Responses to Plague in Early Modern Europe: The Implications of Public Health
Paul Slack
Abstract
Responses to Plague in Early Modern Europe:The Implications of Public Health Paul Slack (bio) 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. That is one reason why any symposium on past and present pestilences ought to consider it. Another is that these outbreaks of plague, extending over four centuries, elicited positive social responses. They stimulated deliberate defensive measures which were socially formative and profoundly controversial at the time, and which have shaped the concepts and practices of "public health" ever since. It was during epidemics of bubonic plague that the towns of late medieval and early modern Europe first developed sophisticated mechanisms intended to control the spread of epidemic disease and to mitigate its effects. Plague victims were isolated and their contacts traced and incarcerated. There were restrictions on movement, bills of health, quarantine regulations for travelers and shipping. Bedding and houses were fumigated. All this necessitated the growth of local administrative machines and an expansion of state power, the invention of "medical police" in fact. It also implied serious restrictions on individual liberty and provoked opposition for that reason, among others. Those conflicts between public and private interests and between [End Page 409] the dictates of medically informed prudence and the imperatives of popular morality, which arose in the case of later epidemics from cholera to AIDS, can first be fully documented in Europe in the age of plague. The critical nature of the phenomenon to which early modern Europeans had to respond can be summarized very briefly. 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 of the population of Europe died. Bubonic plague never again caused that level of fatality over whole countries, but it continued to levy death tolls of similar proportions in individual towns and cities. In Venice in 1347–48 and Genoa in 1656–57, 60 percent of the population is estimated to have died; half the population of Milan died in an outbreak of plague in 1630, and perhaps half the population of Padua in 1405 and of Lyons in 1628–29; the death toll reached 30 percent or more in Norwich, England, in 1579, in Venice in 1630–31, in Marseilles in 1720, and in Moscow in 1771.1 Furthermore, mortalities of this kind were achieved in a very short space of time, usually within six months, between June and December. There can be no question about the scale of the crises caused by plague. These great and sudden disasters cannot wholly account for the developed response to plague in early modern Europe, however; for there was plainly little opportunity to do more than flee from them, if one could. There are other features of plague which are equally important in shaping the social response. First, there is the fact that plague recurred again and again in the same places, over centuries. In London, for example, there were at least 17 outbreaks of plague between 1500 and the last outbreak—the so-called "Great Plague of London"—in 1665. Second, several of these epidemics were of comparatively modest dimensions; and they thus gave people an opportunity to observe the disease in operation more coolly than they could in major crises. The death rate was probably less than 12 percent in the majority of the outbreaks in London, and it is in these relatively minor [End Page 410] epidemics, in London and elsewhere, that we find most evidence of contemporaries deliberately planning administrative responses.2 Third, and finally, there were features of plague which seemed regular and predictable, as it was observed over the years, in motion across continents and countries, traveling from one place to another. No one knew precisely how it moved. The etiology and epidemiology of plague were not worked out until the end of the nineteenth century. The role of rats and fleas as carriers of the disease was not yet appreciated. There were also puzzling features in the spread of plague. It...