister and ritualistic possibilities. And these were derived from ancient popular ideas of magic, of God’s anger and punishment for sin. In other words, the contamination, it was thought by many people, could have moral causes, which had stirred the divine wrath. So, a vigilant community might well try to identify and cast out those who were morally responsible for the calamity. Sin could be the abuse of food and drink; excessive sleep and idleness; immoderate, unnatural or sinful sex; or blasphemous religious practices and beliefs.

The Plague of Rome, Jules Elie Delauney, 1869, oil on canvas / Musée d’Orsay

Let me show you this rather terrifying slide by Jules Elie Delauney, of 1869, which is called “The Plague of Rome.” And it refers to the Rome plague in the seventeenth century, a major epidemic. And what we see here is the Angel of God pointing out to the avenging angel the home of a sinner, and the plague is about to destroy the sinners inside. This is the idea that people had in their heads. So, with that idea, who might be inside? Well, suspicion fell on prostitutes, for example, and they were rounded up in many places and expelled from towns, and brothels were closed. It might fall also on infidels, religious dissenters, Jews and gypsies. There might be attacks on foreigners and outsiders, witches and lepers who were already suspected of being grievous sinners. Or for people who had the view that predestination could be seen by your outward success in life, whether you were the elect or not, was visible by your worldly wealth, then beggars, by their poverty and misfortunes, were seen as having already received a first installment of the punishment they deserved for their secret sins.

So, towns throughout Europe closed themselves to outsiders, and inside the towns undesirables might be rounded up and expelled. Or worse still, in some places there were stonings, lynchings, burnings at the stake; full-scale pogroms, or what we might today call ethnic cleansing. The poisoning hysteria reinforced this idea, and there was often an hysteria that the poisoning and the atmosphere was not a natural event but a crime. And there were anointers called “untori,” or poisoners, who were out to destroy people. This was a diabolical plot, and so a hunt was often on to find the culprits.

Let me give two famous and notorious examples, a first and early one at Strasbourg in the fourteenth century, where rumor had it — you’ll remember in the fourteenth century, the Jews were cast out of the Iberian Peninsula, and the panicked fear was that they were carrying out a plot as vengeance to destroy Christian Europe by poisoning the wells of Christendom. So, crowds at Strasbourg rounded up 8,000 Jews, took them to the Jewish cemetery and burned them alive. Or let me tell you another example from Milan in 1630, and not really a more cheerful one at all, although on a smaller scale. And it’s told in one of the — two actually — of the great works by the inventor of the Italian novel, and one of the great European novelists of the nineteenth century, Alexander Manzoni. The novel is called The Betrothed. And he also wrote a historical work called The Column of Infamy — that is to say, Milan.

Accusing the anointers in the great plague of Milan in 1630 / Wellcome Library

Here’s a picture of the event I want to tell you about, as described by Manzoni, acting as a historian. The city of Milan in 1630 was at war with Spain, and to their misfortune, four hapless Spaniards were found in the city, just as plague was breaking out, and they were accused of starting it by spreading poisonous ointment on the doors of the houses of the city. Under torture, they confessed to the crime and were convicted of high treason, and then sentenced to have their hands cut off, to be broken on the wheel, and then burned at the stake. So, at the site of their execution — and hence the term — we have this, which is the Column of Infamy.

You can see the prisoners being brought, and you can see they’re being broken on the wheel, and all the rest of it in the picture. And you can also see that there was erected — here’s the chief criminal, Jacob Mora. And on the site in Milan, after the plague, a plaque was posted — the column was meant to deter anyone else from ever doing something so diabolical — and this plaque was placed in Latin saying what had happened and what the punishment had been, and warning people to commemorate this event; that no house should ever be built on this site. And this is the inscription on the plaque. So, those were reactions.


Another reaction was one of mass repentance to propitiate an angry divinity. And to do that, how did you go about it? One way was by outdoor processions, confessing your sins, repenting, and urging your neighbors and everyone else you encountered to do the same. There were religious revivals. The plague years were marked in particular by a new cult of saints, the ones held to be most willing to intercede on behalf of humanity and to divert the divine anger. There was a great cult of the Virgin Mary. There was a cult of Saint Christopher. But in particular, of two new saints who had an extraordinary vogue during the plague year. The first was Saint Sebastian, and the other was Saint Rocco or Saint Roch.

Martyrdom of Saint Sebastian, by Il Sodoma, c.1525, oil on canvas / The York Project, Public Domain

Here is Saint Sebastian. And if you think of the iconography, you’ll remember that when we talked in the first lecture about Homer, we saw that Apollo took arrows to shoot the plague, to destroy the Greeks. And so there has been a constant idea symbolically of arrows as symbols of the plague, and Saint Sebastian is someone who was willing to give his life to save his fellows, by absorbing the arrows into his own flesh. He was martyred by the arrows, and this was said to be his way of defending humanity. So, there was a great vogue in this era of Saint Sebastian, who was invoked to help human beings to avoid the plague.

Saint Rocco, c.1600-1610, oil on canvas / Public Domain

Another was Saint Rocco. Now, who was he? He was an aristocrat from Montpellier, and according to legend he gave his riches away to the poor, and set off on a pilgrimage to Italy, where he had the great misfortune of arriving — and you know it was a misfortune — in 1348, at the onset of the Black Death. He, however, fell ill, but survived. And then he stayed to tend to the ill, only eventually to return to France where he faced arrest and finally died in prison. Like Saint Sebastian, he was a man who was held to be willing to sacrifice his body, his wealth and his life, to save the people of God.

Flagellants from a 15th century woodcut / Wikimedia Commons

So, images of these saints, in particular, proliferated in this period — at the entrances to houses, in people’s bedrooms, in public squares — as a protection against the plague. And there was a vogue in these saints’ names that parents gave their children. Another way to propitiate — I said professions. Well, one of the mysterious movements of the plague years, in the early time of the third pandemic, was a mass movement known as the flagellants. Here the adherents vowed to devote themselves for a month to mass pilgrimage and repentance. They carried the cross. They prayed. They listened to preachers, and they underwent public whipping and indeed self-flagellation, in order to satisfy God’s anger. And when you come to look at the film by Ingmar Bergman, The Seventh Seal, one of the depictions in that, one of the scenes that will be most interesting to you, is the capturing on film of this procession of the flagellants. You see them praying and beating themselves, and each other, with whips.

