Pandemic then and now (part 2)...

My current series of historical novels is set in the middle of the 14th century, a period (in)famous for its devastating plague. The events of the first novel occur just after the Black Death has passed on, and so don’t concern the plague itself but rather its consequences for a community that lost so many of its members. But I have recently published the fourth novel in the series, which, sadly, is at least partly “about” plague, which returned to England in 1361 (and many times thereafter).

I was still writing this fourth novel when the world was plunged into chaos by the arrival of COVID-19. Although it was unsettling writing about a pandemic when we were in the midst of one, it did give me food for thought, comparing the two events.

My last post on The History Girls blog, in May, related something of medieval people’s understanding of the reasons for the plague, focussing on the idea that “lewd” fashion, and indeed lewdness in general, might be responsible.

In today’s post, though, for what I think may be my last on The History Girls concerning plague, I thought I’d talk a little more about how medieval people responded to plague. It’s particularly interesting because there are a few fascinating parallels with our own responses to the 2020 pandemic.

In the 14th century, people had some curious (to us) notions about the causes of the disease. Death was of course everyday – accidents were commonplace, illnesses mostly incurable, and even untreatable, life generally subject to manifold risk. Medieval people had a tendency to credit adversity of any kind, be it the loss of a child, dead cows, a bad harvest, or the failure of the butter to churn, to God’s will or the Devil’s work.

Part of a mural in a church in Hrastovlje, Slovenia, painted at the end of the 15th century,

showing people of every rank and station being led by grinning skeletons towards a grave. 

National Gallery of Slovenia. Public domain, via Wikimedia Commons

We know well enough the medieval notion that the coming of the Black Death, or indeed any disaster, was the result of mankind’s sin. That was what the Church promulgated. However, even if this was the generally accepted view, ther were scientific explanations too. Various complicated theories about the movements of the planets were proposed, and also ideas that miasma, or foul air, was to blame. Foul air was thought to be a cause of disease in general, and plague was no different.

But, if medieval people had some notions of the cause of the disease (even if they were wrong), I imagine it was far trickier for them to work out how to deal with it.

Isolation, keeping oneself to oneself generally, was certainly understood. The value of social distancing, as we now call it, was recognised. The premise for Boccaccio’s Decameron (completed in 1353) is the isolation of a group of young people who flee Florence to escape the plague. And a 14th century French physician, Jean Jacmé, wrote in a treatise on the plague:

“In pestilence time nobody should stand in a great press of people because some man among them may be infected” *

So close contact with a victim was to be avoided. People did go into “lockdown”, confining themselves and their families to their homes, only going out “if absolutely necessary”, presumably to fetch water, buy food, tend to their animals or manage their land.

But Doctor Jacmé had some other familiar-sounding advice. He advocated the washing of hands “oft times in the day”*, though he recommended using water and vinegar, rather than soap.

Touch, then, was certainly to be avoided, but another physician posited that looking into a plague victim’s eyes was also risky, on the grounds that disease could be transmitted via the “airy spirit leaving the eyes of the sick man”*, which does seem somewhat less than plausible. But something much more familiar is avoiding a victim’s “foul air” – the emissions resulting from coughing or even breathing. The “plague doctor” bird beak masks of later centuries hadn’t yet been invented, but I can well imagine that those who attended victims might have covered their nose and mouth.

The 17th century equivalent of a “hazmat” suit?

Though these sorts of beak masks weren’t used in the 14th century.

(Copper engraving of Doctor Schnabel (Dr. Beak), a plague doctor in 17th century Rome.

Published by Paul Fürst (1608–1666) who was perhaps also the engraver. Public domain.)

What medieval people didn’t seem to know about, for I have seen no reference to it in the sources I have been reading, was the role of rats and fleas. Rats have long been implicated in the spread of plague, though some scientists now think the speed of spread was, in practice, too rapid and too far for transmission by rat flea alone to be viable. Others have it that the rat fleas jumped host to people, and then human fleas and body lice were infected, making it easier for rapid people-to-people transmission. Yet the situation is unclear. The World Health Organisation, speaking of the present time, says, “human to human transmission of bubonic plague is rare”. Yet, the 1361 outbreak was in the summer months, in which bubonic, as opposed to pneumonic, plague, was in principle more common. Whichever it was, it spread very quickly, and was undoubtedly hideous and terrifying.

Perhaps not quite the culprit he’s been made out to be? But not this cute either!

(Etching by W. S. Howitt, 1808. Wellcome Library, London. http://wellcomeimages.org. Public domain.)

