Debating Death and Disease

John Henderson challenges received ideas on how medieval and early modern societies dealt with perils such as plague.

Doctor treating plague victims from the 15th century fresco of the life of Saint Sebastian

‘At every church they dug deep pits down to the water level; and thus those who were poor who died during the night were bundled up quickly and thrown into the pit; they then took some earth and shovelled it down on top of them; and later others were placed on top of them and then another layer of earth, just as one makes lasagne with layers of pasta and cheese.’

This quotation by Marco di Coppo Stefani, a chronicler who lived through the ravages of the Black Death in Florence in the summer of 1348, points to the drama created by the impact of the plague pandemic that engulfed Europe. It not only underlines the crisis for a major European city, generated by the death of tens of thousands of people, but also demonstrates how, even in recording such a profound crisis, a chronicler might evoke a homely, if provocative, image of lasagne.

Intriguingly, just as the Black Death had a significant impact on European society, so its study has had a major impact on medieval historiography, leading to a series of dramatic debates, in particular over the identity of the disease. The debate was largely sparked by Samuel Cohn, who threw doubt on the long-held belief that the cause of the Black Death was bubonic plague in The Black Death Transformed: Disease and Culture in Early Renaissance Europe (2002). In 2010 DNA analysis by an international team of scientists identified Yersinia pestis, the pathogen responsible for plague, in medieval burial sites in five European countries (see the online article, S. Haensch, R. Bianucci, et al, ‘Distinct clones of Yersinia pestis caused by the Black Death’). These findings have now been absorbed by the historical community, as can be seen in articles in the recent volume edited by Linda Clark and Carole Rawcliffe, ‘Society in an Age of Plague’ in The Fifteenth Century, XII (2013), but it has been questioned how far these very local findings can be generalised – and so the debate continues.

This debate has important implications for the way we see and interpret the past, since an implicit assumption which lies behind traditional studies is that, because medieval men and women did not understand the true nature of a disease, they lived in a benighted state of ignorance in which any official action taken must have been worse than useless. However, this Whiggish perspective has been rightly challenged in many areas of the history of medicine, as in Carole Rawcliffe’s ground-breaking book, Urban Bodies: Communal Health in Late Medieval English Towns and Cities (2013), in which she emphasises the extent of contemporary measures to clean up the environment, seeking to modify the Monty Pythonesque vision of the stinking middle ages and to challenge our preconception that people in this period simply accepted the inevitability of filth and disease.

The new emphasis upon the pro-active nature of medieval and early modern society has also led to a re-assessment of the role of the hospital. Recent studies, such as my own book, The Renaissance Hospital: Healing the Body and Healing the Soul (2006), have demonstrated that in Renaissance Italy hospitals ran a significant medical service, employing leading physicians and surgeons to treat thousands of patients each year, the vast majority of whom left cured. Another significant feature is the fundamental role of the relationship between religion and medicine in the healing process, reflected in the fact that these institutions commissioned leading artists and sculptors to produce devotional objects for their chapels and wards: see also Carole Rawcliffe’s Medicine for the Soul: The Life, Death and Resurrection of an English Medieval Hospital (1999) and, more generally, Religion and Medicine in the Middle Ages, edited by P. Biller and J. Ziegler (2001).

More broadly, the medieval hospital has been presented recently as a ‘non-natural environment’, which provided treatment based on a wide range of Galenic desiderata, see: Peregrine Horden in ‘A Non-natural Environment: Medicine Without Doctors and the Medieval European Hospital’ in B.S. Bowers, ed., The Medieval Hospital and Medical Practice (2007). Historians have also emphasised that official practitioners and the laity had a shared understanding of the Galenic idea of the ‘six non-naturals’ or advice on how to avoid disease, many of which are familiar today in the form of diet, exercise, sleep and the management of emotions: see Cavallo and Storey, Healthy Living in Late Renaissance Italy (2013), reviewed right. This is reflected also in the study of recipe collections, which enables one to examine the relationship between medical theory and practice and the extent to which women and men with and without medical training drew upon the same beliefs about the causes and treatment of disease. As a result, scholars have been prompted to explore medical case books, diaries and letter collections, such as the recipe books kept by gentlewomen, reflecting their widespread activities in producing medicines and treating their families and the poor, for which see Secrets and Knowledge in Medicine and Science, 1500-1800, eds. E. Leong and A. Rankin (2011). Patients and their families have also come to the fore, as seen from their remarkable contracts with practitioners, according to which patients sued and expected compensation from practitioners for non-performance or even killing a relative: see Gianna Pomata, Contracting a Cure: Patients, Healers and the Law in Early Modern Bologna (1998) and M. Pelling and F. White, Medical Conflicts in Early Modern London: Patronage, Physicians and Irregular Practitioners, 1550-1640 (2003).

All these studies have helped to challenge traditional ideas about how medieval and early modern society dealt with epidemic and endemic disease and, above all, have helped to combat the view that the population was simply helpless in the face of the threat of filth and disease, whether to the health of the family or of the body politic.

John Henderson is Professor of Italian Renaissance History at Birkbeck, University of London. He is currently completing a book about plague in early modern Florence to be published by Yale University Press.