The question of the contagiousness of the plague is presented by Procope in a rather unforeseen aspect so that I stop there for a moment. The opinion which he expresses, accepted in his letter and without criticism, would be an argument of some weight in favor of the modern pretensions which have refused to this malady any virulent faculty. If we look closer, we see that Procope contradicts himself, and that he was at least contagionist without knowing it.
He says, with surprise, it is true, that no one gained the disease by the contact of the sick, and that the buryers did all their work without being struck.
How did Procope ensure the safety of these reports? Certainly, he did not mean that the disease had spared all those whowereexposed. What motive could he have for exonerating the contagion, when he saw so many houses completely depopulated? I agree that it is not permissible to measure the proportion of virulent transmissions in the total number of attacks. But is it possible to ignore the competition they have lent to the epidemic genius?
After having admired the constant immunity of the buryers at work, Procope informs us that they died suddenly, at other times, without any appreciable cause. Is it not true that the virus, previously absorbed, showed its effects only after a more or less slow incubation? Whatever the mobility of its appearances, the phenomenon is always reduced to these terms. One would never believe in the contagiousness of corpses, if one demanded that it be revealed at the very moment of impregnation. We do not share Procopius’s surprise, because our doctrine has made us familiar with this order of facts.
Listen to Evagre, who has considered the same question from a broader point of view and more in line with the general observation.
According to him, the plague could be contracted under the most diverse conditions. For some, it was enough to see each other or live together. Others were seized on entering the house inhabited by the sick. There were some who were hit in the street. A number fleeing the infected cities, without having the disease, gave it to the healthy people. Among those who frequented the plague-stricken, or who made the last duties to the dead, many were preserved. Individuals that cruel losses were disgusted with life, and who hoped to get rid of multiplying and extending to design their relationships with patients, remained unperturbed refractories, as if death had not wanted to .
Certainly, one can not affirm more explicitly the mediate or immediate contagion of the plague. The apparent restrictions fall within the spirit of the doctrine which posits as a fundamental principle the contingency of the phenomenon.
Propagate a disease whose germs are carried without being impregnated; to treat with impunity the sick or the corpses; to voluntarily face the morbid poison and to remain invulnerable: all these facts are vulgar in the history of contagion. But there is not one that can shake the belief in transmissibility when it is based on positive observations. Before the practice of inoculation of smallpox had brought unexpected relief against its dangers, children were exposed to contagion during benign epidemics, with the hope of protecting them from deadly epidemics. This expectation was often deceived by the predispositions of the subjects. Have we ever been advised to conclude that smallpox is not contagious? And does not the same remark apply to all diseases whose virulence may differ from activity, without being less certain?
Plague is therefore transmitted to the VI th century as now; but at no time has its contagion been constant or fatal. “We have reasoned on this point with ideas as absolute, as positive as if they were the effects of gunpowder or any other mechanical effect .” It is this antimedical paralogism which has confused and long held in check a question that facts interpreted without prevention, had solved for long centuries.
It is easy to see that Procope, despite his reluctance, suspected the communicability of the plague, since he noted with astonishment, the safety of compromising reports. Does not he also expressly note that the traveling disease always began in the seaports , from where it progressively gained the interior of the land? However, we are not saying anything else today when we point out the danger too sure of imports by ships. Only in the time of Procopius did public opinion only vague notions about this empirical fact which was for her a mystery. It was Fracastor who later justified, in the name of science, popular fears by proclaiming the preventive efficacy of confinement and isolation.
In the relation of Evagre we find an observation which escaped Procopius, and which he would have thought less strange if he had understood the true interpretation of it.
People who lived in a city plagued by the epidemic and intended to evade it by taking refuge in hitherto unspoiled localities, were struck alone, among the healthy population.
Is it not obvious that this is only what is now called imported cases ? The individuals who were going to die in an intact city, after having left a plague center, harbored in themselves the morbid germ whose effects broke out after a certain incubation period. This type of observation has become popular in the history of modern cholera.
The doctors who, to please some theories, denied the recurrence of the plague, could ensure that the issue had already been decided at the VI th century, in the opposite direction.
“Individuals, says Evagrius, who had survived a first and even the second time, did not resist another attack .”
This fact has since been frequently verified: Samoïlowitz, who was the head of a large hospital Moscow, during the plague, was reached three times . Pariset goes further, and assures us that we have counted up to eight , ten, and twelve times .
Desgenettes relates that during the plague in Cairo, to meet the needs of the service, he had trained convalescents to treat the sick. But, he said, many rebuked the disease, contrary to the opinion expressed by many doctors .
When one compares the contemporary stories of the great pestilential invasion, to complete them one by the other, one must not lose sight of the fact that Evagre, much younger than Procope, had survived for many years. The epidemic, which had not ceased to travel the world, had multiplied the facts connected with its history. When Evagre took the pen to record this memory, he had collected some new information which their date recommends to the attention of the epidemics.
“It was not uncommon,” he says, “to see in the infected cities, some families completely destroyed. Often everything was limited to the extinction of one or two families, the rest of the population being spared. Finally, the families that had not counted victims, were only affected the following year. “This last observation had doubtless astonished Evagre, since he thinks it must guarantee especially its accuracy:” Sicut accurata observatione comperimus. ”
These simple lines deserve a long comment. I will content myself with pointing out that they bring to light this community of hereditary and consanguineous dispositions, which seems to indicate to the blows of epidemics the members of the same family. I have elsewhere said that Evagre had the misfortune to give this fact his personal confirmation; the scourge that had struck him in his childhood had been ruthlessly relentless on his own, taking a new toll each time.
The relationship, as stated Senac, is in such a case, a contagion species . It is certain that it is the source of congenital morbid susceptibilities, which, in many cases, naturally reinforces the prolonged action of the same influences of climate, atmosphere, habitation, diet, profession, & c. That a popular disease comes to burst, it finds modified organisms in the same direction, and prepared to fertilize the germ. This explanation is not only adapted to Evagre’s observations, but to some analogous facts which have attracted the attention of several epidemics, and that we have treated incredible because we have not known realize.
Diemerbroeck has seen, for example, several families whose members, although separated and residing in plague-free places, were attacked at the same time as those of their parents who had not left the outbreak of the epidemic.
An inhabitant of Nijmegen, frightened at the progress of the plague, sent two of his sons to Gorcum, a Dutch town, whose health was perfect, and he kept the third with him. The two emigrants spent three months in the best state of health; but they were suddenly mortally struck by the plague, at a very near time than where their father and brother, who had not left Nijmegen were also carried .
Is this an attack of spontaneous plague? or a virulent incubation that would have lasted three months? Whatever explanation one prefers, the coincidence is worth of note .
The documents I extracted from the main contemporary relations of the famous outbreak of the inguinal plague suffice to attribute to it the characteristic of the great popular diseases: universality of domination, originality of symptoms, specificity of nature, indomitable lethality, resistance to treatment: nothing is wanting, except, it will be said, novelty, which is no longer admissible in the present state of the question. But from this point of view, it will not be disputed that it was unknown to our West, when it undertook for the first time its journey around the world, and that it did not recall any of the diseases included in the official nosological framework. .
After ravaging Constantinople, where we studied it, it spread to Liguria, to Gaul, to Spain, whence it was carried to Marseilles by an infected ship. She then reappeared in the East, and in her periodical returns she always displayed the same fury.
It is a fact that I want to establish well. It is because the plague has remained faithful to its precedents, and has preserved through the centuries, this mobility and this unforeseen of forms that surprised Procope so much.