The Black Death

…in men and women alike it first betrayed itself by the emergence of certain tumours in the groin or the armpits, some of which grew as large as a common apple, others as an egg, some more, some less, which the common folk called gavocciolo. From the two said parts of the body this deadly gavocciolo soon began to propagate and spread itself in all directions indifferently; after which the form of the malady began to change, black spots or livid making their appearance in many cases on the arm or the thigh or elsewhere, now few and large, now minute and numerous. And as the gavocciolo had been and still was an infallible token of approaching death, such also were these spots on whomsoever they shewed themselves….^{19}

Medically the only questionable detail in this account is the reference to the bubo as an ‘infallible token of approaching death’. Other contemporary records^{20} as well as observation of subsequent epidemics show that it was by no means unheard of for the buboes to discharge and the patient recover. But certainly this happened in a very small minority of cases. To most of its victims the bubo meant inevitable death and it would not be surprising if Boccaccio had never heard of an instance to the contrary.

It was Gui de Chauliac, physician to the Papal Court at Avignon, who saw most clearly that these buboes were by no means an invariable symptom and that a distinct, still more violent variant of the plague existed.^{21} ‘The mortality… lasted seven months,’ he wrote. ‘It was of two types. The first lasted two months, with continuous fever and spitting of blood, and from this one died in three days. The second lasted for the rest of the period, also with continuous fever but with apostumes and carbuncles on the external parts, principally on the armpits and groin. From this one died in five days.’

The first form, de Chauliac had no doubt, was the more deadly. Even those doctors who failed to perceive the significance of the different symptoms, associated the coughing of blood with certain death: ‘…men suffer in their lungs and breathing and whoever have these corrupted, or even slightly attacked, cannot by any means escape nor live beyond two days.’

The question of how long the sick could be expected to survive caused much confusion to the contemporary chroniclers; confusion that could never be cleared up because of their failure to identify the second and, as we now know, the third distinct form of the plague. Most reports agreed with Boccaccio that, in those cases where there were only buboes, death was likely to come in five or six days but that, when there was coughing of blood, either by itself or as an additional symptom, the course of the disease was more rapid and the patient died within two or three days. But there were other, by no means infrequent references to the disease killing almost instantaneously or within a few hours. Geoffrey the Baker wrote^{22} of people who went peacefully to bed and were dead the next morning, while Simon of Covino described priests or doctors who ‘were seized by the plague whilst administering spiritual aid; and, often by a single touch, or a single breath of the plague-stricken, perished even before the sick person they had come to assist.’^{23}

Through almost every account breathes the revulsion as well as the fear which the plague inspired in all who encountered it. Disease rarely respects human dignity and beauty but the Black Death seemed peculiarly well equipped to degrade and humiliate its victims. Everything about it was disgusting, so that the sick became objects more of detestation than of pity: ‘…all the matter which exuded from their bodies let off an unbearable stench; sweat, excrement, spittle, breath, so foetid as to be overpowering; urine turbid, thick, black or red…’^{24}