The Consilium

Chapter 1:

Gentili da Foligno POV

I arrive in Florence on the fourteenth day of March, in the year of our Lord thirteen hundred and forty-eight.

The city smells of fire and rue. Both are deliberate.

The rue they burn in braziers at every corner and hang in bundles above the doorways of the living, on the theory that corrupted air, meeting the herb's astringency, is neutralized before it enters the lungs.

The fire serves a similar purpose, or so the physicians who remain believe.

I have my doubts about the rue.

I have fewer doubts about the fire.

It is at least doing the honest work of destroying what would otherwise corrupt further.

I note this as I enter through the Porta Romana, my mule stepping over a bundle of cloth that has been left against the gate's southern pillar.

The cloth moves. I stop.

It is not cloth.

A man.

Perhaps fifty years of age, though plague makes arithmetic unreliable — it adds decades to a face in the space of three days.

He is alive.

His eyes find mine with the peculiar focus of the very ill, which is to say the focus of a man conserving every remaining faculty for the single task of not dying.

I dismount.

I examine him.

The bubo in his left groin is the size of a goose egg and has begun to blacken at the edges.

He has perhaps two days.

I give him water from my flask.

I tell him his name will be recorded.

He says nothing. I do not know if he hears me.

I record his name.

He gives it when I ask a second time: Ottavio.

No family name offered.

I write it in the margin of this document because it is the first name and it should be somewhere.

The Signoria receives me in a chamber that smells of camphor and anxiety, two substances which, in my experience, are frequently found together.

There are four of them present — a quorum, they explain, is no longer possible.

The other members are dead or have left the city for their country estates.

I do not say what I think about the country estates.

The contract is straightforward.

I am to serve as physician to the city's population without restriction of income or station.

I am to maintain records of symptoms, treatments, and outcomes.

I am to advise the Signoria on matters of public hygiene as they arise. In return I will receive a stipend of forty florins per month, lodging in a house near the church of Santa Croce, and the cooperation of whatever civic apparatus remains functioning.

I ask what civic apparatus remains functioning.

There is a pause that answers the question more completely than any words could.

I sign the contract.

The oldest of the four men — a Ser Donati, whose hands shake in a way that is not plague but simply age and exhaustion — witnesses my signature and says: God protect you, maestro.

I tell him God has better uses for his protection than spending it on physicians.

He looks at me with an expression I have seen before, on the faces of men who are deciding whether to be offended or comforted. He decides, after a moment, on the latter.

Good. Comfort costs nothing and I cannot afford to spend the city's remaining goodwill on offense.

The house near Santa Croce is adequate.

Three rooms, a small study, a table large enough to work at.

The previous occupant — a wool merchant, from the bolts of unsold cloth stacked against the eastern wall — left in some haste. There is still bread on the table. It is green.

I leave the bread.

I arrange my instruments. I open this document and begin to write.

A consilium, in its standard form, is a record of cases: the patient examined, the malady identified, the treatment prescribed.

I have written hundreds.

This one will be different, though I cannot yet say entirely how.

The pestilence Avicenna describes in the Canon is recognizable in its mechanisms — corruption of the air, imbalance of the humors — but the scale of what I have seen traveling from Perugia exceeds anything in the texts.

I wrote in the treatise I composed last month, and I will write it again here because I believe it to be true:

This pestilence is much to be feared, neither heard of nor seen in books.

What we do not have in books, we must build. That is what this document is for.

I tour the lazarettos in the afternoon.

There are three operating within the city walls.

The first, near the Arno, has been established in what was a wool-dyer's warehouse — its owners dead or fled, the building commandeered by what passes now for civic authority. The smell is what you would expect.

Beneath it, something medicinal and desperate: vinegar and lavender and the burnt-fat smell of the fumigation fires the attendants keep burning in iron pots at each corner of the building.

I count forty-three patients on my first pass.

I will learn not to count patients in the lazarettos.

The number changes too quickly and the counting takes time that belongs to the examining.

The attendants are mostly women.

Three of them are nuns from a convent whose name I do not catch; the other four are laypeople whose reasons for staying when they could have fled I do not ask.

People who stay in plague cities when they could leave are either people with nowhere to go, people who cannot abandon what they love, or people whose constitution of mind is suited to necessary things. All three categories are useful. None of them require my analysis.

