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Epidemics and History: Ecological Perspectives and Social Responses
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Plague

The first case study is the final outbreak of bubonic plague among the inhabitants of Rome, which occurred in 1656. For a variety of political reasons—not least the vanity of the reigning pope—this episode was well-documented.[2] The epidemic was fought with measures developed during the Renaissance, refined over nearly two centuries of organized responses to plague in cities of northern Italy. These measures were widely adopted elsewhere in Europe and in the ensuing centuries became the prototype for public health regulations regarding other diseases, notably yellow fever and cholera.

Although contemporary observers had detected a gradual decrease in the frequency and intensity of plague epidemics in Western Europe, authorities of the Papal States, which included Rome, were nevertheless carefully monitoring the health situation in the Mediterranean. This watch focused especially on the movement of potentially infected ships and their supposedly lethal cargoes. One may ask why the plague was retreating in the face of growing urbanization and increased commercial contacts among nations. Was public health policy on epidemics gradu-


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ally bearing fruit? Probably not. The quarantine system simply stemmed the flow of goods, humans, and ships, only indirectly hampering the movement of the real culprits, namely, infected rodents and their fleas. In fact, the regular recurrence of plague epidemics after 1349 owed more to contacts between urban rodents and their increasingly plague-ridden cousins in the countryside than to the movements of ships with their contaminated cargoes. Today we know that, in spite of millions of human victims, plague remained foremost a disease of rodents.[3]

Significant environmental transformations in seventeenth-century Europe were also affecting the ecology of plague. One of the most critical changes was the gradual separation of urban centers from the surrounding reservoirs of plague-infected rural rodents. Such transformations included deforestation because of preindustrial demands for wood, draining the marshlands, and increasing the acreage under plow; all were designed to feed and shelter the population. These activities unwittingly managed to destroy wild rodent habitats, interposing agricultural cultivation between the teeming urban rat populations and their rural cousins. Even the more mobile brown Norwegian rat, capable of transcending the clearings, was unable to rekindle a decimated rodent population, which indirectly affected humans.[4]

By the mid-seventeenth century, however, bubonic plague was again spreading from North Africa to Spain and southern France. It arrived in Sardinia, then under Spanish control, in 1652. In spite of trade barriers against the island, the plague smoldered for four years, erupting in Naples in 1656, eventually killing an estimated 100,000 people in that city—about a third of the entire population.[5] Unfortunately for Rome, the Kingdom of Naples supplied grain shipments to the holy city as part of a feudal tribute. These imports were particularly welcome in view of the poor harvests that year in regions throughout Italy.

Knowing of Naples' serious epidemic, Roman officials in the spring of 1656 began to patrol the border, making careful inspections of all incoming ships, looking for sick crewmen and travelers. In spite of such precautions, however, a Neapolitan fisherman from the Roman port of Ripa—the destination port of all grain shipments—fell ill on May 10 in a rooming house in the Trastevere district of the city, a slum across the Tiber River. Although suspected of suffering from bubonic plague, the man and his landlady denied or pretended to ignore its true nature until she herself and her family came down with the disease. The fisherman was then sent to a nearby hospital, where he soon died of the plague.


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His demise prompted an official report announcing the presence of the plague in Trastevere.[6] Within days, new cases appeared in the adjacent Jewish ghetto as well as in numerous other parts of the city.

According to the Easter census of 1656 Rome had a population of 120,695. In the ensuing months, the city suffered approximately ten thousand deaths directly attributable to the plague. This mortality rate reflects a lower incidence of disease than, for example, reported by the city of London nine years later, where 80,000 people perished out of a total population of 500,000. The discrepancies are difficult to explain, although it is possible that Rome's death rate was underreported because the city's 1657 census counted only 100,119 inhabitants.[7] Perhaps Rome's rat population, in frequent contact with wild rodents in the adjoining, depopulated marshes, was already partially resistant to plague.

In any event, Rome was a densely crowded city still confined within its medieval walls. Its streets were a disorderly jumble, blocked by stalls with a variety of vendors and by slow-moving carriages. Few inhabitants obeyed the municipal instructions to deposit their rubbish at the appointed heaps along the banks of the Tiber River; most garbage was simply thrown into the streets. "What's the use of living in the grandeur of Rome," wrote one critic, "if one is to walk like beasts rather than human beings. . . . Raise, Holy Father, the poor from the excrement."[8] A busy Congregazione della Strada—the department charged with the cleaning, repair, and improvement of the city's lanes—fought a losing battle, bedeviled by traffic congestion, lack of parking, and after each sweeping, the inevitable recurrence of garbage.

