The Pursuit of Glory, page 9
God took our little girl the day after her mother’s death. She was like an angel, with a doll’s face, comely, cheerful, pacific, and quiet, who made everyone who knew her fall in love with her. And afterwards, within fifteen days, God took our older boy, who already worked and was a good sailor and who was to be my support when I grew older, but this was not up to me but to God who chose to take them all. God knows why He does what He does, He knows what is best for us. His will be done. Thus in less than a month there died my wife, our two older sons, and our little daughter. And I remained with four-year-old Gabrielo, who of them all had the most difficult character.
In Barcelona, as elsewhere, the outbreak of plague led to a breakdown of social order, as the healthy struggled to get out of the city while the going was good, the wealthy sought to buy their way out of quarantine restrictions, and the criminals took advantage of the collapse of law and order. For the survivors everywhere, the rewards could be great, as the acceleration of inheritances concentrated property ownership. The greatest beneficiary of all was the Church–indeed it could not lose, for it was the recipient of benefactions inspired both by hope during the outbreak and by gratitude after it. Catholic Europe is still covered with architectural evidence of this confidence in the power of the Almighty to ward off disease, in the shape of chapels, statues and various votive offerings to the ‘plague saints’ St Rochus (also the patron saint of dogs and dog-lovers) and St Sebastian (also the patron saint of archers). Even if the plague did strike, eventually it would go away, thus confirming God’s infinite mercy. Grandest of all these monuments is surely Santa Maria della Salute, the great baroque church built at the entrance of the Grand Canal in Venice to celebrate the end of the great plague of 1631–2. Visually the most exuberant is the Plague Column erected on the Graben in Vienna by the Emperor Leopold I following the plague of 1679.
The most popular explanation for a visitation of the plague was divine wrath; consequently the most popular prophylactic was propitiation. At Marseilles in 1720, Archbishop Belsunce took the lead, dedicating his fellow citizens to the cult of the Sacred Heart and leading penitential processions. In Barcelona, Miquel Parets recorded:
There are no words to describe the prayers and processions carried out in Barcelona, and the crowds of penitents and young girls with crosses who marched through the city saying their devotions. The streets were constantly full of people, many greatly devout and carrying candles and crying out ‘Lord God, have mercy!’ It would have softened the heart of anyone to see so many people gathered together and so many little girls, all of them barefoot. To see so many processions of clergy and monks and nuns carrying so many crosses and so many rogations that there was not a single church nor monastery which did not carry out processions both inside and outside their buildings.
It was to no avail, and Parets was obliged to add, ‘but Our Lord was so angered by our sins that the more processions were carried out the more the plague spread’.
Two other techniques were employed to avert or arrest the plague. Least effective were the various magical and herbal remedies employed, such as the fumigation with juniper ordered by Peter the Great during the wave of plagues which attacked Russia between 1709 and 1713. If juniper were not available, he decreed that horse manure was to be used, ‘or something else which smells bad, as smoke is very effective against these diseases’. However, most public authorities did understand enough of the epidemics to appreciate the need for isolating the outbreaks and their victims. Most Italian cities, for example, boasted a public health authority or sanità, ready to go into action at the first sign of illness, excluding or quarantining travellers from infected regions, sealing off the houses of the afflicted, establishing pest-houses, disposing of corpses, and so on. Alas, there proved to be too many ways round the regulations: the infected fled, the sick were concealed, soiled garments were not burnt but used again, and plague-controllers were bribed. The need to import provisions meant that no city could be isolated entirely from the outside world, while municipal prohibitions of public gatherings were often overruled by the clergy’s penitential processions.