This affected the iconography of European Art, from the fourteenth century through the seventeenth. There was a theme of the dance of death, the so-called danse macabre, of people being rounded up by the grim reaper. There are also what are called vanitas symbols, which are symbols in art of how life is very insecure; that it’s brief and can end very unpredictably. Now, these weren’t a school of painting, or an artistic style, they were the iconography. They were themes that painters depicted. And it may also be that portraying the disease in this way was a kind of exorcism of the mysterious scourge, and this was a powerful reminder of the transience of all things.

There were also popular superstitions in these days. From astrology, there was the belief that certain metals or precious stones — rubies and diamonds — had protective properties against the plague, as did certain magical numbers. And it won’t surprise you that one of the great numbers that you could conjure with was the number four. You know the drill: four elements, four temperaments, four evangelists, four humors, four winds, four seasons, and so on. So, the number four was very powerful and protective. Another aspect of plague, of course, was that there were people who profited from it, profiteering.

The great cities in grip of plague were lands of opportunity, for rogues of every sort. The epidemics of disease brought, in their train, outbreaks of crime and swindling. Thieves plundered the homes of those who had fled — remember, those who had fled were usually the wealthy — and charlatans peddled every variety of magical remedies, while astrologers sold comfort and advice. Healers charged astounding sums for practicing their dangerous arts. Those were forms of spontaneous reaction to plague.

Organized Public Health Measures


Left: Portrait of Girolamo Fracastoro by Titian, c.1528
Right: Portrait of Kircher at age 53 from Mundus Subterraneus (1664)

What I’d like to do next is to talk instead about something very different, which is organized response by authorities. And this is the first form of organized public health, that eventually leads, by the late seventeenth and the early eighteenth centuries, to the first victory of human beings over a major infectious disease. So, let’s look at what those public health measures were. Well, empirical observation in time of plague gave rise not only to spontaneous reactions that we’ve described but also to a new idea that began to spread alongside medical orthodoxy — a new idea, the idea of contagion. That somehow the plague spread in an unspecified manner from person to person. This idea was largely rejected for centuries by learned official medicine, which clung to the older idea of miasmatism of Galen and his system. But it became an important idea in popular culture, and in the thinking of certain medical heretics. It was fully developed by Fracastoro — whom we’ve mentioned before — of Padua in Italy, in the sixteenth century; but also by the German Jesuit Kircher in the seventeenth century.

The theory was that of a so-called contagium vivum, which consisted of animalcules of some sort. Public policy was — to deal with plague — was first devised in the northern Italian city-states, in the fourteenth and fifteenth centuries — places like Florence, Venice, Milan and Genoa — and then were adapted elsewhere, in France and Spain and Northern Europe. What was involved, as I say, was momentous; the world’s first system of public health. And it turned out to be an organizational idea of genius. The embryo of the system was established during the Black Death, and then became increasingly sophisticated and comprehensive through the middle of the sixteenth and seventeenth and then the eighteenth centuries. But the Achilles heel, early on, was that the system was narrowly municipal or local in scope. A quantum leap was made that turned to make it more effective in the seventeenth and eighteenth centuries, when the idea was taken up by early modern states that devoted the military power of the state to the effort.

The early vision combined, by this time, with the necessary power over a sufficiently large area to make success possible. Now, an interesting aspect of the situation is this: the authorities took action, although there was no medical understanding of — or at least nothing that we would regard retrospectively as an efficacious understanding of the disease they were facing. They acted more or less in the dark, and in the process took measures that were sometimes extreme and heavy-handed; that often wasted resources and were sometimes actually counterproductive. But in the end, the path they pioneered led to the first victory over a major human disease.

So, let’s look at the policies. What were they? First of all was a new institution. Originally, that is, they were called health magistrates. We now know them as boards of health. And these magistrates, or boards of health as they came to be known later and are still known, were endowed with extraordinary powers during emergencies that gave them — they combined in their hands a plentitude of legislative, judicial and executive authority in matters that related to public health. By the late sixteenth century, cities in the vanguard of the movement even had permanent health magistrates, and their example was followed across Europe. That was one thing, a new authority then.

A second plague measure was compulsory burial. And there were so many dead in a major epidemic that you wanted to dispose of them quickly before they poisoned the atmosphere, and you couldn’t bury them individually, and so they were cast into common pits, plague pits. And this was followed by the destruction by fire of their personal effects, and the banning of funerals and funeral processions, a banning of the laying out and the wake. And this problem of burial was an important issue in every outbreak of plague. Priests and gravediggers were decimated, and there weren’t enough people left then to dispose of the dead in normal ways. And it must be remembered that this generated terror in itself; the presence of large numbers of unburied cadavers, in a city where the indignity of disposal of hurling newly dead people into improvised pits heightened the horror of the disease.

Another feature of the plague measures was the control of movement — the control of the movement of people from plague-infested regions by quarantine, and squads of soldiers turning people away from city gates and opening fire on those who tried to cross the line. Another feature of these times was the isolation of the infected, in pest houses, known across Europe as lazarettos. Or alternatively, as you know from Defoe, people were simply shut up, together with their families in their own homes, and forbidden to open the door, while guards enforced the rule and were stationed outside. Most fearful of all was a measure called “general quarantine”, in which everyone in an infected neighborhood was sealed inside his or her home for forty days, with watchmen outside to arrest or even kill those who tried to escape.

Plague: Marseilles, 1720 is a work by Granger / Wikimedia Commons

Let me show you a slide – this is Marseilles in 1720 to 1722, during the time of the plague. And if you looked carefully, you could see many of the events that we’ve been describing taking place in the foreground. Also in London in 1656, that you now know and love, there were watchmen stationed outside to prevent people leaving their houses. Bonfires were lit to purify the air, and the homes were shut up and sealed, with people inside, and doors marked that these are the homes of plague victims.