As in other cities, the poor bore the brunt of crowding and lack of hygiene. Their slums were located in humid, low-lying areas of the city that were periodically flooded by the Tiber, and most of their houses were in advanced stages of decrepitude, with holes in the walls and roofs and "nests of spiders, mice, scorpions and geckoes." Rents were exorbitant and people were forced to live in "cubicles, garrets and holes in the wall"; others were homeless, begging on streets, engulfed in the stench from rotting garbage and animal and human excrement. "Good Shepherd," complained the same critic, "by your leave, we no longer live in Rome but in a pigsty."[9]

The city was ruled by Fabio Chigi, or Alexander VII, a native of Siena elected pope the previous year. Alexander's passion was architecture on a grand scale. His stated goal was the restoration of Rome to its previous splendor through the completion, renovation, and construction of piazzas, palaces, and churches. With a highly developed sense of public


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relations, the pope tried to give the city an image of ample squares, long open streets, attractive buildings, decorative fountains, and renovated monuments. The new look was designed to bolster his personal popularity as well as to attract foreign visitors to a city that had long lost its political importance and was still feared for an insalubrious climate associated with endemic malaria in the surrounding countryside.[10]

Thus, the 1656 outbreak of plague in Rome could not have come at a less opportune time for the pope. Nevertheless, Alexander VII immediately contacted the Congregation of Health, a municipal bureaucracy created in 1630 by Pope Urban VII to monitor and fight disease. Its leader, the prefect cardinal Giulio Sacchetti, counted in turn on the assistance of another cardinal, Francesco Barbarini, who had successfully organized public health measures against the plague in Bologna twenty years earlier. For the next few months, the group met daily and implemented a traditional series of regulations.[11]

Following the fisherman's death, the health authorities ordered the immediate suspension of trade with Naples and the Campagna region surrounding Rome. Most city gates were closed, and military guards were posted at all entrances. Temporary stockades were erected in front of gates and remained only partially open to the movement of goods and people; health certificates were demanded from those trying to enter. Jews had to present a special passport. Money and mail were fumigated, and goods and animals placed in quarantine.[12] At two gates, authorized supplies of grain and wine were transferred through pipes across the fences. Large chains were placed across the Tiber to block all ship traffic to Ripa. Trastevere and the Jewish ghetto, districts where the plague found its first victims, were sealed off and patrolled by guards.[13]

Having secured Rome's borders, the authorities went on to issue a set of rules to deal with plague inside the city. Traffic was severely restricted, and the streets were cleaned of filth and garbage. Schools were closed. City functions attracting crowds such as markets, parades, and religious processions were altogether banned. Indulgences were offered for people praying at home each night while the church bells rang. Prostitution was officially quashed, and vendors, beggars, and otherwise idle folk were put to work on Alexander VII's construction projects. Many of them were marched off to pesthouses opened for people suspected of harboring the plague.

Police were also prominently involved in the handling of individual victims. Suspected cases reported by relatives or physicians were brought to a number of first-line lazzarettos (quarantine hospitals) for screening.


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If clinical signs of plague appeared, the sick were quickly sent on with an escort of soldiers to the larger pesthouse on the island of St. Bartholomeo. Their homes were immediately sealed off by officials; large signs reading "SANITA" (Sanitary Service) were nailed across doors and windows. Surviving relatives could not leave the building under threat of death, remaining there quarantined for several weeks until they could prove their lack of infection.[14]

After usual periods of isolation, buildings that had housed plague victims could be "purged" of the disease through fumigation. Cleansing smoke came from burning sulfur as well as logs of pine, juniper, and laurel. Cleaners dressed in special vests, their faces covered with sponges soaked in vinegar, entered the contaminated premises and hauled out the furniture and other belongings. Some items were promptly fumigated on the spot through placement on racks while the clothing was sent to special laundries set up in nearby monasteries. Some establishments cleaned the woolens, others the linens. Before the belongings were taken away, elaborate inventories of removed household goods were taken in the presence of a notary.[15]

After recovery, survivors were placed in a convalescent category and transported to another lazzaretto for further recuperation. Following a prudent period of observation there, these asymptomatic people were conveyed to another makeshift quarantine station in a jail before their final release. In turn, the dead were promptly loaded onto wagons or boats and conveyed downriver to St. Paolo's churchyard and adjacent meadows. Here all naked corpses were buried in mass graves, their clothing burned to prevent gravediggers from recycling it and getting infected. Once in the ground, the bodies were covered with lime soaked in vinegar and fresh soil.[16]

