The Great Death | The Plague of the Known World
“And so they died. And none could be found to bury the dead for money or friendship. Members of a household brought their dead to a ditch as best they could, without priest, without divine offices ... great pits were dug and piled deep with the multitude of dead. And they died by the hundreds both day and night ... And as soon as those ditches were filled more were dug ... And I buried my five children with my own hands. And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city. There was no one who wept for any death, for all awaited death. And so many died that all believed it was the end of the world.”
Agnolo di Tura of Sienna, 1348
The man pulled the body from the home and dragged it to his wagon. The thought of calling it a person never occurred to him. To him it was just a diseased shell of infected flesh. The person that it was had been young. He guessed in their early twenties. The body was heavy, its stomach bloated. As he approached his cart, one of the cloths wrapped around its foot fell off showing the blackened, rotting flesh. He could smell the rot. Maggots moved in and out of the lesions.
He threw it onto the cart. Fluid came out of the mouth and he moved his foot aside and watched it hit the ground. It puddled there, and when the man picked up the handles to his cart and began to move, he stepped over it. He wrapped a cloth around his face and walked through the street.
There were others in the street with carts. The street smelled of rot and filth. The sun made it worse, seeming to lock in the putrid scents. The walk to the river’s edge wasn’t far today and when he arrived, he waited in line as others dumped the corpses into the water. A breeze picked up and he caught breaks in the stench as fresh air found its way between the buildings.
He got the edge of the Nile and lifted the handles of the cart and heard the bodies fall down the hill. There was no splash. He dropped the handles and saw his pile on top of another. He looked upriver, and stretching to the visible horizon was a sea of bodies so packed together that not a glint of water was visible.
He stepped out of the line, and walked back into the city.
The Path of the World-Breaker
The plague of the 14th century spread quickly throughout the known world thanks to military conflicts, international trade, and socio-economic conditions present during this time. Starting in mainland China in 1346, the plague known as “The Black Death” and “The Great Death” is recorded to have first infected the Mongol Golden Horde as it moved across Asia. As the armies of the Great Khans began to succumb to the disease, they started used it in what now is considered biological warfare. During the siege of Caffa on the Crimean Peninsula in 1347, the Mongol leader ordered infected corpses be catapulted over the high walls to spread the disease to the city's inhabitants. This tactic proved successful, as many in Caffa succumbed within days or fled after seeing the piled dead. They went north seeking safety from the Mongols, arriving by ship in dense urban areas like Syracuse in Sicily and Marseilles in southern France. Those who were infected spread the contagion to the locals thanks to the unsanitary living conditions prominent during this time.
Trade routes established by Marco Polo, specifically along the Silk Road, furthered the contagion as those traveling from the East brought the infection with them. Shipping lanes became polluted by the disease as carriers huddled together in cramped vessels. Soon, the rumors of “plague” and “blight” became a reality, and as treatments continued to fail, panic ensued and caused widespread migrations away from densely populated areas. Just two years after the siege of Caffa, the plague had spread across Western Europe and North Africa, reaching as far north as England, and by 1353 its victims could be found in every city and town on the continent. The infection gained speed and ferocity with every city it encountered.
Pathology in the Masses
The Great Death was comprised of three different plagues, all devastating because of the dieases' aggressive nature and the lack of treatment needed to combat it. The first and most prominent was the bubonic plague, whose victims suffered from masses developing in their armpits and groin area. Called buboes, these lumps filled with blood and pus were the result of the lymph nodes spreading the bacteria. The infection caused a high fever and painful joints in the afflicted, and if left untreated, it caused death in eight days or less in 80% of cases.
The pneumonic plague systemically infected the lungs and respiratory system. Fever, cough, and malaise were present, but the victims also suffered from bloody discharges of mucus from the lungs. This discharge would continue until it would free-flow without a cough, eventually killing 95% of those afflicted.
Septicemic plague was the rarest form, but had a 100% mortality due to its aggressive spread. Buboes did not have time to spread as a result of the infection. Instead, purple patches appeared on the skin and were accompanied by high fever, aches, and pains.
Treatment in the Middle Ages
The rate at which the infection spread, coupled with the lack of even basic sanitary conditions, simply overwhelmed the inadequate medical community at the time. As covered on a previous podcast, medical treatment during this time was wholly inadequate for even simple illnesses. Since germ theory was then unknown, much of medicine during this time was based on precedent as doctors used techniques that dated back to the ancient world. These treatments included bloodletting, sitting close to a fire or in a sewer to drive out the fever, drinking substances like vinegar and arsenic, or rubbing a cut up pigeon all over one’s body. As failures and corpses mounted, the population's distrust of doctors contributed to the panic that ensued in cities across the known world. The medieval French chronicler Jean Froissart described the situation in 1380 with the words, “Doctors need three qualifications: to be able to lie and not get caught; to pretend to be honest; and to cause death without guilt.”