So, those were important, those regulations. Then there were lazarettos, the pest houses. And these shouldn’t be confused with modern hospitals. They weren’t places of cure but rather barrack-like places of horror and death, where inmates died en masse; where people were locked up, not so much to be cured, but to spare the city of the danger of inhaling deadly vapors from their contaminated bodies. The pest house was really the antechamber to eternity. And the word lazaretto comes from a biblical reference to Lazarus, who was raised from the dead.

Bonaparte visitant les pestiférés de Jaffa, by Antoine-Jean Gros, 1804, oil on canvas / Louvre, Paris

Saint Roch Attending the Plague Victims in a Lazaretto, by Jacopo Tintoretto, 16th century, oil on canvas / Wellcome Library

This is a picture from the nineteenth century by Gros of “Napoleon in the Pest House of Jaffa.” And this is a picture by Tintoretto, of whom we’ll see much more next time. Here again is Saint Rocco — remember I promised you Saint Rocco, who stayed behind, who visited Italy in time of plague, and fell ill himself, revived and stayed behind to tend the dead or dying. And here we see him in the lazaretto, which is pretty much a place of dread and horror. And people were conveyed there — and this was important too — by carters.

And the carters also inspired fear. People were forcibly gathered up and hurled into their mournful heaving conveyances. And these were dreaded almost as much as the disease itself. This fear often was due to the fact that these petty officials risked their lives as an investment through extortion. Healthy men and women could be threatened. The ill could be blackmailed, so they could be left to die at peace in their homes. Burglars could be sold information on empty houses. And often they were drunk, as they consumed spirits to fortify their courage.

Another part of the plague regulations was the control of markets and provisions, to guarantee the supply of food to an afflicted locality, so that people wouldn’t die of famine, as well as disease. The health magistrates, or boards of health, had also the power to close brothels and arrest prostitutes. As I’ve said, they often attempted to purify the corrupted atmosphere with bonfires and with sulfur and gunpowder. Well, taken together, all of these plague measures were draconian, and when first applied they probably increased fear and chaos, promoted flight by people desperate not to be locked in a dying city or carted away to a pest house. And this may have assisted the spread of plague itself.

Did the Public Health Measures Succeed?

Anti-plague regulations were causes of suffering, and they often met in various parts of Europe with fierce opposition and caused civil disturbance and social tensions. They involved the infinite horror of the pest house; the separation of family members; the burning of precious possessions; the prohibition of processions and gatherings; the prohibition of movement; the closing of markets; the denial of funeral observances. So, from Moscow to London, all across Europe, the passage of plague was marked by demographic disaster, by social tensions and economic disruption. Great cities took on the appearance of ghost towns. And these scenes were repeated for centuries after 1347, with outbreaks here and there every generation, and great European-wide pandemics several times a century.

As you know, the normal pattern was that the plague laid waste to a locality for months, and then the disease ebbed and faded away, as mysteriously as it began. And this too left a legacy. For the faithful, the final departure of the plague was a sign that God had been appeased, and was a testimony to the wisdom of their repentance, and perhaps to their decision to hunt out the guilty in their midst. And let me remind you that this still is marked in the landscape of urban Europe. And I’d like to show you an example. And this will be the Castel Sant’Angelo, right here, one of the most common tourist sites of memory in modern Rome today. That’s a general view.

Castel Sant’Angelo (Castle of the Holy Angel), Mausoleum of Hadrian, Rome / Wikimedia Commons

Let’s close in a little more closely. And here we see the Castel Sant’Angelo. This then is one of the major landmarks in a major European city today. At the top of the Castel Sant’Angelo is the archangel Gabriel, and what he’s doing is sheathing his sword, as a sign the divine wrath had been appeased, that God had relented and that the scourge of the population of Rome was no more. For a modern epidemiologist, the thinking might be quite different; that a vital link in the great chain of infection had been broken, in the chain of transmission; perhaps that the infected population of black rats had been destroyed; that all of the susceptible members of the human population had already perished; that the onset of winter and cold weather had reduced the activity of fleas.

In any case, the point I want to make was that eventually the plague measures and regulations were, or at least seemed to be, effective, especially after the seventeenth century with the increased military power of an early modern state that deployed standing armies and naval forces to apply the policy rigorously and over a substantial territory. Venice provided perhaps the first important example; that was soon imitated in country after country, until Western Europe was medically isolated by quarantines, lazarettos and sanitary cordons.

Let me talk a little more in detail about the Venetian idea of public health. It was that — and Venice was a great port, as you know — that the ports of Europe could be protected by isolation from an invasion by sea. To achieve this objective, the authorities constructed a great fortress on the outlying islands, to which all arriving ships from the Eastern Mediterranean were directed. There they were impounded for six weeks, while they were scrubbed and fumigated. Crews and passengers were disembarked at these fortresses and quarantined for forty days. And the cargo and passengers’ effects were unloaded, turned in the sun, fumigated and aired. And only at the end of forty days were goods shipped and passengers released to enter the city at will. The theory was that by strict quarantine any pestilential vapors would be given time to disperse. And so the city might be spared.

Port of La Spezia, Northern Italy / Wikimedia Commons

Island of Nisida at Naples / Wikimedia Commons

Pharo Island lazaretto at Marseilles / Wikimedia Commons

Well, let’s look at a couple of lazarettos. One is at a port called La Spezia. And the point I’m trying to make is that these were very complicated and authoritarian institutions. They’re fortresses no less. Another is at Naples, the island of Nisida. Or at Marseilles, a great lazaretto on Pharo Island. This was simple in principle. It was a maritime quarantine. But to be effective, it presupposed state power. A lazaretto was a fortress for thousands of passengers and crew; had to be policed, provisioned and isolated from all contacts with the city. It required a strong naval presence too, to compel unwilling and possibly terrified sea captains to anchor within these waters, and to prevent attempts at evasion or escape.

