Hindsight is 20/20: Medieval Medicine through a Modern Lens
The World Health Organization has recently declared COVID-19, colloquially known as the Coronavirus, a pandemic; that word is not used lightly. This means the Coronavirus has reached global levels and as of now, there are confirmed cases in over a hundred countries. One of the most famous and possibly the deadliest pandemic in history is the Black Death, which ravished Medieval Europe in the 14th century. As people are increasingly urged to quarantine themselves, it might be interesting to see how disease was dealt with some 700 years ago.
But first, we need some basic facts. The Black Death (or the Plague) and the Coronavirus are two different types of infectious diseases. The Coronavirus, as the name suggests, is a virus which is caused by a viral infection just like the common cold is. The Plague, on the other hand, is a bacterial disease caused by the bacterium ‘Yersinia pestis’.
The most important difference between viral and bacterial infections is that many bacterial infections can be treated with antibiotics, while viruses cannot. In fact, viral infections can be significantly more difficult to treat, most importantly because viruses are so much smaller than fungi and bacteria. Both the Plague and the Coronavirus are zoonotic, meaning they are transmitted from animals to humans. The Coronavirus is not new by any means though; COVID-19 is simply a new strain of the disease that was discovered in Wuhan, China in December of 2019.
Scholars believe that the Plague most likely originated from Central or East Asia and traveled to Europe through infected fleas on the backs of rats. It arrived in southern Europe in 1347 and then rapidly spread to countries such as Germany and England. By 1350 it had wiped out at least a quarter of the population of Europe and it would take some 200 years for the European population to return to the same level as before the Plague. In the short term, agriculture and commerce were devastated as production and trade numbers plummeted, but the most impactful consequences were in the long term. As the surplus in labor had disappeared, peasant laborers were able to demand better wages and rents, and particularly the middle classes were able to improve their quality of life.
The term ‘quarantine’ can actually be traced back to this Medieval pandemic. After the first wave of the Plague, the Great Council of Dubrovnik, Croatia implemented a trentino; an isolation period of thirty days. This meant that people from plague areas visiting Dubrovnik were not allowed into the city before completing their month-long isolation. Moreover, citizens of Dubrovnik were not allowed to enter the isolation area and only specific people were allowed to care for those in isolation. Anyone who broke these rules was fined and had to be isolated too. In the next decades, other cities implemented similar laws. At the same time, the period of isolation was extended from thirty days to forty days and so the name was changed from trentino to quarantino, based on the Italian word for forty (quaranta).
But quarantine was not the only reaction to the Plague. Religion and devotion played a crucial role in Medieval society and many Christians saw the widespread death as a punishment from God.
Daily prayer was a common response, but far more dramatic was the flagellant movement. Flagellants whipped themselves as an extreme way to ‘kill’ the sins in their bodies.
This practice existed long before the Black Death but suddenly took hold again as whole groups of believers flagellated themselves in public. It was especially common in Germany. Here, the ‘Brethren of the Cross’ would travel in long lines to towns, gathering in the marketplace in a large circle where they stripped down to their waist before beating their backs and chests with a scourge (Ziegler, 2013).
The framing of the Middle Ages as a dark and ignorant time has largely been reconsidered by historians, but the same cannot be said for Medieval medical sciences. On the whole, medieval doctors were ill-informed and uninspired, in part due to the strong influence of the Church. In fact, priests stood above doctors when caring for the sick. If a patient had not yet confessed then the doctor would have to wait for a priest before administering medication. This made physicians practically useless once the Black Death struck. Most physicians completely avoided visiting plague victims and if they did, they accomplished very little. Medieval physicians also avoided plague victims out of fear of infecting their other patients. The solution to this problem: plague doctors.
Plague doctors were hired specifically by towns and villages dealing with the plague. They were allowed only to treat plague victims and had to isolate themselves from the rest of the population. As I said before, not many physicians were willing to risk their lives to fight the Black Death: it was a dangerous and unpleasant job.
As a result, plague doctors were often unsuccessful, second-rate doctors, or young doctors looking to start their career (Cipolla, 1977). The well-known plague doctor costume was, however, not created until the 17th century. French physician Charles de Lorme recommended the wearing of a wax-covered coat, gloves and a hat made from goat leather, and most iconically: a beak-shaped mask with a 15 cm long nose. Medieval scholars thought that the plague spread through the air and could be fought with strong scents. The mask was filled with perfume or herbs, as de Lorme believed that the long beak would allow enough time for the poisonous air to be purified before reaching the plague doctor’s nose.
Another reason for the limited effects of medieval medicine was its basis on ancient beliefs such as the Greek humoral system. According to this belief, all people had four qualities (cold, hot, moist, dry) based on the four elements, as well as four humours (black bile, yellow bile, phlegm and blood) which determined human behaviour. Some doctors believed that people filled with humours were particularly vulnerable to the Plague, while others saw people with hot and moist blood to be the most likely victims.
While this theory no longer fits into modern medical science, doctors did recognize that seclusion was the best way to avoid the Plague. Those unable to live in seclusion were advised to fill the air with strong aromas to fight the ‘infected atmosphere’, for example by filling the house with flowers and burning scented powder.
Preventative medicine was just as odd. While the Dutch still use treacle on their pancakes, Medieval people sometimes blended ten-year-old treacle with ingredients such as wine and chopped-up snakes to fight the Plague. Blood-letting or bleeding was widely considered to be a useful preventative, but no more than four liters of blood at a time.
Clearly these cures did little to nothing in preventing or curing the Black Death, as more than 50 million people were killed in Europe alone. In contrast to this, modern medicine suddenly seems a lot more efficient and useful. To combat further spread of COVID-19, the World Health Organization recommends frequently washing your hands and keeping at least a meter of distance between yourself and others. And while I’m no more educated in medicine than a Medieval physician, I am quite certain these measures are a lot more effective than treacle and snakes. So you best keep your self-flagellation in the bedroom.
Ziegler, Philip. The Black Death. Faber & Faber, 2013.
Cipolla, Carlo M. “A Plague Doctor.” The Medieval City, edited by Harry A. Miskimin, Yale University Press, 1977.