Charles River Editors - Fighting the Plague in Antiquity and the Middle Ages: The History of Ancient and Medieval Efforts to Prevent the Spread of Diseases

By Charles River Editors

Josse Lieferinxes painting of St. Sebastian pleading with Jesus for the life of a gravedigger affected by the Plague of Justinian

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A medieval depiction of plague victims being buried

Plague and pestilence have both fascinated and terrified humanity from the very beginning. Societies and individuals have struggled to make sense of them, and more importantly theyve often struggled to avoid them. Before the scientific age, people had no knowledge of the microbiological agents unseen bacteria and viruses which afflicted them, and thus the maladies were often ascribed to wrathful supernatural forces. Even when advances in knowledge posited natural causes for epidemics and pandemics, medicine struggled to deal with them, and for hundreds of years religion continued to work hand-in-hand with medicine.

Inevitably, that meant physicians tried a variety of practices to cure the sick, and many of them seem quite odd by modern standards. By the time Rome was on the rise, physicians understood that contagions arose and spread, but according to Galen, Hippocrates, and other Greco-Roman authorities, pestilence was caused by miasma , foul air produced by the decomposition of organic matter. Though modern scientists have since been able to disprove this, on the face of it there was some logic to the idea. Physicians and philosophers (they were very often the same, Galen being an example) noticed that disease arose in areas of poor sanitation, where filth and rotting matter was prevalent and not disposed of, and the basic measures to prevent disease waste removal, provision of clean food and water and quarantining - would have been obvious to them. The scenting of miasmic air with incense and other unguents to expel the foulness would also have thus made sense, though people now know that cant stop the spread of a disease.

Ancient physicians at the time believed that miasma was not the direct cause of disease but rather a catalyst. Maladies were caused by an imbalance of what Galen called the four humors. According to him (and Hippocrates before him), the body contained four kinds of fluids: black bile, yellow bile, blood, and phlegm. These corresponded to the four elements of which the entire universe was composed: earth, fire, water, and air. Black bile was tied to earth, yellow bile to fire, blood to air, and phlegm to water. It was believed that the balance of the humors in the body not only determined an individuals health, but their behavior and temperament as well. A melancholic (from melanos , the word for black) disposition was caused by an excess of black bile. Yellow bile made a person fiery or choleric (from khole , the word for bile), while a phlegmatic (from phlegma , body moisture) temperament denoted a surplus of phlegm. The most desirable temperament was the sanguine ( sanguis , blood), which exhibited happiness, calm and enthusiasm. The ancient Romans thought miasma caused an imbalance in these fluids, and disease resulted. For the ancient physician, as indeed for all physicians for the next 1,500 years or so, illness was not the direct result of external agents.

The theory of the four humors was based on philosophy rather than what today would be called science. It might seem easy to ridicule the idea in hindsight, but the ancient philosophers and doctors did not and could not possess the elementary scientific knowledge that medical practitioners have today, so humorism can be seen as an honest attempt to make sense of the human body and its malignancies.

The High Middle Ages had seen a rise in Western Europes population in previous centuries, but these gains were almost entirely erased as the plague spread rapidly across all of Europe from 1346-1353. With a medieval understanding of medicine, diagnosis, and illness, nobody understood what caused Black Death or how to truly treat it. As a result, many religious people assumed it was divine retribution, while superstitious and suspicious citizens saw a nefarious human plot involved and persecuted certain minority groups among them.

Though it is now widely believed that rats and fleas spread the disease by carrying the bubonic plague westward along well-established trade routes, and there are now vaccines to prevent the spread of the plague, the Black Death gruesomely killed upwards of 100 million people, with helpless chroniclers graphically describing the various stages of the disease. It took Europe decades for its population to bounce back, and similar plagues would affect various parts of the world for the next several centuries, but advances in medical technology have since allowed researchers to read various medieval accounts of the Black Death in order to understand the various strains of the disease.

It was only in the mid-19 th century that scientists established a definitive link between viruses and bacteria and disease, and this allowed the development of vaccines to prevent the spread of killers such as smallpox, typhus, and diphtheria. In the early 20 th century, the development of antibiotics helped immensely, but as the Spanish flu of 1918 and the recent Coronavirus has demonstrated, people have not succeeded in conquering all infectious diseases, and the fear of contagion remains with humanity.

Fighting the Plague in Antiquity and the Middle Ages: The History of Ancient and Medieval Efforts to Prevent the Spread of Diseases looks at the ways past societies have striven to cope with epidemics and the various remedies some bizarre, some desperate, others logical but nonetheless misguided they employed. The approaches include an eclectic mix of medicine, supernatural rituals, religion, natural philosophy, and the use of scientific advances. Along with pictures depicting important people, places, and events, you will learn about ancient and medieval efforts to fight the plague like never before.

The earliest record of any kind of systematized healthcare dates to ancient Mesopotamia and the Sumerian and Babylonian civilizations. For these, healing was in the gift of the gods and physicians operated as their instruments. The goddess Gula (the great physician) presided over medicine for the ancient Sumerians.

For the ancient Egyptians who took up the mantle of Mesopotamian physicians, medicine channelled the power of the gods. It is often noted that ancient Egyptian medicine was advanced for its time and more enlightened in many respects than that of the Middle Ages. Egyptian physicians were aware of the importance of diet; they employed medicines, had a fairly good (though not complete) knowledge of human anatomy, recognized the healing properties of massage and aromatherapy, and performed surgery, including trepanning. A major source of medical knowledge was the practice of embalming and mummification of bodies in preparation for the afterlife, which was performed by priests. Thus, ancient Egyptian priests were also physicians.