Part 4

“The second type of the disease, prevailing during the epidemic time, also had a continued fever, with apostumes and carbuncles at the external parts, principally on the axilla and in the groin; all such attacked usually died in five days.

“The malady was so contagious, especially that form in which blood-spitting was noticed, that one not only caught it from sojourning with the sick, but also, it sometimes seemed, from looking at the disease, so that men died without their servants and were buried without priests.

“The father visited not his son, nor the son his father. Charity was dead and hope disappeared.

“I call the epidemic great, inasmuch as it conquered all the earth.

“For the pestilence commenced at the Orient, and cast its fangs against all the world, passing through Paris towards the West.

“It was so destructive that it left only a quarter of the population of mankind behind.

“It was a shame and disgrace to medicine, as many doctors dared not visit the sick through fear of becoming infected; and those who visited the sick made few cures and fewer fees, for the sick all died save a few. Not many having buboes escaped death.

“For preservation, there was no better remedy than to fly from the infection, to purge one’s self with aloe pills, to diminish the blood by phlebotomy, to purify the air with fire, to comfort the heart with cordials and apples and other things of good odor; to console the humors with Armenian bole and resist dry rot by the use of acid things. For the cure of the plague we used bleedings and evacuations, electuaries, syrups and cordials, and the external apostumes or swellings were poulticed with boiled figs and onions mixed with oil and butter; the buboes were afterwards opened and treated by the usual cures for ulcers.

“Carbuncles were leeched, scarified and cauterized.

“I, to avoid infamy, dared not absent myself from the care of the sick, but lived in continual fear, preserving myself as long as possible by the before-mentioned remedies.

“Nevertheless, towards the end of the epidemic, I fell into a fever, which continued with an aposthume in the groin, and was ill for nigh on six weeks, being in such danger that all my companions believed I should die; nevertheless, the bubo being poulticed and treated as I have above indicated, I recovered, thanks be to the will of God.”

According to the records of that time, many persons died the first day of their illness. These bad cases were announced by a violent fever, with cephalgia, vertigo, drowsiness, incoherency in ideas, and loss of memory; the tongue and palate were black and browned, exhaling an almost insupportable fetidity. Others were attacked by violent inflammation of the lungs, with hemorrhage; also gangrene, which manifested itself in black spots all over the body; if, to the contrary, the body was covered by abscesses, the patients seemed to have some chance for recovery.

Medicines were powerless, all remedies seeming to be useless. The disease attacked rich and poor indiscriminately; it overpowered the robust and debilitated; the young and the old were its victims. On the first symptom the patients fell into a profound melancholy and seemed to abandon all hope of recovery. This moral prostration aggravated their physical condition, and mental depression hastened the time of death. The fear of contagion was so great that but few persons attended the sick.

The clergy, encouraged by the Pope, visited the bedsides of the dying who bequeathed all their wealth to the Church. The plague was considered on all sides as a punishment inflicted by God, and it was this idea that induced armies of penitents to assemble on the public streets to do penance for their sins. Men and women went half naked along the highways flagellating each other with whips, and, growing desperate with the fall of night, they committed scandalous crimes. In certain places the Jews were accused of being the authors of the plague by poisoning the wells; hence the Hebrews were persecuted, sometimes burned alive by the fanatical sects known as Flagellants, Begardes and Turlupins, who were encouraged in their acts of violence by the priests, notwithstanding the intervention of Clement VI.

Physicians were not only convinced of the contagious nature of the disease, but also believed that it could be transmitted by look and word of mouth. Such doctors obliged their patients to cover their eyes and mouth with a piece of cloth whenever the priest or physician visited the bedside. “_Cum igitur medicus vel sacerdos, vel amicus aliquem infirmum visitare voluerit, moneat et introducat aegrum suos claudere et linteamine operire._”

Guillaume de Machant, poet and _valet de chambre_ of Philip the Beautiful, mentions this fact in one of his poems, _i. e._:

“They did not dare, in the open air To even speak by stealth, Lest each one’s breath might carry death By poisoning the other’s health.”

