Book Review

In the Wake of the Plague: The Black Death and the World It Made

N Engl J Med 2002; 347:297-298July 25, 2002

Article

In the Wake of the Plague: The Black Death and the World It Made
By Norman F. Cantor. 256 pp., illustrated. New York, Free Press, 2001. $25. ISBN: 0-684-85735-9

The other day, when I went to pick up my daughter from nursery school, she and her friends were gleefully singing, holding hands, and moving around in a circle. The song, of course, was that perennial favorite, “Ring around the rosies. A pocketful of posies. Ashes, ashes, we all fall down.” What none of the children realized was that this song dates back to the Middle Ages. Its odd lyrics actually refer to the influenza-like symptoms, skin discoloration, and rapid death caused by the infamous bubonic plague of the late 14th century (Figure 1Figure 1 Die Seuche, by A. Paul Weber.).

The Black Death of 1347 to 1350 is the focus of Norman Cantor's brief but elegantly written In the Wake of the Plague. The epidemic may well be “the greatest biomedical disaster in European and possibly world history.” A few vital statistics bear out what one 14th-century Florentine pundit called “the exterminating of humanity.” About 20 million people, or at least one third of the population of Western Europe, succumbed to bubonic plague. And what a ghastly death it was — raging fever, painful buboes, and a rapid demise that seemed both inexplicable and relentless in its spread to others. In comparison, the great influenza pandemic of 1918 sent approximately 30 million people to their graves, but that was a worldwide death toll rather than the death count in one portion of a continent.

Cantor's approach is to explore what happened to “key individuals in a society overwhelmed by biomedical devastation.” More broadly, the author proposes to help present-day readers gain insight into the complex relationship between humans and microbes throughout history, as well as examining the problems this relationship continues to create today.

Cantor succeeds admirably in his first goal. Our tour begins in Bordeaux, one of the great port cities of the Middle Ages. In August of 1348, the 15-year-old Princess Joan, daughter of the king of England, Edward III, arrived at the port en route to Spain. The purpose of the trip was to prepare for her marriage to Prince Pedro, the heir to the throne of Castile. The match, of course, was much more important to international relations than to those of the domestic variety.

On Princess Joan's arrival in Bordeaux, however, it became clear that something much more serious was brewing than the planning of a royal wedding. Hundreds of cadavers were stacked along the docks and streets of Bordeaux. These rotting corpses all had prominent black swellings under the armpits and in the groin. The stench of death inspired medieval lords to walk around covering their noses with perfume-drenched handkerchiefs. Soon after the princess's arrival, the mayor of Bordeaux confessed to her that the plague had visited the city. On August 20, one of the princess's advisors, Robert Bourchier, the former royal chancellor, died of the plague. A few weeks later, on September 2, Princess Joan, too, was listed among the Black Death's many victims.

Thanks to international trade and patterns of human migration, the epidemic spread to England. So Cantor next takes the reader on a whirlwind tour of the British kingdom, whose climate, commerce, culture, and society we discover through the eyes of clergymen, lords, peasants, and members of the royal family. Along the way, Cantor introduces us to many important figures in Britain, including the Abbot of Halesowen, a man named Thomas of Birmingham. The largest city in his parish, Worcester, was struck by the plague in 1349. In a delightful comparison between the medieval abbot and today's university president, Cantor explains that each might be seen as a “corporate chief executive officer, a man of business, a big time capitalist manager.” Consequently, Abbot Thomas needed to be attentive to all the issues and events in his parish that might affect its wealth, commerce, and social status. As he was to learn, an epidemic was a serious threat indeed.

The book also covers the infamous theory of a “Jewish Conspiracy” that blamed Jews for the Black Death and led, first, to the trial of a Jew named Agimet on October 30, 1348, at Chatel, near Geneva. After twice being “put to torture a little,” Agimet confessed to poisoning wells, cisterns, and springs with little packages of plague in Venice, Calabria, Apulia, and Toulouse. When he swore on a Torah as “to the truth of his confession,” the trial of Agimet set in motion a process whereby “Jews throughout the world were reviled and accused in all lands of having caused” the Black Death. This was an early example, but sadly neither the first nor the last, of the social scapegoating that is one of the most common, ugly, and unproductive features of epidemics in human society.

In the Wake of the Plague is less successful in describing the broader relationship between humans and infectious disease in the centuries that followed the Black Death. The history of this relationship is marked by many different types of epidemics and specific microbes, as well as changing scientific and medical views of their causes and the best methods of preventing them. Chronicling such a history would be difficult in a multivolume treatise, let alone in the short book that Cantor has written.

But my complaint ought to be considered mere grousing by a reviewer who loves all things epidemic. Cantor provides a lovely introduction to the Black Plague for the general reader. He writes beautifully and exhibits a masterly grasp of the era he has long studied.

Howard Markel, M.D., Ph.D.
University of Michigan, Ann Arbor, MI 48109-0725
howard@umich.edu