Doctoring the Black Death, Medieval Europe’s Medical Response to Plague by John Aberth

Abstract

Reviewed by: Doctoring the Black Death, Medieval Europe’s Medical Response to Plague by John Aberth Vivian Nutton John Aberth. Doctoring the Black Death, Medieval Europe’s Medical Response to Plague. Lanham, Md.: Rowman & Littlefield, 2021. xii + 486 pp. $39.00 (978-0-7425-5723-9). Between 1911 and 1925, the German medical historian Karl Sudhoff published or commented on some 288 treatises on plague dating from 1346 to 1500. It was a remarkable achievement, for many tracts were difficult to find in a world without the Internet. John Aberth, who is well known for his studies of the Black Death, has extended Sudhoff’s work in many ways, not least by including material in a variety of languages, including Hebrew, that his predecessor had omitted. Plague historians have now a wonderful resource in English that will answer many of the questions about what doctors thought and did when confronted with a plague. Many fled (the section on flight is one of the best in the book); others stayed behind, willingly or unwillingly, to treat and advise their fellow citizens or their patron and his family. The book is divided into four long chapters, dealing respectively with medieval accounts of causes (including the wrath of God); the signs practitioners recognized (or perhaps missed); prevention; and therapy, all clearly subdivided and provided with tables that allow one to judge easily what was typical and what was more idiosyncratic. There is a short introduction and an even shorter conclusion, allied to very brief summaries at the end of each chapter. It is exhaustively footnoted, and, where I have checked the originals, the translations are clear and accurate. Building on Fred Gibbs’s works on poisons, the author emphasizes that many doctors believed that plague was in some way poisonous, a novel approach in his view that contradicted or downgraded the belief in classical Galenic humoral medicine.1 The notion that the infective agent worked like poison through what later became known as an occult or invisible cause (the make-up of its total substance) was, it is suggested, more empirical than what had gone before and gave little place for an individual’s humoral balance. This may be unfair to Galen, who certainly understood the importance of observation and empirical testing when dealing with many drugs, although he said little about epidemic disease in his surviving works, despite his experiences in several “plagues.” The Arabs had also developed his ideas on the potency of substances, as learned medieval physicians well knew. The author often comments on what to him are incompatible explanations or practices, but the doctrine of humors was still significant in thinking about prevention and cure. As the author explains briefly, there was a general belief in a hierarchy of causes, ranging from the wrath of God; the position of the stars and [End Page 157] planets; to air and its possible constituents, including poison; and finally to an individual’s humoral imbalance. Bleeding, which corrected the mixture of humors transported in blood, was thought to restore any imbalance as well as remove poisonous substances. What a doctor considered the most significant cause was an open choice, not necessarily identical to that of his patients or civic authorities. Within its limits as a careful description of these pest tracts, this is an excellent piece of work, but many wider questions go unanswered. Some of these tracts were written ostensibly for a private patron, others to warn or inform the community as a whole. But it is not clear how most were produced or circulated or how some appear to have gained greater authority than others. How this information was produced and transmitted in manuscript may differ from what came after 1470 (one of the reasons why very few authors later than 1450 are discussed here). Even a brief glance at the early printed plague tracts would have helped to estimate the significance of an academic author like Gentile da Foligno over that of a local author like Heinrich Lamme of Lübeck. Although comparisons are made with later bacteriology and particularly with plague outbreaks in the early twentieth century, an opportunity is missed to investigate Fracastoro’s dependence on his...