Within the lazaretto, there were detailed, complex regulations to ensure that hundreds, sometimes thousands of passengers, in different stages of quarantine, would be isolated not only from the city but also from each other, and that the items of the ship’s crew would all be properly fumigated and exposed to the sun. The idea of quarantine was an empirical result of long experience, and its establishment, to be successful, presupposed the bureaucratic naval and administrative resources of the early modern state. Well looking back with modern understanding, you would probably conclude that the medical theory underlying the Venetian system of quarantine was flawed by modern standards. There were no pestilential miasmas, and many of the rituals of purification were to no effect. But the idea of lengthy and military-enforced isolation was highly effective in practice. Forty days exceeded the incubation period of the disease, and so were sufficient to guarantee that a person then released was medically harmless. At the same time, the period of quarantine was long enough to ensure the death of infected fleas, and of the bacterium itself.

So, an inaccurate theory produced sound administrative procedures. The Venetian lazaretto, backed by the Venetian fleet, demonstrated that it could, in practice, protect the city from disaster. And within a generation, other Mediterranean powers imitated the experiment, building lazarettos: Naples, Genoa, Valencia, Marseilles, Corfu. And all ships from the East were compelled to dock at them. By the end of the seventeenth century, the port cities of Europe were no longer so menaced by sea. The disease continued to be imported, but was contained with just two major failures. In 1720, bubonic plague spread from the lazaretto to the city of Marseilles, killing 60,000 people. And then in 1743, the last burst of epidemic plague in Europe, at Messina in Sicily.

Meanwhile, there was the overland threat, and this was seen to by the Hapsburg Empire which, in the course of the eighteenth century, initiated and perfected a great permanent cordon sanitaire of soldiers, stretching across the length of the Balkan Peninsula. The Austrian cordon was ten to twenty miles wide during threat of plague, and 1,200 miles long. It consisted of a great permanent line of soldiers and sentry posts, stationed to prevent people from passing. So, one of the great armies of Europe assumed the task of isolating Western Europe, from the east, just as the lazarettos and the ports isolated it by sea. Thousands of soldiers, 12,000 during times of epidemics, were stationed to do that.

And it was the case then, by the eighteenth century, bubonic plague, the scourge of five centuries, was entirely eliminated, and didn’t return to Western Europe. Let me look at — this is a slide of a — it could be anywhere, it happens to be the city of Bari. And you can see the cordon of soldiers surrounding the city and protecting it from bubonic plague. And it might be said as well that occasionally the pope reinforced the physical sanitary cordon with a spiritual one; that is, threatening anyone who crossed the line with excommunication.

Well, this was the world’s first victory in the conquest of disease. The greatest epidemic disease in European history had been eliminated, not by the advance of medicine or scientific knowledge, but by the deployment of the military and bureaucratic power of the state. Or certainly so it seemed, though we might wonder if other perhaps imponderable factors were also at work. The replacement of our friend the black rat, who you now know and love, that was very sociable and liked to live close to human beings, by the brown rat, that was shy and retiring and kept its distance. Or there were improved standards of sanitation and hygiene. Or people talked about the impact — perhaps it was climatic change that was decisive. And people point to the Little Ice Age, which began in the sixteenth century and reached minima of temperatures about 1650, and again in the 1770s, and then gave way to warming in the nineteenth century.

Enjoying the ice, Hendrick Avercamp, 1630-34, oil on canvas / Wikimedia Commons

And we see this in works of art, in Dutch painting. The seventeenth century gave rise to a great vogue of winter scenes that you don’t really see in the modern Netherlands, when the canals froze in the seventeenth century and people were able to skate on them. And there were many other examples of winter scenes of painting. This was how cold it was in the seventeenth century. Indeed, it swept all of Europe. The River Thames froze in London. The Baltic froze, so that one could travel by sled from Poland to Sweden. And these weren’t good conditions for Yersinia pestis, and the fleas that were its vectors. But we’ve run out of time. But at least we’ve contained the plague. And next time we’ll look at its impact on European culture and thought.

Impacts, Illustrations, and Conclusions

Effects of Bubonic Plague on European Culture

And with that, I’d like to turn to the third bubonic plague, and I’d like to talk about the effects, or some of the effects, of bubonic plaque on European culture. We’ve been trying to suggest that plague had a major impact on European society, and I want to be arguing that that impact was felt not only on political events but also on culture and intellectual life.

But I want us to remember that when we’re talking about those effects, I’ll be trying to say it was the effects not only of plague itself as a disease, but also the impact of the organized reaction to plague, the anti-plague measures, and the sense that for the first time society had means that were effective, and could protect itself against this dreadful outside visitor. Well, let’s start again at the beginning. And, as you know, there is a biblical interpretation for the themes of this course. And this is the one that you’re now well familiar with; this is the Fall.

The Temptation of Adam, by Jacop Tintoretto, 1550, oil on canvas / Gallerie Dell’ Accademia, Venice, Italy

Expulsion from the Garden of Eden before and after restoration, Masaccio, 1425, fresco / Brancacci Chapel in the Church of Santa Maria del Carmine in Florence.

This is Adam and Eve, as painted by the greatest of all — perhaps the greatest of all — plague painters, Jacopo Tintoretto, who was a painter in Venice and lived from 1518 to 1594. You know this is the story of Genesis; that Adam and Eve tasted of the fruit that they were forbidden, and as a result they were expelled from the garden and for the first time became subject to death, and also to disease and illness. And if we move forward, this is the next step. You saw the original sin. We also see Masaccio’s — one of the great painters of the Italian Renaissance — this is his painting, in the Brancacci Chapel in Florence, of the expulsion from the garden. And you know they’re looking extremely miserable. Not only are they going to die and become ill and experience pain in childbirth, but they’re also — and I’m sorry about this — they’re going to have to work. So this is a tremendously painful experience, and you can see the pain written in their faces, of Adam and Eve.

