Plague Hospitals, Poverty, and Writing Histories of Epidemic Disease in the Era of COVID-19 by Neil Murphy

At the end of January 2020, I began teaching my third-year module on plague in late medieval Europe. As well as making my customary comparisons to outbreaks of modern plague – such as those which continue to afflict Madagascar – I also noted the appearance of a new disease in China, which, as I observed, was also where the pandemic of plague which struck Europe from the fourteenth to nineteenth centuries was believed to have originated. By the third week of teaching, the mother of one of my students had just returned to the UK after having attended a festival in Milan and had been instructed to self-isolate at home. I tried to reassure my student that things would settle down. They didn’t. In mid-March we moved to online teaching and days later Boris Johnson announced the first national lockdown. Given the seismic events happening across the globe, the first essay deadline for the module, which came in late March, seemed trivial. Nonetheless, as is the way of universities, the academic calendar rolled on regardless, and, in what is surely a rare example of experiential teaching for medieval history, students had the joy of writing essays about quarantine while themselves being in lockdown.

While plague and COVID-19 are very different diseases (plague was especially deadly and killed perhaps half the population of Europe during the fourteenth-century outbreak known as the Black Death), nonetheless similar measures were used against them, which were largely based around the use of containment. During outbreaks of plague and COVID-19, the impact of these measures, while affecting all to some degree, fell hardest on the poorest socio-economic groups.

In my article in Social History 47,4, I seek to understand the impact which the development of anti-plague measures had on the emergence of wider poor relief systems during the late medieval and early modern eras. My interest in plague goes back a decade and I had been steadily researching the topic during periodic research trips to France. Yet COVID-19 finished off what parenthood had started two years previously in ending my immediate prospect of undertaking archival work in France. Yet, when the nurseries had re-opened, this lack of opportunity to undertake further research made me begin to start writing up the work I had already done. COVID-19 was in its way a medicine against procrastination.

Community, Compassion and Containment

A terrible plague scene in the town of Marseille, 1720

Starting with the development of specialist plague hospitals, the information I found while working through my research notes stood in contrast with the widely accepted view both of these institutions and of poor relief more widely. Rather than finding Foucauldian charnel houses in which the sick languished in hellish conditions until they met a lonely death, I found urban governments taking considerable efforts to give the poorest members of society access to institutions in which they were provided with specialist help from medical professionals, whose services they could not have afforded otherwise. In addition to direct medical treatment, municipal councils aimed to provide the poor with clean beds in well-ventilated rooms, as well as access to nourishing food – measures which contemporary medical treatises stated were the most effective way to combat the disease. And certainly these actions appear to have worked as survival rates for people admitted to plague hospitals could be high. Out of the 2403 infected admitted to Marseille’s two plague hospitals in 1720-21, during the devastating final major outbreak of the disease in France, 1086 survived (45.2 percent).

The Pest Huys, Leiden, Netherlands, commissioned by the city council as a plague house after outbreaks of plague in 1635-36 and again in 1657. It never functioned as a plague hospital but was repurposed by the city.

Urban responses to plague were in part driven by ideas around the common good, which found that elites both had a duty to help the poor and to protect other members of society from infection. The plague hospital was a physical manifestation of both aims. During this period, European social elites increasingly saw plague as principally a disease of the poor. As a result, plague and poverty became conflated in the minds of urban authorities.  Measures against the plague became measures against the poor. In this context, plague hospitals were institutions in which the poor could be contained as well as being given access to food, medical treatment, and salubrious living conditions. While plague hospitals were principally institutions for the poor, they were not open to all those who lived in poverty. Urban councils drew a distinction between the ‘deserving’ local poor and ‘undeserving’ foreign vagrants, who were typically expelled from towns – or prohibited entry – during times of plague. As part of the plague measures introduced at Nevers in 1530, for instance, hundreds of foreign beggars were rounded up from the city streets and taken by boat down the Loire. At the same time, the local poor were placed in the plague hospital.

As plague hospitals became one of the key urban spaces for the distribution of charity to the poor, municipal governments started to use these buildings as places in which to place the poor outside of outbreaks of the disease. The plague hospital constructed at Paris in the 1580s was turned into a poor house following the end of the outbreak, with 2,000 people being confined and fed here. By the early seventeenth century, Lyon’s rulers were using the city’s plague hospital as a general poor house outside of plague outbreaks. Soon plague hospitals across the kingdom were transformed into poor houses. It was natural that such institutions would develop out of plague hospitals as they shared similar aims and conceptional links, in that only the deserving local poor were to be admitted and the foreign poor were expelled. The design of plague hospitals was also highly appropriate for the intended function of the poor houses, particularly in putting those placed in these institutions under surveillance and offering them religious (i.e. ‘moral’) instruction.

In this way, anti-plague measures played an important and formative role in the wider general enclosure of the poor in early modern Europe. These types of institutions persisted into the twentieth century, while the measures they implemented to control plague – from the use of quarantine to the importance of ventilated spaces – remain in use today against COVID-19.

Neil Murphy is Professor of Medieval and Early Modern History at Northumbria University. His background is in French history though recent research has also moved towards England and Scotland.