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  • Black Death: A New History of the Bubonic Plagues of London by Stephen Porter

    Plague has been the greatest scourge of mankind in recorded history. The plague bacillus has been identified in skeletons in Eastern Europe and the Balkans dating from the late Neolithic period and the Bronze Age, perhaps carried by migrations from the Russian and Ukrainian steppes around 4,800 years ago. Since then there have been three pandemics, which have killed millions of people, and the disease still claims roughly a thousand victims a year. The first outbreak began in the mid-sixth century in Ethiopia and reached Constantinople in 541, during the reign of the emperor Justinian. It had subsided by the mid-eighth century and Europe did not suffer from further eruptions of plague until the onset of the Black Death in the 1340s. Its arrival in the Mediterranean world was attributed to a siege by the troops of Janibeg, the Khan of the Golden Horde, of the port town of Kaffa (now Foedosiya) on the Black Sea in 1345-6. From there it spread to Europe, the Middle East and North Africa, reaching Iceland and Greenland. In response to a request from the Pope an estimate of the number of victims was made which put the death-toll at 23,840,000, or roughly one-third of Europe’s population. That cannot be taken as at all accurate, but gives some indication of the scale of the catastrophe and the fear which it produced, for who could hope to survive when a virulent disease was striking down so many?

    A sick patient with his attendants, 1460; a devil which has knocked over the table in the foreground indicates that all is not going well. (Author's Collection, Black Death, Amberley Publishing)

    The nature and symptoms of the plague generated horror and dismay. Victims complained of headaches, quickly followed by a fever and vomiting, with painful blotches developing that were caused by haemorrhaging beneath the skin and buboes forming on the lymph nodes in the groin and armpits, and on the neck. As the buboes grew, so did the pain, which was so excruciating that some victims became uncontrollable and delirious, screaming and running wildly around the streets, and their speech became impaired. Foul smells emanated from the sick, repelling those caring for them, and the affliction produced such fear and revulsion that the sufferers were left unattended. The social structure threatened to disintegrate as the rich fled and many who remained gave themselves up to riotously wild living. Those who were prepared to stay and nurse the sick or bury the bodies were accused of doing so to rob the victims and loot their houses. One complaint that was made was that the clothing ‘of those who were once noble are now divided as spoil . . . among grooms, and maid-servants and prostitutes’. Social norms had been discarded during the epidemic and it took time for them to be re-established.

    Death rates among those infected are hard to determine but estimates of between 75 and 80 per cent are probably not far wide of the mark. Few of those who survived left any record of their sufferings, and from the few accounts that we have what comes across is the pain, fear and sense of desolation that the victims experienced, and the panic and aversion which it caused in others, even family and friends, so that the victims were left to suffer alone.

     

     

    London in the late fifteenth century, an impression by the painter John Fulleylove, based upon a contemporary illustration. (Author's Collection, Black Death, Amberley Publishing)

    The Black Death had subsided by 1352 but the plague returned intermittently over the following centuries. It was never again to spread so universally across the continent as it had done in the fourteenth century, but in the regions and cities afflicted during an outbreak the suffering was no less, the social disruption caused was as damaging and the proportion of the population that died was as high as during that first epidemic. Plague outbreaks contributed to the slow recovery of population numbers in the late Middle Ages; London did not attain its pre-Black Death size until the mid-sixteenth century.

    Not until the late nineteenth century was the plague bacillus Yersinia pestis identified and the means of transmission recognised to be rats’ fleas moving from host to host to feed, carrying the infection and spreading it through their bites as they drew blood. More recent work has acknowledged that human fleas and lice carry the disease, as well as rats’ fleas.