And, in the preface of the “Decameron,” Boccaccio remarks in his turn, “The plague communicated direct, as fire to combustible matter. They were often attacked from simply touching the sick, indeed it was not even necessary to touch them. The danger was the same when you listened to their words or even if they gazed at you.”

One thing is certain, that is, that those who nursed the patients surely contracted the disease.

All the authorities of the Middle Ages concur in their statements as to the contagious nature of the plague. The rules and regulations enforced against the afflicted were barbarous and inhuman. “Persons sick and well, of one family, when the pest developed,” says Black,[14] “were held, without distinction, in close confinement in their home, while on the house door a red cross was traced, bearing the sad and desperate epitaph, ‘_Dieu ayez pitie de nous!_’ No one was permitted to leave or enter the plague-stricken house save the physician and nurse, or other persons who might be authorized by the Government. The doors of such dwellings were guarded and kept closed until such a time as the imprisoned had all died or recovered their health.”

We can well judge of the terror inspired by the pestilence by the precautions taken by the physicians in attendance on the sick. In his treatise on the plague Mauget describes the costume worn by those who approached the bedsides of patients:

“The costumes worn, says he, “were of Levant morocco, the mask having crystal eyes and a long nose filled with subtile perfumes. This nose was in the form of a snout, with the openings one on each side; these openings served for respiratory passages and were well filled at the anterior portion with drugs, so that at each breath they contained a medicated air. Under a cloak the doctor also wore buskins made of morocco; closely sewed breeches were attached to the bottines above the ankle; the shirt, the hat and gloves were also of soft morocco.”

Thus accoutered the doctor resembled a modern diver clad in a bathing suit of leather.

In order not to alarm the population all public references to funerals were forbidden. In the ordinances of magistrates of Paris, passed September 13, 1553, we read, “And likewise be it declared that the aforesaid Chamber forbids by statute all criers of funerals and wines, and all others, no matter what be their state or condition, to render for sale at any church, house, doorway or gate of this city, or on the streets thereof, any black cloth or mourning stuffs such as are used for mortuary purposes, under penalty of forfeiture of their licenses and property, and confiscation of all goods, especially of the aforesaid black cloths.”

Let it be well understood that the great epidemics of plague in the sixth and twelfth centuries were of a nature to terrify ignorant populations. The narratives of the historians of that epoch show them to be imbued with the superstitious ideas of antiquity. This attack of an invisible enemy whose blows fell right and left paralyzed and terrified every one. “In the midst of this orgie of death,” remarks Anglada, “the thought of self-preservation absorbed every other sentiment. Dominated by this selfish instinct the human mind shamelessly displayed its cowardice, egotism and superstition. Social ties were rudely sundered, the affections of the heart laid aside. The sick were deserted by their relatives; all flew with horror from the plague-breathing air and contact with the dreadful disease. The corpses of the victims of the epidemic abandoned without sepulture exhaled a horrible putrid odor, and became the starting point of new infectious centres. The worse disorder overthrew all conditions of existence. Human passion raged uncontrolled; the voice of authority was no longer respected; the wheels of civilization ceased to revolve.”

As to the other epidemics of the plague that periodically devastated France from the fourteenth to the eighteenth century we possess but few historical documents. We have had in our hands an opuscule by Pierre Sordes, who was attacked by the plague in 1587, at the age of twenty, who afterward wrote a treatise on the epidemic, which work he dedicated to Cardinal de Sourdis, the Archbishop of Aquitaine.

