Tuesday, 12 August 2014

A distant mirror of Ebola

The current outbreak of Ebola reminds me of Barbara Tuchman’s account of the 14th Century great pestilence in “A Distant Mirror” (MacMillan 1979). Like Ebola it was highly lethal, untreatable and transmitted by bodily fluids. Although it was not realized at the time, bubonic plague was initially transmitted by rats and fleas, and later it infected the lungs of human victims and spread even faster by respiratory infection, and so became almost impossible to contain in centres of population: an aerosol turbo-charged Ebola, in fact.

Here is Tuchman’s description (page 108) of how some Medieval European towns responded to the plague, which had death rates of approaching 70% in urban centres, and an overall death rate estimated at about 30% in Europe as a whole.

Stern measures of quarantine were ordered by many cities. As soon as Pisa and Lucca were afflicted, their neighbour Pistoia forbade any of its citizens who might be visiting or doing business in the stricken cities to return home, and likewise forbade the importation of wool and linen. The Doge and Council of Venice ordered the burial on the islands to a depth of at least five feet and organised a barge service to transport the corpses. Poland established a quarantine at its frontiers which succeeded in giving it relative immunity. Draconian measures were adopted by the despot of Milan, Archbishop Giovanni Visconti, head of the most uninhibited ruling family of the 14th century. He ordered that the first three houses in which the plague was discovered were to be walled up with their inhabitants inside, enclosing the well, the sick, and the dead in a common tomb. Whether or not owing to his promptitude, Milan escaped lightly in the roll of the dead.

Frankly, given that in 1347 Europeans had no idea how any disease was transmitted, let alone bubonic plague, prompt disposal of corpses and quarantine worked pretty well. Some Medieval Europeans worked out the basics of the pestilence from sharp observation, and then implemented the necessary preventive steps without hesitation or deviation. The towns that did so survived better.

We need to be careful in our comparisons: Europe as a whole suffered greatly, and could have done much better if the vectors of the plague had been understood. From our perspective, they lacked enlightenment. What is most significant is that even in relative ignorance and in the midst of “the end of the world” when all were dying around them, some Medieval Europeans were able to organise themselves to outwit a profound threat they had never encountered before. Clever move. It was not their expert culture, since officialdom had concluded that the cause lay in an unfavourable conjunction of planets. No help there. Rather, it was about making reasonable real world inferences, having a clear plan and then putting it into action.

Surely anyone ought to be able to do that, faced with a less transmissible plague and having far greater knowledge in 2014 ?

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