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Much has been written about the great outbreaks of disease which from time to time have decimated nations, but modern historians till comparatively recent times were too much occupied in chronicling wars and political intrigues to bestow attention on the far-reaching effects of epidemics on social evolution. How potent a factor disease is in the history of a people is well shown by the Black Death. The history of that devastating pestilence has been written from one point of view by Dr. Creighton, and from another by Abbot Gasquet, D. D., the President of the English Congregation of Benedictines, whose learning and literary abilities have earned him a place in the first rank of living English historians. A reprint of his Black Death of 1348 and 1349 has been published recently, and will be read with interest by those who recognize the important part disease has played in the history of all great social upheavals. Dr. Gasquet has estimated the Black Death at its true value. Hitherto, historians have regarded this terrible epidemic as an isolated incident of Edward III’s long and eventful reign, of less interest and far less importance than the French wars. Dr. Gasquet, on the other hand, treats it as the most important event of the Middle Ages, and a prime factor in the making of modern England. It was, as he remarks in his introduction, “a turning point in the national life. It formed the real close of the Mediaeval period and the beginning of our Modern Age.” Tracing the whole course of the plague, which, starting from its home in the East, travelled across Europe and finally spread ruin and desolation throughout the British Isles, the author gives a graphic description of its effects, both immediate and future, and its tremendous results upon English society, religion and morality. There seems to be every reason to believe that the Black Death (which for two or three centuries was known simply as “the death,” “the great mortality,” or, as Piers the Ploughman always calls it, “the pestilence”) was in reality bubonic plague. Simon de Covino, a doctor of Paris, who wrote a poetical account of the outbreak at Montpellier, calls it pestis inguinaria, or bubonic plague of the East. The truth of this theory is proved by all descriptions of the symptoms left us by eye-witnesses. The Black Death in Europe, however, seems to have had certain characteristics peculiar to itself. Theses are enumerated by Dr. Gasquet as follows: “1, Gangrenous inflammation of the throat and lungs; 2, violent pains in the chest; 3, the vomiting and spitting of blood; 4, the pestilential odour coming from the bodies and breath of the sick.” The vomiting of blood is the most distinctive feature of the Black Death, which, in all other respects, exactly resembles the later epidemics of bubonic plague in England. The disease never lasted longer than three to five days, and frequently ran its course in a few hours. Usually it began with swellings under the arm and in the groin, followed by high fever, delirium, and death, but there were several different forms.

Some were struck suddenly and died within a few hours; others fell into a deep sleep from which they could not be roused; whilst others again were racked with a sleepless fever and tormented with a burning thirst.

A peculiarly malignant type of plague was characterized by small black pustules on the skin, and from this very few recovered. The glandular swellings, however, were not necessarily fatal, for we learn from contemporary writers that many people had them and lived; but the spitting of blood was an infallible sign of impending death. It is interesting to note one peculiarity of this epidemic: it claimed a large part of its victims from among the young and strong, whilst the mortality amongst men was greater than amongst women. Medical treatment appears to have been simple enough, consisting merely of lancing the swellings, which in many cases were dry and hard and contained little or no fluid. The unfortunate patient was left to nurse himself, for the fear of infection was so overpowering that none dared enter a plague-stricken house, and the sick and dying were abandoned by their nearest relatives. The dead lay in heaps in the streets or in the deserted houses, with no one to bury them, for it was almost certain death to touch a corpse, or event the clothes he wore, or the bed on which he lay. So deadly was the infection that once the disease of the serfs towards complete freedom and independence, and the gradual rise of the lower orders from mere “dumb, driven cattle” into a powerful body of men, bound closely together by a common interest, protected by the newly formed trades unions, and strong enough to wrest their privileges by force from the unwilling hands of Kings and nobles. The Black Death had yet another important result. Whilst all progress in the art, education, and commerce of the country was checked for years to come, religion received a blow from which it did not recover for a long time. The decay in religious fervour which is so striking a feature of the latter half of the fourteenth century was partly the natural and inevitable result of the overwhelming national catastrophe, but it was also due to the scandalous state of things arising from the lack of priests properly qualified for their work. So, few priests had survived the plague that the bishops were forced to ordain mere boys, half educated, and often wholly unfitted for the cure of souls. The bad example set by many of these men, the frequent scandals and abuses in the Church, had a demoralizing effect upon the people. At that time the seeds were sown that were to bear fruit in a future generation. There can be doubt that the Black Death paved the way for the Reformation, as well as for a new order of things in the body politic. — BMJ, The British Medical Journal, Vol. 2, No. 2549.

April 27

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