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Thursday, June 04, 2020

From Renaissance Italy to now, how epidemics have shaped conversations around the poor and public health

New opinions were encouraged and the Italian health policy of the 14th-15th centuries was quite extraordinary as it linked public health to the lives of the poor and to their access to food.

Written by Shahrukh Alam | New Delhi | Updated: May 10, 2020 10:11:46 am
italy, italy public health, history italian public health, coronavirus, coronavirus italy, black death, plague, Romeo and Juliet, indian express Conversations around public health: The Italian Connection.

ENTER FRIAR JOHN

FRIAR JOHN: Holy Franciscan Friar! Brother, ho!

ENTER FRIAR LAURENCE

FRIAR LAURENCE: This same should be the voice of Friar John.
Welcome from Mantua. What says Romeo?
Or, if his mind be writ, give me his letter.

FRIAR JOHN: Going to find a barefoot brother out,
One of our order, to accompany me,
Here in this city visiting the sick,
And finding him, the searchers of the town,
Suspecting that we both were in a house
Where the infectious pestilence did reign,
Sealed up the doors and would not let us forth.
So that my speed to Mantua there was stayed.

FRIAR LAURENCE: Who bare my letter, then, to Romeo?

FRIAR JOHN
I could not send it—here it is again—
Nor get a messenger to bring it thee,
So fearful were they of infection.

Romeo and Juliet (1597), Act 5 Scene II

I had never realized until now that the final tragic turn in the play hinges on a ‘lockdown’. Romeo had been banished from Verona, and Juliet was being forced by her family to marry Paris. In her desperation, she turned to Friar Laurence, who rather let his imagination run riot. His plan was as follows: he would give Juliet a sleeping potion, which would give her such a deathly pale that everybody’d assume she had died and cancel the marriage to Paris. She’d lie in the family crypt, while in the meanwhile Friar John would take Friar Laurence’s letter to Romeo (in Mantua) explaining the plot. He was to rush back, awaken Juliet and whisk her away. Unfortunately, Friar John was quarantined because the good brother had been tending to the stricken, and thus he couldn’t deliver the letter in time, resulting in Romeo’s fatal ignorance of the grand plot. Romeo heard of Juliet’s ‘death’, found her lying in the crypt and killed himself, alas moments before she awakened. Sudden lockdowns in the absence of back-up plans are always very tragic.

Since the time of the Black Death (1347), there had been cyclical outbreaks of the Plague in north and west Europe. The region had suffered dearly, and in a way that the disease had left its mark on the psyches of playwrights and painters for centuries after.

Luckily those were also the Renaissance years and new opinions were encouraged, and so it was that the Italian city-states recognized the idea of ‘public health’ and slowly focused their efforts on creating a template for containment of epidemics. The Italian health policy of the 14th-15th centuries was quite extraordinary in that it linked public health to the lives of the poor (not in the most gracious ways, but of that later), and to their access to food. It believed that containment of disease during an outbreak required years of institutional preparation, which included developing the general health of the poor. Thus, the Italian city-states set up permanent Health Boards: the sanità. By the time of the next major outbreak of plague in Italy (1629-1631) the sanità were prepared.
Hospitals in the middle ages were run on grants and endowments from the King, and were more centres for compassion (rather than for treatment): they attended to ‘foundlings’ by arranging for wet nurses, acted as orphanages and tended to the dying. The sanità sought to ‘modernize’ them by employing physicians and surgeons (medici del pubblico), who were paid state salaries to treat patients free of charge.

The sanità also kept a close eye on the city’s poor, ‘those who lived and worked in the alleys’, and while distributing free beddings etc., also referred their names to ‘gentlemen in-charge of the district’, who ensured from them proper sanitation by demanding that they don’t sleep on wet floors, and that they drain their cesspools daily.

At the slightest hint of an epidemic, the sanità would requisition cloisters and convents and establish isolation hospitals (lazaretti) for the sick and the dying. It was up to them to declare a general cordon sanitaire, or to make rules to decide who to let into the city in the time of epidemics, who to put into quarantine, and also who to send to the lazaretti. The sanità had its own special police to ensure that everyone was following the rules, and also its own magistracy to prosecute offenders.

