Plagues in World History (8 page)

From the Crimea, plague next commenced its march through the Middle East and Europe. It invaded the Byzantine capital of Constantinople by the late spring or summer of 1347 and then reached Sicily and Alexandria in Egypt around the same time, by the autumn of that year. At the end of 1347, plague may also have established bridgeheads at other strategic places in the Mediterranean, including the island of Mallorca off the eastern coast of Spain, the port of Marseilles in southern France, and the trading cities of Genoa, Pisa, and Venice in Italy. In 1348, plague spread along the coast of North Africa and northward from Egypt through Palestine and Syria, hitting Gaza, Ascalon, Acre, Jerusalem, Beirut, Damascus, Aleppo, and Antioch. In Europe, the plague in that year spread through Italy, the Balkans, much of France, and Spain and invaded Austria, Switzerland, southern England, and perhaps Ireland, Norway, and Denmark. By 1349 and 1350, plague completed its conquest of North Africa, Spain, France, Austria, Switzerland, England, Ireland, Denmark, and Norway, and in addition it had come to Iraq, Germany, Belgium, the Netherlands, Sweden, Wales, Scotland, Poland, Bohemia, Hungary, Romania, and the Baltic States of Estonia, Latvia, and Lithuania. It was not until 1351 to 1353 that plague seems to have spread throughout eastern Germany, Poland, and Russia north of the 36 y Chapter 1

Caucasus. Based on all the available sources, which now include more than just chronicle accounts, it seems that the only large areas bypassed by the plague were Iceland and Finland, perhaps due to their isolation and sparse inhabitation.75

Before we go any further, we should say a word about the controversy over whether the Black Death of the late Middle Ages was actually another pandemic of the disease known as plague. It is curious that no such debate exists for the First Pandemic, even though theoretically the same objections ought to apply, but perhaps this is a function of far less surviving material available to pore through and dissect.76 Recent research, including the emerging field of biomolecular archaeology, is fast rendering this debate obsolete: a tired, stale old chestnut that, to my mind at least, has now been definitely settled in favor of identifying the Black Death as plague. Indeed, so convincing is the accumulating evidence in plague’s corner that I would contend that those who still insist on holding out against it are simply being ornery or, at worst, hypo-critical, since by rights they ought to make the same case for contesting the identity of the First Pandemic but so far have utterly failed to do so.77 Such revisionist histories of the Black Death also seem to find it easier, and perhaps more attention grabbing, to make a negative case against plague than a positive one for any other disease.78 In fact, a very positive case can now be made for identifying the Black Death with plague, based on the recovery of
Yersinia pestis
DNA from human dental pulp found on centuries-old victims of plague.

This was first achieved a decade ago when late medieval and Early Modern mass graves were excavated at Montpellier, France. Although challenged as an isolated and unreliable result, it has now been duplicated in London and Germany for victims from the First Pandemic of plague.79 Provided that such positive identifications continue, biomolecular archaeology will thus soon definitively settle the matter.

One other bone of contention needs to be addressed here with regard to the medieval Black Death: its demographic impact. How many people in the Middle Ages were killed off by the disease? The numerical percentages are important, because they determine how much of an impact the Black Death may have had upon late medieval society. A nearly universal mantra among both past and present histories of the Black Death is that it killed off roughly a third of the population, on average, in its first outbreak in Europe and the Middle East between 1347 and 1350, with progressively lower mortalities rates thereafter when the plague returned throughout the second half of the fourteenth and throughout the fifteenth centuries. Such an assertion made it quite easy for past scholars of the plague to downplay even its initial impact, claiming that this was nothing out of the ordinary within the context of periodic Malthusian declines that are predestined to occur throughout history.80

Plague y 37

However, in recent years, a veritable tidal wave of data has been painstakingly extracted from various sources mainly in England, Spain, Italy, and France, all of which points to an
average
mortality of 50–60 percent during the first outbreak of the Black Death in 1347–1350. This figure can probably be applied to all of Europe and the Middle East, even where comparable records are not available, since what records we do have give a fair enough representation of different patterns of human settlement (i.e., both urban and rural populations), as well as class members of society (i.e., peasantry, priests, professionals, etc.). This is an astonishingly high number that is undoubtedly the highest mortality percentage ever recorded for a single disease outbreak, and best estimates are that it represents a loss of as much as fifty million people throughout Europe in just a few years.81 No such loss can be sustained without very dramatic social, economic, and psychological impacts upon a society.