As millions died, disposal of the infected become a continuous challenge. Mass graves overflowed with mountains of bodies. Rivers and waterways were filled with corpses with the hope that the current would carry them out into the sea. Fire was used to dispose of the dead, and blazing pyres could be seen for many miles outside of major cities. The onslaught of death was so horrific that last rites, ceremony, and all manner of religious practices to honor the victims were forgotten, or ignored.
Amidst the many failures were some successes. As the disease spread, quarantines were issued for infected areas, ships, and for travelers in specific areas. By this time, information had spread about the signs of the blight. Using this knowledge, officials could monitor the health of isolated groups to determine if one or more were infected and keep them quarantined from the healthy population. Cities were depopulated either by death or fleeing inhabitants. As a result, many smaller communities were formed away from the urban areas. These saw saw lower infection rates and were able to respond quickly with quarantine in those affected.
The Infected Society
As medical treatments failed and the death toll began to visibly mount, populations began to panic and increasingly turned to insane reasons for the blight and its spread. Many believed that it was God’s punishment and whipped themselves as they begged for healing, while others considered it a blessing to be infected as they would be seen as a martyr by the hosts of heaven. In many regions, these "cures" were promulgated by the Catholic Church, which lent them its credibility and spread misinformation more widely during the height of the pandemic. Others in religious circles simply believed this to be end of the world, and as the bodies continued to pile up, they became more and more convinced of this outcome.
Within medieval society, some erroneously blamed certain groups for the disease, especially Europe's Jewish communities. According to surviving records, this was due to several factors. First, there was a mistaken belief that these communities were immune from the disease and as a result had inflicted it on the rest of the world. This was because many Jewish customs mandated the washing of hands and maintaining cleanliness, so the spread was not as aggressive. Second, antisemitism was present at this time, and the panic caused by the blight exacerbated these horrific beliefs. Entire Jewish towns and communities were systematically annihilated and the survivors pursued across Europe. Jewish populations fled urban and rural areas, eventually finding refuge in Poland where they were welcomed.
Economically, the depopulation of Europe was devastating to the feudal system. Serfs worked land for the benefit of the nobility and local princes and kings. As the infection spread and the workforce was depleted, more and more of the ruling class were unable to meet revenue expectations. This caused an increased demand for workers, higher wages—or first-time wages—for those who could work, both of which contributed to an improvement of life for the peasantry. In addition, the price of food fell due to the decrease in demand. This, coupled with the higher wages and more opportunities to find employment, increased the freedom of the working class from those who, historically, had ruled them.
The death toll of this pandemic is difficult to calculate because so few reliable records survived. Estimates range that between 30-60% of Europe's population died over the course of four years. The plague was relatively less destructive in the Near East and North Africa, probably due to the warmer climate, but at least one-third of those living in these regions perished. Tax records in various cities provide the best accounts of the death toll. In Paris, half of the people who lived in the city died; the same was true in Florence. London, Hamburg, and Bremen saw more than 60% of their population succumb to the plague. Cairo, the largest city outside China on the Eurasian landmass, witnessed the death of between 30-40% of its people. Worldwide, it is estimated that the plague killed between 75 and 200 million people, and it took nearly two hundred years for the world's population to recover.
Lessons from History
The Great Death still exists today. Our ability to identify, treat, and quarantine it has reduced the mortality rate from 80-100% to 11%. For the medical community, history showed that the spread was caused by fleas on rats, some of whom were immune and others who were not. Fleas would migrate form host to host spreading the infection from rat to human. The medical community linked the spread to unsanitary conditions that existed during the middle ages, informing the leadership of towns, cities, states and nations about the need for improvement in overall sanitation and access to clean water. For these leaders, history proved the hypothesis of the medical community and they worked together to exponentially lower the mortality rate. These groups—and others—learned the lessons of history for the purposes of improving the future.
In this, we can learn from their example. Looking at this dark period in human history we can be thankful for the advancements in medical knowledge, sanitation, and disease prevention. In addition, we can understand that the spread of the worst plague in recorded history occurred without the help of planes, cruise ships, mass transit, and other means of modern transportation proving that contagions are not limited to the old world. We can see modern pandemics through this lens and do our part to stop the spread while using data to interpret present circumstances and next steps.
As Jon stated so well in the last podcast, we can be reminded of one of the biggest lessons from history, that tomorrow is not guaranteed and each day we must work to make the future that much better for those who come after.
