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'Then a boil developed on their thighs, or on their upper arms a boil ... This infected the whole body, so that the patient violently vomited blood. This vomiting of blood continued without intermission for three days, there being no means of curing it, and then the patient died.' So wrote Michael of Piazza, a Franciscan friar, describing the torment of the first victims of the Black Death.
In October 1347, all that the people of the time knew was that a deadly and hitherto unknown infectious disease had appeared from nowhere on the island of Sicily. They could have had no way of understanding the nature of their adversary.
The scale of the catastrophe was unprecedented. There was no cure and anyone who was infected died a truly awful death. This was the first manifestation of a plague that would blight Europe for the next 300 years and claim countless millions of victims - the worst serial killer of all time and the most tragic event in human history.
The first victims: their story
Contemporary accounts of the plague's first appearance speak to us across the centuries, conveying something of the utter terror and despair that afflicted whole populations. Michael of Piazza described how 12 Genoese galleys said to have come from the Crimea entered the harbour ofMessina in Sicily and the crews who carried such a virulent disease 'in their bones that anyone who only spoke to them was seized by a mortal illness and in no way could evade death. The infection spread to everyone who had any intercourse with the diseased. Those infected felt themselves penetrated by a pain throughout their whole bodies.'
It appears that the crews of the galleys were healthy and were not displaying any symptoms, and yet the inhabitants of Messina were rapidly struck down. When the authorities decided that the galleys were responsible for bringing this dreadful disease, they expelled them from the port, forcing them to put out to sea again. The crews, who were still perfectly healthy, must have been perplexed and indignant.
Onward they are said to have sailed to Genoa and, on arrival, a new outbreak of the pestilence began, the disease spreading rapidly almost as soon as the galleys had docked. Again, the reports suggest that the crews escaped the plague and yet:
The infection appeared in Genoa in its most deadly form a day or two after the arrival of the ships, although none of those on board were suffering from the plague [our italics], for we know that there were no cases of plague on board the ships, although the very atmosphere or smell of the new arrival seemed sufficient to taint the air of Genoa and to carry death to every part of the city within a couple of days.
These reports have obviously been greatly embroidered and our conclusion was that the epidemic was already up and running by the time the galleys arrived at Messina. Since the crews were completely healthy after a voyage of at least a month as well as on the further voyage to Genoa, they cannot have been carrying the infection. Their arrival at the time when the people of Messina realized that they were experiencing an epidemic must have been merely coincidental. We decided that, most probably, unrecognized victims had been dying from the plague in Messina for some weeks before the galleys arrived.
In the throes of the ensuing epidemic, the citizens of Messina believed that the slightest contact with the sick guaranteed rapid infection. Michael of Piazza wrote:
Soon men hated each other so much that, if a son was attacked by the disease, his father would not care for him. If, in spite of all, he dared to approach him, he was immediately infected, and could in no way escape death, but was bound to expire within three days. Nor was this the end of it: all those belonging to him or dwelling in the same house, even the cats and other domestic animals, followed him to the grave. As the number of deaths increased in Messina, many wished to confess their sins to the priests and to draw up their last will and testament. But ecclesiastics, lawyers and attorneys refused to enter the houses of the diseased. If one or the other had set foot in such a house to draw up a will, or for any other purpose, he was condemned to sudden death. Minor friars and Dominicans and members of other orders who heard the confessions of the dying were immediately overcome by death, so that some even remained in the rooms of the dying.
Soon the corpses were lying forsaken in the houses. No ecclesiastic, no son, no father and no relation dared to enter, but they paid servants high wages to bury the dead. The houses of the deceased remained open, with all their valuables, with gold and jewels; anyone who decided to enter met with no impediment, for the plague raged with such vehemence that soon there was a shortage of servants and finally none were left at all.
This account may be exaggerated in places, but it does convey vividly the horror and terror that everyone felt when this new plague first struck. They were overwhelmed by the ferocity of this mysterious disease which was completely outside their experience. One thing is quite clear - and this is an important clue - they realized immediately that transmission was directly by person-to-person infection.
With hundreds dying and the merest contact with the sick apparently guaranteeing infection, the remaining Messinians panicked and fled. Nevertheless, although they thought they were perfectly healthy, unbeknown to them they were unwittingly carrying the plague with them.
