The person who wishes to do that evil waits till there is a strong slow wind from some region of the world, then goes against the wind, and puts his flask [full of infected air] against the rocks opposite the city or town which he wishes to infect, and making a wide detour by going back against the wind lest the vapor infect him, pulls his flask violently over the rocks.
A number of the fourteenth-century authors did comprehend the idea of person-to-person infection, though its mechanism was obscure to them: one, a physician from the French town of Montpellier, held that the disease was passed through the optic nerves, such that the well man might look at the sick and immediately be attacked by the pestilence.
No link between the plague and the rats, let alone their fleas, could be apprehended by anyone at the time. Indeed, with the exception of rabies, the whole notion of zoonosis, that humans were being infected by animals, was almost entirely foreign to the medical mind of the Middle Ages. The only other zoonotic disease that seems to have been understood at the time was anthrax—the cattle disease that causes both skin lesions and (if inhaled) death in humans. But awareness of anthrax over the ages was dim and intermittent. While the Bible describes an anthrax-like plague in Exodus 9 (“festering boils…break out on people and animals throughout the land”) and a sixteenth-century “boke of husbandry” describes a similar malady, no descriptions of the disease are to be found in the intervening medical scholarship. (The term anthrakes dates back to Hippocrates, but it is used to describe not the zoonotic disease but the black carbuncles on human skin that typify a number of diseases, most probably smallpox.)
Yet increasing urbanization, and more intensive use of agriculture, were accelerating the rate at which infections passed from animals to humans. And by the fifteenth century a third factor—man’s new mobility, carried out in ocean voyages of staggering length—brought much of the world’s people into contact with devastating germs they had never before encountered. This so-called age of discovery saw two European neighbors, Spain and Portugal, amass enormous empires as they pursued wealth from expanding trade in spices and precious metals; Spain would seize far more territory, colonizing most of the Americas, while Portugal would cover the globe more finely, setting up outposts from Brazil to Angola to Goa to Macau. In ferrying goods, these colonists also ferried germs in all directions.
The bulk of these were human-to-human infections. Most notably, they brought smallpox to the Americas but took away syphilis, which tore through Europe and then eastward into Asia. But meeting new animals meant meeting their diseases, too.
It’s arguable that the greatest devastation Christopher Columbus wrought upon the New World took the form of eight sows, which made landfall in Hispaniola on December 8, 1493. Those pigs are believed to have instigated a massive swine flu epidemic that began the following day, killing Indians in staggering number—“the stench was very great and pestiferous,” observed one Spanish civil servant soberly—and initiating a long run of pestilence that offed some two-thirds of Santo Domingo’s natives in little more than a decade. One Dominican friar later put the death toll from disease in Hispaniola at nearly a million, in less than thirty years, and described similar die-offs in Cuba, Jamaica, and Puerto Rico.
But at the time, no one seemed to have looked askance at those eight fateful swine.* Columbus himself, who fell ill from the flu early in its run and took some three months to recover, was an especially poor epidemiologist: he wrote home that “the cause of the ailments so common among us, is the sustenance, and the waters, and airs.”
Rabies, in contrast to other zoonoses, was universally known and widely feared. Keeping hounds free from its ravages was a key preoccupation of the medieval huntsman. Edward of Norwich, the second Duke of York, who was born in 1373 and died in 1415 at the Battle of Agincourt, published an English-language translation and expansion—entitled The Master of Game—of Gaston’s famous hunting book. It includes a chapter called “Of Sicknesses of Hounds and of Their Corruptions,” tucked in just before the languorous celebrations of the various hound breeds but after the elucidations of their various prey (hare, hart, buck, roe, boar, wolf, fox, badger, wildcat, and, last but certainly not least, otter). The first dog malady, and the one considered at greatest length, is the “furious madness”:
The hounds that be mad of that madness cry and howl with a loud voice, and not in the way that they were wont to when they were in health. When they escape they go everywhere biting both men and women and all that they find before them. And they have a wonderful perilous biting, for if they bite anything, with great pain it shall escape thereof if they draw blood, that it shall go mad whatever thing it be.