As in the First Pandemic, plague was to return to Europe about once a decade throughout the later Middle Ages, striking on average every eleven years in fifteen recorded outbreaks between 1360–1361 and c. 1500. (This almost exactly matches the average of 11.6 years for the eighteen outbreaks recorded between 541 and 750 C.E.)82 Although the virulence of these recurrences of plague seems to have gradually declined, based on testamentary and other evidence, the cumulative impact of even low mortalities could take their toll. Thereafter, plague recurred slightly less frequently during the Early Modern period, averaging an outbreak every 13.4 years between 1535 and 1683. However, plague continued to have the reputation of being the most lethal disease: Indeed, one of the ways in which seventeenth-century Italian doctors distinguished plague from other fever-type diseases such as malaria or typhus was whether or not the epidemic carried off the majority of the town’s population.83 Spectacular eruptions of the disease continued to occur, such as the Plague of Naples in 1656 that killed half of the city’s roughly three hundred thousand inhabitants, or the Great Plague of London of 1665 that carried off one hundred thousand victims, representing 20

percent of the city’s population. By 1670, plague is thought to have virtually ceased in Western Europe, but it continued to strike in Eastern Europe and Russia down through the eighteenth century. In the Balkans, North Africa, and Southwest Asia, plague was endemic up until the first half of the nineteenth century. The last major outbreak in Europe, in 1720 at Marseilles in southern France, came from a cargo ship originating in Syria.

The varied impact of plague’s ravages upon late medieval society—medical, religious, social, and economic—will now be examined in a comparative way between Europe and the Middle East. First to be considered is the medical response to the Black Death. In terms of the first outbreak of 1348–1350, doctors in both Europe and the Middle East had a remarkably similar set of answers to 38 y Chapter 1

the all-important questions of what caused the disease, how was it to be prevented, and how was it to be cured? These framed the structure of almost all medical treatises on the plague down to the end of the Middle Ages and beyond.

Such consistency owes largely to the common inheritance that both Christian and Muslim cultures shared from the ancient world, namely, the Greek and Roman medical traditions of Hippocrates and Galen, as mediated by Arabic physicians of the early and high Middle Ages, especially Ibn Sina or Avicenna (980–1037). This meant that both Christian and Islamic physicians explained the plague as caused by a miasma, or substantial corruption of the air, either from a higher source (i.e., the planets) or a lower one (swamps, rotting corpses, earthquakes, etc.). Both subscribed to the six “nonnaturals” as a means of prevention—regulating intake of air, diet, exercise, sleep, repletion and evacuation, and “accidents of the soul,” or mental states—in order to avoid predisposing the body to the disease. And both prescribed surgical intervention and special medicines in their “cures” of plague. Although both acknowledged that the Second Pandemic of plague presented an unprecedented and overwhelming challenge (both in terms of its virulence and its geographical extent) that was virtually unknown to ancient authors, this did not invalidate, in their minds, the age-old theoretical underpinnings of their profession. After all, plenty of explanations, such as the predisposition of an individual’s “complexion” to the disease, could be brought forward to explain failures of treatment. Indeed, the typical contemporary response to the plague was to do what their predecessors had done, only to do it more intensely and more urgently, such as by bleeding in greater amounts and as soon as possible, with little regard to the usual constraints and cautions surrounding the procedure. Likewise, theriacs, pestilential pills, and other medicinal compounds, whose recipes were handed down since ancient times, were now prescribed in greater variety and number. Rather than any real evolution in medical attitudes or approaches to plague over the course of the later Middle Ages and down into Early Modern times, it seems that whatever empirical observation and experience doctors obtained of plague was used to actually reinforce the traditional assumptions, or “paradigm,” they had inherited from past authorities.84 If ancient doctors had never had to face a disease like the Black Death, then this simply meant that they never had the chance to apply and test their medical expertise in the crucible of plague, as doctors were now doing. That a First Pandemic had equally challenged the medical profession was either unknown or conveniently forgotten.85