And of course doctors in the 14th century really didn’t know how to treat the disease, though some undoubtedly thought they did. Some would probably have tried their favourite cure-all, blood-letting, or applied a variety of substances to the suffering body, from herbs and vinegar, to urine and excrement, none of which were beneficial. In my novel, I have a barber-surgeon lancing the buboes, a practice that wasn’t necessarily carried out in the 1300s, though it was a couple of centuries later. But I can imagine eager medieval surgeons trying various methods to save their patients, just as the university-trained physicians ceaselessly sought answers in the heavens. And, even in the 14th century, catching plague wasn’t absolutely a death sentence, for some people clearly did survive it – even people who had been close to, or even nursed, victims.

It’s been a strange year for all of us, and of course it’s not over yet. When I embarked upon writing the fourth novel, back in 2019, I could never have imagined how close to home the events I wrote about might seem. As the 2020 pandemic took off, I recoiled a little at that “closeness”. Yet, since then, I have welcomed the opportunity once more to compare experiences then and now, finding, as so often, that, despite the centuries between us, there is much that we share.

* Quotes are from The Black Death, translated and edited by Rosemary Horrox. If you’d like to read more about plague in the 14th century, I really do recommend it, for it has a wealth of fascinating detail, and uses contemporary texts to reveal the thinking of the time.

Pandemic then and now... by Carolyn Hughes

My series of historical novels is set in the middle of the 14th century, a period (in)famous for its devastating plague. The first novel wasn’t actually about the Black Death, but about its aftermath and the social consequences for a community that lost between a third and a half of its population.

Now, however, I’m writing the fourth novel in the series and, unfortunately, it is at least partly “about” plague, for the pandemic returned to England in 1361. As a result, right now I’m in the rather curious, and admittedly somewhat uncomfortable, position of writing about a pandemic whilst living through one. I suppose I could have steered the story away from such ghastly happenings, but I planned the book’s storyline long before we’d even heard of COVID-19, and I’m disinclined to ditch a narrative I’ve been working on for a year… For a while I was too unsettled and distracted by the unfolding present-day disaster to even think about the “plague” chapters, let alone write them, but recently I’ve got a grip and am at last making some progress.

But, because I’ve had to think about plague all over again, I’ve also been rereading some of the textbooks on medieval plague, to refresh my understanding about what medieval people thought and felt about it, and how they responded to and dealt with it.

The way COVID-19 has spread so fast and so easily is frightening enough, but doctors and scientists do at least know what it is (they understand the nature of viruses), understand how it spreads (for example, coughing), have some idea of how to mitigate it (for example, isolation, ventilators), have found a way of testing for the disease and are hopefully well on the way to finding a vaccine.

Whereas in the 14th century, people had no idea what the disease actually was, or how it spread. The black rat and its fleas have always been implicated in the spread, but there is also a view that human fleas and lice might also have carried it from person to person, given the speed of the disease’s transmission. Of course, people then didn’t necessarily understand the role of fleas as vectors for disease, though it’s clear they did believe that close contact with a victim was to be avoided.

Perhaps not quite the culprit he’s been made out to be? But not this cute either!
(Etching by W. S. Howitt, 1808. Wellcome Library, London. http://wellcomeimages.org. Public domain.)

People did seem to understand the value of isolation as a way of avoiding plague although, practically and logistically, running away cannot have been easy or even feasible. But keeping oneself to oneself was certainly understood. Eyam in Derbyshire is famous for going into “lock-down” in 1665 after plague invaded the village (from fleas in a bolt of cloth apparently). But Boccaccio’s Decameron (completed in 1353) is based on the isolation premise, being a collection of stories told by a group of young men and women who fled Florence to a secluded villa in order to escape the Black Death.

A Tale from the Decameron by John William Waterhouse, 1916.
National Museums, Liverpool. Public Domain, via Wikimedia Commons

In the 14th century, death was of course everyday – illnesses were mostly incurable, accidents commonplace, life generally subject to all manner of risk. Medieval people ascribed every mishap or disaster, be it the loss of a child, dead cows, a bad harvest, or the failure of the butter to churn, to either God’s will or the Devil’s work. So it was presumably entirely understandable, if terrifying, to be told that the coming of the plague was God’s punishment for man’s sin, for your sin. Especially when God was supposed to be merciful rather than vengeful.

This was what priests told their congregations. In September 1348, at the behest of the king, Edward III, a letter was sent from the office of the Archbishop of Canterbury to all the bishops in the southern counties, ordering them to arrange urgent prayers to be offered up against the plague. It is clear from the letter that the coming of the Great Mortality was seen as divine punishment for sin:

“Terrible is God towards the sons of men… Those whom he loves he censures and chastises… he punishes their shameful deeds in various ways… He…allows plagues, miserable famines, conflicts, wars and other forms of suffering to arise and uses them to terrify and torment men and so drive out their sins.” #

Letters were then sent by the bishops to every parish in their diocese, reiterating this assertion that the Great Mortality was God’s punishment for mankind’s sin, and urging priests and their parishioners to repent earnestly of their sins and beg God for His mercy. These words come from the bishop of Winchester’s letter to his clergy:

“…God often strikes us, to test our patience and justly punish us for our sins… it is not within the power of man to understand the divine plan… the most likely explanation is that human sensuality has now plumbed greater depths of evil, producing a multitude of sins which have provoked the divine anger, by a just judgement, to this revenge.” #

So, according to the bishop, it was “sensuality” that had provoked God’s especial anger…. And one particular aspect of sensuality that some held up as a prime cause of God’s anger was allegedly the fashion for clothing that was considered by some to be both outlandish and indecent.