     

     

    Plague was a disease of the trade routes and was brought to England in vessels such as this one. (Author's Collection, Black Death, Amberley Publishing)

    Taken by surprise and with no notion of what caused the disease or how it spread, contemporaries were at first unable to take steps to protect their communities. But from that first bewildering outbreak in the 1340s steps were devised to try to halt the progress of the disease, with the Italian cities leading the way. Isolation of the sick, either in their houses or in especially-built pesthouses, and control of movement, with the exclusion of people from areas known to be infected, were gradually introduced. Some cities forbade access to those coming from an infected area or anyone carrying or transporting linen or woollen cloth, reflecting the suspicion that the disease emanated from textiles. To identify the presence and progress of plague, records began to be kept of the number of victims who had died and the figures for all deaths. That gave the authorities information which they required to decide what steps to take, and to gain acceptance of their policies, for they did not have the means to enforce either quarantine or restrictions on travel if the population did not agree with such measures. Merchants were bound to resent restrictions on trade and so too were those who supplied food and fuel to their local city or town.

    Foul air was also thought to harbour the disease in the miasma which arose from stagnant water or piles of garbage, and so the cleanliness of public places by the frequent removal of dirt and waste and the washing down of streets became integral elements of the measures against plague. The well-to-do citizens who occupied parts of houses which were away from the rubbish of everyday existence seemed not to be afflicted to the same extent. That was because those spaces did not attract rodents and their parasites, although of course the connection was not recognised at the time. Many such householders absented themselves until the epidemic had subsided, while the poorer people could not leave. The plague came to be regarded as a disease of the poor, whose lifestyles, even the size of their families, made them vulnerable. The disease was socially divisive, to say the least.

    The Charterhouse and Charterhouse Square in the mid-eighteenth century; the site of the Black Death burial ground. (c. The Charterhouse, Black Death, Amberley Publishing)

    From those procedures and an awareness of steps taken elsewhere, similar policies on public health matters developed across Christian Europe and were continued and extended after the gradual ending of the plague threat, from the mid-seventeenth century onwards. London’s last and most deadly outbreak, the Great Plague, came in 1665. Quarantining of shipping and naval controls applied at ports around the coasts of north-west Europe had become a major element in plague prevention, while overland cordons in continental Europe also proved to be effective. Such measures pushed the source of the disease further away and cities such as London, Dublin, Bristol, Southampton and Amsterdam could be kept free of the disease, for the infected fleas could not survive the long voyages from beyond the cordon. But in the Ottoman Empire plague prevention was not implemented because Islam was deemed to require a fatalistic response to epidemics.

    Yet plague recurred in east and south Asia and Africa in the late nineteenth century and continued to claim victims through much of the twentieth century. Despite such failures, the measures taken to limit plague were not only retained but became the core of public health policy. When an epidemic of another disease, designated as SARS, struck in 2003, control of travel, confinement of victims and their contacts, and the use of isolation hospitals were implemented, and were effective in halting its progress. Plague’s depredations have created a fear which is still with us and the word has been given a wider meaning, as a curse or a menace, but the responses to plague have developed into a range of practices that are of enormous benefit for public health. Perhaps we should be more aware that plague’s legacy has not been entirely detrimental.

    Stephen Porter's new book Black Death: A New History of the Bubonic Plagues of London is available for purchase now.

  • Quacks! Dodgy Doctors and Foolish Fads Throughout History by S. D. Tucker

    THE TWILIGHT ZONE: The Quack Discipline of ‘Zone Therapy’

    In an extract from his new book Quacks! Dodgy Doctors and Foolish Fads Throughout History, out now in paperback, SD Tucker examines the bizarre ‘medical’ advice that combing your hands and squeezing your fingers can cure all ailments known to man.

    Albert Ankers's 1879 painting Der Quacksalber illustrated perfectly the origins of the word 'Quack'; namely, an old Dutch term for someone hawking dubious medicines. (Quacks! Dodgy Doctors and Foolish Fads Throughout History, Amberley Publishing)

    One of the most comical pseudo-medical fads of all time was something called either ‘Zone Therapy’ or ‘Zonotherapy’, depending on how fancy your local quack wished to sound. This involved splitting the body up into ten different vertical zones, and claiming that symptoms in one area of the body could be diagnosed and then resolved by applying pressure to other, corresponding, zones, as everything was connected beneath the skin by nerves. Most of these nerve-networks seemed to terminate in one or other of the fingers or toes.

