The Black Death Part 1

The Black Death, and The Dancing Mania.

by Justus Friedrich Karl Hecker.

INTRODUCTION

Justus Friedrich Karl Hecker was one of three generations of distinguished professors of medicine. His father, August Friedrich Hecker, a most industrious writer, first practised as a physician in Frankenhausen, and in 1790 was appointed Professor of Medicine at the University of Erfurt. In 1805 he was called to the like professorship at the University of Berlin. He died at Berlin in 1811.

Justus Friedrich Karl Hecker was born at Erfurt in January, 1795. He went, of course--being then ten years old--with his father to Berlin in 1805, studied at Berlin in the Gymnasium and University, but interrupted his studies at the age of eighteen to fight as a volunteer in the war for a renunciation of Napoleon and all his works. After Waterloo he went back to his studies, took his doctor's degree in 1817 with a treatise on the "Antiquities of Hydrocephalus," and became privat-docent in the Medical Faculty of the Berlin University. His inclination was strong from the first towards the historical side of inquiries into Medicine.

This caused him to undertake a "History of Medicine," of which the first volume appeared in 1822. It obtained rank for him at Berlin as Extraordinary Professor of the History of Medicine. This office was changed into an Ordinary professorship of the same study in 1834, and Hecker held that office until his death in 1850.

The office was created for a man who had a special genius for this form of study. It was delightful to himself, and he made it delightful to others. He is regarded as the founder of historical pathology. He studied disease in relation to the history of man, made his study yield to men outside his own profession an important chapter in the history of civilisation, and even took into account physical phenomena upon the surface of the globe as often affecting the movement and character of epidemics.

The account of "The Black Death" here translated by Dr. Babington was Hecker's first important work of this kind. It was published in 1832, and was followed in the same year by his account of "The Dancing Mania."

The books here given are the two that first gave Hecker a wide reputation. Many other such treatises followed, among them, in 1865, a treatise on the "Great Epidemics of the Middle Ages." Besides his "History of Medicine," which, in its second volume, reached into the fourteenth century, and all his smaller treatises, Hecker wrote a large number of articles in Encyclopaedias and Medical Journals. Professor J.F.K. Hecker was, in a more interesting way, as busy as Professor A.F.

Hecker, his father, had been. He transmitted the family energies to an only son, Karl von Hecker, born in 1827, who distinguished himself greatly as a Professor of Midwifery, and died in 1882.

Benjamin Guy Babington, the translator of these books of Hecker's, belonged also to a family in which the study of Medicine has pa.s.sed from father to son, and both have been writers. B.G. Babington was the son of Dr. William Babington, who was physician to Guy's Hospital for some years before 1811, when the extent of his private practice caused him to retire. He died in 1833. His son, Benjamin Guy Babington, was educated at the Charterhouse, saw service as a midshipman, served for seven years in India, returned to England, graduated as physician at Cambridge in 1831. He distinguished himself by inquiries into the cholera epidemic in 1832, and translated these pieces of Hecker's in 1833, for publication by the Sydenham Society. He afterwards translated Hecker's other treatises on epidemics of the Middle Ages. Dr. B.G. Babington was Physician to Guy's Hospital from 1840 to 1855, and was a member of the Medical Council of the General Board of Health. He died on the 8th of April, 1866.

H.M.

THE BLACK DEATH

CHAPTER I--GENERAL OBSERVATIONS

That Omnipotence which has called the world with all its living creatures into one animated being, especially reveals Himself in the desolation of great pestilences. The powers of creation come into violent collision; the sultry dryness of the atmosphere; the subterraneous thunders; the mist of overflowing waters, are the harbingers of destruction. Nature is not satisfied with the ordinary alternations of life and death, and the destroying angel waves over man and beast his flaming sword.

These revolutions are performed in vast cycles, which the spirit of man, limited, as it is, to a narrow circle of perception, is unable to explore. They are, however, greater terrestrial events than any of those which proceed from the discord, the distress, or the pa.s.sions of nations.

