The Great Mortality: An Intimate History of the Black Death, the Most Devastating Plague of All Time

by John Kelly

the renowned Paris medical faculty pronounced the cause of the disease to be “an unusual conjunction of Saturn, Mars, and Jupiter at one on the afternoon on March 20th, 1345.”

When asked why he was more profligate than his predecessor, Clement VI replied haughtily, “My predecessors did not know how to be popes.”

To reflect their new eminence, in the decades prior to the plague, physicians began to adopt a more professional—that is, authoritative—demeanor and code of behavior. A cardinal “don’t” in the new medical etiquette was: don’t jeopardize your professional dignity by visiting patients to solicit business. “Your visit means you are putting yourself in the patient’s hands,” warned William of Saliceto, “and that is just the opposite of what you want to do, which is getting him to express a commitment to you.” A cardinal “do” in the new etiquette was to conduct a comprehensive physical exam on a first visit; the exam should include not just urinalysis, but a detailed medical history and an analysis of the patient’s breath odor, skin color, muscle tone, saliva, sweat, phlegm, and stool. Some physicians also cast a patient’s horoscope on the first visit. Another cardinal “don’t” in the new etiquette was to admit to diagnostic uncertainty. Even when in doubt, said Arnauld of Villanova, a physician should look and act authoritative and confident. For the uncertain physician, Arnauld recommended prescribing a medicine, any medicine, “that may do some good but you know can do no harm.” Another strategy was to “tell the patient and his family that [you are] prescribing this or that drug to cause this or that condition in the patient so that [they] will always be looking for something new to happen.” A third “don’t” in the new etiquette was volubility. Reticence conveyed authority, espe...