In 1344, an English monk spoke of the “grotesque fashions of clothing” then current in England, and he upbraided the English for abandoning the “old, decent style of long full garments” for:

“clothes which are short, tight, impractical, slashed, every part laced, strapped or buttoned up.” #

A few years after the second outbreak of the plague in 1361, a chronicler associated the lewd style of clothing with the evil that would undoubtedly follow:

 “…the English…remained wedded to a crazy range of outlandish clothing without realising the evil which would come of it.” (From a chronicle of 1365) #

This chronicler was writing twenty years after the monk, so one presumes the “outlandish” clothing was still in vogue.

So, what was it like, this clothing? Indecency and impracticality, as well as frivolousness, seem to have been the main complaints. Here are a few examples from the 1365 chronicler describing men’s fashion:

“…full doublets, cut short to the loins” “…which failed to conceal…their private parts.”

“…particoloured and striped hose…which are called harlottes, and thus one ‘harlot’ serves another, as they go about with their loins uncovered.”

“…a long garment reaching to the ankles, [but] not opening in the front, as is proper for men, but laced up the side to the armhole in the style of women’s clothes, so that from the back their wearers look more like women than men.”

“…little hoods, tightly buttoned under the chin in the fashion of women…the liripipe ankle-length and slashed like a jester’s clothes.”

“They also possess shoes with pointed toes as long as a finger…more like devil’s talons than apparel for men…” #

The three images below give you some idea of very short doublets, and very pointed shoes (the chap on the right in the middle image). These are Italian men so maybe Englishmen’s clothes would have looked a little different but, from the criticisms above, one might deduce that the principles of style were much the same!

All these images are from the 14th century treatise on health Tacuinum sanitatis.

Public domain via Wikimedia Commons.

Women of course didn’t escape censure – far from it. I think some members of the church were always very willing to find fault with the “daughters of Eve”…

As an example of women’s “lewd” clothing, the sideless surcoat became fashionable in the mid-14th century, a long, sleeveless overdress, with very large armholes, which revealed the fitted gown underneath. Some moralists abhorred the style, saying it drew unwarranted attention to the shape of the woman’s body, in a titillating way that would surely inflame men’s thoughts…

This image shows the style rather well, albeit she is very much a member of the nobility.

Miniature in the manuscript Chroniques de France ou de St. Denis, showing 

Maria of Brabant’s marriage with the French king Philip III.

British Library Royal MS 20 C VII, fol. 10. Public Domain via Wikimedia Commons

Tight clothing does seem to have been the principal concern, and the monk in 1344 gives us another example of it:

“Women followed with the tides of fashion…even more eagerly, wearing clothes that were so tight that they wore a fox tail hanging down insider their skirts at the back, to hide their arses.” #

All these clothes were seen as signs of both lewdness and pride, for men and women alike, and the inevitable precursor to disaster. The monk predicted:

“The sin of pride manifested in this way must surely bring down misfortune in the future.” #

And the later chronicler said much the same, but brought all the other sins into the equation too:

“Because the people wantonly squander the gifts of God on…pride, lechery and greed – and all the rest of the deadly sins – it is only to be expected that the Lord’s vengeance will follow.” #

Clearly all the clothes in these illustrations were worn by the better off rather than peasants although, as some peasants and artisans became more prosperous, they too aspired to, and acquired, more fashionable clothes, which was even more deeply frowned upon. In the 1360s, sumptuary laws were brought in to curb this unseemly blurring of the social hierarchy, but this was presumably more about the upper classes wanting to maintain their fashionable distinction than worries about indecency…

But doesn’t it all seem rather odd – hilarious, even – that fashion was held responsible for the coming of the plague? Or even that immorality should take the blame? But the chroniclers were certainly moralists of one kind or another. And plague was perhaps a good pretext for them to criticise the masses for their bad behaviour. Not that most people, of course, would, or could, have read the chronicles, though I suppose they might have heard similar sentiments coming from the mouths of their priests. But I wonder to what extent the average Englishman or woman believed them? How I’d love to know…

# All texts are taken from The Black Death, translated and edited by Rosemary Horrox.

'No News but Flu': The Spanish Flu Pandemic, 1918 by Sheena Wilkinson

In real life I’m the world’s most squeamish person. Cough beside me on public transport and I guarantee we won’t be companions for long. But for some reason I can cope with almost anything on the page, which came in very handy when, several years ago, I decided to set a novel, The Greater Malady,  during the 1918/19 influenza pandemic.  