By annihilations they awaken new life; and when the tumult above and below the earth is past, nature is renovated, and the mind awakens from torpor and depression to the consciousness of an intellectual existence.

Were it in any degree within the power of human research to draw up, in a vivid and connected form, an historical sketch of such mighty events, after the manner of the historians of wars and battles, and the migrations of nations, we might then arrive at clear views with respect to the mental development of the human race, and the ways of Providence would be more plainly discernible. It would then be demonstrable, that the mind of nations is deeply affected by the destructive conflict of the powers of nature, and that great disasters lead to striking changes in general civilisation. For all that exists in man, whether good or evil, is rendered conspicuous by the presence of great danger. His inmost feelings are roused--the thought of self-preservation masters his spirit--self-denial is put to severe proof, and wherever darkness and barbarism prevail, there the affrighted mortal flies to the idols of his superst.i.tion, and all laws, human and divine, are criminally violated.

In conformity with a general law of nature, such a state of excitement brings about a change, beneficial or detrimental, according to circ.u.mstances, so that nations either attain a higher degree of moral worth, or sink deeper in ignorance and vice. All this, however, takes place upon a much grander scale than through the ordinary vicissitudes of war and peace, or the rise and fall of empires, because the powers of nature themselves produce plagues, and subjugate the human will, which, in the contentions of nations, alone predominates.

CHAPTER II--THE DISEASE

The most memorable example of what has been advanced is afforded by a great pestilence of the fourteenth century, which desolated Asia, Europe, and Africa, and of which the people yet preserve the remembrance in gloomy traditions. It was an oriental plague, marked by inflammatory boils and tumours of the glands, such as break out in no other febrile disease. On account of these inflammatory boils, and from the black spots, indicatory of a putrid decomposition, which appeared upon the skin, it was called in Germany and in the northern kingdoms of Europe the Black Death, and in Italy, _la mortalega grande_, the Great Mortality.

Few testimonies are presented to us respecting its symptoms and its course, yet these are sufficient to throw light upon the form of the malady, and they are worthy of credence, from their coincidence with the signs of the same disease in modern times.

The imperial writer, Kantakusenos, whose own son, Andronikus, died of this plague in Constantinople, notices great imposthumes of the thighs and arms of those affected, which, when opened, afforded relief by the discharge of an offensive matter. Buboes, which are the infallible signs of the oriental plague, are thus plainly indicated, for he makes separate mention of smaller boils on the arms and in the face, as also in other parts of the body, and clearly distinguishes these from the blisters, which are no less produced by plague in all its forms. In many cases, black spots broke out all over the body, either single, or united and confluent.

These symptoms were not all found in every case. In many, one alone was sufficient to cause death, while some patients recovered, contrary to expectation, though afflicted with all. Symptoms of cephalic affection were frequent; many patients became stupefied and fell into a deep sleep, losing also their speech from palsy of the tongue; others remained sleepless and without rest. The fauces and tongue were black, and as if suffused with blood; no beverage could a.s.suage their burning thirst, so that their sufferings continued without alleviation until terminated by death, which many in their despair accelerated with their own hands.

Contagion was evident, for attendants caught the disease of their relations and friends, and many houses in the capital were bereft even of their last inhabitant. Thus far the ordinary circ.u.mstances only of the oriental plague occurred. Still deeper sufferings, however, were connected with this pestilence, such as have not been felt at other times; the organs of respiration were seized with a putrid inflammation; a violent pain in the chest attacked the patient; blood was expectorated, and the breath diffused a pestiferous odour.

In the West, the following were the predominating symptoms on the eruption of this disease. An ardent fever, accompanied by an evacuation of blood, proved fatal in the first three days. It appears that buboes and inflammatory boils did not at first come out at all, but that the disease, in the form of carbuncular (_anthrax-artigen_) affection of the lungs, effected the destruction of life before the other symptoms were developed.

