Plague, Public Health and Democracy: Pistoia Responds to the Black Death



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Marianne Mueller

Prof. Linda Paulson

MLA 102

December 14, 2005


Plague, Public Health and Democracy:

Pistoia Responds to the Black Death
Paradoxically, plague brought out the best in Pistoia. This was true at least at the governmental level, where public health was concerned. Pistoia had a somewhat democratic system of government, but most importantly, the population had trust in authorities, a sense of civic duty, and a willingness to obey. The administration and the populace had a healthy relationship. Democratic traditions, nurtured since 1105 when Pistoia became a commune, were key. Thanks to these democratic and participatory patterns, Pistoia responded better when the plague arrived in 1348. The plague, and 14th century famines and warfare, exacted a heavy toll, but out of the crisis, public health boards were established.

Why study Pistoia? Pistoia is a representative city-state of the 300 city-states in northern and central Italy in the 14th century. A small town surrounded by its contado1, Pistoia stands for the hundreds of town and cities carrying on a form of democracy. Pistoia is blessed with a number of original source materials from the late Middle Ages and from the time of the bubonic plague itself. In 1348, the Pistoian authorities issued a famous plague proclamation, detailing ordinances meant to help stop or slow the spread of the plague. This document survives complete. The historian David Herlihy chose Pistoia as the focus of his social and economic survey of medieval Italy. He translates and summarizes a large number of source documents into tables and graphs helpful for studying population and mortality. Pistoia is not only a typical city-state, but it is unusually well-documented.

Pistoia in 1348 was a small but vibrant city of about 5,000 people. Herlihy painstakingly reconstructs rural population from the 1244 Book of Hearths, estimates what the hilly rural area could sustain, and arrives at the figure 23,964 for the year 1344.2 Notably, this is down from his estimate of 31,220 for the year 1244. He estimates that in 1244, in rural Pistoia, there were 38 persons per square kilometer (49/km2 if the city of Pistoia is included). The Pistoian contado were thinly settled high hills and mountains; Herlihy infers these lands were not the best for farming. He examines the marriage-rate and birthrate in the countryside, and concludes both were falling precipitously. As people grew more crowded and there was more contention for resources, marriages were delayed. People could not afford dowries or imagine ways for yet another new family to subsist on the already overburdened land. As the marriage-rate fell, so did the birthrate. By 1348, the birthrate in rural Pistoia hovered around 1.5 children per couple – a remarkable statistic that is counter to our notion of the medieval peasant with a dozen or fifteen children. He concludes that too many people were trying to live on too little land, but he carefully steers clear from a purely Malthusian explanation for the population checks of the famines and the plagues. The population had been steadily declining for a century before the terrible plague of 1348. The changing social and economic conditions – the lack of arable farmland, the falling marriage-rate – contributed as much to the depopulation as did the plague.

The economy was changing, but from 1250 through the early 1300’s, Pistoia experienced a boom. Herlihy writes, “Never before or since was [Pistoia] to enjoy such importance as a commercial and banking center as in the late 13th century.”3 There were sharp distinctions between city and country life, but people could migrate into the urban classes. Pistoia was dominated by landowners, not by merchants, as was the case in Venice and Genoa. As in the other city-states in Italy, Pistoian society was more urban, and culture more lay, than in England, northern France or Germany.4 Pistoia was surrounded by bustling, busy and full cities: Italy’s population was 7-9 million, compared to half that for the British isles.5 Serfs were emancipated in this region throughout the second half of the 13th century, ahead of the rest of Europe. But Pistoia’s long years of growth and political consolidation were coming to an end. Founded as a commune in 1105, it became a dependency of Florence in 1351.

Pistoia was slow to develop a large class of artisans. In the 13th century, less than 2% of the population that took the city’s oath can be identified as artisan.6 The guilds that organized workers can be considered professional guilds as well as artisan guilds. Members included judges, notaries, dealers in spices, merchants of cloth, iron workers, stone masons, barbers and vintners. As elsewhere in Italy, people often had more than one occupation: a builder might be a farmer, a woodworker an innkeeper.

The government of Pistoia, the commune, developed over centuries as a practical way to deal with day-to-day problems. There were no revolutions; there was no overriding ideology, although Italians were enthusiastic about classical antiquity. The pagan Roman past and Christianity were simply put together; they were never reconciled. From the start of the commune period in the 11th century, authority was seen as coming from the community, not from empire or pope. According to Waley, there were three distinct phases to becoming a commune. First, the local boni homines (the ‘law-worthy’ men) evolved into consuls. Second, the commune replaced the bishop as local authority. Third, the commune acquired rights outside the city, and began to interact with other communes. Although the communes’ claim to authority at first was not exclusive, eventually it did represent all local power, and the role of the bishop became that of a figurehead.