    This was curious, as anatomists had never managed to actually see these particular nerve-networks before, when cutting up human bodies for analysis. The Zone Therapists conveniently replied that this was because they were invisible.

    Invented around 1909 by Dr William H. Fitzgerald (1872–1942), the chief physician and senior ear, nose and throat surgeon at St Francis Hospital in Connecticut, the fake discipline first came to the attention of the wider world thanks to an article written for Everybody’s Magazine in 1915 entitled ‘To Stop That Toothache, Squeeze Your Toe!’ by the man who would become Fitzgerald’s long-time partner in such nonsense, Dr Edwin F. Bowers (b.1871).

    Unfortunately, whilst Dr Fitzgerald was a real, genuine surgeon, well-educated and well-travelled and with medical certificates spilling out of his ears, nose and throat, ‘Dr’ Bowers was not. An investigation carried out into Bowers by American medical authorities in 1929 revealed that the man had not so much as attended medical college for even a single day’s worth of instruction.

    Simply gripping a comb tightly in your hand in the fashion illustrated above would be enough to ensure an entirely painless childbirth for any woman. (William H. Fitzgerald & Edwin F. Bowers, Zone Therapy; Or, Relieving Pain At Home, Quacks! Dodgy Doctors and Foolish Fads Throughout History, Amberley Publishing)

    There’s One Born Every Minute

    Having established himself as Zonotherapy’s chief propagandist, Bowers set to work collaborating on a book with Dr Fitzgerald, 1917’s Zone Therapy: Or, Relieving Pain at Home, whose introduction jauntily promised it would advance medical knowledge far beyond geneticists’ recent discovery of ‘the evil possibilities in marrying one’s cousin’. The basic idea was that, when your eyes were hurting, say, you would look up in a Zonotherapy book which other part of your body secretly corresponded to these organs, and then apply pressure to this area to put a stop to the pain.

    In this case, the nerves within the first and second fingers of the human hand corresponded to the eyes, so the best remedy was to tie elastic bands around them, or encircle them tightly with little wire-springs until they turned blue. If neither of these items were to hand, you could always try attaching clothes-pegs to them instead – this is not a joke, this was Bowers and Fitzgerald’s actual advice, and they provided S&M-style photographs of people transformed into human washing-lines to prove it.

    The book was marketed primarily as a practical means for dispelling pain when it erupted around the home, away from your doctor with his reassuring stores of opium – even if the pain arose from as serious a thing as childbirth. In order to achieve a painless birth, all the expectant Zonotherapy-loving mother had to do was sit there with a metal comb in each hand, gripping onto them and thereby numbing her nerves whilst she pushed away merrily.

    Doing this, said the authors, would result in a new mother laughing and joking her way through the complete non-trauma of pushing a live infant out through her genitals. One new mother told her Zonotherapist that ‘she did not experience any pain whatever’ using this method, and ‘could not believe the child was born’. ‘This is not so bad,’ she laughed happily, no doubt wanting to drop out another immediately, just for fun.

    Fitzgerald claimed to have performed several successful minor operations without anaesthetic, rendering the whole procedure painless simply by applying constant pressure to his patients’ fingers prior to applying the knife, a discovery he initially termed ‘Pressure Anaesthesia’. Sceptics were invited to let practitioners squeeze the nerves in their hands, then close their eyes and see if they could feel it when pins were jabbed into their flesh.

    Apparently, they said they couldn’t; one daring fellow kept his lids open and let his Zonotherapist attach a hook into his eyeball without feeling so much as a scratch. The keen quack then ‘put several pins into his face’ before calling the man’s wife into the room to show her what he had done. The wife did not seem pleased.

