Plague and Pandemics
Updated: Jun 18, 2022
Beginning in the 1300s plague affected populations and economies. Europe suffered illness, death, population decimation, economic downturn, recovery, and then in a year or more the cycle would repeat. Covid-19 and fourteenth and fifteenth century plague have commonalities, including disagreements about what to do or not to do, and what remedies might be effective.
Stay at home orders, quarantine, and contact tracing were part of the response six hundred years ago. We'll look at three consequences of plague in Italy. The 1348 plague gives us insight into the economic impact and demographic disaster in Florence. The 1468 plague in Milan highlights the government conflict and disease management struggles. And early modern Venetian artists created images and architecture that inspired hope and gratitude for survival.
According to the Mayo Clinic and the CDC the underlying cause of plague is the bacteria Yersinia pestis. Plague is transmitted through a flea infected with the bacteria to a host animal, usually a rodent. The rodent may die and now the flea needs to find a new source of blood, usually other animals or humans. Humans can also be infected by transference of tissue or bodily fluids from an infected animal.
There are three types of plague based on where the infection is located: Bubonic (swollen lymph nodes), Septicemic (blackened skin from bacteria in the bloodstream), and Pneumonic (lung infection). The Black Death refers to the blackened skin (gangrene) on fingers, toes, or face from plague. The most common form of plague is bubonic, frequently depicted in art of plague victims. Plague can also cause pneumonia, the rarest form, and is the only way it can pass from person to person, via infected droplets. Plague can present with various symptoms from a large swollen lymph node close to where the flea bite took place, blackened skin, or coughing and shortness of breath.
1924-25 was the last U.S. urban outbreak of plague in Los Angeles, but it can still occur in the developing world and there are currently some cases reported in the southwestern United States today. Before antibiotics it was very rare to survive any form of plague, but septicemic and pneumonic plague resulted in nearly 100 percent mortality. It wasn’t until the end of the 1800s that scientists learned the true cause was from flea bites infected with bacteria.
The 1348 Tuscan Plague
Tuscany’s greatest economic impact from 1200-1600 occurred with the 1348 plague. Florence was, up until that time, the third largest city in Italy. Florence was an urban center, much more so than Rome, cultured, and flourishing. The economy was based on textile manufacturing, importing and exporting, especially wool, linen. Florence was also a banking center. Plague first started in the far east and brought to Italy via merchants. Plague followed the international trade routes. Waves of plague lasted for over three to four months resulting in a market free fall in Florence’s grain demand and a labor shortage due to deaths. About half up to three quarters of the population died. The countryside was also decimated with some areas experiencing a sixty percent decline in population.
But by September the agricultural and textile market had stabilized with wages doubling for unskilled labor, which remained at that elevated level. Economic consequences were dire, but also presented opportunities for growth. Bankruptcies were common and banks were financially strained. Banks that survived created efficiencies in organizations, closing branches and instead using agents to maintain clients. It took until the late 1500s for the population to stabilize – more than two hundred years.
The Alberti wool merchant business ledger is the only surviving business documentation from the 1348 plague. A sudden decline in Alberti cash payments occurred along with a complete halt to wool sales. Almost half the employees perished, and although the two owners escaped death, many family members succumbed. This situation occurred repeatedly in Florence and other cities. With so much death, litigation resulted concerning estates, businesses, and real estate. It was chaotic but there were no uprisings.
An unanticipated consequence of the plague was the redistribution of wealth. Charities benefitted as in some cases there were no longer heirs to the family. Widows also fared well economically. Immigrants flowed into the city earning good wages. Food was adequate and did not increase much in price. Florence went into the plague with a strong economic position, a good foundation of banking, industry, and ties to foreign marketplaces, which helped the economy to rebound quickly.