“Ars Moriendi”: The Art of Dying

Jeremy Taylor / Wikimedia Commons

So that, in a way, is a story of our course. And I’d like to talk now about some attitudes towards what followed — that is, illness and death — just before the arrival of the Black Death. And I’d like to refer to the work of a French historian who died fairly recently and was the great, perhaps, historian of death. His name is Phillippe Ariès, and he had an idea, that before the Black Death, he talked of it as “death tamed.” That is, there were ways that people had beliefs, practices and rituals, that helped them to face the issue of our mortality; to cope with loss; to heal the tear that was caused in a family or a community, the loss of a member of a family; and also to express grief and to pay one’s last respects. And there were two great aids in doing that. One we might say was the ars moriendi, which was “the art of dying.”

There were certain rules that you should be aware of that would prepare you for the final moment and the passage from this life to the next. And then there were what were called a memento mori, which is a reminder of death; that is, a reminder — you should surround yourself with reminders that it’s time to get ready, because any day could be the last and death could come very soon. We’ll see the art of dying portrayed in instructions; sometimes in paintings or engravings; also in books on how to die properly, according to Christian doctrine — who should be there?; what are the last rites?; that is, extreme unction — the final confessions of sins; the last communion and viaticum; the funeral rites; the laying out of the body; the wake; the procession, with perhaps a town crier announcing the event; the funeral service and a burial ceremony with a blessing; an interment in consecrated ground; and finally a funeral meal for surviving friends and relatives.

Leading themes in this are themes of solidarity, dignity and community. And in this slide of the ars moriendi, we see a dying person inhabiting two worlds: the natural world he’s about to leave with possessions, friends, family and home, and a supernatural world he’s about to enter, and that only he can see, but is represented by angels and devils vying for his soul. We can also see in another example by Nicolas Poussin, also a great seventeenth century French painter, who — this is a painting of extreme unction. It’s an illustration of the good death to which everyone should aspire.

Now, the seventeenth century, the time of Defoe’s great work, also witnessed in Britain the publication of the work of one of the most famous of all writers on the theme of ars moriendi, the art of dying; that was the extraordinary Anglican preacher and bishop, Jeremy Taylor, who lived from 1613 to 1667, and wrote two major works, both of which have gone through edition after edition, they were so popular and so influential. The first was called The Rule and Exercises of Holy Living, of 1650, and the other was The Rule and Exercise of Holy Dying, of 1651. Taylor argued that this life is short and unimportant, and so we should use our time primarily to prepare for the eternal world, making certain that we die with our worldly affairs in good order, and with our souls in a state of grace, prepared to meet our maker on Judgment Day. His books then were instructional manuals on how to do that. And he reminds us that there really isn’t a moment to waste, especially with the threat of plague ever-present, with sudden death that could happen any moment now.

“Mors Repentina”: Death Unleashed

So, Phillippe Ariès thinks then the opposite of the good death is death by bubonic plague. That is something we might call “death unleashed,” a sudden mass death for which society had no defenses, and no one was prepared. This sudden death is mors repentina — sudden death — which was always feared. Because sudden death catches a person unprepared, with his will unwritten in this world, and his soul in a state of sin that could lead to eternal damnation in the next. And death from plague was not only sudden but, as we know now, agonizing and dehumanizing. It often meant that the sufferer was alone and abandoned, and it was death without the attentions of the clergy, without funeral rites and proper burial. Or your body was hurled unceremoniously into a mass plague pit; burned perhaps; thrown into the sea, picked over by vultures and crows.

Now, remember, don’t think that this fear of mors repentina was something medieval and very distant from us, or simply early modern. The historian Drew Faust, in her extraordinary recent book on the American Civil War, This Republic of Suffering, places the fear precisely of mors repentina at the center of her account of the Civil War. It was a widespread anxiety, pervasive among the soldiers on both sides of the conflict, and it recurred again and again in the letters they wrote home. Total war, like bubonic plague, provides unlimited opportunity for an unprepared and sudden death that could set us all on the wrong path for eternal life. Well, literature also gives expression to this new and horrifying reality. You’ve seen Boccaccio in his introduction to The Decameron. You’re reading Defoe and The Journal of the Plague Year. You could read about it again in Camus’s The Plague, or Edgar Allan Poe’s short story, “Mask of the Red Death.”

Remember too that another aspect of mors repentina, the sudden unprepared death, was the fear of premature burial. The certification of death in the early modern world, say at the time Defoe was writing, was extremely imprecise. The only really certain indication was putrefaction. And, so, those religious rites of laying out — the wake, the funeral procession and so forth — were practical, in that they allowed time, and they ensured observation, to be certain that the dead person really was dead before being interred. But plague, on the other hand — we’ve seen the plague regulations. They meant instead a rapid, hasty burial, with no attention and no observation, and isolation raised a real danger of being buried alive.

In times of epidemic diseases that swept populations, this fear of death was very pervasive. And we’ll come back to it when we talk about cholera in the nineteenth century, when the cemeteries had all sorts of experiments with providing caskets with little bells above ground and a rope underground, so that someone could raise the alarm if they woke up unexpectedly. So, the plague then really led to death unleashed. Let’s look at some of the portrayals of it, in painting and sculpture, from the plague centuries of the second pandemic — remember, from 1347 to 1743. Here’s a bas-relief of Pierre Puget. This was the plague in Marseilles, and I think one can see the extraordinary portrayal.

The Plague at Ashdod, Nicolas Poussin, 1631, oil on canvas / Wikimedia Commons

I wanted to move on though to this particular painting, one of the most important of the plague years. And this again is Poussin, whom you saw earlier telling you how to die properly, what the good death should look like, who should be there and all the rest. This is his famous painting of 1631, now in the Louvre in Paris, called “The Plague of Ashdod.” Let me remind you, it’s again a biblically inspired painting. Let me remind you of what Ashdod was. The story is from the First Book of Samuel in the Old Testament. Ashdod was a city in the Holy Land near Gaza, occupied in biblical times by the Philistines who worshipped the idol Dagon. The Philistines defied the Israelites in battle, and confiscated the Arc of the Covenant as war bootie, and set it up in the Temple of Dagon in Ashdod.