It is recognized that such a condition, if not temporary, is invariably fatal: “Their madness cannot last but nine days but they shall never be whole but dead.” As a protective measure against rabies, the book follows Pliny in recommending that the “worm” beneath a hound’s tongue—in truth, a ligament—be cut out, by disabling the jaws with a staff and cutting out the offending worm with needle and thread or (in Edward’s addition) “a small pin of wood.”
For men bitten by mad dogs, The Master of Game suggests a number of remedies, though a few of these are dismissed in the same breath as they are proposed. For example, some bitten men go to the sea and allow nine waves to pass over them, but “that is but of little help.” Other men pull all the feathers from around a live rooster’s anus and, hanging the poor bird by the neck and wings, set the anus on the bite wound, on the theory that said anus would suck forth the poison. If the rooster swells up and dies, then the hound is mad, but the man will be healed; that is, the book avers, “many men say” this is the case, but “thereof I make no affirmation.” The authors seem to feel on more solid footing with the suggestions of cauterization (“it is a good thing for to hollow it all about the biting with a hot iron”) and bloodletting, both of which might actually have done the victim some good. They also spell out some recipes for medicinal salves. First is prescribed a sauce of salt, vinegar, garlic, and nettles; second, and more appetizing still, is a paste in which the garlic and nettles have been combined with leeks, chives, olive oil, and vinegar.*
The most lavish prophylaxis against hydrophobia in the hunting hound was carried out, fittingly, by the kings of France. In the hunting accounts of the French palace, historians have found annual outlays for all the king’s hounds to undergo a special ceremony. They were transported to the Church of St. Menier les Moret, in order “to have a mass sung in the presence of the said hounds, and to offer candles in their sight, for fear of the mal de rage”—that is, the disease of rabies. One wonders whether the hounds howled along.
The medieval period is also when our contemporary terms for rabies and hydrophobia began to enter the vernacular—in both their literal and metaphorical meanings. The French word rage is a derivative of rabies, which in Latin served as a rough equivalent of lyssa. As with that Greek term, rage in French begins its life both as a horrible disease and as something more profound, a sort of animalistic fury tinged with madness. The earliest documented uses are in The Song of Roland, circa 1100; the first of these appears in the reaction by the king, upon hearing that the treacherous count Ganelon has tapped Roland, his own stepson, to lead the rear guard (Ganelon has cut a deal with the enemy, the Muslim king Marsil in Spain, that his Saracens will attack from the rear). Says the poet:
When the King hears, he looks upon him straight,
And says to him: “You devil incarnate;
Into your heart is come a mortal hate [rage].”
The second is used to describe the folly of a Saracen who, in the heat of battle, launches an ill-advised attack on Roland: “Par sun orgoill cumencet mortel rage,” or “A mortal hate he’s kindled in his pride.”
It was not until the seventeenth century that “rabies” and “rabid” seem to have found purchase in English. Interestingly, the OED’s earliest use of the latter precedes the former—a reference to “rabid mastifs” in a
1596 translation from the Greek. The seventeenth-century uses of both terms seem to have been restricted, if not to the literal disease (or the semblance of it) in animals, then to a particularly vociferous rage, verging on madness: for example, “Rabid with anguish, he retorts his looke Vpon the wound” (1621); “Hee…strokes and tames my rabid Griefe” (1646). But rabies is irresistible as a metaphor; in both English and French, the word began to fan out into far more playful contexts within a century or two of adoption in both cases. By 1288, a French wag is wondering over “tel conseil et tel rage,” or “such counsel and such rage,” that is given to the king; by 1678, we have the very contemporary sense, true in English as well, of rage as a fashion, for example, la rage de la bassette, the faddishness of a then-popular card game. “Rabid” in English being significantly newer, the drift occurred somewhat later, and so we must wait until the nineteenth century to get, for example, the “rabid desire for the good opinion of every thing human” (1838).