The podesta, a single, powerful executive in the commune, emerged in the early 13th century. The word derives from the Latin for “power”. After forty years of experimentation, by 1210, the podesta became a fixture. He served for one year or six months, and usually came from another city or region. The podesta’s powers and duties were defined and agreed upon beforehand. The podesta was the head of the commune and the highest judge. He was chairman of the various councils, in charge of peace within the city and commander-in-chief in time of war.

But the collection of guilds, known as the Popolo, included the newly rich who were not always of one mind with the (usually noble) podesta. No one unskilled or without property could take the Popolo’s oath. At first a pressure group, then a public body, by the early 14th century, the Popolo emerged as the dominant party within the commune. The triumph of the Popolo has been called a “democratic revolution in the life of the city-states”.7 It was a democratic revolution by and for landed males, but it did further interests common to professionals and artisans. The government numbered now in the thousands, not in the hundreds, and power had shifted from the podesta to the Popolo.

This state – this political structure – made itself felt in every way in the social and economic life of its people. Taxes and military duty were the prices people paid for services and defense. The concept of defense in a small city-state is much different than in a large nation-state; it isn’t abstract, it’s visceral. When a dispute with a neighboring city flared up, Pistoiese were literally on the front lines. Services like keeping the streets hygienic (or at least free of the worst refuse) and regulating how butchers and tanners work and rid themselves of offal clearly demonstrated to the people the value of local regulations. But regulations extended into every branch of life. The commune might claim a monopoly on the sale of flour, but at the same time set maximum wages for bakery workers. Waley describes how the details of work were regulated: “…the commune itself decreed that millers should always use lower millstones larger than upper ones, that every sack at the millers should bear the owner’s name, that bakers should always have water and brushes ready in front of their ovens as a precaution.”8 Government was present in every aspect of life. The attitude was that problems were solvable. People placed trust in the law, the council and the judges. In addition to issuing minute regulations on every matter, the councils provided for public charity, hospitals for the poor, food and clothing for the poor, and even dowries for poor girls. The government kept a few doctors on the payroll, who served the people of Pistoia – an early nod towards public health policies. In fact, Pistoia had a long history of publicly-employed doctors. As far back as the 8th century, Pistoia had a public doctor.9 Teachers, too, were employed by the state. Twenty men, masters of wood and iron, made up the firefighting force, and more then 200 men were in the ranks of the guards (including some men whose sole purpose was to prevent love-making in public parks during certain festivals).10 Herlihy notes that this period saw a shift from medieval contemplation and asceticism to an emphasis on charitable and social endeavors.11 The typical person in Pistoia was used to regulation and saw its benefits. He or she either contributed to works of public charity, or benefited from public programs and public health measures. The expectation that the state was there to analyze and solve problems was firmly in place in the early 14th century.

The traits of the city-state grew out of its makeup. Most important was the presupposition that the city was there to take charge and to help. Pistoiese developed a sense of civic loyalty and pride and patriotism, unfortunately sharpened by frequent bloody clashes with other cities (notably Florence). The fusion of Pistoia with its contado formed the civitas, an entity that endured since the earliest recorded times and that endures today. The country could undergo vast changes, yet the civitas endured. It is not possible to exaggerate the importance of the small size, and scale, of Pistoia, when considering how people related to each other. People were personally acquainted. There were only about 5,000 people in the city proper, and 24,000 people in the countryside. Coincidentally, this fits Plato’s ideal of the appropriate number of citizens in a polis (although only a perhaps a fifth of the 5,000 inhabitants of Pistoia were citizens). Citizens were drawn into a direct involvement with the city through participation in the councils. Since councils contained at times as many as 1,000 men, a large proportion of citizens did participate directly in governance. Pistoia adhered to the principle set down by Aristotle that a citizen should “rule and obey in turn” (Ethics IX, 10). But it was not as grim as that might sound. People enjoyed politics.12 Peter Riesenberg describes this sort of local political engagement as a “subject-participant political culture”.13 The citizens felt a sense of loyalty and identification and a willingness to obey the laws. Many made demands upon government that became laws that were enforced. There was an active ideal of participation. Waley observes: “It is evident that the Italian participation in government and administration was of the same order as the Athenian”.14 When the disasters of the 14th century hit, the Pistoiese were predisposed to look to the councils for guidance and deliverance.

