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One of the most feared diseases of Grunewald's lifetime, the plague swept relentlessly through Europe in repeated epidemics, helped by mistaken medical theory and ineffectual remedies.
In the foreground of Grunewald's Temptation of St Anthony lies a helpless, diseased figure, covered with sores. This panel forms a part of The Isenheim Altarpiece, which was painted for the church of the brothers of St Anthony, who devoted themselves to nursing the sick. The altarpiece offered comfort and hope to the inmates of the Isenheim hospice, many of whom were dying of syphilis and the plague.
Outbreaks of the plague occurred frequently from the mid-14th to the mid-17th century, often reaching epidemic proportions. Plague was explained by the Church as a divine punishment for sin, to be countered by prayer, fasting, confession, religious processions and the rejection of vain pleasures such as dancing and cards. Images of the dance of death, which appear in church art and in popular woodcuts, were an early artistic response to the deadly epidemics which began with the 'Black Death' of the 14th century.
Religious art of the time often depicted an angry God shooting arrow of plague at the sinful. The ancient Greeks had prayed to Apollo, the archer-god whose arrows brought pestilence, to spare them; Christians prayed to St Sebastian, martyred by arrows, for protection from the plague. He too appears as a figure on The Isenheim Altarpiece.
Medical writers sought natural explanations for the plague, but could not agree on either the cause or the treatment. The European plague, or pestilence, of Grunewald's day was bubonic plague, which we now believe to be transmitted to man by the fleas of plague-infected rats. In its most deadly, pneumonic, form, it was spread, like the common cold, by droplets sneezed out by one victim and inhaled by another. The children's singing game Ring a Ring of Roses is supposed to contain a reference to these fatal sneezes in the line: 'Atishoo, atishoo, we all fall down'.
In the 15th and 16th centuries, doctors explained the cause of plague according to the teachings of Hippocrates, who believed that outbreaks were due to a local corruption of the air. This, in turn, was thought to infect the inhabitants, contaminating the bodily fluids or 'humours' which determined a person's temperament and causing disease and death. This corrupt or 'putrid' air might be the result of unusually warm and humid weather, or of a particular conjunction of the stars, which transmitted their malign effects to earth through the air.
Because of the analogy with rotting and putrefaction, the cause of plague was associated also with unpleasant smells, including the vapours arising from volcanoes, burial grounds and even dunghills. Some theories suggested that the air was not merely corrupted but actually poisoned: an explanation which, doctors argued, explained the fact that it might attack at any time of the year not just in hot, damp weather and struck with the speed and deadly effect of a poison.
Plague was usually classed by doctors as a fever, the effect of which was to upset the balance of the four humours blood, phlegm, choler and black bile resulting in an excess of hot and moist qualities. Those who suggested that plague, like the newly identified disease of syphilis, acted in the manner of a poison, claimed that it attacked the 'total substance' of the body directly, and was far more virulent than the 'qualitative' diseases.
Whatever the proposed cause, methods of medical treatment were almost entirely ineffective. The most practical was the advice to avoid breathing the 'deadly air' by leaving plague-stricken cities. Those who could afford to leave did so, often in defiance of quarantine regulations designed to prevent the spread of disease.
Much of the medical treatment aimed to drive the plague poison out of the body, by sweating, purging, inducing vomiting and blood-letting. The buboes or swellings which characterized the disease were lanced, and blisters were raised and then opened to draw out the pus. Other drug remedies treated the symptoms of the disease, such as thirst and sleeplessness.
Because of the suggestion that plague acted in the same way as a poison, antidotes, such as the famous mithridatum and theriac or 'Venice trcacle', were popular ingredients in plague remedies. Town physicians and academics wrote treatises on the proper treatment of the disease, containing their favourite recipes. New chemical remedies were introduced by followers of the German physician and alchemist Theophrastus Paracelsus. Quacks made the most of the opportunity, selling 'cures' to the desperate, who had often been abandoned by qualified doctors who put survival above their professional duties. People also attempted to counter the plague by fighting the unpleasant smells associated with its cause. They burned fires with sulphur and other chemicals, wore or carried nosegays (pomanders filled with aromatic herbs and spices or vinaigrettes) and, from the 16th century onwards, even tried to ward off the disease by smoking tobacco plague-pits are often identified by the clay pipes of the gravediggers.
Doctors rarely noted the contagious nature of the disease, which did not fit in with the Hippocratic theory of miasma or unhealthy air. An attempt to prevent dung heaps and rotting garbage from corrupting the air led in some cases to orders for improved street cleaning and public hygiene, which would have had an indirect effect on public health. City governments and public health officials, however, clearly recognized that plague was spread by the movement of travellers and goods, and Italian cities in particular developed elaborate quarantine procedures, isolating recent arrivals and imported goods in lazarettos outside the city, which were also used as isolation hospitals in time of plague.
British and German towns had fewer lazarettos, though Nuremberg had a newly built one at the time of an attack of plague in 1562, and London acquired its first pest-house at the end of the century. In major epidemics only a fraction of the sick could be accommodated, and in London the city government passed harsh legislation forbidding anyone to leave a house where a case of plague had been found. Doors of infected houses were marked with a cross to warn passers-by. Contact with the sick or with the bodies of plague victims was supposed to be confined to the government plague-spotters or 'searchers' who reported new cases, and to the gravediggers who toured the streets at night with carts for the dead, and buried them in mass graves outside the city.
Despite all the precautions and remedies, the death toll in major epidemics was apallingly high. A Nuremberg doctor reported some 8600 deaths from plague in the city in one year, 1494. At its height, the London Great Plague of the 17th century claimed over 7000 victims a week and the bills of mortality on which this figure is based may represent only half the real total.
Plague was not the only epidemic disease of Grunewald's day smallpox, the sweating sickness, and syphilis also claimed many victims. But it was one of the most spectacular, marking victims with swellings and carbuncles, and sometimes with red, black or blue spots. The man in The Temptation of St Anthony may, indeed, be a plague victim a detail which adds to the nightmarish quality of the scene. Believing the plague to be 'God's Scourge', victims in Grunewald's day suffered from a form of supernatural torment which matched that of the saint himself.
Writer – Marshall Cavendish