So, the Book of Samuel tells us: “And so it was. The hand of the Lord was against the city, with a very great destruction. And the Lord smote the men of the city, both small and great, and they had emerods in their secret parts.” A special reward to any of you who tell me what an emerod actually is. But anyway, this slide is about the destruction of the great temple of Dagon. You can see that here. This may be the Arc of the Covenant. It is, then — again we can see it’s a representation in painting of plague as being a punishment for divine anger and for sin. Some of the things we can note are the gruesome and particular details. We can see that there are rats scurrying. You know the role that rats played in plague.

Wax statues depicting effects of the plague, Gaetano Giulio Zumbo / La Specola, Florence

The Plague of Naples in 1656, Micco Spadaro, oil on canvas / Museo di San Martino, Napoli

We can see our friend Rattus rattus playing a starring role. We can see the passerby holding his nose because of the stench of the victims and the fear of miasma. Or let’s look at another portrayal. We see a sculpture by Pietro Gaetano “The Plague of the Late-Seventeenth Century.” Or quite a terrifying picture by Micco Spadaro, “The Plague of Naples in 1656.”

While we look at this, let’s think of the reference that it’s making. You can see that things are happening in the heavens. And this is Naples being devastated by the plague. There are plague pits and all the rest of it in this picture. I think we should remember how people thought of this. It seemed to be an acting-out of the Book of Revelations, the day of the Apocalypse. The Dies Irae, the day of wrath, and the Lord’s judgment, when the lamb opened the Great Book, closed with seven seals; and that’s the reference in Bergman’s film to The Seventh Seal.

And in the Book of Revelations, let me remind you of what people were thinking at times like this. In Chapter VI it says: “And I saw when the lamb opened one of the seals. And I saw him behold there was a white horse. And he that sat on him had a bow, and he went forth conquering and to conquer. And when he’d opened the second seal, there went out another horse that was red, and power was given to him that sat thereon to take peace from the earth, that they should kill one another. And when he had opened the third seal, I beheld a black horse, and he that sat on him had a pair of balances in his hand. And he opened the fourth seal. I looked and beheld a pale horse, and he that sat on him was death, and hell followed with him… At last the lamb opened the seventh seal and seven angels appeared, bringing the wrath of God. There was thunder, lightening and earthquake. The sea turned to blood. The grasses were burned up. The waters turned to wormwood. The sun and moon were smitten and a bottomless pit opened. And I saw another sign in the heavens, great and marvelous: seven angels bringing the seven last plagues. For in them is filled up the wrath of God. And I heard a great voice out of the temple saying to the seven angels, ‘Go your ways and pour out the vials of the wrath of God upon the earth’. And the seventh angel poured out his vial into the air. And thence came a great voice saying, ‘It is done.'” I think that’s what’s happening in the heavens here.

The Triumph of Death, Pieter Bruegel the Elder, c.1562, oil on panel / Museo del Prado, Madrid

Well, other examples of death unleashed are portrayed in the theme that was common in European painting in the time of bubonic plague, during the plague centuries, and that’s the theme of the triumph of death, which is often complete with the horsemen of the Apocalypse, that I just read to you about, and a usual scene is a great cart, pulled by oxen, driven by the figure of death, wielding a great scythe, while before him there goes the Angel of Death blowing a trumpet. And all around you may see dead people and graves that are opening and skeletons. Let me give you one of the scariest paintings I know. This is “The Triumph of Death,” now hanging in the Prado in Madrid. And if you look at the details, I think it becomes all the more disturbing, the closer you look at it. You see death coming with his scythe and mowing down the population in their masses, which is what bubonic plague does in particular.

“Vanitas” and “Danse Macabre”: Life as Transitory and Fragile, and Death as a Merry Dance

The Triumph of the Virtues, Andrea Mantegna, 1506, oil on canvas / Musée du Louvre, Paris

We can look at another artist. This is Andrea Mantegna, who died in 1506, his painting “The Triumph of the Virtues.” There were other new themes in European art that emerged during the plague centuries. And one of these, was the theme of vanitas; a new theme in European art during the plague centuries, when death was unleashed in Europe repeatedly. Vanitas, as a theme, flowered in the sixteenth and seventeenth centuries. Now what did it mean? Well, vanitas paintings were meant to display the temporal goods of this world: flowers perhaps; fruits; symbols of learning and culture such as musical instruments or books; or signs of earthly achievement and wealth, like gold and jewels. But they’re juxtaposed to striking and more shocking symbols of what’s meant to be the deeper reality of this transitory, fragile life that we live, and the imminence of death.

And, so, alongside these earthly things, you’ll see a skull; a candle whose flame has just gone out; an hourglass marking the passage of time; the crossbones. And the message is — that also is a biblical one — vanity from Ecclesiastes. Let me just read you a sentence. “What profit hath a man of his labor under the sun? One generation passeth away and another generation cometh.” In an age of sudden mass death, human achievement was futile and impermanent, and you should instead be preparing yourselves for the true reality of death and the ever-lasting life. Now, this we can see directly linked to what you’re reading about in Defoe.

London Bills of Mortality / Wikimedia Commons

Here we have the London Bills of Mortality, in 1664 to 1665. And this is the illustration that introduced the bills. It helps us to make the direct connection between plague and the iconography I’ve just been talking about. You’ll notice that the symbols are the classic vanitas symbols of the seventeenth century. You see the skeleton, the crossbones, the shovel and all the rest of it, all around the edges. The skull, the hourglass here. The time is running out. And indeed you’ll see right here that this is — the inscription is a memento mori. This is to remind you that death is coming and could strike at any moment, and you had best prepare.

Hans Burgkmair and His Wife, by Lucas Furtenagel, 1527, oil on canvas / Wikimedia Commons

Let’s look at another painting of these centuries, from Lucas Furtenagel, in the sixteenth century in Germany. This is “Hans Burgkmair and His Wife,” a painting of 1527. And the point is that looking in the mirror, they see the true reality of themselves, which is their skulls after death. And, so, this is reminding us that this is the true reality that lies beneath all of us. Or let’s look at another painting.