When the 1348 plague ended, the Alberti company hired additional workers and resumed trading. New entrepreneurs emerged and new families created wealth and gained political influence. Many middle class families emerged as upper class families, and the opposite happened also. Florence’s economy in the second half of the fourteenth century experienced significant growth in banking, expanded Mediterranean trade, and diversification of the traditional wool manufacturing to silk and other luxury textiles. For Florence, the great 1348 plague, although it decimated the population, did not spell economic disaster for the city.
Milan Death Records
Milan, Italy is located in the Lombardy region of northern Italy. As a large industrial and modern city and region, it is also the economic engine of modern Italy. Lombardy is also the area hardest hit by Covid-19. Lombardy is about the same size in square miles (9,206) as the states of Vermont or Maryland by comparison. About ten million people live in Lombardy. About half the Covid-19 deaths in Italy, as of this writing, took place in Lombardy. So far, about 80,000 cases have been confirmed in Lombardy. This isn’t their first pandemic, but it’s been a long time.
Serious outbreaks of plague occurred in northern Italy in the mid-1300s. New ideas about demographic record keeping helped rulers and governments make decisions on how to handle outbreaks. During the late 1300s Italians first began to keep death records for their population. After about 1450 Milan required documentation as to the cause of death. Milan has some interesting record keeping which gives us insight as to how physicians and rulers managed and thought of the nature of diseases, particularly plague.
By 1374 a third plague wave impacted Milan. The ruling dukes of Milan instituted the first documented quarantine and what we would know as “stay at home” orders to mitigate the disease. All illnesses had to be reported to the parish head who in turn reported to the duke’s head of council. Contact tracing was taken as a serious matter to control the spread. Procedures were not modified with changes in politics, revolts, or invasions.
The duke created a public health manager whose job it was to decide how and where to deploy medical and hospital personnel, issue burial permits, and enforce strict separation of the sick and healthy. Some believed plague was spread by human to human contact. People stricken with plague, and their families, were housed away from the city in an effort to quell the illness. Travel bans were instituted with extra guards at the city gates. Sometimes these measures were effective, and sometimes not so much. The Milanese inhabitants became very restless with travel and stay at home restrictions.
The concept of disease spread was very different from today. Correlation and causation were not related in the same way we think of today. And there were many common diseases and physicians did not understand how they were transmitted or how to diagnose: rabies, typhoid, malaria, smallpox, measles, leprosy. Epilepsy was considered contagious while measles was not.
Physicians blamed “mal aria” or bad air as being the most likely cause of plague along with possible exposure to rabies. Measles and the painful lymph node swelling associated with plague were considered internal diseases perhaps caused by contaminated soil. Physicians often did not make a diagnosis until examining the body post mortem. Plague killed quickly, usually in a matter of days, and was often a determining factor in making the diagnosis. Frequently many household members succumbed in a short period of time. For protection, physicians wore a long tunic covering and mask covering their head with a strange beak-like nose. The mask’s nose was stuffed with herbs and aromatics to cleanse the air. There was perhaps some benefit to their masks and protective wear.
Milan had a population of about 60,000 by mid 1450s. The ruling duke at the time had control over public health decisions, not physicians. Duke Galeazzo Maria Sforza ruled Milan from 1466-until his assassination in 1476 (he was a mean, sadistic ruler). Between 1464 and 1467 all the major cities in central and northern Italy suffered plague outbreaks.1467 and 1468 were both plague years in Milan, often occurring more forcefully in warmer months. Plague always came in waves, beginning with cases in May, often with a lull in June, and rebounding in July and August being the worst months. Illness and deaths would subside only to reappear in force. People experienced waves of fear and resuming near normalcy.
Physicians and government officials were at odds with each other in how to curb the spread. Dukes blamed the physicians for not being aggressive or quick enough in their diagnosis and physicians blamed the dukes for overzealous quarantine measures, seen as unnecessary and provoking fear.