Thus did the plague rage in Avignon for six or eight weeks, and the pestilential breath of the sick, who expectorated blood, caused a terrible contagion far and near; for even the vicinity of those who had fallen ill of plague was certain death; so that parents abandoned their infected children, and all the ties of kindred were dissolved. After this period, buboes in the axilla and in the groin, and inflammatory boils all over the body, made their appearance; but it was not until seven months afterwards that some patients recovered with matured buboes, as in the ordinary milder form of plague.

Such is the report of the courageous Guy de Chauliac, who vindicated the honour of medicine, by bidding defiance to danger; boldly and constantly a.s.sisting the affected, and disdaining the excuse of his colleagues, who held the Arabian notion, that medical aid was unavailing, and that the contagion justified flight. He saw the plague twice in Avignon, first in the year 1348, from January to August, and then twelve years later, in the autumn, when it returned from Germany, and for nine months spread general distress and terror. The first time it raged chiefly among the poor, but in the year 1360, more among the higher cla.s.ses. It now also destroyed a great many children, whom it had formerly spared, and but few women.

The like was seen in Egypt. Here also inflammation of the lungs was predominant, and destroyed quickly and infallibly, with burning heat and expectoration of blood. Here too the breath of the sick spread a deadly contagion, and human aid was as vain as it was destructive to those who approached the infected.

Boccacio, who was an eye-witness of its incredible fatality in Florence, the seat of the revival of science, gives a more lively description of the attack of the disease than his non-medical contemporaries.

It commenced here, not as in the East, with bleeding at the nose, a sure sign of inevitable death; but there took place at the beginning, both in men and women, tumours in the groin and in the axilla, varying in circ.u.mference up to the size of an apple or an egg, and called by the people, pest-boils (gavoccioli). Then there appeared similar tumours indiscriminately over all parts of the body, and black or blue spots came out on the arms or thighs, or on other parts, either single and large, or small and thickly studded. These spots proved equally fatal with the pest-boils, which had been from the first regarded as a sure sign of death. No power of medicine brought relief--almost all died within the first three days, some sooner, some later, after the appearance of these signs, and for the most part entirely without fever or other symptoms.

The plague spread itself with the greater fury, as it communicated from the sick to the healthy, like fire among dry and oily fuel, and even contact with the clothes and other articles which had been used by the infected, seemed to induce the disease. As it advanced, not only men, but animals fell sick and shortly expired, if they had touched things belonging to the diseased or dead. Thus Boccacio himself saw two hogs on the rags of a person who had died of plague, after staggering about for a short time, fall down dead as if they had taken poison. In other places mult.i.tudes of dogs, cats, fowls, and other animals, fell victims to the contagion; and it is to be presumed that other epizootes among animals likewise took place, although the ignorant writers of the fourteenth century are silent on this point.

In Germany there was a repet.i.tion in every respect of the same phenomena.

The infallible signs of the oriental bubo-plague with its inevitable contagion were found there as everywhere else; but the mortality was not nearly so great as in the other parts of Europe. The accounts do not all make mention of the spitting of blood, the diagnostic symptom of this fatal pestilence; we are not, however, thence to conclude that there was any considerable mitigation or modification of the disease, for we must not only take into account the defectiveness of the chronicles, but that isolated testimonies are often contradicted by many others. Thus the chronicles of Strasburg, which only take notice of boils and glandular swellings in the axillae and groins, are opposed by another account, according to which the mortal spitting of blood was met with in Germany; but this again is rendered suspicious, as the narrator postpones the death of those who were thus affected, to the sixth, and (even the) eighth day, whereas, no other author sanctions so long a course of the disease; and even in Strasburg, where a mitigation of the plague may, with most probability, be a.s.sumed since the year 1349, only 16,000 people were carried off, the generality expired by the third or fourth day. In Austria, and especially in Vienna, the plague was fully as malignant as anywhere, so that the patients who had red spots and black boils, as well as those afflicted with tumid glands, died about the third day; and lastly, very frequent sudden deaths occurred on the coasts of the North Sea and in Westphalia, without any further development of the malady.