Giulia Calvi and John Hendelson have written fascinating books on the Florentine plague (1630-31), relying on the rich documentation of the plague in official chronicles (and private diaries of citizens), and also of the official responses to the plague, which are in turn available in the detailed correspondences between health officials, the sanità accounts books and also the sanità court records.
The sanità had an odd relationship with the poor. In its view they simply lacked the dignity and the discretion to ‘break the chain’ during an epidemic. At the same time, the sanità also accepted that their famine-battered and weakened bodies made the poor acutely susceptible to the disease (the Florence chronicles acknowledge that the famines, the large scale unemployment and violent religious conflicts in the years preceding the plague of 1629-1631 had made the peasants and the artisans terribly vulnerable). Thus, the sanità’s public health efforts focused on both the moral, and the physical improvement of the poor: towards its former goal, it first scrutinized, then regulated behaviour, and towards the latter end, it loosened its purse strings quite considerably.

Giulia Calvi agrees that the sanità rules overwhelmingly intervened in and investigated the lives of the poor, but this was the case primarily because such lives were easily available for official scrutiny.

Francesco Rondinelli was the official chronicler of the Florentine plague and records the ‘chain of events’ that brought the plague to Florence. He describes the scenes in their minutest details, almost as if he were himself present: one hot summer day, a chicken farmer came down the hills of Bologna, ‘dragging his feet just a little’, his eyes downcast and listless, and his body oscillating very slightly as he walked. He came to the Florentine village of Trespiano, where the guards should have immediately sent him back, but he claimed that he was related to Viviano, a resident of the village, and was allowed entry. Viviano agreed to take him in and within days the chicken farmer, as also Viviano’s entire family, were lost to the plague. In the meanwhile, Sisto, a wool merchant from Florence, came to the village of Trespiano in order to buy cheap wool. He took the plague ‘nestled in bales of wool’ to Florence and infected all his workmen. Sisto also stood at his window and gazed indiscreetly into the courtyard of a widow, who happened to be his neighbour. Within days, the widow and her children had died; Sisto’s entire workshop had perished too.

Rondinelli recreates these ‘chains of interactions’, writing disapprovingly (and with the benefit of hindsight) of behaviour that had encouraged the spread of the disease: Viviano was reckless to take in his relative; Sisto was imprudent in traveling to Trespiano to buy cheap wool, and also in gazing into his neighbour’s courtyard. The widow should not have been lounging in her courtyard for so long. The Sanità, for its part, relied on these narratives to identify patterns of behaviour that deserved to be banned to stop the spread of disease.

Sanità rules interrupted the most basic instincts of people: like taking pity on sick relatives and giving them shelter, or stepping out of the house, or even moving across courtyards or standing at one’s window. Antonio Trabellesi was put on trial for having violated sanità rules by standing in the street and looking up and talking to Monna Maria who was at her window. He testified that he was on some errand, when Maria who had been quarantined and was thus lonely, called out of her window and asked how he was – he had only replied that he was well, when the sanità police arrested him.

On the other hand, there was no matching scrutiny of lives lived inside palazzos, or villas, because Rondinelli couldn’t very well turn up at such residences and inspect the behaviour of its inhabitants in the same way. He would simply not be allowed in.

Rondinelli’s ‘chain of interactions’ and ‘cataloguing of behaviour’ breaks each time the plague reaches a villa: the narrative then stops at the door. There was the servant of an important ambassador, who came to buy second-hand sleeves from a clothier in Sisto’s neighbourhood, and thus carried the plague back to the ambassador’s house. At this point, however, the narrative chain is closed. Rondinelli is only able to say that the plague burrowed in old sleeves, reached the ambassador’s house and caused the death of his wife Madonna Leonora. He cannot track it any further in terms of the mistress’ ‘chain of interactions’ with her friends, servants, doctors and priest. He must, thereafter, start a new thread.

When the plague arrived, patricians often left the city and went to their villas in the country, their entourage of servants following. The sanità, in the absence of any recorded instances of willful frivolity involving the nobility, did not frown upon such movements. The city was left to petty merchants and workers (quarantined inside their houses), the beggars and the homeless who were moved to the lazaretti, and officials of the sanità, who ruled the streets.

Since the sanità rules mostly regulated the poor, the reported violations involved them almost exclusively too. Ironically, while the poor were considered to not have the strength of character required to protect their fellow citizens from spread of disease, many trials involved cases where they had asserted a social ethic which compelled them to tend to a sick relative, despite the risks. Hendelson narrates a case, where the wife of a baker was tried for having illegally traveled to Trespiano to nurse her sick daughter, catching the infection herself, and then spreading the plague amongst her household upon her return. The woman’s defense was that she could not have left her own daughter unattended.