Each ward in the city organized its own local health commission composed of two physicians and a priest. These individuals went from house to house, the doctors checking for disease while the priest held confessions and administered last rites. They were all considered tainted because of their contact with plague victims and were thus forced to live in isolation during the epidemic. On their appointed rounds, these men were forced to display wooden crosses, a sign of their contamination. Other doctors worked in the lazzarettos. In the course of these duties many of them contracted plague and died.[17]

The epidemic of 1656 unquestionably caused a great deal of fear and panic in the population. Many inhabitants, including physicians, immediately fled the city, while others simply denied the existence of the dis-


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ease. After the slum of Trastevere was cordoned off by authorities, its impoverished inhabitants complained bitterly about the enforced isolation, which took away their livelihood and "freedom of action from all." Although the pope and a deputy—his brother, Mario Chigi—repeatedly crisscrossed the city handing out money to the needy and especially the shut-ins, complaints about these "guardians" (military guards) only increased, as if "the remedy was the true illness," not the plague.[18] Others were angry with physicians who took advantage of the panic to peddle profitable prescriptions.

In turn, "many sick carried illness without revealing it, hoping to cure the pestilential lungs secretly."[19] Causes given for such lack of reporting were fear of job loss, terror of being severely punished for disobeying quarantine laws, and just plain embarrassment among the well-off, who refused to confess their defilement by a disease usually associated with poverty and filth. Individuals considered tainted through contact with plague victims, and thus guilty of breaking the law, were shot.[20]

Most seventeenth-century public health measures were rooted in the widespread lay and medical belief that filth and organic decay generated poisonous vapors that contaminated the urban atmosphere. Floating in the form of invisible particles, these vapors were thought to either penetrate the skin or be inhaled; occasionally they passed from one person to another as contagion. Once in the body, such matter could disturb the victim's humoral balance, but only if his or her constitution was already compromised and thus predisposed to illness.[21]

Based on such a system of explanations, most public health measures focused on two objectives: eliminating the sources of poisoned air, or miasma, and keeping the healthy away from the sick. Environmental cleanups and quarantines, trade bans, and isolation of suspected victims were the central aims. Representing the values and concerns of a healthy elite, the public health authorities took an energetic and heavy-handed approach to protect its long-term political and commercial interests. Privacy was invaded, suspects forcibly removed from their homes, lists of victims published, houses closed, relatives shut in, beggars expelled. Violators of public health regulations were fined, summarily executed by firing squads, or hanged from gallows erected in piazzas around the city. Those committing serious crimes were actually torn apart, and their limbs publicly displayed. Informers usually received a third of the levied penalties.[22]

Scapegoats were easily found. First, of course, there were the foreigners, especially those who had arrived from plague-ridden Naples


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and could therefore be blamed for introducing the disease. The first victim was thought to have imported tainted "feminine ornaments—silk ribbons,"[23] thereby starting the epidemic. As always, there were the Jews, more than four thousand of them, already crowded into an unhealthy and densely populated ghetto less than a square mile in diameter near the Tiber. As a result of their strict confinement, nearly 20 percent of the ghetto inhabitants died during the epidemic.[24] The poor, who inhabited the slums like the Trastevere district, were also convenient scapegoats. Initially they suppressed information about the presence of plague in their midst out of fear of being quarantined; later they were also less than forthcoming about presenting themselves to the magistrates who were trying to screen them for disease. According to statistics, more than half of Trastevere's three thousand residents died during the epidemic.[25]

Whether the public health measures actually hampered the progress of the epidemic throughout the city remains questionable. In the Jewish ghetto and Trastevere, however, the quarantines served to facilitate human contact with plague-infected rats, thus significantly increasing morbidity and mortality in those areas. Although the papal authorities tried hard to portray their determination to care for all Romans and to mitigate individual hardships, the powerless, as usual, bore the brunt of the disease. They were the scapegoats, deprived of jobs, food, and adequate shelter, and herded into disease-infested places separated from the rest of the population. The observation of a contemporary that the "judgment of the masses was ungrateful regarding the charity of their rulers"[26] would indicate that those who suffered most during the epidemic were not very impressed with Alexander VII's public health measures. It was "as if the evil [plague] was imaginary and the cure the real evil," admitted one official.[27]


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