Why the fascination with the so-called Spanish Flu? It grew out of my long-held obsession with World War One, whose ending overlapped with the flu, perhaps one reason why this crisis – the single worst demographic disaster of the 20 century – has been comparatively overlooked. Again and again I consulted histories of the period, to find the pandemic passed over in a paragraph or two. Yet it killed at least 50 million people worldwide, and its after-effects were felt for years by many survivors. 

Despite the name, it didn’t start in Spain, nor was Spain affected more than anywhere else.  Theories disagree as to whether it began in China or India, or possibly in America, where it attacked thousands of soldiers in training camps. Germans called it ‘Tommy flu’ at first, and the English called it ‘German flu’. But Spain was neutral in World War One and therefore not bound by the same reporting restrictions as the fighting powers. When morale was already so low after four years of war, the last thing governments could afford was people panicking about infection.

And at first there seemed no need to panic. The flu came in three waves, and the first one, in spring 1918, seemed no worse than the usual seasonal flu.  But by the autumn, doctors were horrified and puzzled by this illness, described in The Lancet as ‘flu, but not as we know it.’ As well as the common symptoms of fever, cough, and severe aches, many people were stricken by
dysenteric and haemorrhagic symptoms, with many choking to death on their own blood as their lungs disintegrated. The characteristic marks of cyanosis turned the faces of oxygen-starved sufferers dark blue, which led to its being called the blue flu, or the black flu. It resembled and was sometimes referred to as ‘plague’, and it killed many more people than the Black Death, but it was ‘only’ flu nonetheless. It could strike so suddenly that many people got up feeling perfectly well, only to collapse and die by nightfall. 

It infected 1/3 of world’s population, about 500 million, with a death toll of 10-20% depending on conditions. Unlike most infections, it killed the young and fit disproportionately. The death toll of c.50 million is probably a conservative one, as people often died of after-effects, related complications etc. From about 1920 war memorials started to go up in towns and villages round the world, but there are no memorials to the flu dead. It’s hard to imagine the scale – but think of how difficult it would be for life to go on with one in three people ill. Life did go on, by and large, in a population hardened by years of war, but even so, there are widespread reports of coffins piled up in the streets, the dead lying unburied, and children starving to death because their parents were lying dead in their beds. On one day in October 1918, at the height of the second wave, sixty people dropped dead in the street in London alone. 

 Why was it so bad?  I’m not an epidemiologist or scientist, but people in 1918 were often living in close quarters, in filthy trenches, army camps, and at home in factories and overcrowded housing conditions.  There was a great deal of movement of troops and support personnel. Think of how often today we get sick after travelling. On the home front, there were food shortages, low morale, and crucially a severe shortage of doctors and nurses, 50% of medical personnel on military service. Nobody was equipped to deal with a pandemic on this scale. 

Why isn’t it better known? I’ve described it as a horror story but we choose to remember other horrors – indeed remembering horror is important in helping us not to repeat the mistakes of the past. But this was horrific in a different way from war, and maybe people were scared to remember it because they knew how powerless they were to prevent its happening again. The medical profession had made improvements in public health and infection control in the 19^th and early 20^th C, and the war led to great strides in wound treatment, mental health, brain surgery, cosmetic surgery etc. Powerlessness against flu doesn’t fit that narrative of medical progress and confidence, and it was accepted that there was very little doctors could actually do. Nursing -- and luck -- played the greatest role. 

Another narrative it doesn’t sit easily with is that of heroism, so important at the time. While death in battle could be seen – however grim the reality – as noble and sacrificial, death from a disease was simply bad luck. It’s also very hard to romanticize – the symptoms were so disgusting. And maybe, after over four years of the most terrible war, people simply couldn’t bear any more horror. 

We know now that, like most influenza pandemics, the 1918 flu lasted for about a year and then petered out, but those living through it had a great deal of uncertainty. What exactly was it? When would it end? Would they get it? Would they die? Was it in fact the end of the world? Was God punishing humanity for the devastation of the war? These are the questions people were almost afraid to ask at the time. They must have felt like they were living through a medieval plague, and who wants that to mess up the sense of 20^th century modernity?

Funnily enough – I didn’t think it funny at the time – The Greater Malady, which I spent two years writing, was never sold. Clearly the publishing world did not share my fascination with this pandemic. But when I wrote Star by Star, set at the end of World War One, I knew that the flu would be a central issue in the book, and all that disgusting, horrific research would come in very handy. And in my forthcoming novel, Hope against Hope, set in 1921, the heroine’s family has also been bereaved by flu, not because I was being lazy and repetitive but because, a hundred years ago, with one third of the world’s population affected, there can have been very few families immune.