    About as Much Use as a Comb to a Bald Man

    Deafness, meanwhile, could be treated by clamping a clothes-peg around your third toe or poking at your teeth with a cotton-bud, thus enabling you to hear nearby people laughing at you. You could also try combing deaf people’s hands, or solve an earache by fastening a clothes-peg ‘for five minutes or thereabouts’ on the tip of your ring-finger.

    Headaches were dispelled by sucking your thumb and pressing it hard into the roof of your mouth, thus allowing you to ‘push the headache out through the top of the head’. Alternatively, you could ‘attack’ your migraine by shoving your fingers up your nose. If your friends’ heads felt all fuzzy, you could even invade their nasal orifices for them, although it was wise to inform them of your intentions first.

    If you were going bald, meanwhile, you had to sit there ‘rubbing the fingernails of both hands briskly one against the other in a lateral motion for three or four minutes at a time, at intervals throughout the day’ until your hair re-sprouted, thus making you glad you had already invested in a metal comb for your pregnant wife upon the Zonotherapists’ wise advice.

    Those disposed to stomach-ache were advised to ‘arm yourself with a wire-hair brush and a metal comb’ every time they boarded public transport. Then, rather than vomiting over their fellow passengers, they could simply ‘get busy with the comb and brush – not on your head – but on your hands’, thus dispelling travel-sickness, indigestion and ‘distension from gas’. The sight of you obsessively combing your bare hands until you farted might still make people want to sit far away from you, however, in which case it was recommended, for no apparent reason, that you just eat some salted popcorn instead.

    If your baby had a tummy-ache, you could pursue similar methods. Rather than beating your crying infant ‘up and down the room’ with your slippers until it either shuts up or dies, why not just comb the baby until it goes peacefully to sleep?

    Submitting to Zone Therapy treatment may have cured your pain, but it could severely injure your dignity. (William H. Fitzgerald & Edwin F. Bowers, Zone Therapy; Or, Relieving Pain At Home, Quacks! Dodgy Doctors and Foolish Fads Throughout History, Amberley Publishing)

    Dentally Disturbed

    Even sharp needles could be banished from dentistry via sensible use of Zone Therapy. Instead of having cocaine injected into your mouth to numb the pain, it was much simpler to just sit there with elastic bands wrapped around your fingers. As the fingers and teeth were intimately connected, this meant you would surely feel no pain whilst lying back and relaxing within the dentist’s chair. However, because for some unknown reason (presumably related to the differing level of quasi-hypnotic suggestibility of individual patients) Zonotherapy only worked for 65 per cent of the time, the authors of Zone Therapy were careful to advise that, sometimes, the numbing needle did work best after all.

    Not only pain, but actual disease, could be cured by the Zonotherapists, or so they said. Whooping cough was banished simply by pressing a hidden bodily button located somewhere at the back of the throat. Cancer, appendicitis, goitre, even polio, all could be beaten off, at least temporarily, with naught but clothes-pegs and combs. One woman given Fitzgerald’s treatment went so far as to simply wee a bothersome tumour out from between her legs one day, causing it to make ‘a happy exit’ down the drain.

    There was no end to the wonders Zone Therapy could perform. Attending a dinner-party one evening, Dr Fitzgerald met a female opera-singer who complained that her voice was in terminal decline. Eager to help, the surgeon asked if he could fondle her feet in front of the other guests. As he did so, Fitzgerald discovered a calloused area on the big toe of her right foot. He squeezed it for a bit, then told her to sing. Amazingly, ‘Not only was she able to exactly reach the notes she had been missing, but she was able to reach two notes higher than she had ever done before.’ Dr Fitzgerald must have had a grip like a vice! If only his brain had been in such good working order too …

    S. D. Tucker's new book Quacks! Dodgy Doctors and Foolish Fads Throughout History is available for purchase now.

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