Between the Black Death of the fourteenth century and the great epidemics in Marseilles and Moscow in the eighteenth century, bubonic plague was responsible for a succession of the greatest epidemic disasters in recorded history. It was during epidemics of bubonic plague that the towns of late medieval and early modern Europe first developed responses to control the spread of epidemic disease and mitigate its effects. I will begin by looking at the early European societal response to plague and then discuss the measures implemented by governments once they had decided to intervene.
Early Responses to Plague
The mortality levels reached during outbreaks of plague were unparalleled. During the Black Death itself, between 1347 and 1351, it is estimated that something like a third to two thirds of the population of Europe died. The recurrence of plague accounted for the developed response by governments in early modern Europe.
In early Christian Europe, plagues were thought of as a divine scourge, a retribution for the sins of mankind. Repentance and prayer were therefore universally regarded as the proper and first recourse against an epidemic of plague, and these were demonstrated publicly as well as privately. The second option, often the most popular choice, was simply to flee. If divine providence was the first cause, however, it worked its purposes through secondary natural causes. The natural causes of plague were many, from disorders in the heavens to earthquakes and buried corpses, but they all produced “miasma”, the bad air of an infected place. This was deemed to be the immediate cause of the disease. This miasma could be attacked by fumigants and even by setting off guns or lighting bonfires in the street, as they did in London in the 16th and 17th centuries.
The plague-ridden nations of Europe were gloomy parts of the world. Pessimism marked the art of the period and the recurrence of the danse macabre in texts and in painting and sculpture was innately tied to plague outbreaks. During the Black Death, bands of flagellants wandered over much of Europe and the Jews were once again targeted and attacked as the cause of the disaster. In this early period, however, the two most pedestrian responses were firstly: flight from infected towns. This was recommended by most medical writers at the time as the only sure preservative; secondly, a ruthless preservation of the self even if that meant cruelty to others. Servants, for example, were turned out by their masters if they caught plague. Neighbours sometimes refused to offer charitable help to neighbours and some of the infected were denied a decent burial and had to be interred in their own gardens.
The first reaction of civic governments to outbreaks of plague at home was a studied refusal to contemplate them or at least a denial of their existence for as long as possible. This was as much a matter of policy as of wishful thinking. Public acknowledgement of an epidemic meant the spontaneous flight of the richer inhabitants and immediate damage to commerce. In the end, however, governments had to acknowledge an outbreak and several actions were subsequently taken.
Improvement of Public Hygiene
European city and state interventions to improve public hygiene began to take effect once governments had linked hygiene to plague. This mainly included a limit on the breeding of animals in homes, requiring city residents to install cesspools and to store rubbish in receptacles and dispose it in an orderly manner. These initiatives were not as radical as they might first appear since the previous method of disposing rubbish was to simply throw it out of the window, and without regard for any passers-by.
Charity and Poor Laws
City councils in European cities began to take over the duty of handling charity from the church. This was less to do with sharing the burden of helping the poor than it was an opportunity to wrestle even more power away from the declining institution of the church. Plague had hit members of the clergy far harder than the rest of the population due to a variety of factors. Mortality rates among monks, nuns and collegiate chapters was almost 60 per cent higher than the general population. As a result, various changes in the recruitment of church personnel led to an erosion of the church’s power, which governments were quick to exploit.
Once the sole domain of the church, the dispensation of charitable services by secular agents, through civic organisations, strengthened the bargaining power of governments when it came to controlling the infected. An infected city would soon find itself ostracised and was granted help from outside only on condition that it maintained itself in isolation. In the seventeenth century, the magistrates of English counties arranged the provision of food for infected towns, provided that no one wandered out of them.
The infected and their families had to be supported, if poor, from public funds. The poor, however, were generally seen as an impediment to modern, clean cities. As a result, cities began issuing anti-begging regulations and introduced criteria that distinguished between “deserving” poor, who qualified for assistance, and “undeserving” who were forced to work, fined, imprisoned, or expelled from the city. An elaborate charity system run by the church had sustained its authority over many of its followers, who were dependent on the congregation for assistance. The wresting of much of that authority from its hands through a series of laws and regulations regarding poverty, beggars, and the sick further weakened the church. As a result, many deserving poor and sick, who once would have found unreserved assistance from the church, were left abandoned by the state whose administrative procedures for means testing the poor and the sick were less than non-discriminatory and infallible.