What befell Pistoia in the 14th century? Solemnly reciting the calamities - famine, plague, warfare, local political unrest – does not depict the horror. Pistoia suffered an epidemic (not the plague) in 1339 that took 25% of its population. Another epidemic hit in 1347 before the arrival of the Black Death in 1348. Pistoia suffered further epidemics in 1357, 1389 and 1393. An outbreak of bubonic plague in 1399 is said to have claimed 50% of the population.15 Herlihy speculates that Pistoia was due a plague (or plague-like event) in mid-14th century, due to overpopulation, over-taxation, pressure on arable land, soil exhaustion, malnutrition and even starvation.16 Famine had been a part of the landscape for decades. The famines of 1313, 1328-9, 1339-40, 1346 and 1347 enfeebled the population. The plague of 1348-51 hit hard, given these starting conditions. An anonymous Pistoiese chronicler records that on one day, March 13, 1349, “1573 noblemen [were] buried, not counting the others of petty affairs.”17 The meticulous statistics-gatherer of Pistoia, Ser Luca Dominici, the chief officer of Pistoia’s hospitals, wrote that once someone contracted the plague, he or she “died within one or two days”.18 Herlihy conducted a thorough study of the population of rural Pistoia over the years 1200-1430. He concluded the population of 40,000 in the late 13th century had been reduced to only 14,000 by the early 15th century. Herlihy estimated that the population of the rural countryside declined from 23,964 in 1344 to 14,178 in 1383, a 41% decrease over just 39 years. From 1344 to 1404, population in rural Pistoia declined an astonishing 62%, from 23,964 to 8,989. Although it is difficult to estimate the number dead of the plague alone, he estimated a third of the population died.

At the same time, local warfare was intensifying. The infamous White and Black Guelf and Ghibbelline factions originated in Pistoia, as documented by the contemporary chronicler Villani.19 In 1305, Florence laid siege on ‘White’ Pistoia, and by 1306, occupied the town and razed the city walls. The podesta20 was thereafter appointed by Florence; the captain of the military, by the city of Lucca. The warfare between the rival White and Black factions would continue for decades. It is telling that Pistoia maintained a standing army. Herlihy states that 15th century northern Italy was more feudal than in the 13th century – the prolonged fighting had its political toll. In the mid-14th century, the signoria system rose up, and a single autocratic ruler wrested control from the commune. “The transfer of power to a single individual or family … was undoubtedly the most important political development [of the late 14th century], and it was one over which the empire and the papacy exercised little influence,” writes Hyde.21 The signoria system was spreading in northern and central Italy. But at the time of the plague, the democratic commune was still in control.

Pistoia’s reaction to the plague was surely not unique in northern Italy, but it is uniquely documented in the “Ordinances against the spread of plague, Pistoia, 1348.”22 Horrox notes that “[the ordinances] show Pistoia rethinking and amending its strategy as the plague developed.” The ordinances concern themselves with the danger of the spread of infection. A few highlights are:


  • No person shall travel to or from Pisa or Lucca (centers of disease).

  • No one shall bring into the city old linen or woolen cloths. Such cloths shall be burned in a public piazza.

  • Bodies of the dead may not be moved until they are enclosed in a wooden box, and the lid nailed down.

  • No one shall bring a corpse into the city.

  • No butcher shall hang up meat, or keep and sell meat hung up.

  • Butchers may not stable horses near where they sell meat.

  • No butcher may keep on the counter meat from more than one ox, calf or cow at once.

  • Butchers may slaughter meat on meat-eating days (Sundays and feast days) and sell it the same day. This ensured the supply of fresh meat on days when slaughtering would ordinarily be forbidden.

  • No butcher may slaughter any animal without first obtaining permission from the podesta or the captain.

  • No tanning of skins within Pistoia’s walls.

All references to Pistoia in the ordinances apply to the contado as well.

