Ever wonder who people turned to when the Black Death or later plague outbreaks swept through town? For nearly four hundred years, waves of plague terrified Europe. While we often picture the famous beaked plague doctor, the reality of healthcare back then was a fascinating, complex, and sometimes bizarre mix of characters and ideas.
The Medical Cast of Characters
You might think “doctors” were the main players, but the medical world was much more varied. University-trained physicians were just one part of the picture. Their education was super theoretical, all based on ancient Greek and Roman texts (like Galen) passed down through centuries. They believed illness, including plague, came from imbalances in the body’s four “humors” (blood, phlegm, yellow bile, black bile) and was often triggered by bad air (“miasma”), the alignment of stars, or even God’s wrath.
Physicians (The Bookish Bunch): These guys were the intellectuals. Their job involved examining urine (holding up those iconic glass flasks), taking pulses, and prescribing treatments based on complex theories. Heavy lifting? Not really. They famously swore oaths not to do manual surgery. They diagnosed, theorized, and directed, but often kept their hands clean.
Surgeons and Barber-Surgeons (The Hands-On Healers): If you needed something physically done, you went to a surgeon or a barber-surgeon. These folks learned their trade through apprenticeships, not universities. Their knowledge was practical, gained from experience. What did they do? Everything from setting bones, dressing wounds, and amputating limbs to pulling teeth. Oh, and bleeding patients – a super common treatment believed to rebalance those pesky humors. Barbers among them also cut hair, shaved beards, cleaned teeth, and even picked lice. Their shops, sometimes marked by a bowl of blood (later the striped barber pole), were often community hubs, noisy places with chatter, music, and maybe even gambling to distract patients from, well, getting bled without anesthetic (ouch!). Though often seen as lower status than physicians, surgeons were crucial, especially during epidemics when they did a lot of the dangerous frontline work, like bleeding the sick and working in plague hospitals. Some women practiced surgery too, especially in earlier centuries, though this became less common as the profession became more formalized (and male-dominated).
Apothecaries (Masters of Mystery Mixes): Think of apothecaries as the pharmacists of their day, but with way more mystique. They ground herbs, roots, minerals (and sometimes weirder things like dried toads or scorpions!) with mortars and pestles to create powders, pills, syrups, and ointments. Their shops were often exotic places, lined with colourful jars holding spices from afar, local honey, and perhaps even a stuffed crocodile hanging from the ceiling for flair. They guarded their recipes closely, leading to accusations of fraud – did that pricey potion really contain what they claimed? One of the most famous plague remedies they concocted was Theriac, a complex mixture with dozens of ingredients (including roasted viper flesh!) that took ages to prepare and age. The main goal of most medicines was Galenic: to help the body purge unwanted humors through sweating, vomiting, or defecation. Apothecaries were experts in laxatives and purgatives. Interestingly, they tended to survive plague outbreaks at higher rates than physicians or surgeons, which probably boosted their reputation.
Women Practitioners (From Noble Ladies to Village Healers): Beyond the guilds, women played huge roles in healthcare. In the countryside, “wise women” or folk healers were the go-to for most people. They used a mix of common sense, herbal knowledge passed down through generations, and sometimes a dash of superstition. While officials often dismissed them, ordinary people trusted them deeply. Wealthy noblewomen also often tended to the sick on their estates as a form of charity, sometimes building impressive knowledge from books. And let’s not forget midwives. Childbirth didn’t stop for the plague, and midwives were essential. They cared for mothers and newborns, sometimes under harrowing conditions. Some cities even hired specific “plague midwives” to work only with infected families to prevent spreading the disease. Sadly, the era of the witch hunts sometimes cast suspicion on female healers, blurring the line between healing and perceived malevolence.
Empirics, Quacks, and Charlatans (The Unlicensed Operators): With established medicine often powerless against the plague, it’s no surprise that unlicensed healers thrived. Empirics might simply rely on observed experience rather than theory. Quacks and charlatans were often more about showmanship. They’d set up benches in public squares (these “mountebanks” got their name from mounting benches), hawking miracle cures, pills, elixirs, and amulets with loud promises and maybe even a bit of street theatre (juggling, music, fake testimonials). People were desperate, and these sellers offered hope, however dubious. Authorities often tried to regulate them but also sometimes needed anyone willing to help during a crisis. Books were even written by “proper” doctors to try and debunk the claims of these charlatans and steer people back to professional care.
Doctors in Demand (But Did They Help?)
So, you had all these different healers, but what about the university-trained physicians? How available were they, and what was their actual standing?
