A Blast from the Past: Preventative Medicine During the Black Death

By Manal Riadi, Public Health Major, 2021

The COVID-19 pandemic is not the only known outbreak of an infectious disease. For several years, the bubonic plague caused some of the harshest outbreaks in history. Today, it is the most common infection developing from the bacterium Yersinia pestis, totaling 80% of Yersinia pestis-related cases worldwide.1 There have been three known waves centered around this disease.2 The second wave of the bubonic plague, famously known as the “Black Death” was recognized as a very fatal pandemic. This plague took over Europe and several nations in Asia and Africa. The height of the bubonic plague pandemic was between 1346 to 1351.1

Today, we know that the bubonic plague can pass on to humans from flea bites that have fed on infected vectors.1 However, in the 1300s, no one fully understood what the cause, treatment, or prevention for such a disease was. Doctors would even describe it as an instantaneous death for how fast it would end someone’s life.3 It was common for doctors to treat this disease with bloodletting and boil-lancing, which were both dangerous treatments. In addition, communities created treatments based on superstitions, such as aromatic herb burning or bathing in rosewater or vinegar solutions.4 It was also a common belief that the plague was a punishment from God for their sins and behavior.

Severe labor shortages for both farmers and skilled craftsmen caused a scarcity of food and supplies, which severely impacted them compared to those from a higher class. In some nations, like Italy, individuals lost their status in power, creating a middle class for the first time in written history.2 Those with higher status, such as royalty, noblemen, or clergymen, were not as impacted by the pandemic because they had more access to resources that protect against infection than the poor.5

In “Medical Care or Disciplinary Disclosures? Preventive Measures against the Black Death in Late Medieval Paris: A Brief Review’’, Yong Jin Hong and Sam Hun Park examined how one’s position of power during the pandemic gave them more opportunity to obtain medical knowledge. They mainly observed a prescription plan written and published by the University of Paris called “Compendium de Epidemia” that was exclusively prescribed to the royal family and nobles. This book gave instructions on how to maintain health by practicing different regimens as preventative care. Surprisingly, some of these practices are still common today. The prescription plan was both politically and faith-based, primarily adopted from Islamic-Arabic academia. Some of the same resources were also used to create a better understanding of the pathogenesis of the disease.5 Information for this work was primarily influenced by the scholar Ibn Sina (who is also known as Avicenna). Additionally, information on how to treat the disease was collected from physicians who made reports of the six major outbreaks that took place in France during this time.5 The “Compendium de Epidemia” primarily focused on preventative care and steered away from the causes of the disease since there was a limited understanding.

A Plague Doctor during the Black Death. The beak-like mask contained herbs said to fight the widespread plague

Photo courtesy of The New England Journal of Medicine.

One of the main beliefs was that heat and humidity played a role in making the body vulnerable to disease and that it caused contracting the bubonic plague. It was assumed that if one had a fever quite often, they were more likely to become ill. Hong and Park connected this to celestial phenomena. For example, interactions between the planets lead to a chain of causal relationships like the production of humidity, causing corruption to air.5 As a result, they concluded that this type of disruption infiltrated the heart and lungs, making an individual vulnerable to disease. The prescription plan was designed to help prevent the body from facing the disease, advising individuals to not overwork their bodies to prevent them from producing heat and humidity. To practice this, they recommended treatments that are still common today. Practices included sleeping well, developing a habit of regular physical activity, and consuming a well-rounded diet of legumes. Mental health was also recognized to be a vital practice, encouraging individuals to develop habits of avoiding excessive anger, depression, and anxiety.5 Since it was common to believe that the Black Death was God’s will, the prescription plan also recommended people to adopt a life of faith, believing that a faith-based connection would also prevent illness.5

Hong and Park drew some interesting conclusions from their findings. Firstly, they recognized that this knowledge of early preventive medicine should not be treated as common medical knowledge of this era. As mentioned before, the prescription plan was only provided for those of a higher status in society, and it was written entirely in Latin, making it inaccessible to the general public. Lastly, remedies such as eating a well-rounded diet were unrealistic for the lower class. Overall, this helped the authors create a narrative of the social realities and issues that took place during the time of the pandemic. Another unique characteristic that the authors pointed out is how the prescription plan encouraged a life of faith rather than making any direct associations to religious faiths. This was necessary during this time, especially when crimes against Jewish communities and flagellants were prevalent.5

The Black Death was such a fatal pandemic that many believed it to be a punishment from God. It took a toll on many communities, especially those within the lower class. However, we can create a better narrative of the realities that took place by looking at sources such as the “Compendium de Epidemia”. Not only would we have a better idea of what happened in the past but we can also use these historical references to better equip us for the challenges that we face today.

A one-page manuscript created by Pierart dou Tielt showcasing the citizens of Tournai, Belgium, burying those who succumbed to the plague.

Photo courtesy of Royal Library of Belgium.7

[1] Plague FAQ | CDC. (2019, November 26). Centers for Disease Control and Prevention. https://www.cdc.gov/plague/faq/index.html Bramanti, B., Dean, K. R., Walløe, L., & Chr. Stenseth, N. (2019). The Third Plague Pandemic in Europe. Proceedings of the Royal Society B: Biological Sciences, 286(1901), 20182429. https://doi.org/10.1098/ rspb.2018.2429.

[2] Cohn, S. K. (2008). 4 Epidemiology of the Black Death and Successive Waves of Plague. Medical History, 52(S27), 74–100. https://doi.org/10.1017/s0025727300072100.

[3] The Black Death may have transformed medieval societies in sub-Saharan Africa. (2019, March 7). Science | AAAS. https://www. sciencemag.org/news/2019/03/black-death-may-have-transformedmedieval societies-sub-saharan-africa.

[4] Glatter, K. A., & Finkelman, P. (2020). History of the Plague: An Ancient Pandemic for the Age of COVID-19. The American Journal of Medicine, 1–7. https://doi.org/10.1016/j.amjmed.2020.08.019.

[5] Hong, Y. J., & Park, S. H. (2017). Medical Care or Disciplinary Discourses? Preventive Measures against the Black Death in Late Medieval Paris: A Brief Review. Iranian journal of public health, 46(3), 286–292.

[6] Earnest, M. (2020). On Becoming a Plague Doctor. The New England Journal of Medicine. https://doi.org/10.1056/NEJMp2011418.

[7] dou Tielt, Pierart. Antiquitates Flandriae. 1353, Royal Library of Belgium, Belgium.