In another trial, Monna d’ Antonio was prosecuted for mending her son’s clothes, while he was quarantined one floor below her. The sanità police had found her lowering a basket from her window to his, with the idea that he would put his trousers in it for her to mend. She was arrested for this infraction, but was let off with a fine, when she pleaded in court that she was only doing her duty by her son.

Calvi also describes a number of cases, which were ‘property crimes’, where the transgressions involved ‘pilfering’ of some personal effect of the dead. Families often recycled clothes and sheets, even if infected, out of sheer need; sometimes an article of personal use was taken away as a memento to grieve the dead (rather than letting all personal belongings of a dear departed be destroyed by detached health officials). A woman kept her sister’s shawl at her death and was tried for it.

The sanità police were quick to arrest, but the magistrates hardly ever ordered jail terms for these crimes. The only time a convict was executed for thieving of a dead person’s property was when he was not able to show any emotional connection to the deceased, or any right to the property under laws of succession, or even any particular need for it. Andrea Passignani was a self-declared thief, with no ties to family or friends. He was young and unemployed and entered houses that had been sealed by the sanità, with the sole purpose of looting the dead. Unlike the other cases, Passignani did not pilfer out of sentimentality or immediate need. He was hanged, on the logic that he would have looted (and met a similar fate) even if there were no epidemic.

Calvi says that each infraction by the poor (and its indulgence by the magistrate) can actually be seen as a hope that things will eventually return to normal: it was a moment when practical concerns and survival strategies for the future took precedence over the immediate context of a deadly and overwhelming disease.

The sanità viewed the poor both as victims, and as careless vectors of diseases, but it didn’t give any concessions to the Jews, or to the prostitutes who were regarded as being wholly villainous. While the ‘war metaphor’ (enemy at the gates), was quite common to describe the arrival of the plague, people also correlated it quite literally to war, and with the notion that disease spread on the backs of flea-ridden, exhausted soldiers who traversed mountain passes and rivers (and countries and continents) without heeding sanitation laws. As the sanità declared cordon sanitaire at the city gates, ‘outsiders’ became instantly unwelcome.

It’s a cliché that history repeats itself, but sometimes it really does: In Milan particularly, the fear of strangers (and the fear of disease) led to a rumour about the untori (the anointers/ the plague spreaders), who would slip past the bored guards, enter the city and rub infected potions on surfaces (or spit on them). Soon, people discovered that it was a convenient way to settle personal scores. All one had to do was point to a person and shout ‘untore!’ and he was very likely to be lynched thereafter.

It was believed that the ‘invisible enemy’ would attack from outside the city walls, but there were groups within that would form the weakest link in that attack. These were communities that were considered guilty of ‘enhanced putrefaction’: the Jews, who were banned from coming out of their ghettoes; prostitutes who were believed to generate too much heat because of their profession and which made them more susceptible. Prostitutes were banned from laughing loudly, even inside their houses, because laughing would cause corrupted air to travel farther. There was a case where the police heard the sound of two women laughing inside their houses, and knowing them to be prostitutes, considered it well within their rights to enter. They discovered that in addition to the two women, there was also a young man with them, whom they had dressed in a carnival hat: they were all taken to prison, but later let off (without a fine) because the man turned out to be their brother, but more crucially also a priest, and explained to the sanità that despite their rather different vocations, the siblings often got together for a laugh.

The sanità enforced quarantines upon the city’s poor, but Hendelson argues that there was also an element of compassion (or at least good sense) in their policies. The Florence Account book shows that during the 1630 quarantine, the sanità organized the delivery of food, wine and firewood to all 30,452 quarantined homes. There was a grand menu too: each quarantined person was entitled to a daily allowance of two loaves of bread and a pint of wine. Meat on Sundays, Mondays and Thursdays; sausage seasoned with pepper, Fennel and Rosemary on Tuesdays; and on Wednesdays, Fridays and Saturdays, people were delivered rice and cheese.

All of this was paid for by the sanità, and although some elite Florentines complained about the taxes, the city administrators considered it necessary in the larger interest of the city.

It would be useful if contemporary discussion on the epidemic were to also move beyond looking for ‘the single source’, but rather involve the most vulnerable communities in comprehensive public health initiatives.

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