The Medieval Review 13.09.10

Crawshaw, Jane L. Stevens. Plauge Hospitals: Public Health for the City in Early Modern Venice. The History of Medicine in Context. Burlington: Ashgate, 2012. Pp. xiv, 290. $124.95. ISBN: 978-0-7546-6958-6. . .

Reviewed by:

Ann G. Carmichael
Indiana University

Lazarettos in historical writing have been as walled off and strangely silent as were the spaces and their typically illiterate internees. In the history of early modern plagues little more than brief account of their presence is found. Even in the history of medicine, or more surprisingly, the history of hospitals sustained attention is rare, despite their medicalized features. Lazarettos in Italy became one complex component of urban responses to recurring plagues, but have not been seen in the important cultural and religious contexts of Renaissance, Reformation, and Catholic reform. Wanting to redress the narrow-cast consideration of pest houses, Crawshaw offers considerably more than a singular case study of Venetian lazarettos, sustaining detail of an astonishing array and depth. Precisely because so little can be found in English, she sets up this splendid first book in a way to walk us through the stages of confinement mute patients would have experienced. Her organization of the topic is thus synchronic, more descriptive than analytical, and structured so that we see how similar Venetian lazaretti were to others in Italy during the sixteenth and seventeenth centuries.

The lugubrious stations of an early modern patient's experience of the pest house begins with "first impressions," including architectural aspects of the institution and comparative cultural and literary resonances. Grounding her parallel excavations of archival sources in two exceptionally detailed Venetian narrative accounts--Ludovico Cusino's from Venice's 1555-1558 plague and the even more extraordinary one by Rocco Benedetti, describing the 1575–1577--Crawshaw supplements with most of the best known lazaretto texts in Italian or English, most of them written in the seventeenth century or later. Yet what was truly distinctive and original to Venetian plague management, envisioning the barrier islands of the lagoon as liminal city spaces for the separation and management of different aspects of plague control, was not an option elsewhere. Venetians uniquely used natural, geographical "architecture" to manipulate, eventually locating disinfection of goods to one island, ill persons and hospital activities to another, quarantine of merchandise and foreign merchants on another. Ironically, Venice did not have pest "houses"--their lazaretti were islands.

The patients' experience follows quarantine and isolation of both well contacts and the ill. Most the first-person plague diaries of this era were from persons confined in their residences, rather than removed to the lazaretto islands, thus not part of our focus here. We next meet the lazaretto staff who provided much of the care and services that did not specifically involve the administration of medicines, but not in formulaic or familiar job descriptions. Here we learn that different persons held different keys to access any area where patients' valuables were safeguarded, that boats carrying persons to the old or new lazaretto island were color-coded: restricted to this one use, and were white if the individual was still well, black if ill or, alas, dying en route. By 1630 there were designated boats for corpses. The individuals rowing these boats were not, however, plague-time-only employees, though Venice had at least one family business specializing in post-plague island disinfection. We learn that that household pets of plague victims were slaughtered and likely burned. (Several mentions of burning plague corpses appear in the book, but there is no firm evidence that this occurred in the sixteenth century. Indeed such would be disturbing and noteworthy in post-Tridentine context.) Other interesting bits abound: washers were female, but disinfection specialists were always male, and their work spaces occurred on different islands; priests used a tool to administer the Eucharist, and heard confessions at a distance--thus likely deathbed sentiments were heard by a great many persons, some of whom survived. There were, at least later on, some use of distinctively identifying marks on clothing for the staff, though we find in Venice no mention of the now-popular plague mask. It certainly did not predate 1600. The chapter on "Syrups and Secrets," shows some of the study's more surprising results: that medical practitioners in the lazaretto were often long-serving individuals, and that plague specialization could be profitable: some developed or adopted proprietary preparations of medicines advertised as "secrets." Extraordinarily, some experimentation with medicines may have been undertaken on the lazaretto islands. Here and elsewhere Crawshaw devotes separate attention to the care and handling of children, but oddly offers no expected discussion of surgical treatments and procedures. We do find evidence that the common status and practical boundaries between physicians and surgeons is not one that applies to the plague doctors.

This book includes a wonderfully old-fashioned set of handsome color illustrations, so unusual to find in academic publishing today. These and the last two full chapters, one on dying, the other on survival and reentry into the city proper, are the most haunting and effective of the book. Crawshaw adds much more to her earlier-published study of the pizzagamorti (whom she characterizes as "body-clearers" rather than gravediggers, to capture their many activities), especially in providing an appropriately nauseating sense of the smells and indignities surrounding any time spent in this purgatory. However most of her evidence on rituals and religious activities within the lazaretto spaces and connected to release from the prison come from cities in the Terraferma, where water did not create as strong an experience of a passage, reentry and starting over.

A clear explanatory sense of chronology and change over time is not the book's strength or purpose. But the conclusion efficiently repackages the material to show how much the story of Italian lazarettos involves changes, adaptations, and bureaucratic refinements to civic plague controls over the course of the sixteenth century. Some will want to read it first. Fierce debates about what medicines and policies were effective and desirable ended before the two last major plague waves in seventeenth century Italy (1630 and the 1650s). Plagues overturned traditional structures of urban and parish governance, where priests, not members of the Health Office or appointed district doctors, were the linchpins in deciding who would be exported to the islands. In the 1500s the Health Office tried to keep parish populations together on the islands, reimbursing the parish and city sectors for overall costs. By the seventeenth century expensive, wholesale eviction of household and neighborhood contacts of the victims was increasingly less routine. As a consequence, overall plague mortality decreased in the 1630 plague, but those who recovered were now unmoored from their neighborhood contacts. Women also lost any position of power within the evolving system over the course of the sixteenth century, and the tendency to associate control of poverty and orchestrated plague control increased. One-time plague hospitals became mercantile-era quarantine centers. The epilogue should be saved and savored. It offers a plague-history counterpart to contemporary-era traces of haunted old tuberculosis sanatoria.