The Black Death and Public Health


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By the sixteenth and seventeenth centuries, northern Italian cities had developed a sophisticated system of public health. A group called the Health Magistracy, comprised of several political figures spearheaded the movement and prominent doctors commissioned to study the plague, its causes and treatments. Florence, Milan, Venice, Genoa, Verona, Parma, Mantua, Bologna, Modena and Lucca each had Magistracies who communicated by letter regularly once every two weeks  - and several times a week during plague crises. These cities shared sanitary practices, medical treatments, and information about which areas the plague was raging and where it was likely strike.

The commission of public health in Milan had a president and six other members – four magistrates and two doctors.

One shared policy was the quarantine of goods and people that had come in contact with plague victims. Banishment and suspension were terms that meant that no person, boat or merchandise or letter from an actual plague infested area or a suspected one could enter the territory of the banishing state. Only in specific ports were they allowed, and then quarantine was demanded.

For example, on June 14, 1652, the Genoese Health Deputies sent a letter of notification to Florence and other northern Italian cities. It stated, “Information has been received here in Genoa by qualified persons that in the city of Alghero in Sardinia, contagious diseases have been uncovered which have caused the death of several people.” The Magistracy of Genoa proceeded to banish the city of Alghero and suspend the entire island of Sardinia. The Duke of Tuscany followed suit. Capital punishment awaited anyone caught violating suspension or banishment; a huge gallows was erected outside the port of Leghorn for approaching ships to see.

After the 1348 epidemic, the Magistracies believed even more strongly that the only way to stop the spread of the plague was to stop all intercourse with plague infested people and objects. While the rich were locked up in their homes for quarantine purposes, the plague-stricken poor were housed more and more frequently in a lazaretto or pesthouse built outside the cities’ walls. Named after Lazarus, whom Jesus raised from the dead, the lazaretti were of two different natures. One was the quarentena brutta (or ugly) where the illness was so advanced that the inhabitants waited to die. The purga di sospetta, however, was a building meant to quarantine anyone or anything that had come in contact with the plague. The duration of quarantine spanned from forty days to at times even a year.

While it was the Health Deputies’ responsibility to provide the lazaretto with food and water, conditions inside varied from bad to horrific. The lazaretto was the plight of the city’s poor.

For more on the lazaretti, click here 

Manotti or baccamorti (literally vultures) were hired sextons who carried the dead from the streets to the massive graves. By night, however, the manotti broke into homes, asking for outrageous sums and threatening to haul the healthy and the sick to the lazaretto if their demands were not satisfied.

For more about manotti, click here

Winter, 1630, Milan.

The Health Magistracies suggested that all the beggars, whether sick or well, should be gathered together in a single place, namely, the lazaretto, where they would be fed and looked after at the public’s expense.

The lazaretto was usually a rectangular enclosure outside the city proper, separated from the city wall by only the width of the moat. At the time the rooms numbered 288. The original lazaretto was begun in 1489, and its original function was to provide shelter for those stricken by the plague. Many of the beggars went in voluntarily; beggars and all those who were lying sick in the streets and in the squares were taken in. In the first few days more than three thousand arrived…It was thought best to pass from invitation to compulsion. The police were sent round to dispatch al the beggars to the lazaretto, and to take all those who resisted there in chains. The round up was so effective that it was not long before the number of people in the lazaretto had risen to ten thousand.


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It was to be hoped that there were separate quarters for women and small children, although memoirs of the period say nothing about it. They slept heaped up in lots of twenty or thirty in those tiny cells; lying either on a little rotten and stinking straw or on the bare ground. There was even a shortage of water – wholesome and pure water, that is to say. The water course that flowed round the outer-course of the lazaretto was a shallow, slow-moving stream and soon reduced to the state one might expect with a multitude cramped just by it – but it had to serve as the common water source.

 To the real discomforts of the people were added a general feeling of ill-being, the boredom and restlessness caused by being shut up, the memory of earlier habits, grief for dead relatives, uneasy thoughts of the absent, and spite and revulsion the members of the crowd inspired in one another, and countless other feelings of humiliation and rage. Another factor was the frequent spectacle of death…

 Criminals who neither suffered nor feared the effects of the plague found fresh scope for their activities. The tasks of the monatti and apparitori  attracted such men. Although commissari were appointed to control them, the monatti, in particular, began to assume absolute power. They entered people’s homes as masters – or as enemies. We need not ask what robberies they committed, or how they treated the poor wretches whom disease betrayed into their hands.

But those infected, villainous hands were also laid on the healthy, on the patients’ children, parents or wives or husbands, who were threatened with transportation to the lazaretto if they did not ransom themselves with large sums of money. On other occasions the monatti would demand payment for their legitimate services, refusing to take away putrefying corpses until they had received so many scudi for each one.

 Monatti used to drop infected clothes of the carts on purpose, in order to maintain and spread the pestilence, which had become their livelihood, their domain, their pride and joy. The monatti wore a small bell attached to one ankle, as a badge or office and as a warning of their approach. Various other wretches adopted this as a disguise, with which they obtained entry into people’s houses to commit all sorts of crimes.

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