To France, this plague came in a northern direction from Avignon, and was there more destructive than in Germany, so that in many places not more than two in twenty of the inhabitants survived. Many were struck, as if by lightning, and died on the spot, and this more frequently among the young and strong than the old; patients with enlarged glands in the axillae and groins scarcely survive two or three days; and no sooner did these fatal signs appear, than they bid adieu to the world, and sought consolation only in the absolution which Pope Clement VI. promised them in the hour of death.

In England the malady appeared, as at Avignon, with spitting of blood, and with the same fatality, so that the sick who were afflicted either with this symptom or with vomiting of blood, died in some cases immediately, in others within twelve hours, or at the latest two days.

The inflammatory boils and buboes in the groins and axillae were recognised at once as prognosticating a fatal issue, and those were past all hope of recovery in whom they arose in numbers all over the body. It was not till towards the close of the plague that they ventured to open, by incision, these hard and dry boils, when matter flowed from them in small quant.i.ty, and thus, by compelling nature to a critical suppuration, many patients were saved. Every spot which the sick had touched, their breath, their clothes, spread the contagion; and, as in all other places, the attendants and friends who were either blind to their danger, or heroically despised it, fell a sacrifice to their sympathy. Even the eyes of the patient were considered a sources of contagion, which had the power of acting at a distance, whether on account of their unwonted l.u.s.tre, or the distortion which they always suffer in plague, or whether in conformity with an ancient notion, according to which the sight was considered as the bearer of a demoniacal enchantment. Flight from infected cities seldom availed the fearful, for the germ of the disease adhered to them, and they fell sick, remote from a.s.sistance, in the solitude of their country houses.

Thus did the plague spread over England with unexampled rapidity, after it had first broken out in the county of Dorset, whence it advanced through the counties of Devon and Somerset, to Bristol, and thence reached Gloucester, Oxford and London. Probably few places escaped, perhaps not any; for the annuals of contemporaries report that throughout the land only a tenth part of the inhabitants remained alive.

From England the contagion was carried by a ship to Bergen, the capital of Norway, where the plague then broke out in its most frightful form, with vomiting of blood; and throughout the whole country, spared not more than a third of the inhabitants. The sailors found no refuge in their ships; and vessels were often seen driving about on the ocean and drifting on sh.o.r.e, whose crews had perished to the last man.

In Poland the affected were attacked with spitting blood, and died in a few days in such vast numbers, that, as it has been affirmed, scarcely a fourth of the inhabitants were left.

Finally, in Russia the plague appeared two years later than in Southern Europe; yet here again, with the same symptoms as elsewhere. Russian contemporaries have recorded that it began with rigor, heat, and darting pain in the shoulders and back; that it was accompanied by spitting of blood, and terminated fatally in two, or at most three days. It is not till the year 1360 that we find buboes mentioned as occurring in the neck, in the axillae, and in the groins, which are stated to have broken out when the spitting of blood had continued some time. According to the experience of Western Europe, however, it cannot be a.s.sumed that these symptoms did not appear at an earlier period.

Thus much, from authentic sources, on the nature of the Black Death. The descriptions which have been communicated contain, with a few unimportant exceptions, all the symptoms of the oriental plague which have been observed in more modern times. No doubt can obtain on this point. The facts are placed clearly before our eyes. We must, however, bear in mind that this violent disease does not always appear in the same form, and that while the essence of the poison which it produces, and which is separated so abundantly from the body of the patient, remains unchanged, it is proteiform in its varieties, from the almost imperceptible vesicle, unaccompanied by fever, which exists for some time before it extends its poison inwardly, and then excites fever and buboes, to the fatal form in which carbuncular inflammations fall upon the most important viscera.

