COVID-19 – The great plague of Lombardy – a not so distant resonance chamber

April 14, 2020

Tom Jefferson and Carl Heneghan

What happened in Lombardy (the richest and most densely populated region of Italy) in the late winter of 2019/20 will be the topic of future commentary. Before describing and trying to analyse the events of 2020, we would like to point out another extraordinary contribution that this region made to the epidemiology of communicable diseases. 

Generations of Italians have been brought up reading Alessandro Manzoni’s I Promessi Sposi (The Betrothed). Set in Milan, during the Thirty Years’ War, it contains a masterful description of the great plague of 1630.  Two hundred years after the event, Manzoni used contemporary eye witness accounts and official reports by Tadino and Ripamonti to describe a horrifying chapter of European history 

The Plague, like Covid 19, was imported into Lombardy from abroad. It was preceded by a period of instability and famine which probably undermined immunity.

Harbouring bubonic plague, the invading armies of Wallenstein passed through Lombardy (known as the Duchy of Milan, then under Spanish domination). Those who came down with strange symptoms were sent into what at the time passed for hospitals, and mixed with other cases. Bubonic plague was only recognised after elderly survivors of the previous wave of plague – some 50 years previous – recognised the tell-tale signs.

Distancing measures were slowly introduced by edict, although it would appear fear was the greatest motivator. Manzoni describes bakers selling bread to customers through an elaborate system of pincers to avoid contact, and coins sterilized in a solution containing vinegar and water.

Various conspiracy theories arose: explaining the origins of the plague and uncertainties over the identity of the index case. One of the most quoted theories was a plot involving poison-makers who distributed their products by anointing church pews and walls of houses with their “unto” or greasy mess, hence the modern Italian term untore. 5G had not been invented then.  

Eventually, the City’s senators asked the Spanish Governor for financial and material assistance. 

They ended up separating the plague cases by admitting them in the standing Lazzaretto, a huge square structure with 288 separate rooms arranged around an open courtyard in the middle of which was a church, which is still standing.  Each room was designed to provide distancing and privacy.    We cannot find a reason for the Lazzaretto’s layout, but we note that it resembles closely that of the hospital or valetudinarium of a Roman legion. Space, air, privacy and confinement.    

From the late summer of 1630 the plague passed, after having killed nearly three-quarters of the Duchy’s population. In Milan, 60,000 were killed out of a  population of 130,000.

We shall leave our readers to make up their minds as to how much has changed since 1630, but we would like to pass on Manzoni’s view, through the mouth of one of his surviving characters:

“If those who have survived [the plague] do not start using their head after this……there is nothing left, but the end of the world!”

Recommended reading for pandemics: The Betrothed Paperback by Alessandro Manzoni

Tom Jefferson is an Epidemiologist.
Disclosure statement is here

Carl Heneghan is Professor of Evidence-Based Medicine, Director of the Centre for Evidence-Based Medicine and Director of Studies for the Evidence-Based Health Care Programme. (Full bio and disclosure statement here)