Honestly, physicians were pretty scarce, especially outside major cities. Figures varied wildly, but in many rural areas, there might be only one physician for thousands of people. Even in cities, the numbers weren’t huge compared to the population. Most physicians served wealthier clients – merchants, nobles, high-ranking clergy. They needed patients who could pay their fees. This meant that during plague outbreaks, physicians often fled town with their rich patrons, leaving ordinary folk without qualified (in theory) help. Some towns even tried to punish doctors who bailed! Guy de Chauliac, a famous papal physician during the first wave in 1348, admitted he stayed put mainly to avoid shame, though he was terrified.
Physicians guarded their status jealously. They organized into guilds, much like craftsmen, to control who could practice, set standards (based on their theories, of course), and discipline members. Over time, especially in cities with universities, powerful “Medical Colleges” emerged. These weren’t just teaching institutions; they became regulatory bodies, often appointed by rulers, examining candidates, granting licenses, and fiercely defending traditional Galenic medicine against alternatives like Paracelsianism (which involved more chemical remedies). These colleges, like the Royal College of Physicians founded in London in 1518, cemented the physicians’ elite status, sometimes even granting members noble titles. Despite their inability to actually cure the plague, their social standing, complex theories, and association with the powerful allowed them to maintain authority for centuries.
Trying to Stop the Unstoppable: Plague Prevention
If you couldn’t cure the plague (and they largely couldn’t), the next best thing was preventing it. Their strategies were all based on the dominant theories: bad air, humoral imbalance, and celestial influences.
Cleaning the Air: Since “corrupted air” or “miasma” was the prime suspect, dealing with air was key.
- Flee: The number one advice, repeated for centuries: get out of the infected area! Head for the countryside, preferably somewhere with dry air (though some argued for low ground to be further from the stars!).
- Seal Up: If you couldn’t flee, shut windows and doors tight, especially those facing south (believed to be a source of bad air). Maybe crack a north-facing window briefly in the morning.
- Fumigate: Burn things to purify the air. Pleasant smells were popular: juniper, rosemary, pine, incense, ambergris (for the rich). Some believed in fighting stink with stink, burning sulfur, leather, or even keeping buckets of human waste nearby! Large bonfires were also lit in streets or halls (Pope Clement VI famously sat between two huge fires in Avignon).
- Personal Air Fresheners: People carried pomanders – balls of aromatic substances (like ambergris, musk, spices, or simply an orange stuck with cloves) held in ornate containers – to sniff when out and about. Tobacco, newly arrived from the Americas, quickly became popular as a personal fumigant; people smoked pipes constantly, believing it protected them. Samuel Pepys famously bought some tobacco to chew and smell after seeing plague-marked houses in London in 1665.
- Cleanliness (Sort Of): Vinegar was used to wash down walls and coins. Clothes and bedding were laundered more often – a good move, as it might have killed fleas! But washing the body? Generally discouraged, as it was thought to open the pores to bad air.
Eat Right, Feel Right, Stay Safe? What you ate and how you felt were considered crucial for keeping your humors balanced and resisting plague.
- Diet: Avoid foods considered “warm and moist” (like fatty meats, dairy, some fruits) or things that were hard to digest, as these could “corrupt” the body. The ideal was foods considered “cold and dry.” Moderation in eating and drinking was always advised. Specifics varied wildly between doctors.
- Mood: Strong emotions were bad! Fear, anger, anxiety, even excessive joy could heat the body or upset the humors. Sadness was also dangerous. The ideal was a calm, moderate disposition. Boccaccio’s famous Decameron, where young nobles flee plague-ridden Florence to tell stories in the countryside, reflects this advice: escape the bad air and the depressing sights and sounds. Relaxing activities like listening to music were recommended.
- Behavior: Regular bleeding and purging were often recommended preventatively. Avoid hot baths, strenuous exercise, and even sex – these activities heated the body, increased breathing, and opened pores, inviting the plague in.
Potions, Pills, and… Gold? People eagerly consumed preventative medicines. Some were standard apothecary fare like Theriac. Others were bizarre: eating burnt nuts with urine, drinking extracts of horse dung, munching raisins, chewing garlic (to keep tiny plague “insects” away), or drinking coffee. Alchemical ideas suggested metals could absorb poison; some recommended keeping a gold coin (preferably an Elizabethan one!) in your mouth. Patent medicines, like Anderson’s Scots Pills (a strong purgative), became popular, offering easily accessible (if not effective) options.
Magical Thinking: Amulets and Talismans: Believing that objects could hold protective power was widespread. Amulets were hugely popular against plague. These ranged from Christian relics or Bible verses worn in lockets to specific gemstones (diamonds were thought to counteract poison). Organic materials were common, especially dried toads worn against the skin (some doctors swore they saw the toads swell up as they absorbed poison!). Paracelsians and alchemists created complex amulets involving mercury, arsenic, ground-up gems, and even weirder ingredients like menstrual blood or toad vomit, often prepared under specific astrological conditions and stamped with symbols. While some thinkers were skeptical, many prominent physicians and scientists (like Robert Boyle) believed in their efficacy, and people clung to them for hope.