Yet the period 1648–1815 did see, first the retreat, and then the virtual disappearance of the plague from Europe: England was afflicted for the last time in 1665, central Europe in 1710, France in 1720–21, the Ukraine in 1737, southern Europe in 1743 and Russia in 1789–91. Numerous explanations have been advanced. It is possible that the black rat (Rattus rattus), which liked to live cheek-by-jowl with humankind, was replaced by the brown rat (Rattus norvegicus), which was less sociable. It is also possible that all rats developed a higher degree of immunity to the plague bacillus, so the fleas had less need to abandon them for human hosts. The increasing use of stone for dwellings, as opposed to wood, wattle and daub, probably created a less welcoming environment for rodents of all kinds. Another hypothesis speculates that the bacillus itself naturally transmuted into a less virulent form. The American scholar James Riley has argued that what he calls ‘the medicine of avoidance and prevention’ made an important contribution to the decline of all infectious diseases, singling out for special mention improved drainage, lavation, ventilation, interment, fumigation and refuse burial, the relocation of refuse-producing industries and waste sites, and cleaner wells. More effective quarantine regulations were also adopted by a number of European states. The most important was the Habsburg Monarchy which, following the reconquest of Hungary from the Ottoman Turks, issued strict regulations to keep out plague carriers. The long frontier which straggled for 1,200 miles (1,900 km) across the Balkan peninsula, from the Adriatic to the Carpathians, was turned into a great cordon sanitaire. The quarantine period for anyone wishing to cross the frontier from the east was twenty-one days in plague-free times, forty-two days if an outbreak was rumoured and eight-four days if the rumour was confirmed. Guards were under orders to shoot to kill anyone trying to evade the restrictions. Equally tough action was taken by the French government to confine the 1720 outbreak to Provence.
None of these possibilities can be a sufficient cause for the decline in the incidence and severity of plague. Nor can that decline be a sufficient cause for the increase in Europe’s population. In one of those tricks of which malevolent nature is so fond, just as plague was waning, other diseases were waxing. Influenza, typhoid fever, typhus, dysentery, infantile diarrhœa, scarlet fever, measles and diphtheria all played their part in keeping the mortality rate up. The great killer of the eighteenth century was smallpox, an air-borne virus which enters the human body through the mouth or nose, then multiplies in the internal organs, causing high fever and a rash which turns into blisters and then pustules. The lucky escape with pock-marked skin, caused when the pustules dry; the less fortunate will be made blind, deaf or lame (or any two of three); about 15 per cent will die. On occasions, the mortality rate could be much higher: between 1703 and 1707, for example, Iceland lost 18,000 of its original population of 50,000. In Dublin between 1661 and 1745 20 per cent of reported deaths were ascribed to smallpox. James Jurin, secretary of the Royal Society of London, estimated that smallpox had killed a fourteenth of London’s population between 1680 and 1743. At Lodève in Languedoc outbreaks in 1726 and 1751 increased the death rate by almost 200 per cent.
Among the high-profile casualties in this period were the Elector Johann Georg IV of Saxony, who was infected when he insisted on kissing his dying mistress good-bye; the Emperor Joseph I, whose untimely death in 1711 at the age of thirty-two gave a decisive twist to the War of the Spanish Succession; Louis XV, who was rumoured to have caught the disease from the pubescent peasant-girl he had raped; and the Elector Maximilian Joseph of Bavaria, whose untimely death in 1777 precipitated the War of the Bavarian Succession. As these examples demonstrate, smallpox was impeccably democratic, decimating the palace as well as the hovel. If less destructive than the plague, it was more ubiquitous. In Candide, Voltaire wrote that if two armies of 30,000 each met in battle, two-thirds of the combatants would be pock-marked. The position and severity of the scars were used as a means of identifying criminals and, significantly, it was thought worthy of comment if they were not marked. The figure usually given for total European deaths per annum from smallpox in the eighteenth century is 400,000, although this must be a very rough guess indeed. In 1800 in the German principalities of Ansbach-Bayreuth it was recorded that 4,509 people had died from smallpox, or about 1 per cent of the total population. As an ever-present memento mori, it also caught the attention of the poets like Lady Mary Wortley Montagu, who contracted the disease in 1715 at the age of twenty-six. She survived the ordeal but at the expense of her beauty, as she recorded the following year:
How am I changed! alas! how am I grown
A frightful spectre, to myself unknown!
Where’s my complexion? where the radiant bloom,
That promised happiness for years to come?
Then, with what pleasure I this face surveyed!
To look once more, my visits oft delayed!
Charmed with the view, a fresher red would rise,
And a new life shot sparkling from my eyes!
Ah! faithless glass, my wonted bloom restore!
Alas! I rave, that bloom is now no more!