The first ordinance is prefaced “So that the sickness which is now threatening the region around Pistoia shall be preventing from taking hold of the citizens of Pistoia …” Interestingly, this prohibition on travel, put into place on May 2, 1348, was completely revoked on May 23, 1348. It may be that the city consuls decided even a partial self-imposed quarantine was more onerous than it was worth; it may be that the disease spread so rapidly that this measure came to be viewed as superfluous. But it is clear that avoiding the spread of sickness was the paramount concern. The most interesting ordinance is that barring the importation of old linen and wool cloths. Did the city fathers know that infected fleas, hiding in old linens, would latch onto new hosts once they were moved into the city? This is unlikely. It could be that people who used cloths formerly used by victims of the plague also fell ill, and that this was noted and subsequently guarded against. Burning the cloths in a large, open square is another perhaps serendipitous reaction – the perfect way to destroy the fleas without giving them a chance to find hosts. It is significant that the first two ordinances directly confront the threat of infection.

Some of the ordinances reflect the prevailing belief that a miasma, or sour infection of the air and atmosphere, was responsible for the spread of the plague. People commonly walked about clutching herbs to their faces, to filter and purify the air. Some even held vinegar in their mouths. The ordinances concerning the deceased may stem from the perhaps superstitious belief that a person could become infected with the plague by being near a corpse. There may be something to this, since in the immediate hours following death, fleas would still be on the person, and probably eagerly searching for a new host. Hence the deceased must be enclosed in a coffin with the lid nailed shut, and corpses may not be brought into the city. Even in times of no epidemic, these measures come across as sensible public health measures.

The ordinances regulating how meat can be butchered and sold seem distant from plague prevention. But in the 14th century, the cause of the plague and the way that it was transmitted were mysteries. People had experience with sickness due to poorly-run meat markets. Perhaps the consuls were taking no chances, and chose to regulate and get in order everything in the city that might possibly be cause for alarm. The prohibition on keeping meat on the counter from more than one animal is fascinating. The government was keeping a careful eye on all commerce and comings and goings in the city and countryside. Officials adjudicated and collected fines. Only compliance was reported; no one seemed to think the state was overstepping its bounds.

Cipolla reports that “the origins of the Health Boards in Italy go back to the pandemic of 1347-51 and to the epidemics that followed”.23 The Pistoian ordinances formed the basis of an ongoing public health system. Gallagher acknowledges that “[northern Italy in 1348] pioneered public health policies and institutional organizations.”24 We have seen that the governmental structures were in place to make this possible; traditions of officials serving the public good, of citizens trusting and complying with local laws, of presuppositions that government was expected to cope with not only day-to-day regulations but crises. Without that context, public health boards could not have arisen. Ziegler notes that Pistoian administration was exceptionally good; he describes the Pistoians as having a responsible attitude.25

Other than survival rates, long-lasting effects of the plague are telling. Fischer reports that Pistoiese workers’ incomes doubled from 1349-1400, probably due to an acute labor shortage. Grand civic projects ground to a halt, lacking both funds and workers. Contemporaries report a surge in greed and wanton living.26 The usury of the early 14th century virtually came to an end.27 Whereas pre-1348, people in the countryside were paying six times the tax of their peers in the city, in the last half of the century, the situation equalized. The imbalance between rent for land, and the value of what could be grown on the land, likewise equalized. Both the capital investment needed to develop land (tools, animals, fertilizers, hired workers) and the risk associated with farming shifted from the poor peasant farmer to the landlord. To be sure, these economic shifts had little or nothing to do with public health measures, but they also reflect effects of a more egalitarian political system.

One remarkable effect of these years is that “patterns of law, authority and administration … survived to early modern period without fundamental change.”28 Hyde refers to the effect of several centuries of (somewhat) democratic governance. It is noteworthy that these patterns were well-established enough to survive the stress of famine and plague. Government did not crumble in Pistoia; public health institutions were founded, or, strengthened.

The outcome of all this on the population is hard to gauge. Certainly mortality during the plague years was very high. Public health was the unlikely and unexpected beneficiary. Political winds were blowing that spelled an end to the centuries-long democratic city-state rule, however. The era of the signoria, or local lord, was beginning. By the end of the 14th century, much of the power of the council and the Popolo had been taken by the new overlord.



Democracy’s benefits are trust, loyalty and willingness to obey just laws. This atmosphere contrasts sharply with closed, secretive governments, which, we can infer, would fare less well when confronted with a crisis such as plague. Although Pistoia’s democratic form of government did not survive the late Middle Ages, but was replaced by the signoria or despot system of the early Renaissance, it was in the right place at the right time. Not only did the city of Pistoia manage to issue sensible and helpful edicts for the health of its population and that in the contado, but its experiences during the plague years led to the creation of the first public health boards in Italy. As our own society confronts Avian flu and other dreadful infectious agents, we should remember that an open, trusting society will fare better than one shrouded in any sort of superstition or secrecy.




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