Cultures of Plague: Medical Thinking at the End of the Renaissance

It is claimed that the first form of popular literature in the West was the "plague tract", a vernacular genre arising out of the Black Death of 1348, and remaining, so historians have assumed, largely unchanged in content until the 17th century or even later. In a book of marvellous detail and range, Samuel K.Cohn challenges this view, arguing that "such writing was hardly static over the 500 years of the plague, or over the 16th century; rather, it evolved as did the plague itself".

Cohn's book, therefore, is not just about detecting literary variation, but variation in the symptoms or epidemiological traits of the plague itself, regardless of its agent. But as his comment above shows, he is not engaged in a pan-European, five-century survey, but rather slices out the 16th century, specifically in Italy, and especially across the plague years of 1574-78. Nevertheless, his range within this bracket is superb, extending from discussions of town planning to analyses of poetic reactions to plague.

One of his most successful discussions is of Giovanni Filippo Ingrassia's Sicilian plague tract of 1576. Ingrassia commenced his work with the usual noises about God's wrath, and discussed other conventional topics such as symptoms and preventive measures. But he also broke new territory in describing the administration of the sick, setting down rules to be adopted by the duke and the city's health board, and detailing the design and organisation of hospitals and lazar houses, the principles of civic hygiene, quarantine, regulation of butchers and disciplinary countermeasures, such as suitably theatrical execution for thieves of infected goods. In short, he was treating plague as a civic rather than a personal matter, and by introducing these considerations into his writing, he was implicitly claiming that medicine was a social science, and that the physician had a public and even political role to play.

It is no coincidence, as Cohn elsewhere shows, that poetry on the plague was transformed in the period from a genre of lamentation to one of civic celebration, offering "liberation of the city" narratives in which the virtues of community and communal effort were praised. Cohn also offers a way of relating this to the Counter-Reformation: far from plague weakening the hold of the Church on the state, he argues, the behaviour of pious clergy such as Cardinal Borromeo - who processed barefooted through the streets of Milan, with bleeding feet, a hood, a rope round his neck and 1,000 flagellants following him - bound the Church ever closer to civic interest and civic virtue.

The strength and subtlety of this book flow in part from Cohn's documentary control. Drawing from more than 50 libraries or archives in over 30 cities, his minute focus generates surprising, even revolutionary conclusions.

The major surprise here is that the Milanese records of the health board physicians of 1452-1523 suggest that the plague they observed and suffered was not, as is always assumed, the Yersinia pestis discovered in 1894. Whatever it was that happened in 16th-century Italy, it does not look the same as the documented plagues of India and China during the late 19th and 20th centuries.

Cohn's conclusions, then, are twofold. First, 16th-century plague in Italy encouraged physicians to redefine their role in society in terms of public health directives, rather than the one-to-one doctor-patient relationship. Second, observers of plague were increasingly trying to understand the phenomenon by tracking its contagion and its progress, rather than treating it as a static entity. We tend to trace clinical developments to the later 17th century, and epidemiological focus to the 19th century. Perhaps it was all happening much earlier.