MEDICINE
Yet in this case it really was darkest before dawn. It was as a pock-marked spectre that Lady Mary travelled to Constantinople with her husband, the British consul in the city. There she found that Turkish peasant women had found a way of preventing the disease through a form of inoculation. As she explained in a letter to a friend in 1717:
Apropos of distempers, I am going to tell you a thing that will make you wish yourself here. The smallpox, so fatal and so general among us, is here entirely harmless by the invention of engrafting, which is the term they give it. There is a set of old women who make it their business to perform the operation every autumn in the month of September when the great heat is abated…They make parties for the purpose…the old woman comes with a nutshell full of the matter of the best sort of smallpox, and asks what veins you please to have open’d. She immediately rips open that you offer to her, with a large needle (which gives you no more pain than a common scratch), and puts into the vein as much matter as can lie upon the head of her needle, and after that, binds up the little wound with a hollow bit of shell, and in this manner opens four or five veins.
These enterprising ladies were exploiting what was common knowledge everywhere–that a mild form of smallpox granted immunity for life. The technique may have been known already in western Europe too, but it was certainly Lady Mary’s proselytizing that led to its popularization. Although she could not set a personal example herself, as she already enjoyed immunity, she did the next best thing by having her five-year-old daughter inoculated when she returned to England in 1721. Her example was quickly followed by the Prince of Wales, who had both his daughters inoculated. Other social leaders to set examples included the duc d’Orléans, Frederick the Great of Prussia, the Empress Maria Theresa, the King of Denmark and Catherine the Great of Russia. It proved to be uphill work, not least because inoculation was not without its dangers. There was another major outbreak in London in 1752, when 17 per cent of all deaths were attributed to the disease. This concentrated the minds of potential victims everywhere, with the result that there was a rapid increase in the rate of inoculation during the second half of the century. Members of the Sutton family, who toured rural areas offering the treatment, claimed to have inoculated 400,000 in the thirty years after 1750. The dramatic effect inoculation could have on mortality rates is shown by a number of local studies which demonstrate that by the end of the eighteenth century, inoculation had spread down from monarchs to the common people.
A second breakthrough came at the very end of the century when an English country doctor, Edward Jenner, discovered the much safer and less elaborate technique of vaccination. He had noticed that infection with cowpox, a disease that is relatively benign when contracted by humans, granted immunity against smallpox. In 1796 he inoculated an eight-year-old boy with pus taken from the pustule of a milkmaid infected with cowpox. The boy suffered nothing worse than a mild fever, but when inoculated a short time later with the smallpox virus he proved to be immune and experienced no ill effects whatsoever. This discovery was publicized by Jenner in An Inquiry into the Causes and Effects of the Variolae Vaccinae, published in 1798. By 1801 it had gone through two more editions and the technique was well on its way to gaining universal acceptance. It was made compulsory in a number of continental countries: in Sweden, for example, where deaths from smallpox per 100,000 fell from 278 in the late 1770s to 15 in the 1810s. In Bavaria, where the King set a personal example and then made it compulsory in 1807, total deaths from the disease fell from c. 7,500 per annum to 150 and then to zero by 1810. Napoleon had his entire army vaccinated. When Jenner wrote to him to ask for the liberation of a British prisoner of war, Napoleon is reported to have replied: ‘Anything Jenner wants shall be granted. He has been my most faithful servant in the European campaigns.’
Smallpox was not eradicated from the world until 1977, according to the World Health Organization, but it had ceased to be a serious killer in Europe by 1815. Its virtual eradication was a rare example of an unequivocal success story for medicine in this period. It also provides a good example of how folk-remedies (the Turkish peasant women’s ‘smallpox parties’) could combine with scientific observation and experimentation (Jenner’s vaccination) to produce real improvements in public health and reduce mortality. Much more typical of early modern attitudes were the other treatments used to combat smallpox. They were based on the Hippocratic-Galenic tradition which still dominated western medicine despite–or Perhaps because of–the antiquity of its eponymous founders (Hippocrates had lived 450–370 BC and Galen of Pergamum AD 129–200). At its heart lay the belief that human health was determined by the interrelationship between four ‘humours’ in the body. These were blood (hot and wet), black bile (cold and dry), yellow or red bile (hot and dry) and phlegm (cold and wet). According to time of life or time of year, any one of these humours could become predominant, with adverse effects. Too much black bile led to melancholy, too much phlegm led to torpor, too much red bile led to belligerence, and so on. The task of the physician was to restore the desired balance by draining off any excess.