Vanitas, by Harmen Steenwijck, 1640, oil on canvas / Leiden

The Ambassadors, by Hans Holbein the Younger, 1533, oil on canvas / National Gallery, London

Vanitas, Simon Renard de Saint-Andre, 17th century, oil on canvas / Musée des Beaux-Arts de Marseille, France

This is Harmen Steenwijck, a painting called “Vanitas,” of 1640. I’m trying to show you paintings from different countries, from England, France, the Low Countries, Germany and so on. This is the Low Countries. And this painting, housed in Leiden, and is quite clearly about exactly what we’ve been talking about; the candle, the skull, the books that are evanescent. Or more subtly but quite famously, this is Hans Holbein the Younger’s painting called “The Ambassadors,” which now hangs in London in the National Gallery. It’s an ironic commentary on the court of Henry VIII. All about the painting you see the display of symbols of wealth, power and learning: elegant costumes, the globe, the book, musical instruments. But in somber juxtaposition to them all is the apparent smudge in the foreground of the painting. But if you look at it closely, what it actually is, is a large and perfectly constructed skull, seen from a different perspective; a technique known as an anamorphosis. Let’s look at one more vanitas. This is Renard de Saint-Andre’s seventeenth-century painting called, appropriately, “Vanitas”. I think you get the picture.

Another theme of these centuries, of death unleashed, is the theme called the danse macabre, the dance of death. Now, let me stress that once again this is not a school of painting. This is part of the iconography. It’s the theme in the painting. It appears as a common motif in European Art, from the mid-fourteenth century to the sixteenth; in paintings, in prints and very importantly on tombstones. It began with the Black Death. And with the eighteenth century and the vanishing of the plague, it becomes rarer and rarer, it more or less fades out.

The danse macabre portrays death as a skeleton, inviting people of all ages, ranks and sexes to join in the merry dance of death. And death is usually armed with a scythe, or an arrow, or a dart, and often plays a musical instrument. In the words of The Catholic Encyclopedia: “The Black Death brought before popular imagination the subject of death and its universal sway, as never before. At this time, death appeared as the messenger of God, summoning men to the world beyond the grave. During those years, many churches enacted literal dances of death, or transformed it into a play conveying the idea of the fragility of life and the nearness of death and the need for repentance.” There are other examples.

Dance of the Macabre murals, St. Mary’s Church of Lübeck, Germany / Wikimedia Commons

I’d like to show you three pictures (above) from St. Mary’s Church of Lübeck in Germany. A glorious mural from 1463, one of the glories of the Renaissance in Germany. But unfortunately it was destroyed by Allied bombing in the war, and so there’s only a black and white reproduction that I can show you. But the theme comes across quite clearly, and is a good example of the danse macabre. What it is, is a portrayal, in separate paintings, of a whole society suddenly summoned by Angel of Death, the bubonic plague. The first one is the pope and the emperor being summoned by death. It doesn’t matter who you are, everyone falls victim in time of plague. Well, here we see another level of society, a canon and a nobleman being called again by death. Or the third is the parish priest and the artisan, who are also being asked to take part in the dance, and then the priest and peasant. The whole of society, in other words, is being stricken by mass death.

Cults of Plague Saints

Saint Sebastian, by Sandro Botticelli, 1474, tempera on panel / Staatliche Museen, Berlin

Saint Sebastian, by Raphael, oil on wood / Accademia Carrara, Bergamo

Saint Sebastian, Guido Reni, 17th century, oil on canvas / Wikimedia Commons

Saint Sebastian, by Hendrick Ter Brugghen, 1625, oil on canvas / Allen Memorial Art Museum, Oberlin

There was another major development of the plague centuries, and this was the emergence of cults of famous plague saints. Saint Sebastian, San Rocco and Saint George. You remember why Saint Sebastian, an image shown earlier, was so important? Because the arrows were symbols of the plague, and Saint Sebastian is offering his body to defend humanity against the wrath of the Lord. And Saint Sebastian is a theme who becomes very important in these centuries, for the first time in European painting. This is Sandro Botticelli’s painting of Saint Sebastian of 1484. Or there is another major painter, Raphael’s “Saint Sebastian.” And yet another – Guido Reni’s picture of him. Finally, from the Low Countries, Hendrick Ter Brugghen’s early-seventeenth-century painting, 1635, Saint Sebastian.

The Madonna della Misericordia crowns this triptych by Andrea da Murano depicting Saints Vincent Ferrer, Roch, Sebastian and Peter Martyr. Triptych by Andrea da Murano / Wikimedia Commons

It was also, as I said, — the time of the cult of another saint — and this is Saint Roch, or we can call him San Roch. You know his life already. He was from Montpellier in France, and devoted himself during his travels to tending the plaque-stricken in Italy, and protecting the faithful. After his death, then, his intercession was invoked across Europe, and his cult spread from country to country. Often we see Sebastian and Roch painted together. This is Andrea da Murano, “Christ Embracing the Saints,” Sebastian here to his right, and San Rocco to his left. And you can almost always tell that San Rocco has the bubo in his thigh. It’s clearly the bubonic plague that’s being referred to here.

In addition, it was larger scale than just paintings. It also affected architecture across Europe, and churches were built to San Roch across Europe, in France, in Austria, in Vienna, in Rome. But I think if we’re going to talk about plague and its impact on the built environment and architecture, as well as painting, I think the best place we could go is Venice. Venice, as you know, because of its site in the Mediterranean, at the center of the trade routes, was scourged again and again by bubonic plague, and was the place that first devised the anti-plague measures. So, Venice has a deep association with bubonic plague, and it left its imprint in stone and on canvas. I’d like to look at some of — if you were to visit Venice, you would see that its whole urban landscape is deeply affected by bubonic plague. Also, even the gondolas are, in fact, a reference — that’s why they’re black — to bubonic plague; from conveying the bodies at the time.