Even diagnosing plague wasn’t as straight forward as it would appear to us. Swollen lymph nodes could arise from various sources according to fourteenth century medical think. A telltale sign of a swollen egg size lymph node in the armpit or groin would be cause for great concern today but physicians would attribute it to troubled urine. Treatments included heating up the body to produce sweat, bloodletting, or lancing the lymph node. Plague did become less common as the centuries wore on and historians believe quarantines eventually greatly lessened the severity of plagues.
The Art of the Plague
Plague was conceived as retribution for misdeeds in the religious world. Art served to insure protection, prevention, and gratitude. The church and faithful turned to Saints Roch, Sebastian, and Thecla in times of plague.
St. Sebastian endured great torture, starting with Roman soldiers shooting him with arrows. He recovered from this ordeal, and later on was bludgeoned to death. He was an early saint, persecuted by Roman Emperor Diocletian. Because of his great suffering, ability to persevere, and faith, he was often prayed to at times of plague. Families, churches, and religious orders regularly commissioned paintings of St. Sebastian at times of plague. He was a frequent subject in Renaissance painting. His popularity is most likely due to recurring plague as well as the opportunity to depict a nearly nude male body as a demonstration of artistic talent, knowledge of anatomy, and acknowledgement of the rediscovery of Greco-Roman art.
Northern Italian artist Andrea Mantegna painted the saint for the bishop of Mantua during an episode of plague. The painting was still in his studio at the time of the artist’s death in 1506. At the bottom right hand corner is a painted candle, just extinguished, with smoke drifting from its wick. Around the candle is an inscription: “Nothing is stable if not divine. The rest is smoke.” If you’re ever in an art museum and see a male figure with an arrow, or many arrows piercing his body, you can be fairly certain it is St. Sebastian.
St. Roch is a plague survivor. Probably the number one saint the faithful turned to for intersession, he is usually depicted raising his tunic up to reveal the telltale sign of Bubonic plague, a swollen lymph node, or bubo, in his thigh. Roch was a Frenchman known as a healer who started out on a pilgrimage to Rome when plague struck. He tended to the sick in fourteenth century Italian hospitals and cured a cardinal and others of the plague. When he exhibited signs of the plague, he took refuge in the forest while his faithful dog brought him food to survive. Cured, he continued on his pilgrimage, but was arrested under suspicion as a spy, and died in prison. Documentation is lacking to verify his existence or miraculous deeds. Did Italians invent him as a plague hero? The dual nature of victim and survivor was particularly appealing to Europeans. Whether he really existed or not is beside the point – people needed something to hope for and believe in.
Venice was proud to retrieve a body said to be Roch’s and instill it in a church they built to honor him. It was a major feat to have intact relics of a saint’s body and the Venetians made the most of it. Not only is there a church devoted to him, but next door to the church is an opulent and large confraternity of St. Roch. Confraternities were Catholic lay organizations that helped the poor and were somewhat akin to today’s Knights of Columbus.
Venetian artist Tintoretto painted a series of scenes of the saint’s life in the church. One in particular is unusual - a nocturnal scene with St. Roch (known as San Rocco in Italian) visiting a hospital and performing healing. He is in the center of the painting with a halo. Victims are depicted with the swollen lymph nodes in various stages of illness and suffering. The setting is dark and ominous. This painting is the first time plague victims are depicted in Venetian art. St. Roch is depicted frequently, especially in Italy, France, and Northern European countries. Usually he is shown in a forest setting or with other saints, particularly St. Sebastian, and the Madonna and Child.
St. Thecla, a lesser known saint, was also depicted as intervening on behalf of the Venetians during the 1630 plague. Giovanni Battista Tiepolo painted St. Thecla nearly 130 years afterward the event. The memory of the plague must have been seared in the minds of the Venetians and surrounding countryside to commission a painting so long after the miracle. An early Christian saint, Thecla became a follower of St. Paul and vowed to remain celibate and preach the gospels and baptize people. She was persecuted, thrown into an arena with wild beasts, from which she remained unharmed, and also emerged unscathed from being burnt alive for her beliefs. She remained a recluse hermit and died a natural death.