So the preferred treatment of early modern medicine took the form of laxatives, emetics, dehydration and phlebotomy, to encourage purging, vomiting, sweating and bleeding respectively. As Edward Topsell defined the objective in the early seventeenth century: ‘the emptiyng or voiding of superfluous humors, annoying the body with their evill quality’. That is why so much literature of the seventeenth and eighteenth centuries refers to the arrival of the barber-surgeon with his bleeding-cups and leeches as soon as illness struck. Indeed, the physician was often referred to as a ‘leechman’ who charged a ‘leech-fee’ and worked at a ‘leech-house’ (hospital). For the smallpox victim, it need hardly be said, none of these treatments did any good whatsoever, on the contrary. Nor did such exotic remedies as the ‘red cure’, which required the patient to dress in red clothes, sleep in a bed surrounded by red drapes and drink red-coloured fluids. Yet such was the authority of humoralism that its precepts were accepted by most without question. Samuel Pepys had himself bled when he thought he was ‘exceedingly full of blood’ and believed that it would improve his failing eyesight. Rare indeed was the strong-minded individual such as the Princess Palatine, of whom Madame de Sévigné recorded when she first arrived at Versailles in 1670: ‘she has no use for doctors and even less of medicines…When her doctor was presented to her, she said that she did not need him, that she had never been purged or bled, and that when she is not feeling well she goes for a walk and cures herself by exercise.’
There was no lack of medical services on offer in the early modern period, indeed there was an embarrassment of riches. For most patients, the first port of call was the household’s fund of accumulated wisdom, supported by herbal remedies and magical invocation. If a member of the family was literate, one of the many printed manuals, such as Samuel Tissot’s Avis au peuple sur la santé (1761) or William Buchan’s Domestic Medicine (1769) could be consulted. Resort could also be had to the local wisewoman or wiseman, the village priest, the blacksmith (if bones needed setting) or even the lady of the manor. A community might be lucky enough to have in its midst an individual with special powers, such as the seventh son of a seventh son, or a natural healer identified by being ‘born with the caul’ (i.e. with a piece of the placenta sticking to his head). There were plenty of travelling salesmen and quack doctors roaming the country, peddling patent medicines in the style of Dr Dulcamara of Donizetti’s L’Elisir d’amore. And there were also, of course, the official men of medicine–the physicians, the barber-surgeons and the apothecaries. There was no need to confine oneself to just one of these sources of medical advice and probably most sick people sought a second or third opinion.
Any temptation to divide these various resources into the scientific and the superstitious should be resisted. The former often did more harm than good, the latter often did more good than harm. A striking example of the shadowy relationship between the two was provided by the discovery of the cardiotonic properties of the foxglove plant by the Shropshire physician William Withering in 1775. Unable to help one of his patients with a serious heart condition, he was suitably embarrassed when the patient obtained a herbal tea from a gypsy-woman and promptly recovered. Withering systematically tested each of the brew’s twenty-odd ingredients until he had isolated foxglove as the benefactor. The digitalis purpurea the plant produces increases the intensity of the heart muscle contractions while reducing the heart rate, and can also be used to treat dropsy. After extensive trials on animals and human patients, Withering published in 1785 An Account of the Foxglove and Some of its Medical Uses etc; With Practical Remarks on Dropsy and Other Diseases which advertised its curative properties to the world. It has been used ever since. There were several other ‘folk-remedies’ which turned out to be based on sound science, such as willow-bark tea, which contained salicylates, the active ingredient in aspirin, or ‘Jesuit bark’, the bark of the cinchona tree which contains quinine. There was plenty to be said for preferring the practical experience of the wisewoman to the book-learning of the quack. Thomas Hobbes observed: ‘I would rather have the advice or take physick from an experienced old woman that had been at many sick people’s bedsides, than from the learnedst but unexperienced physician.’
