A tranquil mind was one of the surer armours against infection. Ideally one should retreat to Boccaccio’s enchanted glade, live beautifully, pass one’s time in dalliance and in practising the art of conversation. But dalliance should not be carried too far: sex, like wrath, heated the members and disturbed the equilibrium. One’s mind should be resolutely closed to the agonies of one’s fellow men; sadness cooled the body, dulled the intelligence and deadened the spirit.
It seems unlikely that the intelligent and enlightened men who worked out these preventive measures had any great faith in their efficacy. Essentially they were a morale-building exercise: the morale of the physician, in that they made him feel at least remotely in control of the situation, and of the patient, in that they offered a slight hope of escape from death. But if the doctors lacked confidence in their capacity to keep the plague at bay, still more did they doubt their ability to cure it once it had struck. They knew too well how few of the sick recovered. But this knowledge of their helplessness did not stop them putting forward a host of remedies.
Bleeding was an even more important part of the cure than it had been of prevention. The blood that emerged from the infected would normally be thick and black; it boded even worse for the victim if a thin green scum rose to the surface. If the patient fainted, instructed Ibn Khātimah somewhat heartlessly, pour cold water over him and continue as before. Most surgeons bled for the sake of bleeding, not worrying much where the incision was made. John of Burgundy{137} was more scientific. He believed in the existence of emunctories, from which the poison could be expelled by bleeding. The evil vapours, having entered by the pores of the skin, were carried by the blood either to the heart, the liver or the brain. ‘Thus, when the heart is attacked, we may be sure that the poison will fly to the emunctory of the heart, which is the armpit. But if it finds no outlet there it is driven to seek the liver, which again sends it to its own emunctory in the groin. If thwarted there, the poison will next seek the brain, when it will be driven either under the ears or to the throat.’ Each emunctory had a surface vein which corresponded to it and a skilled surgeon could there intercept the poison on its devil’s progress around the body and draw it off before it did more mischief. A common and disastrous mistake was to make the incision on the wrong side of the body; this not only wasted good blood but meant that healthy limbs were corrupted by the degraded liquid which poured in to make up the loss.
As well as bleeding, it was useful to open and cauterize the plague boils or buboes. Various curious substances were applied to the boils to draw off the poison. Gentile used a plaster made from gum resin, the roots of white lilies and dried human excrement, while Master Albert was in favour of an old cock cut through the back. Ibn Khātimah believed that an operation on the bubo was possible between the fourth and seventh day of the disease when the poison was flowing from the heart to the boils. But even a slight mistake in timing could lead to the escape of the vital principle from the heart and the immediate death of the patient.
Various soothing potions were prescribed, in particular a blend of apple-syrup, lemon, rose-water and peppermint. This must at least have been pleasant to drink. Even this consolation was removed when powdered minerals were added to the mixture. There was some belief in the virtues of emeralds and pearls and the medicinal qualities of gold were taken for granted by most authorities. Take one ounce of best gold – was Gentile’s recipe – add eleven ounces of quicksilver, dissolve by slow heat, let the quicksilver escape, add forty-seven ounces of water of borage, keep airtight for three days over a fire and drink until cure or, more probably, death supervened. At least the high price of gold ensured that not many invalids could afford to be poisoned by such medicines.
Just how little the doctors learned from the Black Death is shown by the Tractate of John of Burgundy or John à la Barbe, published in 1365.{138} It is true that the author had gained much of his experience and no doubt devised his treatments in 1348 and 1349 but he had lived through a second great epidemic in 1361 and, at the time he wrote, was distilling what should have been a lifetime’s learning. The same sterile analysis of causes appeared, the same catalogue of futile preventive methods and still more futile cures. Given the state of medical learning no great leap forward was possible but if Hippocrates had been alive he would at least have discarded a lot of dead wood of proven uselessness and made some sensible and valuable deductions about the conditions in which the epidemic seemed to thrive and the best means of removing them. Of this there was nothing; only the regurgitation of long discredited dogmas and, from time to time, the addition of some new mineral or vegetable gimmick to give the technique of the writer a flavour of modernity.
Fourteenth-century men seem to have regarded their doctor in rather the same way as twentieth-century men are apt to regard their priest, with tolerance for someone who was doing his best and the respect due to a man of learning but also with a nagging and uncomfortable conviction that he was largely irrelevant to the real and urgent problems of their lives. They were, of course, ready to believe almost anything which was told them with authority but their faith had been undermined by the patent lack of confidence on the part of the doctors themselves. Sometimes, under intolerable stress, scepticism would give way to something more primitive and violent, tolerance would crack and the doctor find himself execrated as the architect of the disease which he had proved so signally ill-qualified to check. But such moments of revulsion were rare and in general the doctor preserved a privileged position. Chaucer’s mockery and the occasional abuse of an aggrieved patient was the worst that he had to bear.
However little use the doctors may have been, the average Parisian at least had the comfort of knowing that he was far better provided with medical attention than his contemporaries. There were more doctors, predominantly Jewish, in Paris than in any other city of Europe and all surgeons had passed an examination and had been licensed by a panel of master surgeons trained at the Châtelet.{139} The fashionable course for study was based on the works of the Arab surgeon Razi and an ointment called ‘Blanc de Razès’ was on sale at apothecaries as a cure recommended for virtually any ailment. But no amount of ointments nor the wisdom of the august Faculty of Medicine itself could do much to help the Parisian when the Black Death broke about him.
It seems that the first authenticated cases of plague in the capital were noted in May or June 1348, though the full force of the epidemic was not felt until several months later. It did not die out until the winter of 1349. The chronicler of St Denis put the death roll at about fifty thousand,{140} a surprisingly conservative estimate for a city that may well have had more than two hundred thousand inhabitants.{141} Certainly there is no reason to think the figure exaggerated. An analysis based on church warden accounts for the parish of St Germain l’Auxerrois showed that seventy-eight legacies were bequeathed to the church between Easter 1340 and 11 June 1348.{142} In the next nine months the number rose to four hundred and nineteen – a rate forty times as high. ‘It seems,’ commented Mollat, ‘that the plague sent men to their lawyers as fast as to their confessors.’ On this, admittedly somewhat slender basis, he calculated that the plague was at its worst almost at the end, in September and October 1349, and that it ran an unusually protracted course. The Bishop, Foulque de Chanac, died in July 1349; the Duchess of Normandy, Bonne de Luxembourg, in October and her mother-in-law, Jeanne de Bourgogne, when the danger must have seemed almost over, on 12 December.
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