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Spotting the Enemy: Diagnosing the Plague
Before treating the plague, you had to be sure that’s what it was. Diagnosis involved looking at the environment and the patient.
Doctors believed nature gave warnings. Signs of impending plague included weird celestial events (comets, meteors), strange weather (mists, lightning, storms), unusual animal behavior (mass deaths, creatures fleeing an area), crop failures, bad smells from the earth, or even an increase in frogs and snakes. Basically, anything that seemed unnatural or out of balance could signal corrupted air and the coming pestilence.
The Doctor’s Toolkit: When examining a patient, physicians used their senses and a few key tools:
- Pulse: Taken with four fingers, physicians claimed to distinguish dozens of subtle variations (“antlike,” “sluggish,” etc.), often relating the pulse to astrology and the “music of the spheres.”
- Urine: The iconic uroscopy flask or “jordan” was essential. Doctors held it to the light, swirling the urine to judge its color, clarity, texture, and sediment. Elaborate color charts linked specific urine appearances to humoral imbalances and diseases.
- Other Fluids: Blood and feces were examined for color, consistency, smell, and abnormal contents.
- Observation: Body temperature (by touch), skin condition (rashes, sores), breath and body odor, breathing difficulties, vomiting, diarrhea, energy levels, restlessness, and mental state were all noted.
The most famous sign was the bubo – the painful swelling in the lymph nodes (groin, armpits, neck). But doctors also recognized pneumonic plague (affecting the lungs, causing bloody sputum, often faster and deadlier) and septicemic plague (infection in the bloodstream). They looked for various skin manifestations often called “tokens”: blisters, blotches, pustules, dark spots indicating tissue death. Fever, weakness, vomiting, delirium, and sleeplessness were also common symptoms. The sheer variety of symptoms described has led modern historians to wonder if other diseases were sometimes lumped in with plague diagnoses.
Treatments: Desperate Times, Desperate Measures
Once plague was diagnosed, treatment followed the same logic as prevention: rebalance humors, fight the “poison,” draw it out, and support the body’s natural defenses (as they understood them).
Attacking from the Outside:
- Bleeding: Still the go-to treatment. Phlebotomy (opening a vein with a lancet), cupping (using heated glass cups to draw blood to the surface, sometimes through small cuts), or applying leeches were used extensively to remove “excess” or “corrupted” blood. Doctors had complex charts showing where to bleed based on the location of buboes or other symptoms, often linked to astrology. Some physicians noted poor outcomes, but it remained standard practice.
- Treating Buboes: Doctors tried desperately to deal with the swellings. Ointments made of honey, herbs, turpentine, egg yolks, or even “scorpion oil” were applied to try and draw out the poison. Poultices of onion or salt were used. A particularly strange (but widely recommended, even by London’s Royal College of Physicians!) method involved pressing the plucked rear end of a live chicken against the bubo until the chicken died, repeating with fresh chickens until one survived, supposedly having absorbed the venom. More invasively, surgeons would lance the bubo to drain the pus, sometimes cauterizing the wound with a hot iron or covering it with absorbent lint soaked in complex mixtures, or even applying the flesh of freshly killed animals (pigeons, dogs).
Fighting from Within: Internal remedies aimed to counteract or expel the poison.
- Antidotes Galore: Hundreds of recipes existed, from simple pills of aloe or myrrh to complex concoctions involving herbs (rue, valerian), minerals, powdered gems, gold, animal parts (horns, dung, urine), and standard complex formulas like Theriac and Mithradatum. Absorptive clays were sometimes used. Anything that induced purging (vomiting, diarrhea, sweating) was generally seen as good, helping the body expel the poison. Unicorn horn powder (probably narwhal tusk) and bezoar stones (gallstones from animals) were expensive, sought-after ingredients, though some doctors eventually debunked them. Powdered viper remained a respected ingredient, believed to trace back to Hippocrates. Distilled alcohol (“aqua vitae”) was used as a solvent for preparing potent tinctures.
Conclusion
For centuries, Europe faced the plague with a medical system based on ancient theories that simply didn’t match the reality of the disease. Physicians, surgeons, apothecaries, midwives, folk healers, and even outright quacks all played a role, offering everything from prayers and poultices to purgatives and pomanders. While many practitioners were dedicated and brave, risking their lives daily, they were ultimately hampered by flawed ideas about humors and miasma.
It wasn’t until long after the Second Pandemic faded (for reasons still debated) that medical science finally began to understand the true nature of infectious diseases. The story of plague medicine is a powerful reminder of how deeply held beliefs can shape actions, even in the face of overwhelming crisis.
