Lawrence Wright Traces the Parallels Between the Black Death and the COVID-19 Pandemic

On 14th-Century Italy, Medieval Medicine, and the Consequences of the Plague
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Great crises summon profound social changes, for good or ill. The consequences of wars and economic depressions have been amply studied; those of pandemics, less so. I thought to look at the past through the eyes of Gianna Pomata, a retired professor at Johns Hopkins University. After retiring, Pomata returned to her hometown, the old city of Bologna. When we first spoke, on March 27, 2020, she and her husband had been locked down for 17 days. Italy was in the teeth of the contagion.

“You know Bologna, right?” she asked.

Decades ago, I was the best man at a wedding there. I recalled the giant churches, the red-tiled roofs, the marble walkways under arched porticoes; a stately city, low-slung, amber-hued, full of students and indomitable old couples. During the Middle Ages, Bologna was home to more than a hundred towers, the skyscrapers of their era, which served as showplaces of wealth and ambition for powerful oligarchs. Two of the remaining ones have become symbols of Bologna: one slightly out of plumb, the other as cockeyed as its cousin in Pisa.

“You remember the Piazza Maggiore, the very heart of the city near the two towers?” Pomata said. “That’s where I live.”

The day we spoke, confirmed cases in Italy reached 86,498, surging past China’s total. Only the United States had a higher number, having just eclipsed China the day before.

“In Italy, the streets are always crowded, night and day,” Pomata said, as we spoke on Zoom. “Our cities are medieval, made for a different way of life. Not for cars but for people. Right now, to see them empty of people is so sad.”

Pomata was 69, with brown hair and a long, open face. Her tortoiseshell glasses rested at half-mast on her nose, beneath upward-pointing, quizzical eyebrows. Since she had spent much of her adult life in the United States, her English had little accent, but she retained an Italian lilt, lingering on the broad vowels. Like me, she was beginning to show the pallor of confinement. The governor of Texas, Greg Abbott, had closed the restaurants, schools, bars, and gyms one week before; and although we hadn’t gone into full lockdown yet, Austin, where I live, was already hibernating. But what world would we wake up to?

“The Black Death really marks the end of the Middle Ages and the beginning of something else.”

When I asked Pomata to compare Covid-19 to the pandemics of the past, she pointed to the bubonic plague that struck Europe in the 14th century—“not in the number of dead but in terms of shaking up the way people think.” She explained: “The Black Death really marks the end of the Middle Ages and the beginning of something else.” That something else became the Renaissance.

I asked Pomata if she were able to walk out of her apartment 672 years ago, during the Black Death, how would Bologna appear different?

“If you try to imagine a plague-stricken city in the Middle Ages, the first thing you’d see would be dead people on the streets,” she said. “Just as we have to send the army to take coffins to crematories in other cities, as in Bergamo right now, in the Middle Ages they couldn’t cope with so many dead. The bodies just piled up on the streets.”

She paused and added, “I don’t have an idyllic vision of the Middle Ages.”

*

In the 14th century, Tatar warriors in Crimea laid siege to the Black Sea port city of Caffa, which was owned by a group of wealthy Genoese traders. Like so many armies in history, the Tatars were also fighting an unseen enemy: they carried with them a ghastly disease, which killed some victims in a few days, and left others to die in indolent agony. Before retreating from Caffa, the Tatar general, Khan Jani Beg, ordered the diseased bodies of dead warriors catapulted over the city walls, perhaps the first instance of biological warfare. Terrified citizens took to boats, navigating through the Dardanelles into the Aegean Sea and the Mediterranean. A dozen ships made it to Sicily, in October 1347. The plague traveled with them.

Sicilians were appalled to find dead men still at their oars. Other sailors, dead or barely alive, were in their bunks, riddled with foul-smelling sores. The horrified Sicilians drove the ships back to sea, but it was too late. Rats and fleas, the carriers of Yersina pestis, the bacterium that causes the plague, quickly infested the port of Messina. By January, Italy was engulfed. Incoming ships were required to sit at anchor for quaranta giorni—40 days, which is where the term “quarantine” comes from.

Medieval mortality figures are a matter of speculation, but Bologna is believed to have lost half its population in 1348; Florence, as much as three quarters. Cities all over Europe were emptied. That first outbreak, between 1347 and 1351, is estimated to have killed at least 75 million people worldwide, and maybe as many as 200 million.

“Child abandoned the father, husband the wife, wife the husband, one brother the other, one sister the other,” a contemporary chronicler, Marchionne di Coppo Stefani, observed. Deep trenches were dug in the churchyards.

“Those who were responsible for the dead carried them on their backs in the night in which they died and threw them into the ditch,” Stefani continued. The next morning, dirt was thrown on the bodies as new corpses were piled on, “layer by layer just like one puts layers of cheese in a lasagna.”