I examine fourteen patients before the light fails.

Symptoms consistent across all: the fever arriving first, then the swellings in the groin or armpit or behind the ear, then the blackening.

Some have the spots beneath the skin that appear in the final stage. One woman — young, perhaps twenty-five, wearing a ring that suggests recent marriage — has only the fever so far. I adjust her treatment.

I record everything.

On my way out I step around a body that has not yet been collected.

A man.

Old.

His hands are folded across his chest in what looks like deliberate arrangement.

I assume an attendant has done it.

An act of dignity for the dead, common among those who work with them.

I note it and move on.

This is what I will later understand to be the first mistake: assuming the ordinary explanation.

But I am only arrived.

Florence has not yet taught me what it knows

.

Historical Note: Gentili da Foligno

Gentili da Foligno was a real man. Born around 1280 in Foligno, Umbria, he studied and later taught medicine at the University of Bologna and the University of Padua, where he was called by Ubertino I da Carrara, Lord of Padua, to serve on the faculty. He later taught at Siena, where his annual stipend was recorded at sixty gold florins, before returning to Perugia for the remainder of his career.

He was among the first European physicians to perform a dissection on a human body — in 1341, a practice long considered taboo. His commentary on all five books of Avicenna's Canon of Medicine was among the most widely copied medical texts of the medieval period. More than a century after his death, the Nuremberg Chronicle of 1493 remembered him as Subtilissimus rimator verborum Avicenne — "that most subtle investigator of Avicenna's teachings."

Historical Note: Black Death

The plague that reached Florence in the spring of 1348 was the most catastrophic epidemic in recorded human history.

It had been moving west for years before it arrived in Italy — carried along trade routes from Central Asia, through the Crimea, into Sicily in October 1347 on Genoese trading ships whose sailors were already dying when they docked. By January 1348 it was in Genoa and Venice. By March it was in Florence.

What followed was unlike anything the medieval world had experienced or had the framework to understand. The disease killed quickly and without apparent logic — striking the young and healthy as readily as the old and weak, moving through households in days, emptying neighborhoods in weeks. Physicians had no effective treatment. The Church had no satisfying explanation. The civic authorities had no adequate response. Florence, one of the wealthiest and most sophisticated cities in Europe, watched its population collapse in a single summer.

The mortality estimates vary by source and method, but the consensus is staggering. Florence lost between half and two thirds of its population between the spring and autumn of 1348. Across Europe, the Black Death killed an estimated thirty to sixty percent of the total population over the following years — somewhere between twenty-five and fifty million people in a continent that had no means of stopping it and no understanding of what it was.

The cause would not be identified for more than five centuries. The bacteriumYersinia pestis, transmitted primarily through the bite of infected fleas carried by rats, was not identified until 1894. In 1348 the leading medical theory was miasma — bad air rising from corrupted ground or carried on the wind from distant places of death. Physicians recommended avoiding night air, burning aromatic herbs, and fleeing to higher ground. None of it worked.

Giovanni Boccaccio was in Florence during the outbreak. He survived it. HisDecameron— one hundred stories told by ten wealthy Florentines who have retreated to a villa outside the city to wait out the plague — opens with one of the most vivid eyewitness accounts of the epidemic ever written. He describes the bodies in the streets, the collapse of social order, the abandonment of the sick by their families, the mass graves dug outside the city walls.

He also describes the people who stayed.

Gentile da Foligno stayed. He was not the only one — the grave diggers stayed, the Franciscan friars stayed, the lay sisters in the lazarettos stayed, the apothecaries and the porters and the clerks who kept the civic records going as long as the civic records could be kept. They stayed and they worked and most of them died and the ones who survived carried the memory of what they had seen into whatever Florence rebuilt itself into after the dying stopped.

The dying stopped, eventually. Not because anyone understood it or stopped it. Because the disease ran its course through a population that had no immunity and left behind — in addition to the dead — a Europe permanently altered in its labor markets, its social structures, its relationship to the Church, and its understanding of what medicine could and could not do.

Florence rebuilt. It took generations.

The Black Death returned. It always returned — 1363, 1374, 1383, recurring for the next three centuries in waves that never quite matched the catastrophe of 1348 but never fully released their hold on European life either.

Yersinia pestisstill exists.