One group of refugees settled in the fields and vineyards of southern Sicily, but many fell down on the road and died. Others sought refuge in the neighbouring port of Catania, where they were tended in the hospital until death overcame them, but the Catanians rapidly realized their mistake - they should not have introduced this appalling infection into their town. The corpses were quickly pitched into trenches outside the walls and further immigration was strictly controlled.
Michael of Piazza relates that 'the population of Catania was so godless and fearful that no one among them would have intercourse with or speak to the fugitives, but each fled hastily on their approach'. Whether this was a sign of 'godlessness' or plain common sense, it was too late and the Black Death ravaged the town: 'The town of Catania lost all of its inhabitants, so that it ultimately sank into complete oblivion.' Michael of Piazza was probably exaggerating again, but the picture is unmistakable.
Fleeing in uncontrollable terror, the people from Messina spread the plague all over Sicily; the death toll was high in Syracuse and the port of Trapani was said to be completely depopulated.
What were the symptoms?
What was it like to contract the Black Death? Michael of Piazza's graphic description of the symptoms is not for those with weak stomachs:
The 'burn blisters' appeared, and boils developed in different parts of the body: on the sexual organs, in others on the thighs, or on the arms, and in others on the neck. At first these were of the size of a hazelnut and the patient was seized by violent shivering fits, which soon rendered him so weak that he could no longer stand upright, but was forced to lie on his bed, consumed by a violent fever and overcome by great tribulation. Soon the boils grew to the size of a walnut, then to that of a hen's egg or a goose's egg, and they were exceedingly painful, and irritated the body, causing it to vomit blood by vitiating the juices. The blood rose from the affected lungs to the throat, producing a putrefying and ultimately decomposing effect on the whole body. The sickness lasted three days, and on the fourth, at the latest, the patient succumbed.
This account may be supplemented by the following description, given by the Florentine humanist Giovanni Boccaccio when the plague ravaged Florence:
Unlike what had been seen in the east, where bleeding from the nose is the fatal prognostic, here there appeared tumours in the groin or under the armpits, some as big as a small apple, others as large as an egg; and afterwards purple spots in most parts of the body: in some cases large and but few in number, in others smaller and more numerous - both sorts were the usual messengers of death. Neither medical knowledge, nor the power of drugs, was of any effect to cure this illness ... nearly all died on the third day from the first appearance of the symptoms; some sooner, some later, without any fever or other accessory symptoms. What made this plague so virulent was that, by being transmitted from the sick to the hale, it spread daily ... Nor was it caught only by conversing with or coming near the sick, but even by touching their clothes.
It was soon obvious that there was no cure: once the dreaded symptoms appeared, the agonizing end seemed to be inevitable. When 'God's tokens' - haemorrhagic spots caused by blood seeping from damaged blood vessels beneath the skin - were found on the body, this was the death certificate and a prelude to four or five days of agony, frenzy and delirium. The victims' thirst was unquenchable and some of them ran naked through the streets, screaming, and plunged into water cisterns. Others went completely mad with the pain and even threw themselves out of windows. There was internal bleeding and, in the final days, the vital organs began to liquefy. Death was truly a merciful release.
The terror spreads throughout Italy
From its starting point, the plague was carried abroad in two ways: by ship, when it could jump over many miles and appear in a completely new port, and on foot, advancing slowly but surely over land.
Sicily occupies a pivotal position in the Mediterranean, and Messina and Catania were important stop-over ports for sea trading. It was trade that spread the plague and from Sicily the disease expanded to North Africa via Tunis, to the Balearic Islands and Cyprus, and to Corsica and Sardinia. If it had been confined to these areas, the epidemic would probably have fizzled out and perhaps even been forgotten by history. However, the plague then made some critical strikes almost simultaneously.
It arrived in the northern Italian port of Genoa in January 1348 (some three months after the galleys had docked in Messina). It also made the short jump across the strait to southern Italy.