The people of Este, about 40 miles west of Venice, claimed St. Thecla interceded on their behalf during the plague. Like St. Roch, we’re not sure Thecla was invented or a historical person. The Venetian Tiepolo was the top painter of his day and received international commissions. This is a preparatory oil sketch for a large altarpiece installed in the church of Este on Christmas 1759.
Chapels and churches were also built to protect from the plague or to express gratitude for the end of the plague. Santa Maria della Salute (St. Mary of Health) in Venice represents the city’s commitment to survive the 1630-1 plague which killed about one third of the population. The Venetian Senate decreed that a new church would be built dedicated to the Virgin Mary in hopes of stopping the plague. Huge amounts of state funds were spent to build the church.
Although not completed until 1681, twenty-six-year-old Venetian architect Baldassare Longhena designed a church destined to be a Venetian icon. Positioned strategically across from St. Mark’s square on a peninsula called Punta della Dogana (Custom House Point), the church has been depicted by many modern artists, including American John Singer Sargent.
The Salute, as the Venetians call it, lies at the beginning of the Grand Canal. It’s hard to miss if you visit Venice and is a popular photo opportunity. The octagonal shape is unlike other buildings in Venice and was considered modern in its time, yet it fits comfortably with the earlier Gothic and Renaissance inspired Venetian architecture.
Santa Maria della Salute, Venice
The Salute is the most important seventeenth century building in Venice. There are more than one million wood pilings driven into the sea bed to sustain the building. The high dome makes the church recognizable from a distance and is especially beautiful from across the canal and lagoon day or night. Merchants coming from afar would enter Venice from the beginning of the Grand Canal, passing next to the Salute. After completion of the church the Doge processed to the Salute on November 21, Festa della Salute, to honor Mary and give thanks for good health. A parade of boats from San Marco across the water to the Salute is still carried out each year on that date and Venetians gather with pride to show respect for their city and traditions.
Artists were also victims of plague. Death was ever present and common place. Many children did not live to see adulthood. Violence, disease, and poor nutrition contributed to many illnesses. Life expectancy in 1300 Florence was only forty years; after the plagues of the fourteenth century the average was twenty years. The 1348 plague wiped out most of the Sienese artists. Ambrogio Lorenzetti, who painted the famous Allegory of Good and Bad Governments fresco in Siena, died of the plague as did his brother Pietro, plus Bernardo Daddi, Andrea Pisano, and in 1457 Andrea del Castagno died of plague. He is buried in a mass grave. Venetian artist Titian died of the plague in 1576 at age 89 after a long and successful career.
Bowsky, William M. The Black Death: A Turning Point in History? Huntington, 1978.
Carmichael, Ann G. “Contagion Theory and Contagion Practice in Fifteenth-Century Milan.” Renaissance Quarterly, vol. 44, no. 2, 1991, pp. 213–256.
Cohn, Samuel K., and Guido Alfani. “Households and Plague in Early Modern Italy.” The Journal of Interdisciplinary History, vol. 38, no. 2, 2007, pp. 177–205.
Goldthwaite, Richard A. The Economy of Renaissance Florence. The John Hopkins University Press, 2009.
Herlihy, David and Christiane Klapisch-Zuber. Tuscans and Their Families: A Study of the Florentine Catasto of 1427. Yale University Press, 1985.
Howard, Deborah. The Architectural History of Venice. Yale University Press. 2002.
Marshall, Louise. “A Plague Saint for Venice: Tintoretto at the Chiesa Di San Rocco.” Artibus Et Historiae, vol. 33, no. 66, 2012, pp. 153–187.
Marshall, Louise. “Manipulating the Sacred: Image and Plague in Renaissance Italy.” Renaissance Quarterly (Autumn 1994): 485-532.