Attempts at Control and Prevention

The Black Death was in many ways a completely unprecedented experience for those who suffered through it. Plague had virtually disappeared from the Middle East and Europe during the centuries between the end of the first pandemic in the eighth century and the beginning of the second pandemic, and although the first half of the fourteenth century had been marked by a number of epidemics of other diseases, none approached the Black Death in de-structiveness and universality. Contemporaries reacted vigorously against the disease, attempting to halt its spread, mitigate its virulence, and alleviate the suffering it provoked. For the most part, however, their responses took traditional forms: Rather than developing new strategies for managing the crisis, they fell back on established measures, though in many cases they applied these with unprecedented rigor.

For those who could afford it, the most common reaction sanctioned by established medical authorities was flight; even in the Islamic world, where religious authorities inveighed against the practice and exhorted believers to accept the mortality as a martyrdom and a mark of divine mercy, people abandoned infected cities in search of more healthful territory. Those who remained sought spiritual remedies. In both Islamic and Christian countries, religious leaders organized prayers, processions, and special religious services, supplicating God to lift the epidemic. The European reaction, however, had a unique perspective, which was lacking for the most part among Muslims for whom the epidemic was a morally neutral event: Drawing on traditional teachings concerning sin and penance, Christians on every level of society interpreted the plague as a mark of divine wrath and punishment for sin and, in some cases, even as a sign of the approaching apocalypse.

In many Italian cities, private individuals engaged in acts of piety and charity in an attempt to ensure the safety and salvation of themselves and their communities, while public authorities released poor prisoners and passed temporary laws against concubinage, swearing, sabbath-breaking, and games of chance. But public reaction often took more extreme forms - among them, groups of flagellants, who professed publicly, whipping themselves and preaching repentance, in order to ward off God's wrath and the Black Death. This movement seems to have begun in Italy, where it drew on thirteenth-century precedents, but it reached its height in northern and central Europe, in Austria, Thuringia, Franconia, the Rhineland, and the Low Countries. In Thuringia it was associated with a radical critique of ecclesiastical authorities, which led Pope Clement VI to condemn the practice as heretical.

The most extreme and shocking example of Christian religious reaction to the Black Death, however, was directed against Jewish communities in Provence, Catalonia, Aragon, Switzerland, southern Germany, and the Rhineland. Jews in these areas were accused of spreading the plague by poisoning Christian springs and wells. This kind of scapegoating was not unprecedented - earlier fourteenth-century epidemics had provoked similar accusations against lepers, foreigners, and beggars as well as Jews - but the violence of the popular reaction was extraordinary, in some places resisted and in some places abetted by rulers and municipal governments.

Despite the protests of the pope, hundreds of Jewish communities were completely destroyed in 1348 and 1349, their members exiled or burned en masse, while the residents of many others were imprisoned and tortured, with their property confiscated. The destruction was great enough to shift the center of gravity of the entire European Jewish population significantly eastward. Like the flagellant processions, with which they were occasionally associated, many of these pogroms had a prophylactic intent; some of the most violent episodes took place before the plague had actually reached the areas in question. There is no evidence for practices of this sort in Islamic communities, which could boast both a long tradition of religious pluralism and tolerance and a less morally loaded theological interpretation of the epidemic.

A second set of defensive reactions belonged to the realm of medicine and public health. Although both Muslims and Christians identified Divine Will as the ultimate cause of plague, most accepted that God worked through secondary causes belonging to the natural world, and this allowed them to interpret the epidemic within the framework of contemporary medical learning. Both societies shared a common medical tradition based on the works of Greek writers such as Hippocrates and Galen, which explained epidemics as the result of air corrupted by humid weather, decaying corpses, fumes generated by poor sanitation, and particular astrological events. Thus both Muslim and Christian doctors recommended (with some differences in emphasis) a similar set of preventive and curative practices that included a fortifying diet, rest, clean air, and moderate bloodletting for the healthy, together with salves, internal medication, and minor surgery for the sick.

Where Europe and the Islamic world clearly diverged was in their attitudes toward public health. There is little evidence that Islamic communities (where theological teachings combined with the classical medical tradition to deemphasize contagion as a cause of infection) engaged in large-scale social measures to prevent plague, beyond religious ceremonies and occasional public bonfires to purify the air. From the very beginning of the epidemic, however, the populations of a number of European cities-above all, in central and northern Italy, which boasted a highly developed order of municipal and medical institutions - reacted aggressively in a largely futile attempt to protect themselves from the disease. Initially they fell back on existing sanitary legislation, most of it dating from the thirteenth and early fourteenth centuries; this emphasized street cleaning and the control of particularly odoriferous practices like butchery, tannery, dyeing, and the emptying of privies. As the plague moved closer, however, a number of Italian governments instituted novel measures to fight contagion as well as corrupt and fetid air. They imposed restrictions on travel to and from plague-stricken cities and on the import and sale of cloth from infected regions and individuals. They passed laws against public assemblies and regulated the burial of the dead. They hired doctors to study the disease and treat its victims (many physicians had fled the cities along with others of their class), and they appointed temporary boards of officials to administer these measures. In Milan the ducal government boarded up the houses of plague victims, and in Avignon, the pope created a settlement of wooden huts outside the city walls to receive the sick and isolate them from the rest of the community.

These measures against contagion were unprecedented in the context of both contemporary medical theory and municipal practice; they seem initially to have been a response to the experience of pneumonic plague, which ravaged the cities of Italy and southern France in the winter and spring of 1347-8. The ecology of plague and problems of enforcement made such measures largely ineffective, although it is striking that Milan, which applied anticontagion practices most drastically, was the least affected of all major Italian cities. Nonetheless, such measures represent the beginnings of large-scale public health organizations in Europe; succeeding epidemics saw their elaboration and their spread to other parts of the continent, where they eventually became the basis for widespread practices such as quarantines and cordons sanitaires.

Katharine Park

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