In terms of other communal responses to the Black Death, three “religiolegal principles” are assumed to distinguish medieval Muslim communities in the Middle East and Spain as compared to those in the Christian West: these include that plague is a mercy and martyrdom for believers; that one should not flee Plague y 39

from or enter into a plague-infected region; and that plague comes directly from God and through no other agency, such as person-to-person contagion.86 In actual fact, the differences between the respective communities along these lines are much more nuanced than have been previously portrayed, as are the nature of the beliefs held within each community itself.87

Contrary to popular perception, the Prophetic tradition of Islam was not universally hostile to the concept of contagion. Since Islam embraced, and indeed passed down to the West, much of the intellectual heritage of ancient Greece and Rome, it should come as no surprise that Galen’s theory of contagion as the “seeds of disease” passing from person to person in the form of a localized miasma should be taken up by doctors in the Muslim world during the ninth and tenth centuries, who applied it especially to leprosy and who interpreted it as no different from an infection that spread from a sick person to a healthy one.

Pre-Islamic societies in Arabia also subscribed to contagion, expressed as the “stinging of the
jinn
” or demonic spirits, a concept that Muhammad according to the hadith is said to have explicitly endorsed, along with another tradition in which the Prophet allegedly commanded, “Flee from the leper as you would flee from a lion.” Contagion was also instinctively understood from the spread of mange disease among the Arabs’ camel herds, even though the hadith has Muhammad counter with the reply “And who caused the mange in the first one?”

as a way of drawing the ultimate chain of causation back to God. A contradictory attitude is likewise evinced to the
jinn
during the Plague of ‘Amwâs in the seventh century, when one of the Companions of the Prophet reportedly spread this belief among the rank and file of the Arab army in Syria, until he was sharply rebuked and contradicted by a more pious superior, who asserted that the plague was a “chastisement” (evidently not yet the “martyrdom” for believers of later tradition) sent down from God as he had done earlier to the Israelites. But by the fourteenth century, on the eve of the Black Death, even the “medicine of the Prophet,” which claimed to be rooted in the religious canons of Muhammad, accepted the Greek humoral theory of disease causation and listed contagion as one of the possible secondary causes of plague that was not incompatible with God as its ultimate source.88

The famous plague treatises of the Moorish physicians and scholars, Ibn al-Khatīb and Ibn Khātima, who wrote at the time of the first outbreak of the Black Death in 1349, were not therefore rationalist exceptions to the Islamic tradition just because they endorsed contagion with empirical arguments. Even though they took diametrically opposite views on the relationship that religion should have with medicine, both Khatīb and Khātima cite concrete “proofs” for person-to-person transmission of the plague, such as through the infected breath or bodily vapors of the sick or through their personal belongings, including cloth-40 y Chapter 1

ing, furnishings, utensils, and even a single earring! But of course, this is not an accurate depiction of the epidemiological realities of bubonic plague, so one can question whether it is indeed a rational or empirical response to the disease at all (except for cases of pneumonic plague, which Khātima does seem to provide).89

Furthermore, both Khātima and Khatīb do attempt to demonstrate that their “empirical” observations of plague’s contagion are not incompatible with the Prophetic tradition of Islam. This is far more pronounced in the case of Khātima, who devotes the last four chapters of his treatise solely to the Prophetic tradition itself (thus being concerned with religious rather than medical matters) in an effort to reconcile and smooth over what seems like a jarring contradiction on the subject of contagion, especially as stated briefly under the heading of “infection”