Hospitals and Public Health
A related development was the change in the nature of hospitals, from houses caring unselectively for the poor and sick, managed by the church and run by a priest and bishop, to institutions run by civic officials under city regulations. By the mid-sixteenth century, many cities and states had Poor Laws that governed the administration and funding of hospitals and defined who would be entitled, or forced, to receive treatment in them. The poor and sick regulations had already weakened the role of the church and led to further control of the population by governments. Civic authorities in the Medieval world turned hospitals into institutions for the involuntary confinement of the poor who refused to work or leave town, the sick, and prostitutes. Boards of health in countries like Italy used a model whereby the sick were isolated in pesthouses and their contacts in other places of isolation. The empty houses would then be completely cleansed and fumigated. These anonymous plague hospitals were primarily utilised to house the poor after removing them away from the public gaze since the rich were permitted to stay with their servants and domestic comforts at home.
Quarantine Stations at Ports
Quarantine as a method of preventing the spread of disease was first formulated by Ibn Sina in the 11th century. It became in vogue across Europe in the beginning of the 15th century as a means of controlling plague. Quarantine stations at ports enabled the monitoring of suspect ships and possibly infected goods. The failure of such measures in Marseilles in 1720 led to the great epidemic there. The control of shipping through this method was thus not entirely successful in limiting the spread of plague.
Quarantine of Individuals
The spread of plague gave European governments the justification to increase state power not only in the area of commerce and international trade but also in relation to individual rights. Infected houses were identified and contact with their inmates prevented, either by removing the sick to special hospitals (pesthouses or lazarettos) or by sealing the houses with the inhabitants still inside them for a fixed period, sometimes a month, sometimes a full quarantine of forty days.
Ban on Movement of Goods and People
Although bans on the movement of goods and people began in 1348, it was only in the 18th century that cordons sanitaire around plague-stricken cities became common. These were often maintained by military force. During 1720-22 when the disease threatened London from Marseilles, the government drew up plans that if plague arrived, they would move the infected by force to pesthouses and station troops around London, shooting anyone who escaped. There was a vast public outcry and the plans were eventually withdrawn. This mindset, together with experience on the ground at home, was to serve the British well when engaging with the rebellious citizens of the nations they were to conquer in their imperial heyday.
Ban on Assembly and Public Gathering
Governments began to place limitations on public assembly which was also conveniently useful in quelling political opposition to the expansion of state power and the restrictions on individual liberty. Popular games and festivities were often banned; children were prevented from playing in the streets; in some countries such as Italy, there was sometimes a “general quarantine” of all who could be prevented from moving outside, especially children: they were confined to their houses. Attendances at funerals was commonly limited to a few close relatives of the deceased and efforts were made in some places to stop religious processions because of the danger of contagion.
Deeming plague to be caused by poisonous vapours, cities began to prohibit burial in churchyards and established extramural cemeteries instead. By the late sixteenth century, burial outside city limits was the norm in many European towns.
Broader Question of Social Control
“There is no doubt that plague regulations were designed as more than instrumental measures against contagion. They were methods of social control.” (Paul Slack, Responses to Plague in Early Modern Europe: The Implications of Public Health). In Florence, they were developed at the same time as a campaign against beggars and prostitutes. In Venice, they were formulated as part of a reaction against all the diseases of the poor which seemed to threaten civic health and, in particular, the health of the wealthy and privileged. In England, they moved hand in hand with the Poor Law and exhibited the same concerns: anyone wandering out of an infected house could be whipped as a vagrant; if he had a plague sore on him, he could be hanged as a felon. The plague-infected poor were to be controlled and, if necessary, punished in the interest of both public health and of public order. This had the effect of intertwining the fear of the poor with the fear of the plague.
The danger of contagion was used to justify the new social policies of sixteenth-century municipalities. In the sixteenth century, towns were larger, the virulence of plagues less severe, and its concentration in slums and suburbs became even more pronounced. As a result, plague regulations were most clearly and most strictly formulated when the socially discriminatory incidence of the disease became conspicuous. Some governments took this further than others. It is noteworthy, for example, that the English practice of total household incarceration was more ruthless than parallel procedures in the Netherlands. There, the inmates of infected households were at least allowed visits from clergymen or specially appointed “comforters,” and they were incarcerated only during the day, being allowed out at night.
The European battle against the plague was as much about civic rulers and patrician elites employing and enhancing state authority to control the threat from below as it was about controlling contagion. The measures taken to deal with plagues were not infallible especially given the limitations of medical knowledge at the time and the idea that contagion was largely a problem emanating from the poor. Some of these measures were in fact counterproductive but remained in place largely because they gave governments the justification to expand state power and control over their populations. Many of these measures are still in use today for dealing with endemics and pandemics.
Charles Creighton, History of Epidemics in Britain
David Herlihy, The Black Death and the Transformation of the West
R. S. Gottfried, The Black Death
William McNeill, Plagues and Peoples
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