Horrors of Medieval Medicine: The Black Death Edition

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Episode I: An Introduction You’ve probably heard of the grim Bible story about the Ten Plagues that were sent down by the God of Israel to wipe out the Egyptians. Water was turned into blood. Frogs, locusts and deceased livestocks littered their lands. It was a time of darkness, thunderstorm, and the slaying of firstborn children.

Oh no, save that look of devastation for later. W-wait a minute -- there’s actually something worse?

Welcome to the Great-Grandmother of all Plagues, The Black Death (dun dun DUN DUUUUN), one of the deadliest epidemics in world history that single-handedly killed 75-200 million people between 1347-1351, including those in Europe, one of the heavily affected continents.

mapEpisode II: Origins

Picture masses of people with enlarged lymph nodes (buboes) in the armpits, neck and groin area. And by “masses”, we really mean about one-quarter of the European continent then (“The Black Death in the Fourteenth Century” by J.F.C. Heckler, pg. 121).

The pandemic was also characteristic of high fever, vomiting, discharge and of course, its eponymous namesake -- blackened skin. These symptoms lasted mere days before the patient perished.

Acral_gangrene_due_to_plague

How did they deal with their sufferings? There was no advanced medicine then, and in many cases people turned to churches like the way we would turn to hospitals today.

Inspired by Black Death, "The Dance of Death" is an allegory on the universality of death and a common painting motif in late medieval period @ Michael Wolgemut, 2012

We know now that the Black Death is mainly the bubonic plague, an infectious disease that is caused by the bacterium Yersinia pestis and is transmitted to humans from infected rats by flea. But back in the 14th century, they had many theories, of course: Evil humors carried in the air, Jews poisoning their wells, but the majority consensus seemed to be divine punishment because of… sin.

"This cruel plague has now begun a similarly savage attack upon England. we are struck by terror lest (may God avert it!) this brutal disease should rage in any part of our city. Although God often strikes us, to test our patience and justly punish our sins, it is not in the power of man to understand the divine will." -- Bishop Edendon of Winchester, England, 1346-1366.

And hence they devised treatments to treat its “origin”. Remember, these were the days of medieval medicine, before anesthesia and proper sanitation levels.

"The treatments were more fatal than the Plague, and added to the numbers of the dead." -- Nathaniel Hodges, official physician during the Black Death.

A popular belief was the Theory of the Four Humors (Medicine & Philosophy: A Twenty-First Century Introduction, by Ingvar Johansson; Niels Lynøe, pg. 27): black bile, yellow bile, phlegm and blood in your body. These fluids had to be balanced for you to be healthy, and also had effect on your temperaments.

Can you identify your "humour" back then?

The Four Humors with their corresponding elements, seasons, sites of formation, and resulting temperaments alongside their modern equivalents [Table] @ David Kiersey, 1998 

Episode III: Treatments

Bloodletting

Bloodletting in 1860, one of only three known photographs of this procedure @ The Burns Archive

During the Black Death, plague doctors practiced the removal of blood as an attempt to reduce the harmful ‘humors’ in the body. (“At Medical School”, p.16). If the patients could afford leeches, good for them -- the treatment process would be much less gruesome. And if they could not afford the blood-sucking worms, they had to go with the age-old method of snipping open a vein with a sharp blade for the ‘bad blood’ to flow out.

Aromatherapy

A plague doctor, introduced as “Dr. Beaky”. His nose case is filled with herbal material to keep off the plague [Engraving] @ Paul Fürst, c. 1721The circulation of air was also quick to be blamed. People started carrying sweet-smelling flowers or herbs with them in attempt to resist infection. “Plague Doctors” would also wear masks stuffed with aromatic trinkets supposedly designed to protect them from the putrid air. Modern studies later revealed that although the contagion of air might have been one way to spread the disease, aromatherapy did little to kill the bacteria lurking in the air.

Killing the Jews

Contemporary drawing of Jews being burned to death during the Black Death Persecutions @ Anonymous, the Medieval Manuscript

Another way they “treated” themselves was by massacring the Jewish population. Jewish religious rituals include regular cleansing and bathing, so their living spaces were cleaner than that of their Christian neighbors. With better hygiene, they had lesser rats and fleas around, hence they suffered less severely during the Black Death (“Transition to Modern Times”, pg.154).

This led to rumors of the plague being a Jewish conspiracy to eliminate Christians. Anti-Jewish communities retaliated by murdering and burning the Jews in the belief that it would stop the spread of the plague. The ruthless persecution of the Jewish population nonetheless had no effect in containing the magnitude of the Black Death, and only contributed to another page of racist tragedy in history.

Flagellation

Believing the plague to have been caused by sin, groups like the Order of the Flagellants rose, a self-flogging collection of people who believed man needed to atone for sins through their own physical suffering (The Effects of the Black Death on the Life, Culture and Mentality of Medieval people by Jacques Klick, pg. 2)

Witchcraft

Desperate times called for desperate measures. When doctors didn’t work, they turned to witchery. Some recommendations by “witches” included placing a live hen next to the swelling to draw out the pestilence from the body, or drinking a glass of your own urine to wash off the bacteria. More expensive methods included swallowing a spoonful of crushed emeralds to cure the plague.

Episode IV: A New Hope Modern Day Plague

What? It still exists?

Unfortunately, if you thought this story has a happy ending, you would be “dead” wrong (#geddit). The bubonic plague still lurks today, and not just in third world countries, but also the United States (U.S.). In 2015, fifteen people have been found infected with the plague, four of them fatal.

BUT DON’T PANIC.  While the U.S. sees an average of seven cases annually, the good news is that the plague is no longer the death sentence it was centuries ago. When detected early, it is treatable with modern medicine such as antibiotics. However, since there are so few cases, experts do not recommend taking antibiotics unless a person has been exposed to plague-infected animals.

But there is still no commercially available cure that can kill the Black Death for good. So how can we combat bubonic diseases today? Besides quarantining the sick and early detection, the only other way is by good old-fashioned prevention. This means public health education to inform citizens on the causes and symptoms of bubonic diseases.

If we are to avoid the tragedy of the past, people worldwide need to be aware and also uphold basic hygiene standards. Until the day a cure is available, prevention is all we have. Just in case all else fails and the pandemic returns in apocalyptic form, study hard now so you can breed a zoo of leeches, or y’know, order your own coven of witches.