How should we feel about these uses of rabies as simile, as trope, as joke? In Illness as Metaphor, Susan Sontag chronicled the myriad ways that our popular understandings of disease—tuberculosis and cancer, in particular—have been polluted by literary associations throughout history. As she demonstrates, disease metaphors gave rise to a particularly pernicious form of pseudoscience, fostering the myth that certain personality types (the romantic, decadent figure in the case of TB, the repressed and dissatisfied in the case of cancer) had a greater propensity to contract each disease. Metaphors also helped to stigmatize the ill, as moral judgment slipped backward from literary invocations of the disease (“cancer in the body politic,” or Victor Hugo’s remark in Les misérables that monasticism is “for civilization a sort of tuberculosis”) to taint the sufferer. Sontag’s point, which she declares with thunder on her very first page, “is that illness is not a metaphor, and that the most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, most resistant to, metaphoric thinking.”
The injunction is an admirable one, but it’s hard to look at the function of disease in history (especially in history before the Pasteurian era of the late nineteenth century, when people first learned about the microscopic nature of disease) without concluding the injunction to be an impracticable one as well. For millennia, disease was metaphor—the carrying of a mysterious foreign meaning within the familiar vessel of a human being; the very etymology of the term (pheroō, or “carry,” plus meta, or “across”) invoked just such an act of freightage. And this inevitability of metaphor in disease is nowhere more present than with rabies, where the name itself in multiple languages—lyssa, rabies, rage, rabia—also describes a human emotion of fury, with the twinned meaning extending back indefinitely, neither the medical nor the figurative sense taking clear precedence. Rabies was identical with a visitation of animal rage; or, if it was not quite a true identity between the two, the link transcended mere metaphor to become intrinsic to both poles of the comparison. Insofar as rabies (from the Babylonians to The Office) has served as grist for comedy, it’s the extremity of the fury that provides the punch line—the rage for the card game, or the “rabid desire” for others’ acclaim, or being a “rabid Justin Bieber fan,” all derive their implicit wit from the notion of aficionados so passionate as to be foaming at the mouth.
During the medieval period, the real advances in the medical understanding of rabies—as with advances in medicine more generally, for that matter—occurred almost entirely in the Islamic world. Through assiduous translation to Arabic, the great Muslim physicians perpetuated and extended the work of the Greeks and Romans. Arguably this process began in fifth-century Syria, where fleeing Christian heretics, expelled from the Byzantine church after denying the Nicene Creed, commingled with Arab-speaking Muslims and brought Greek traditions and texts to their attention. By the tenth century, Baghdad boasted an impressive system of hospitals; the thirteenth century saw the establishment of the Arab world’s first medical madrassa, in the old goldsmiths’ quarter of Damascus. Medieval Islamic physicians are even believed to have been the first to lay out a process akin to scholarly peer review: as prescribed by the Syrian doctor al-Ruhāwī, cases were double-checked afterward by a local council of fellow physicians, on the basis of whose judgment a doctor could be sued for malpractice.
The three titans of medieval Islamic medicine—al-Rāzī (known to European history as Rhazes), Ibn Sīna (Avicenna), and Ibn Zuhr (Avenzoar)—all addressed rabies in some detail in their central works. The first of these scholars, al-Rāzī, who wrote and practiced in Baghdad at the turn of the tenth century, recounted the cases of rabies he had personally witnessed:
There was with us in hospital one such man who barked during the night and then died. Another did not drink water, but when some water was brought to him, he was not afraid of it, but said: “It stinks, and the stomachs of dogs and cats are in it.” Yet another patient, when he saw water, shuddered, shivered, and trembled until it was taken away from him.
His preferred treatment for bites—cauterizing and scarifying the wound, followed by the application of suction cups to it—is as sensible as any described to that time.
Ibn Zuhr, who wrote in Spain between 1121 and 1162, included an essay called “On Furious Madness” in the Kitab al-Taysîr, his magnum opus. As al-Rāzī did before him, he anchors his observation with a personal narrative. “My father,” he wrote, “to whom God grants mercy, taught me that a mule, having been affected by this sickness, will aim to bite a man. The latter, fleeing before the animal, will enter into an alleyway whose entrance is quite narrow. The mule will rush towards the entrance, head down, and will become so tightly compressed in it that it will only be able to extricate itself by its own death.”