Such was the form which the plague a.s.sumed in the fourteenth century, for the accompanying chest affection which appeared in all the countries whereof we have received any account, cannot, on a comparison with similar and familiar symptoms, be considered as any other than the inflammation of the lungs of modern medicine, a disease which at present only appears sporadically, and, owing to a putrid decomposition of the fluids, is probably combined with hemorrhages from the vessels of the lungs. Now, as every carbuncle, whether it be cutaneous or internal, generates in abundance the matter of contagion which has given rise to it, so, therefore, must the breath of the affected have been poisonous in this plague, and on this account its power of contagion wonderfully increased; wherefore the opinion appears incontrovertible, that owing to the acc.u.mulated numbers of the diseased, not only individual chambers and houses, but whole cities were infected, which, moreover, in the Middle Ages, were, with few exceptions, narrowly built, kept in a filthy state, and surrounded with stagnant ditches. Flight was, in consequence, of no avail to the timid; for even though they had sedulously avoided all communication with the diseased and the suspected, yet their clothes were saturated with the pestiferous atmosphere, and every inspiration imparted to them the seeds of the destructive malady, which, in the greater number of cases, germinated with but too much fertility. Add to which, the usual propagation of the plague through clothes, beds, and a thousand other things to which the pestilential poison adheres--a propagation which, from want of caution, must have been infinitely multiplied; and since articles of this kind, removed from the access of air, not only retain the matter of contagion for an indefinite period, but also increase its activity and engender it like a living being, frightful ill- consequences followed for many years after the first fury of the pestilence was past.

The affection of the stomach, often mentioned in vague terms, and occasionally as a vomiting of blood, was doubtless only a subordinate symptom, even if it be admitted that actual hematemesis did occur. For the difficulty of distinguishing a flow of blood from the stomach, from a pulmonic expectoration of that fluid, is, to non-medical men, even in common cases, not inconsiderable. How much greater then must it have been in so terrible a disease, where a.s.sistants could not venture to approach the sick without exposing themselves to certain death? Only two medical descriptions of the malady have reached us, the one by the brave Guy de Chauliac, the other by Raymond Chalin de Vinario, a very experienced scholar, who was well versed in the learning of the time. The former takes notice only of fatal coughing of blood; the latter, besides this, notices epistaxis, hematuria, and fluxes of blood from the bowels, as symptoms of such decided and speedy mortality, that those patients in whom they were observed usually died on the same or the following day.

That a vomiting of blood may not, here and there, have taken place, perhaps have been even prevalent in many places, is, from a consideration of the nature of the disease, by no means to be denied; for every putrid decomposition of the fluids begets a tendency to hemorrhages of all kinds. Here, however, it is a question of historical certainty, which, after these doubts, is by no means established. Had not so speedy a death followed the expectoration of blood, we should certainly have received more detailed intelligence respecting other hemorrhages; but the malady had no time to extend its effects further over the extremities of the vessels. After its first fury, however, was spent, the pestilence pa.s.sed into the usual febrile form of the oriental plague. Internal carbuncular inflammations no longer took place, and hemorrhages became phenomena, no more essential in this than they are in any other febrile disorders. Chalin, who observed not only the great mortality of 1348, and the plague of 1360, but also that of 1373 and 1382, speaks moreover of affections of the throat, and describes the back spots of plague patients more satisfactorily than any of his contemporaries. The former appeared but in few cases, and consisted in carbuncular inflammation of the gullet, with a difficulty of swallowing, even to suffocation, to which, in some instances, was added inflammation of the ceruminous glands of the ears, with tumours, producing great deformity. Such patients, as well as others, were affected with expectoration of blood; but they did not usually die before the sixth, and, sometimes, even as late as the fourteenth day. The same occurrence, it is well known, is not uncommon in other pestilences; as also blisters on the surface of the body, in different places, in the vicinity of which, tumid glands and inflammatory boils, surrounded by discoloured and black streaks, arose, and thus indicated the reception of the poison. These streaked spots were called, by an apt comparison, the girdle, and this appearance was justly considered extremely dangerous.

CHAPTER III--CAUSES--SPREAD

An inquiry into the causes of the Black Death will not be without important results in the study of the plagues which have visited the world, although it cannot advance beyond generalisation without entering upon a field hitherto uncultivated, and, to this hour entirely unknown.

Mighty revolutions in the organism of the earth, of which we have credible information, had preceded it. From China to the Atlantic, the foundations of the earth were shaken--throughout Asia and Europe the atmosphere was in commotion, and endangered, by its baneful influence, both vegetable and animal life.