In January 1348 the disease also arrived in Venice, probably having come by sea from Sicily. A contemporary estimate of the death toll was 100 000, though this is probably an overestimate. One Venetian wrote:
A certain man bled me, and the blood spurted onto his face. On that same day he was taken ill, and the next day he died; and by the mercy of God I have escaped. I record this because, as by mere communication with the sick, the plague mortally infected the healthy ... so the healthy man studiously avoided the sick. Even priests and doctors fled from those who were ill, in fear, and all avoided the dead. In many places and houses when an inmate died, the rest quickly expired, one after another. And so great was the overwhelming number of the dead, that it was necessary to open new cemeteries everywhere.
Can we learn something here? Was the man who was being bled suffering from the pestilence and yet recovered?
A stranger (obviously a person who was already infected) is believed to have brought the disease to Padua and the resulting devastation was great: an astounding two-thirds of the population died. If one person in a household fell sick, the whole family quickly succumbed. Was this an important clue concerning the nature of the disease? Pisa was struck, probably via the port of Leghorn, in March 1348. From here the plague spread northwards to Tuscany and southwards to Rome. Italy was truly overwhelmed.
Europe was now fighting a war with the plague and the struggle seemed hopeless; this disease was completely outside people's experience or understanding. The enemy was invisible and nobody knew when or where it would next appear. When it did strike, people could not defend themselves and many were overcome. The more they panicked and fled, the more the disease was spread. The plague held all the trump cards.
From Genoa it was carried to Piacenza, about 60 miles (100 kilometres) to the north-east, and Gabriele de Mussi, a resident of Piacenza who practised as a notary, wrote:
But as an inhabitant I have been asked to write more of Piacenza, so that it may be known what happened there in the year 1348. Some Genoese who had fled from the plague raging in their city betook themselves higher. They rested at Bobbio, and there sold the merchandise that they had brought with them. The purchaser, together with all his family and many neighbours, were quickly stricken with the sickness and died. One of these, wishing to make his will, called a notary, his confessor, and the necessary witnesses. The next day all these were buried together. So greatly did the calamity increase that nearly all the inhabitants of Bobbio soon fell victim to the sickness, and only the dead remained in the town.
In the spring of 1348 another Genoese who was infected with the plague came to Piacenza. He sought out his friend Fulchino della Croce, who took him into his house. But he died almost immediately afterwards and Fulchino was also quickly carried off, together with his entire family and many of his neighbours.
Gabriele de Mussi clearly believed that this disease was directly infectious. He continued:
The plague was rife throughout the city in a brief space of time. I do not know where to begin: everywhere there was weeping and mourning. So great was the mortality that men hardly dared to breathe. The dead were numberless, and those who remained alive gave themselves up as lost and prepared for the tomb.
His account brings home to us the terrible scale of the disaster:
The cemeteries failing, it was necessary to dig trenches to bury the corpses. Whole families were frequently thrown together in the same pit. It was the same in the neighbouring towns and villages. One Oberto de Sasso, who had come from an infected place to the church of the Friars Minor to make his will, summonsed a notary, witnesses, and neighbours. All these, together with sixty others, died within a short space of time.
Florence, situated only some 40 miles (60 kilometres) from Pisa, was one of the greatest cities in Europe, a democratic centre of culture, art and learning, its treasures including the works of Dante and Giotto.
Excerpted from Return of the Black Death by Susan Scott Christopher Duncan Excerpted by permission.
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Chapter 1: Birth of a serial killer.
Chapter 2: The Black Death crosses the Channel.
Chapter 3: After the Black Death: the French connection.
Chapter 4: Tentacles of the plague.
Chapter 5: England under siege.
Chapter 6: Portrait of an epidemic.
Chapter 7: The Great Plague of London.
Chapter 8: How bugs and germs operate.
Chapter 9: Building an identikit of the killer.
Chapter 10: Debunking history.
Chapter 11: Bubonic plague - a myth revisited.
Chapter 12: DNA analysis - a red herring.
Chapter 13: The true story of an historic village.
Chapter 14: The surprising link between AIDS and the Black Death.
Chapter 15: Assembling the jigsaw puzzle.
Chapter 16: The Black Death in hiding.
Chapter 17: Why did haemorrhagic plague suddenly disappear?
Chapter 18: The dangers of emergent diseases.
Chapter 19: The return of the Black Death?
Chapter 20: Is there something more terrible than the Black Death?