The author in this monograph endeavors to explain the remedies then in use for preservation against the infection of the disease. “Avoid all fatigue, anger, intemperance, too much association with women, as the act ennervates our forces and enfeebles our spirits. One should clothe himself in the wools of Auvergne and the camulets of Escot.” Moreover, says our author, “one should perfume his clothes with laurel, rosemary, serpolet, marjolane, sage, fennel, sweetbriar, myrrh, and frankincense.” When the room was to be disinfected “one should use fumigations of good dry hay. One should not go out early without eating and taking a drink. One should close the ears with a little cotton scented with musk and hold in his mouth a clove or piece of angelica root. One should hold in his hand a piece of sponge saturated in vinegar, which should be smelled frequently. One should wear upon his stomach an acorn filled with quicksilver and a small pouch containing arsenic. Finally, one should take twice a week a pill composed of aloes, myrrh, and saffron.”

Notwithstanding all these precautions, Pierre Sordes was attacked by the plague; having a buboe in the left groin, which caused him acute pain and to which he applied “_un emplastre de diachyllum cum gummis_” and afterwards a blister. Not being able to obtain resolution, feeling his strength undermined and perceiving his entire body “covered with black lumps and spots, fatal prognostic signs to all who are found thus marked, I called for a surgeon, the last one left alive, and he brought his cautery and with it pierced through the apostume. From then the fever disappeared little by little, and I was perfectly cured eight days after the application of the aforesaid cautery, with the exception that, reading in a draught Bartas “Treatise on the Plague,” I brought on another attack of fever that well nigh carried me off.

“This is my experience at Figeac in the year 1587, when the plague destroyed 2500 people, with all the miseries and calamities that can be read in Greek and Roman histories.”

LE MAL DES ARDENTS.

Towards the end of the tenth century a new epidemic appeared in Europe, the ravages of which spread terror among the people of the Occident; this disease was known by the name of _mal des ardents_, sacred fire, St. Anthony’s fire, St. Marcell’s fire, and hell fire.

This great epidemic of the Middle Ages is considered by many modern writers as one of the forms of ergotism, notwithstanding the contrary conclusions arrived at by the Commission of 1776, composed of such men as Jussieu, Paulet, Saillant, and Teissier, who were ordered to report as to the nature of the disease by the Royal Society. According to the work of this Commission the _mal des ardents_ was a variety of plague, with buboes, carbuncles and petechial spots, while St. Anthony’s fire was only gangrenous ergotism. This is a remarkable example of the confusion into which scientific facts were allowed to fall through the fault of careless authors. It is in such instances that we may estimate the importance of history. We find in the “Chronicles of Frodoard,” in the year 945, the following: “The year 945, in the history of Paris and its numerous suburban villages, a disease called _ignis plaga_ attacked the limbs of many persons, and consumed them entirely, so that death soon finished their sufferings. Some few survived, thanks be to the intercession of the Saints; and even a considerable number were cured in the Church of Notre Dame de Paris. Some of these, believing themselves out of danger, left the church; but the fires of the plague were soon relighted, and they were only saved by returning to Notre Dame.”

Sauvel, the translator of Frodoard, remarks that at this epoch the Church of Notre Dame served as a hospital for the sick attacked by the epidemic, and sometimes contained as high as six hundred patients.

Another historian of the time was Raoul Glaber,[15] who mentions that “in 993 a murderous malady prevailed among men. This was a sort of hidden fire, _ignis occultus_, the which attacked the limbs and detached them from the trunk after having consumed the members. Among some the devouring effect of this fire took place in a single night.

“In 1039,” continues our author, “divine vengeance again descended on the human race with fearful effect and destroyed many inhabitants of the world, striking alike the rich and the poor, the aristocrat and the peasant. Many persons lost their limbs and dragged themselves around as an example to those who came after them.”

In the _Chronicle of France_, from the commencement of the Monarchy up to 1029,[16] the monk Adhemar speaks of the epidemic in the following terms: “In these times a pestilential fire (_pestilential ignis_) attacked the population of Limousin; an infinite number of persons of both sexes were consumed by an invisible fire.”

