Naturally, comparisons to the Black Death are echoing around now.
The bubonic plague was a highly contagious bacterial disease that came and went throughout Europe and beyond for three centuries. In its first explosive visitation in the mid-1300s it might have led to the deaths of one-third of Europe’s population in under a decade. Some say we shouldn’t draw comparisons as too alarmist. The plague’s mortality rate was at least 50 percent as compared to something around 3.4 percent for COVID-19. Besides, they argue, today we’re enlightened; we have medical science, mass communication, knowledge of vaccines.
But now as then, the best defense against epidemic is quarantine—and the success of quarantine depends upon leadership, haste, and completeness, as one story about a hero of the plague illustrates.
By the time it took firm action against the epidemic, the Italian town of Prato, not far from Florence, had already lost its best chance. In the early summer of 1630 there were reports of deadly illness (which many said had been brought by notoriously filthy German soldiers) on the borders of Tuscany. When there was an uptick in illness in mid-summer within the walls of Prato, some city leaders believed plague had arrived and appealed to the Tuscan capital of Florence. But officials there issued public reassurances, probably out of a worry that Florentine merchants might be banned from neighboring duchies. When, by early September, Prato’s town council asked Florence for aid in establishing a quarantine hospital in preparation for the worst, Florence declined, arguing that recent rains had no doubt cleansed the region of any pestilence.
It was Sept. 16 that an attendant in Prato’s small hospital fell ill with violent coughing while treating a suspicious case; three days later, he was dead. Prato alerted the capital at once. Such a rapid and well-documented case of pneumonic plague could not be denied. The days of denial were finally over; but the chance at stopping its spread was gone.
Within a day, Florence issued the following decree to every corner of Tuscany:
You must straightaway order that the persons of the family of the deceased be confined to the house… You must bar the door of the house from the outside. The family of the deceased must receive victuals through the windows. Make sure no one comes out… You will inform us of what follows.
Florentine authorities also commanded that local elected boards of health throughout Tuscany perform a long list of emergency duties. In Prato, one of eight people who stood for the office was Cristofano Cessini, and in his classic history, Cristofano and the Plague, the late historian Carlo Cipolla told the story of this man’s exhausting efforts to lessen the damage of months of official denial about the epidemic.
Cessini was a middling sort of landowner, hardly an aristocrat, a father of two, experienced in accounting, and periodically stood for various town offices. In sum, he was a decent man who took a job that the town council feared few would accept. Cessini didn’t have any medical training, but understood his instructions and meant to follow them to the best of his ability as an act of civic duty.
He immediately set to his task, making sure that houses with known plague-contacts were quarantined, boarded up, or had a guard placed on the door, with food and a small allowance regularly delivered. For those stricken or strongly suspected, Cessini made sure that the quarantine hospital and convalescent houses were provided with resources and well-run. That included things like opening up new convalescent homes, hiring staff, making sure food got delivered, even buying cookware and furniture. He was in charge of releasing houses from quarantine after 22 days, after which their mattresses and other items must be burnt, and the rooms washed with vinegar and fumigated with sulphur. He oversaw the guards who policed the walled town’s gates, made sure the gravediggers were doing their jobs quickly, and undertook any public health orders issued from Florence. Meanwhile, he collected and passed to the capital data on quarantine, mortality, and recovery in a constant flow of correspondence.
Cessini and his contemporaries believed that contagion spread through close bodily contact, though the exact mechanism was up for debate. Also, making a practical observation, they also believed unhealthy miasmas lingered in unclean or infected places, which explains the vinegar-washing and fumigation. Alas, animal vectors went unchecked. Fleas, at least, could be slowed by winter weather.
For the next two months, the citizens of Prato, population 6,000, died of plague at the rate of around 12 per day. Three or four months later, it was still around 5 per day. On any given day that fall of 1630 there were usually around 100 people suffering in the town’s small quarantine hospital, and around 30 houses placed under quarantine. The town coffers, meanwhile, got lighter and lighter as trade, and thus taxes, dried up. Cessini quickly began to struggle to isolate and care for sufferers and pay for staff, turning to loans and pleading for charity. His office came with a small salary—equal to a gravedigger’s—but he spent far more of his personal wealth than he ever earned from it.
Even with all of the suffering around them, there were those in Prato who frustrated Cessini with their recalcitrance. Wealthier townspeople forced to quarantine at home due to contact with the infected refused to be sealed in and instead paid for their own guards. Cessini discovered some would slip away and only reappear at home to collect food deliveries. When his board wanted to requisition a wealthy family’s villa as a convalescent home, the influential family fought it and appealed to the Grand Duke in Florence (who overruled the family). A wealthy monastery in the area similarly barred its gates against the ill.
Besides people of privilege, Cessini worried over the poor people who sometimes snuck out of the quarantine hospital to communicate with loved ones. Others, desperate for money, sometimes concentrated in the vineyards to harvest grapes. Bureaucrats and officials like hospital board members also made trouble for him, asserting privileges or jurisdiction.
A year after the epidemic first appeared in Prato it died away, but not before claiming the lives of one in four townspeople in a slow but unrelenting burn. Cessini had worked tirelessly, doing his best with the limited measures of quarantine and an unresponsive God. When it was all over and the last of the quarantine hospitals’ mattresses and other items were burning in a pyre, Cessini resolved to write a book about his experiences so future generations might avoid the mistakes his had made. In his notes he wrote, looking back:
the epidemic started…slowly at first so that people took no notice of its gathering momentum, thinking that any day it would end. In truth people went about their business and took little account of what was beginning to happen because they had no experience of such a catastrophe.