The Black Death decimated Europe in the 14th century, and it is estimated that 50 million people died due to this disease. This may not seem much compared to the modern population of over 8 billion, but 50 million equated to roughly half of Europe’s population in Medieval times. This disease was caused by the bacterium Yersinia Pestis (which results in the bubonic plague), and was spread initially through rats and fleas.
The first introduction of the Black Death to Europe is believed to have been an act of biological warfare on Kaffa in the Crimea. Due to a long history of trading disputes, invading Mongols laid siege on Kaffa, which eventually fell apart when a mysterious illness decimated the Mongol forces. Knowing that the siege was over, the Mongols loaded their diseased dead into catapults and hurled them across the city walls, in the hope that those inside would suffer the same fate as their attackers. The people of Kaffa tried to escape the illness and death, but only managed to spread the disease further into Europe, resulting in the infamous pandemic.
Transmission of the Black Death
Rats carrying the bubonic plague arrived at new areas on ships, carrying the fleas on their backs. Fleas feed on blood, so feeding on the infected rats ensured that they acted as vectors of the disease. The bacteria would multiply in the fleas’ guts and cause obstructions, meaning the fleas would regurgitate to try and clear the blockage before feeding again. When biting a human, the flea would regurgitate the bacteria into the feeding site, causing infection in the human host. Of course, if flea bites were the only way of contracting the disease, it would not have spread that rapidly through Europe. For human-to-human transmission, inhaling infected respiratory droplets was sufficient to cause infection. In this respect, the disease spreads much like a cold or flu.
Science in the 14th century was certainly not as advanced as it is now, and they had no knowledge or understanding of how diseases arose. Popular folk beliefs regarding the Bubonic plague regarded its existence as due to the aligning of planets causing a great pestilence in the air, or that it was a plague sent by God to punish sinners. They also believed that bad smells infiltrating the body could cause disease, and so many were wary about being near dead bodies (for good reason too!).
Whilst avoiding those infected or killed by the plague was a good idea, the more effective attempts to reduce transmission that we observe today were completely ignored. Basic hygiene was severely lacking in the 14th century. For example, bathing was believed to be a temptation by many members of the church, and regular bathing was actively discouraged by notable members like St Benedict. Human and animal waste was strewn all over the streets, which provided another place for disease to fester and spread, and it certainly didn’t help that the majority of the population had pre-existing malnutrition contributing to their weak immune systems. All of these factors, coupled with some valiant but ultimately futile attempts to stop the spread, contributed to the fast and deadly transmission of the Black Death.
Prevention of spread
The pandemic protocols the people of the Middle Ages followed weren’t all that different to the ones we follow today. In 1348, before the plague could reach them, the city of Pistoia in Italy set out a series of ordinances to pre-emptively prevent the spread of the plague in the city. It detailed burial arrangements and how deep a grave should be to prevent the smell from creeping out and also restricted the selling of meat and linen from within and beyond the city. Although these health ordinances did in fact reduce the spread of the plague in the city, they were not as effective as they hoped.
A pandemic protocol that we all know and love is that of quarantine. The port city of Ragusa in Sicily in 1377 was one of the first to implement a quarantine on incoming ships and trade caravans to screen for infection. They were made to stay on the island of Mrkan or the town of Cavtat for at least a month, ensuring that no sign of infection occurred. This isolation period was eventually upped to 40 days, and a plague hospital was established outside of the city walls, which kept the healthy and the diseased separated from each other. Modern-day quarantines were effectively born from the measures taken by Ragusa, but the idea of isolation actually has its roots in ancient times, and is detailed in the Old Testament of the bible for keeping those afflicted with leprosy away from others.
Treatment of plague
A widely used treatment for the plague in the 14th century was the Vicary method. A live chicken would be plucked clean, strapped to the swollen areas of the patient, and would hopefully draw out the disease and absorb the illness. This process was repeated until the chicken became ill or died, more likely due to being strapped to a parasite-ridden peasant rather than due to any healing processes. Another cure was to drink various potions and concoctions, though oftentimes these were made from ground-up emeralds or even mercury, which ended up killing the patients before the plague could.
The most recognisable medical measure associated with the Bubonic plague is plague doctors. The first suggested use of masks to prevent plague was in 1373 with the first pandemic outbreak, but it wasn’t until 1619 in Paris when the first plague doctor was described. Plague doctors came to prominence during the second pandemic of Bubonic plague, and even though almost 300 years had passed since the first pandemic, many protocols from the 14th century were kept in place and didn’t evolve much beyond their initial conception.
A Plague doctor’s uniform consists of a long-beaked mask stuffed with herbs and spices to protect the wearer from miasma, and an overcoat covered in wax (in the hopes that the disease would be unable to penetrate). The spices didn’t do much for protection, but because of the length of the beak, it forced the wearer to remain a certain distance from the infected patient, which may indeed have prevented the contraction of the plague. The overcoat also prevented fleas from latching onto the doctor’s skin, and this is widely thought to be one of the precursors to the modern hazmat suit.
The purpose of these plague doctors was to treat patients, though many of their ‘treatments’ were ineffective. They performed bloodlettings, thought to release the bad humours from the body, autopsies, to determine what exactly the plague did to patients, and surveys, to compile public records of plague death. Most plague doctors were contracted by the town’s administration to treat plague patients only, and they were paid very well because of the inherently dangerous nature of the job.
Ultimately, the treatments that plague doctors provided did little to help patients, and the most important legacy of plague doctors was the records they compiled and their striking figure as a harbinger of death in modern culture.
Modern developments in pandemic protocol
Bubonic plague outbreaks still do occasionally occur in the modern day, but because of advancements in medicine, patients can be treated with a course of antibiotics. Nowadays, we have vaccination programmes for deadly viral diseases, and we have a far better understanding of what causes these diseases in the age of information we live in.
Despite advances in education, there are still certain individuals who disagree with modern medicine such as anti-vaxxers, so our methods of prevention and treatment will never be 100% effective until everyone decides to participate in them. Quarantines and lockdowns are still used today 700 years later, yet now we must be more wary of how fast diseases can be transmitted, especially when transport methods have become so much faster and more advanced than horse and carriage.
Certain attitudes towards the spread of diseases remain the same, and xenophobia remains rife in our culture. The Black Death historically was blamed on the Jews, and more recently Covid-19 was blamed on the Chinese. This really shows that however far our protocols and scientific knowledge have advanced, at heart many of us are still intolerably ignorant of how our world works. Future pandemics will put our practices and beliefs to the test, and hopefully, we’ll have advanced even further by then.