Santa Maria della Salute, 1631-1687, Venice / Wikimedia Commons

This is the church of Saint Mary of Health [Santa Maria della Salute], built in the 1630s. And what it’s doing is after the plague had passed, this is a church that’s built to commemorate the passage of plague, and to thank God for allowing his wrath to be assuaged, and for health to be returned. And, so, that’s why we have one of the most important churches in Venice is Saint Mary of Health. And these are a couple of closer pictures of it. And that’s moving into the interior. Let me also show you another church.

Non Basilica del Santissimo Redentore (Il Redentore), 1577-1592, Venice / Wikimedia Commons

This is the Church of the Redeemer, and it’s a church also built at time of plague to thank God for the assuaging of his wrath and the survival of the city. A closer picture. And we’ll move on. This is again one of the glories of Venetian art. It’s called the Scuola Grande di San Roch, which is the Great School of Saint Roch. Let’s remember what the school meant. There were three-hundred or so so-called “schools” at Venice in the sixteenth and seventeenth centuries. What they were is confraternities, associations of laymen, including the leading trades of the city. Some of them had large and wealthy memberships, and played a major role in the government of the city, and amassed enormous wealth.

Scuola Grande di San Roch, Venice / Wikimedia Commons


Scuola Grande di San Roch interior, Venice / Wikimedia Commons

The functions of the confraternities were originally devotional. And given the exposure of Venice to the plague, it’s not surprising that the very largest and most powerful of the schools chose Saint Rocco as its patron saint. And this is — it bears the name. It constructed a magnificent building, and commissioned the greatest Venetian artist of the century, Jacopo Tintoretto, to decorate it, in veneration of Saint Rocco, and in direct rivalry to the Sistine Chapel in Rome. So, let’s move inside. There we are. And we’ll see that we’re looking at — in these plague scenes, we’ll be seeing that we’re going to look at the magnificence of the art. And this is the interior of it.

Pestsäule (Plague Column), Vienna, 1683-1693 / Wikimedia Commons

Pilsen plague column, Czech Republic / Wikimedia Commons

Holy Trinity plague column, Hungary

I just wanted to show you that at the height of the painting is Tintoretto’s painting of the Triumph of San Rocco; San Rocco, the great plague saint, achieving his reward in heaven and going up to God. Plague also affected across Europe. Let me also say another theme in the urban landscape involved plague columns. And you can see these, particularly in Central and Eastern Europe, a great plague column in the center of Vienna, or also in Pilsen in the Czech Republic. Or in — here’s yet another in Hungary. Now, in these plague scenes, of course, remember that by definition we’re looking at works by survivors, whose sense of horror was tempered perhaps by a bit of relief. If it were possible to have works by the victims, perhaps the scenes would be even more wrenching. There are also aspects that aren’t mentioned in the literature and are unknowable, but perhaps probable.

Plague as a Factor in European Intellectual History

What happened to those who suffered from the plague and then were recovered? Was their fertility affected? Were there long-term sequelae and neurological deficits? Were there psychological effects that we would now term posttraumatic stress syndrome? But in our discussion of plague, I also want to say that there were a couple of speculative, large-scale conclusions that I want to hint at. The presence of plague over four centuries, as we’ve just seen, had a major impact on religion, on culture, on societal attitudes toward life and death, and left a major imprint on architecture, on painting and sculpture. In addition, I want to speculate for a moment and say that we might also think that perhaps the plague — and especially not the plague itself, but the triumph over it, by the means we described last time — may have been a factor that helped to transform European intellectual history.

Now, it’s one of the great clichés that the eighteenth century, the Age of Enlightenment, was a great age of optimism and belief in progress. But I’d argue that perhaps the belief in progress required some tangible material foundation, and that this was grounded in a new sense that life, in fact, was becoming more secure, and that perhaps mankind could master its environment and its destiny. And, so, I would argue that it’s very significant that the first great medical conquest — at least public health conquest — resulted from the application of the power of the state, of administrative measures in the plague regulations. And it’s no coincidence then that the eighteenth century — and during this time, the State came to be seen as a source of redeeming power, that could transform human lifeand society. Here was an impetus towards reform, and a re-thinking intellectually.

Medical history, in a sense, one could argue, was one factor that helped to sound the death knell of the old regime, dramatically and successfully demonstrating humans’ capacity — that is, man’s capacity to make his or her own history. Here was a basis for a new faith in reason, and the creative potential of political power. Perhaps it’s suggestive to remember that Jean-Jacques Rousseau, the founder of modern revolutionary political thought, began his — and one of the heroes of the Enlightenment — began his career in Venice, which for a time he regarded as a model regime. And that his time there included a month of reflection, as he underwent a term of quarantine in the great Venetian lazaretto. But again, I want to avoid giving any suggestion that I want to propound a germ theory of history.

As a historian, I’m opposed, by training, to mono-causal explanations of major events. And, so, what I’m not saying is that the conquest of the plague caused the Enlightenment; I’m not saying that. I merely want to note that the conquest over the plague first — and we’ll be talking next week about smallpox second — were extraordinary influences, triumphs over the two most feared diseases of the seventeenth and eighteenth centuries, the first conquest over infectious disease. And I would say that that wasn’t a million miles away from being a background influence on the coming of the Age of the Enlightenment.

I would also speculate that the triumph over plague first, and then smallpox, also played a role in the coming of the industrial revolution; that the plague and smallpox had been enormous brakes on demographic growth and the growth of the economy. And the conquest of the plague by the eighteenth century, followed by victory over smallpox, had a major impact on launching a great age of European population growth. And population growth, in turn, was a precondition for the coming of the Industrial Revolution. Again, note that I’m not saying that the conquest of plague was a mono-causal explanation for the coming of the Industrial Revolution. I’m saying simply that it was one of many pre-conditions; that it was a growing population that provided that endless supply of free laborers for factories, mines and sweatshops. And it also provided a growing market for industrial products. Demographic change then supplied a large home market for industry.



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