The sentiments on rabies expounded by Ibn Sīna, the most heralded of all medieval Islamic authors, seem lamentably off-key by today’s standards, even when compared with the views of his contemporaries. In the fourth book of his mammoth Al-qanun fi al-tibb (The Canon of Medicine)—composed during the early eleventh century, in Persia—the great doctor expressed the belief that heat and cold helped foment the disease, causing this “serious and venomous melancholy” in dogs. Moreover, he attributed it to the consumption of bad water and bad meat. Among the symptoms Ibn Sīna describes in human patients is a hallucination of little dogs, which one supposes to be possible enough. But among the treatments he recommends for human sufferers is cantharis, the legendary aphrodisiac that today we call Spanish fly; this seems a particularly odd choice for a malady whose symptoms, even on Ibn Sīna’s list, include priapism.
A fairly lengthy treatment of rabies is found in the writings of Moses Maimonides, a twelfth-century Jewish philosopher and physician who practiced in Morocco and then, later, in Egypt. He recognized, contrary to widely held belief, that the bite of a mad dog did not cause greater pain than that of a healthy one. More important, he states outright that any treatments for the rabid bite are useless after the onset of hydrophobia. He also recognized that symptoms of madness in humans can often be delayed by a month or more. Besides the time-honored treatments, which he endorses in passing—widening the bite through incision, bloodletting through cupping, and so on—he prescribes a dizzying array of potions and poultices: the pulverized ashes of river crabs, drunk in water daily; bitter almonds crushed in honey and applied to the affected site; a raw bean, chewed into a paste and then rubbed on the wounds; or, by the same method, crushed wheat, or onions, or unleavened bread. Maimonides wisely urges caution on bites, instructing readers to fear the worst. “If the condition of the dog is in doubt,” he writes, “conduct yourself as if the dog is mad.”
Artifact collectors have preserved one last rabies treatment from the era, one that seems to have begun in the twelfth century: the magic-medicinal bowl, a metal vessel elaborately inscribed with various therapeutic instructions, such as hot water to aid colic or saffron water to ease a difficult childbirth. A cure for rabies, and for animal p
oisons more generally, was often promised by these bowls. The oldest surviving specimen, made in 1167 for the Syrian ruler Nuūr al-Dīn Mahmuūd ibn Zangī, claims to assuage not just the rabid bite (through the drinking of milk, water, or oil, “by the help of God Almighty”) but also chest pain, migraine, and even demonic possession.
During the early days of the Inquisition, in the latter decades of the fifteenth century, a mysterious brotherhood of healers roamed from town to town, offering protection against rabies. These were the so-called saludadores, and they crackled (so they claimed) with powers bestowed by hallowed saints. They were blood relatives of Saint Catherine of Alexandria and carried her mark: a toothed wheel, representing the apparatus on which the third-century saint was tortured to death. Or they were in league with Saint Quiteria, another early Christian martyr whose intercession was often called upon for protection from rabies. (Quiteria also had the distinction, in Portuguese Christian lore, of being the leader of a savage all-girl team of nonuplet infidel slayers.) Through the grace of these sanctified women, saludadores could nullify the savage bite, often with their saliva or their breath. They could touch red-hot iron, wash their hands with boiling oil, or even clamber inside a fiery oven without injury.
The Inquisition saw such claims as heretical, and its official position was to squelch the saludadores. The few firsthand accounts from these healers that survive tend to be from those who confessed, under questioning, to having been frauds. In 1619, a shoemaker named Gabriel Monteche confessed that he had
held the office of saludador for many years, pretending he had the virtue to cure the bites of rabid dogs, and to cure other sicknesses and to deliver villages from hailstorms, saying that he bore on one arm the wheel of Saint Catherine and on the other a cross, which signs he had made himself with a needle to deceive people and let them think he had been born with them.