Francis Gasquet - The Great Pestilence (A.D. 1348-9)

In its common form the disease showed itself in swellings and carbuncles under the arm and in the groin. These were either few and large – being at times as large as a hen's egg – or smaller and distributed over the body of the sufferer. In this the disease does not appear to have been different from the ordinary bubonic plague, which ravaged Europe during many centuries, and which is perhaps best known in England as so destructive to human life in the great plague of London in 1665. In this ordinary form it still exists in Eastern countries, and its origin is commonly traced to the method of burying the dead in vogue there.

The special symptoms characteristic of the plague of 1348–9 were four in number: —

(1) Gangrenous inflammation of the throat and lungs;

(2) Violent pains in the region of the chest;

(3) The vomiting and spitting of blood; and

(4) The pestilential odour coming from the bodies and breath of the sick.

In almost every detailed account by contemporary writers these characteristics are noted. And, although not all who were stricken with the disease manifested it in this special form, it is clear that, not only were many, and indeed vast numbers, carried off by rapid corruption of the lungs and blood-spitting, without any signs of swellings or carbuncles, but also that the disease was at the time regarded as most deadly and fatal in this special form. "From the carbuncles and glandular swellings," says a contemporary writer, "many recovered; from the blood-spitting none." 16 16 See Lechner, Das grosse Sterben , p. 15. De' Mussi gives the same account. Matteo Villani, one of the most exact writers about this plague at Florence, says that the sick "who began to vomit blood quickly died;" 17 17 "Chi cominciavano a sputare sangue, morivano chi di subito." The contemporary chronicle of Parma by the Dominican John de Cornazano also notes the same: "Et fuit talis quod aliqui sani, si spuebant sanguinem, subito ibi moriebantur, nec erat ullum remedium" ( Monumenta historica ad provincias Parmensem et Placentinam pertinentia , vol. v, p. 386). whilst Gui de Chauliac, the Pope's physician at Avignon, who watched the course of the disease there and left the most valuable medical account of his observations, says that the epidemic was of two kinds. The first was marked by "constant fever and blood-spitting, and from this the patient died in three days;" the second was the well-known and less fatal bubonic plague.

The characteristic symptoms of this epidemic, noted in numerous contemporary accounts, appear to be identical with those of the disease known as malignant pustule of the lung; and it would appear probable that this outbreak of the plague must be distinguished from every other of which there is any record. "I express my profound conviction," writes an eminent French physician, "that the Black Death stands apart from all those which preceded or followed it. It ought to be classed among the great and new popular maladies." 18 18 Anglada, Étude sur les Maladies Éteintes (Paris, 1869), p. 416. The idea that this peculiar malady was altogether novel in character is confirmed by its specially malignant nature. According to a well-recognized law new epidemics are always most violent and fatal. The depopulation of the Fiji Islands by the measles is an instance of the way in which a comparatively mild disease may in its first attack upon a people prove terribly destructive. It is commonly thought that it has been the action of some new disease whereby the races which built the great prehistoric cities of Africa and America have been completely swept away.

Be that as it may, the disease, as will be subsequently seen in the accounts of those who lived at the time, showed itself in various ways. Some were struck suddenly, and died within a few hours; others fell into a deep sleep, from which they could not be roused; whilst others, again, were racked with a sleepless fever, and tormented with a burning thirst. The usual course of the sickness, when it first made its appearance, was from three to five days; but towards the close of the epidemic the recovery of those suffering from the carbuncular swellings was extended, as in the case of ordinary Eastern plague, over many months. 19 19 The following account of an outbreak of disease somewhat similar to the "Black Death" appeared in the British Medical Journal of 5 November, 1892: – "An official report of the Governor-General of Turkestan, which has recently been published in St. Petersburg, states that that province has been severely visited by an epidemic of 'Black Death,' which followed upon the footsteps of cholera. On September 10 (22) it appeared suddenly at Askabad, and in six days it killed 1,303 persons in a population of 30,000. 'Black Death' has long been known in Western Asia as a scourge more deadly than the cholera or the plague. It comes suddenly, sweeping over a whole district like a pestilential simoon, striking down animals as well as men, and vanishes as suddenly as it came, before there is time to ascertain its nature or its mode of diffusion. The visit here referred to was no exception to this rule. After raging in Askabad for six days the epidemic ceased, leaving no trace of its presence but the corpses of its victims. These putrified so rapidly that no proper post-mortem could be made. The Governor-General gives some details as to the symptoms and course of the disease, which, though interesting as far as they go, do not throw much light on its pathology. The attack begins with rigors of intense severity, the patient shivering literally from head to foot; the rigors occur every five minutes for about an hour. Next an unendurable feeling of heat is complained of; the arteries become tense, and the pulse more and more rapid, while the temperature steadily rises. Unfortunately no thermometric readings or other precise data are given. Neither diarrhœa nor vomiting has been observed. Convulsions alternate with syncopal attacks, and the patients suffer intense pain. Suddenly the extremities become stiff and cold, and in from 10 to 20 minutes the patient sinks into a comatose condition, which speedily ends in death. Immediately after he has ceased to breathe large black bullæ form on the body, and quickly spread over its surface. Decomposition takes place in a few minutes."

Such is a brief account of the disease which devastated the world in the middle of the fourteenth century. Before following the course of the epidemic in Italy, to which it was conveyed, as De' Mussi relates, from the Crimea, some account of its ravages in Constantinople and in Sicily may be given. From the Crimea Constantinople lay upon the highway to the west. Italian ships crossing the Black Sea would naturally touch at this city, then the great centre of communication between the Eastern and Western Worlds. From the relation of De' Mussi it appears that Caffa, the plague-stricken Genoese city in the Crimea, besieged by the Tartars, was in communication by ship with countries from which it received supplies. To Constantinople, therefore, it seems not unlikely that the dreaded disease was conveyed by a ship coming from this plague centre in the Crimea. An account of the pestilence at the Imperial city has come from the pen of the Emperor John Cantacuzene, who was an eye-witness of what he reports. And although he adopted the language of Thucydides, about the plague of Athens, to describe his own experiences at Constantinople, he could hardly have done so had the description not been fairly faithful to the reality. "The epidemic which then (1347) raged in northern Scythia," he writes, "traversed almost the entire sea-coasts, whence it was carried over the world. For it invaded not only Pontus, Thrace, and Macedonia, but Greece, Italy, the Islands, Egypt, Lybia, Judea, Syria, and almost the entire universe."