“Chroniclers of the plague describe the crumbling of the family,” Pomata said. “At the same time, human beings are creative. They react to this perceived moral decay by creating new institutions; for instance, they create boards of health, which are in charge of quarantine.”

For the first time, hospitals split up patients into specific wards, so that broken bones and wounds, say, were treated separately from diseases. There was also a rise in trade associations, to take care of medical costs and funeral expenses.

“So you can see both trends,” Pomata said. “On the one hand, the plague works as a kind of acid; on the other hand, people try to recreate ties and perhaps better ties.”

*

Italy at the beginning of the 14th century was a conglomeration of prosperous city-states that had broken free of the feudal system. Some of them, such as Venice, formed merchant republics, which became seedbeds for capitalism. Venice and other coastal cities, including Genoa, Pisa, and Amalfi, set up trading networks and established outposts throughout the Mediterranean and as far away as the Black Sea. Other Italian cities, such as Bologna, became free communes, which meant that peasants fleeing feudal estates were granted freedom once they entered the city walls. Serfs became artisans. A middle class began to form. The early 14th century was robust and ambitious. Then, suddenly, people began to die.

Bologna’s famous university, established in 1088, the oldest in the world, was a stronghold of medical teaching. “What they had we call scholastic medicine,” Pomata told me. “When we say ‘scholastic,’ we mean something that is very abstract, not concrete, not empirical.”

European scholars at the time studied a number of classical physicians—including Hippocrates, the Greek philosopher of the 5th century BC, who is considered the father of medicine, and Galen, the 2nd-century Roman who was the most influential medical figure in antiquity—but scholastic medicine was confounded with astrological notions. When the king of France sought to understand the cause of the plague, the medical faculty at the University of Paris blamed a triple conjunction of Saturn, Jupiter, and Mars in the 40th degree of Aquarius, which had occurred on March 20, 1345.

“Whether it descended on us mortals through the influence of the heavenly bodies or was sent down by God in His righteous anger to chastise us because of our wickedness, it had begun some years before in the East,” Giovanni Boccaccio wrote in the Decameron, which was completed by 1353 and is set during the plague in Florence. “At its onset, in men and women alike, certain swellings would develop in the groin or under the armpits, some of which would grow like an ordinary apple and others like an egg.” These pus-filled swellings, called buboes, were inflammations of the lymph nodes. They eventually erupted. Internal organs broke down in a bloody froth, and bodies darkened with gangrene, which is why the plague came to be called the Black Death.

“On the one hand, the plague works as a kind of acid; on the other hand, people try to recreate ties and perhaps better ties.”

Before arriving in Italy, the pestilence had already killed millions of people as it burned through China, Russia, India, Persia, Syria, and Asia Minor. It was said that there were entire territories where nobody was left alive. The source of the disease was sometimes thought to be “miasma”—air that was considered to be unhealthy, such as sea breezes. Paradoxically, there was also a folk belief that attendants who cleaned latrines were immune, which led some people to confine themselves for hours absorbing the presumed medicinal odors.

“The advice of doctors and the power of medicine appeared useless and unavailing,” Boccaccio wrote. Some people maintained that “the surest medicine for such an evil disease was to drink heavily, enjoy life’s pleasures, and go about singing and having fun, satisfying their appetites by any means available, while laughing at everything.” Others, he observed, “formed themselves into companies and lived in isolation from everyone else.”

The Decameron tells the story of ten friends who shelter in place, trading tales while the plague rampages through the city. These ribald tales give little thought to medieval notions of sacredness or piety; indeed, the society the young, sequestered people describe is hypocritical and cheerfully amoral. Priests are portrayed as stupid, lustful, greedy connivers. Illicit sex is exalted. The earthy realism of the Decameron, written in Italian vernacular rather than classical Latin verse, sounded a fanfare for the approaching Renaissance.

I asked Pomata about Italy’s economic experience after the Black Death. “It was a great time to be an artisan,” she said. “Suddenly, labor was scarce, and because of that, market wages had to go up. The bourgeoisie, the artisans, and the workers started to have a stronger voice. When you don’t have people, you have to pay them better.” The relative standing of capital and labor reversed: landed gentry were battered by plunging food prices and rising wages, while former serfs, who had been too impoverished to leave anything but a portion of land to their eldest sons, increasingly found themselves able to spread their wealth among all their children, including their daughters. Women, many of them widows, entered depopulated professions, such as weaving and brewing.

“What happens after the Black Death, it’s like a wind, fresh air coming in, the fresh air of common sense,” Pomata said. The intellectual overthrow of the medieval medical establishment was caused by doctors who set aside the classical texts and gradually turned to empirical evidence. It was the revival of medical science, which had been dismissed following the fall of ancient Rome, a thousand years earlier.

“After the Black Death, nothing was the same,” said Pomata. “What I expect now is something as dramatic is going to happen, not so much in medicine but in economy and culture. Because of danger, there’s this wonderful human response, which is to think in a new way.”

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