Michael Felibien, a Benedictine friar of Saint Maur, also left notes on the epidemic of gangrene. He states in his _History of Paris_: “In the same year, 1129, Paris, as the rest of France, was afflicted by the _maladie des ardents_. This disease, although known from the mortality it caused in the years 945 and 1041, was all the more terrible inasmuch as it appeared to have no remedy. The mass of blood, already corrupted by internal heat which devoured the entire body, pushed its fluids outwards into tumors, which degenerated into incurable ulcers and thus killed off thousands of people.”

We could make many more citations, derived from ancient writers, but we think we have quoted enough authors to prove that the _mal des ardents_ was only the plague confounded with the symptoms known as gangrenous ergotism. Could it not have been a plague of a gangrenous type? We cannot positively affirm, however, that it had no connection with poisoning by the _sphacelia_ developed in grain, particularly on rye. Its onset was sudden, and often very rapidly followed by a fatal termination. The _mal des ardents_ had no prodroma with general symptoms and marked periods, as in gangrenous ergotism, but it had, to the contrary, an irregular march, rapid in its evolution, “devouring,” as Mezeray says, “the feet, the arms, the face, and private parts, commencing most generally in the groin.”

THE ERUPTIVE FEVERS OF THE SIXTH CENTURY —— VARIOLA, MEASLES, SCARLATINA.

Before the sixth century, the terrible period of the plague, one never heard of the eruptive fevers. Small-pox, measles and scarlet fever were unknown to the ancients. Neither Hippocrates nor Galen nor any of the Greek physicians who practiced in Rome make mention of these diseases. The historians and poets of Greece and Italy who have written largely on medical subjects remain mute on these three great questions in pathology. Some authors have endeavored to torture texts for the purpose of throwing light on the contagious exanthemata, but they have not been repaid for their fresh imagination.[17] It is admitted to-day that the eruptive fevers are comparatively new diseases, which made their appearance in the Middle Ages.

The first document that the history of medicine possesses on this point is that left by Marius, Bishop of Aventicum, in Switzerland, who says, in his chronicle, “_Anno 570, morbus validus cum profluvio ventris et variola, Italiam Galliamque valde affecit_.”[18]

Ten years later, Gregory of Tours described the symptoms of the new disease in the following terms:[19]

“The fifth year of the reign of Childebert, 580, the region of Auvergne was inundated by a flood and numerous weather disasters, which were followed by a terrible epidemic that invaded the whole of Gaul. Those attacked had violent fevers, accompanied by vomiting, great pain in the neighborhood of the kidneys, and a heaviness in the head and neck. Matter rejected by the stomach looked yellowish and even green, many deeming this to be some secret poison. The peasants called the pustules corals.[20] Sometimes, after the application of cups to the shoulders or limbs, blisters were raised, which, when broken, gave issue to sanious matter, which oftentimes saved the patient. Drinks composed of simples to combat the effects of the poison were also very efficacious.

“This disease, which commenced in the month of August, attacked all the very young children and carried them off.

“In those days Chilperic was also seriously afflicted, and as the King commenced to convalesce his youngest son was taken with the malady, and when his extremity was perceived he was given baptism. Shortly afterwards he was better, and his eldest brother, named Chlodobert, was attacked in his turn. They placed the Prince in a litter and carried him to Soissons, in the chapel of Saint Medard; there he was placed in contact with the good Saint’s tomb, and made vows to him for recovery, but, very weak and almost without breath, he rendered his soul to God in the middle of night.

“In those days, Austrechilde, wife of King Gontran, also died of the disease; while Nantin, Count of Angouleme, also succumbed to the same malady, his body becoming so black that it appeared as though calcined charcoal.”

Gregory of Tours, in another chapter, narrates:

“The year of the reign of King Childebert, 582, another epidemic broke out; this was accompanied by blackish spots of a malignant nature, with pustules and vesicles, and carried off many victims.

