The Black Death

Bleeding was an even more important part of the cure than it had been of prevention. The blood that emerged from the infected would normally be thick and black; it boded even worse for the victim if a thin green scum rose to the surface. If the patient fainted, instructed Ibn Khātimah somewhat heartlessly, pour cold water over him and continue as before. Most surgeons bled for the sake of bleeding, not worrying much where the incision was made. John of Burgundy^{137} was more scientific. He believed in the existence of emunctories, from which the poison could be expelled by bleeding. The evil vapours, having entered by the pores of the skin, were carried by the blood either to the heart, the liver or the brain. ‘Thus, when the heart is attacked, we may be sure that the poison will fly to the emunctory of the heart, which is the armpit. But if it finds no outlet there it is driven to seek the liver, which again sends it to its own emunctory in the groin. If thwarted there, the poison will next seek the brain, when it will be driven either under the ears or to the throat.’ Each emunctory had a surface vein which corresponded to it and a skilled surgeon could there intercept the poison on its devil’s progress around the body and draw it off before it did more mischief. A common and disastrous mistake was to make the incision on the wrong side of the body; this not only wasted good blood but meant that healthy limbs were corrupted by the degraded liquid which poured in to make up the loss.

As well as bleeding, it was useful to open and cauterize the plague boils or buboes. Various curious substances were applied to the boils to draw off the poison. Gentile used a plaster made from gum resin, the roots of white lilies and dried human excrement, while Master Albert was in favour of an old cock cut through the back. Ibn Khātimah believed that an operation on the bubo was possible between the fourth and seventh day of the disease when the poison was flowing from the heart to the boils. But even a slight mistake in timing could lead to the escape of the vital principle from the heart and the immediate death of the patient.

Various soothing potions were prescribed, in particular a blend of apple-syrup, lemon, rose-water and peppermint. This must at least have been pleasant to drink. Even this consolation was removed when powdered minerals were added to the mixture. There was some belief in the virtues of emeralds and pearls and the medicinal qualities of gold were taken for granted by most authorities. Take one ounce of best gold – was Gentile’s recipe – add eleven ounces of quicksilver, dissolve by slow heat, let the quicksilver escape, add forty-seven ounces of water of borage, keep airtight for three days over a fire and drink until cure or, more probably, death supervened. At least the high price of gold ensured that not many invalids could afford to be poisoned by such medicines.

Just how little the doctors learned from the Black Death is shown by the Tractate of John of Burgundy or John à la Barbe, published in 1365.^{138} It is true that the author had gained much of his experience and no doubt devised his treatments in 1348 and 1349 but he had lived through a second great epidemic in 1361 and, at the time he wrote, was distilling what should have been a lifetime’s learning. The same sterile analysis of causes appeared, the same catalogue of futile preventive methods and still more futile cures. Given the state of medical learning no great leap forward was possible but if Hippocrates had been alive he would at least have discarded a lot of dead wood of proven uselessness and made some sensible and valuable deductions about the conditions in which the epidemic seemed to thrive and the best means of removing them. Of this there was nothing; only the regurgitation of long discredited dogmas and, from time to time, the addition of some new mineral or vegetable gimmick to give the technique of the writer a flavour of modernity.

I pray to God, so save thy gentil cors
And eek thyne urynals and thy jurdones,
Thyn ypocras and eek thy galiones.
And every boyste ful of thy letuarie.[2]