“Touraine was cruelly devastated by this disease. The patient attacked by fever soon had the surface of his body covered by vesicles and small pustules. The vesicles were white and very hard, presenting no element of softness, and were accompanied by great pain; when they had attained maturity they broke and allowed the humor within to escape. Their sticking to the clothing of the body added considerably to the pain. Medical art was wholly impotent in the presence of this malady, at least when God did not come to the doctor’s aid.

“The wife of Count Eborin, who was attacked by the disease, was so covered by vesicles that neither her hand nor the sole of her foot nor any portion of her body was exempt; even her eyes remained closed. Soon after the fever ceased the fall of the pustules occurred, and the patient recovered without more inconvenience.”

Small-pox came, then, from the Orient—that eternal center of all pestilences and curses. From the seventh century the Saracen armies spread the malady wherever they passed—in Syria, Egypt, and Spain; in their turn, the Crusaders, in returning from the Holy Land, brought the disease into France, England, and Germany. From thence the great epidemics of the twelfth and thirteenth centuries, after which the small-pox became epidemic, appearing and disappearing without causation, but always destroying myriads of victims. “In 1445,” says Sauvel “from the month of August to Saint Andres’ day (November 30), over 6,000 infants died in Paris from small-pox.[21] The physicians knew neither the nature nor the treatment of the new disease.[22]

The measles was first noted at the same time as the small-pox, making its first appearance as an epidemic in the sixth century.

It is more than probable that the measles originated in Egypt, and according to Borsieri, it had such an extension throughout Western Europe that there were but few persons who had not suffered attacks. The history of measles, however, is less clearly defined than that of small-pox, although Anglada says that it figured among the _spotted diseases_, of which Gregory of Tours speaks.[23] But it was only in the sixteenth century that Prosper Martian exactly describes the disease.

Says Martian, “It is a disease of a special type peculiar to children, who can no more avoid it than small pox. It commences with a violent fever, followed, towards the third day, by an eruption of small red spots, which become elevated by degrees, making the skin feel rough to the touch. The fever lasts until the fifth day, and when it has ceased the papules commence to disappear.”

Measles was designated in the middle ages under the name _Morbilli_, which signified a petty plague, the same that _Morbus_ meant a special plague. It is then fair to presume that the type of disease was no more serious than it is at the present day.

It is probable that the measles of the sixth century included at the same time small-pox, measles and scarlet fever, of which the ancients made no differential diagnosis. Anglada affirms the co-existence of all forms of eruptive fevers and gives the following reasons:

“The contemporaneous appearance of variola and rubeola represents the first manifestation of an epidemic constitution, resulting from a collection of unknown influences as to their nature, but manifest by their effects. The earth was from thence prepared to receive scarlatina, and it soon came to bear its baleful fruits. We do meet some mention of scarlet fever in the writings of the Arabian School, but it is merely suspected and only vaguely indicated. But when we remember how difficult it often is to diagnose at first between variola and measles, we are not astonished at the indecision manifested in adding another exanthematous affection to the medical incognito. It was only after innumerable observations and the experience of several centuries that the third new disease received its nosological baptism. There is nothing to prove that it did not co-operate with earlier epidemics of variola and rubeola, remaining undistinguished as to type, however.”

What clearly proves that there was confusion between the various fevers of exanthemata is that Ingrassias describes scarlatina in 1510, under the name of _rosallia_, adding, “Some think the measles and _rosallia_ are the same malady; as for me, I have determined their differences on many occasions. _Nonnulli sunt qui morbillos idem cum rossalia esse existimant. Nos autem soepissime distinctos esse affectus, nostrismet oculis, non aliorum duntaxat relationi confidentes inspeximus._”[24]

These facts appear conclusive enough to admit that measles and scarlet fever are, like variola, the products of the epidemic constitution developed during the sixth century, as contemporaries of the bubonic plague, all these maladies representing the medical constitution of the first centuries of the Middle Age.

THE SWEATING SICKNESS OF ENGLAND.