The Black Death and its Effect on the Change in Medicine 

Historians have argued if the Black Death in the 13th century advanced science and medicine or if it was just a terrible plague that wiped out most of the European population. The Black Death did in fact bring many discoveries to most of Europe. The aftermath of the plague led to advancements of medications and swayed everyone from their hardcore beliefs. Medical practices went from being theoretical, based on their theories of the human body, to being more based on evidence which was gained through experience from prior patients.

The questions I want to answer in this paper are: why did it took so long to find a cure for the plague? Was the disease difficult to understand in general? Lastly, did other theories hold up to Galen’s?

It all started in 1347, the time of the century where the people of Europe could not think it could be any worse. Slightly before this time, in 1316-1317, the people were already suffering from a famine due to volcanic eruptions which blocked out the sun. Later, came the cooling process as it rained too much for crops to grow. Families have doubled size roughly between 1000 and 1300’s and there simply was not enough food to feed the people of Europe. It wasn’t until 1347 when the Black Death, also known as the bubonic plague, was brought back by ship from Kaffa to the islands of Sicily.

Kaffa was a Genoese trading center along the Black Sea, but, in 1346, the Huns were trying to take over the trade routes. This however, had allowed the Huns to become the victim of the plague. This caused at least 5 million deaths in China which caused the Huns to dump the bodies into Kaffa. This lead them into thinking it would cause the end of the plague but, unfortunately, the infected fleas will jump to different host bodies after the death of their original host body. This plague was then also brought to other European countries and it spread north.

Everyone was equally harmed by this disease meaning, not only did this disease affect those who were poor, but also those who were rich. At this point, the people have been forgetting the proper burial and would be thrown into a mass grave. By 1350, with an exception to few, all of Europe’s trading routes were devastated by the disease (Sayre 443). Not only did the Black Death plague break out once, but also again in 1363, 1388-90, and 1400.

Keep in mind these people were already suffering from lack of a supplementary food supply and their bodies were already severely weakened. The European people and those around them had not experienced a pandemic to the level of the Black Death in a quincentenary, and the plague’s re-visitation in the 1400s was viewed as completely unparalleled. Therefore, the European people and those around them had no remembered period of time or an event to which they could turn to for guidance and stability. There was no past epidemic similar to the plague, meaning, they didn’t have any historical time period to look back to. “I believe that epidemic disease and environmental crisis were the most important factors in shaping European history in the fourteenth and fifteenth centuries. I think that many, if not most, specialists agree with me …” (Gottfried). Not only was the plague one of the biggest periods in European history, but it would later spark a revolution in the medical field.

Galen’s theories were highly believed during this time, and he had created a medicine that could help with the plague. Theriac was one of the most popular plague medicines that he created. However, this medicine was not as easy as you would think to get. That medicine alone, simply contained 80 different ingredients. Physician's responsibility was the prevention of disease and to maintain and promote good health. The belief was that the disease was an imbalance of the four humors. “'Dry' and 'cold' in the humoral schema, such foodstuffs could engender the type of humors suitable to corroding and overcoming the pestilential poison, itself 'hot' and 'moist'.” (Fabbri 250). Medicines in this time typically fell between three categories, purgatives, cordials, and antidotes. Puratives would cleanse the perfluous humors, Cordials strengthened the heart, brain, and liver, and antidotes neuralized poisons. Theriac was originally made for poisonous snake bites and was believed to be supremely effective against poison.

Opium was one of the most significant simple ingredients contained in Theriac. This medicine was actually formed from one of the best medications, mithridatium, which was derived from Mithridates, King of Pontus (120-63 BC), and later, Andromachus the Elder added viper flesh into the recipe which increased the proportion of opium (Fabbri 254). “It had been noted that when theriac was fresh, it constipated the bowels, for it contained opium and other 'constrictives'; this effect was thought to be due to insufficient aging” (Fabbri 255). Although it was considered the best form of medicine at the time, it took 10 years to sit and reach its true form. “The advent of the Black Death provided ample opportunity to make use of the expanded pharmacopoeias of Arabic tradition, which had replaced many of the early monastic recipe books” (Fabbri 262). What Fabbri is referring to is that the black Death allowed for the older recipes for medicine to be changed to a newer Arabian tradition of medicine and newer recipes were available in texts.

Translations of Arabic pharmacopoeias, a book containing a list of medicinal drugs with directions on how to use them and their effects, were based on Greek, Persian, and Arabic terms (Fabbri 249). These were often but transliterations; this was more like a glossary or a lists of synonyms that were helpful, but without universal scientific criteria, linguistic, geographic, or functional confusion was easy. “Moreover, their use of multiple types of preparations and routes of administration was further evidence of their pharmacologic expertise” (Fabbri 269). Historians that went into pharmacology would try to avoid studying about medicaments during this time frame due to prejudices against ineffective therapies.

It was difficult for the people of Europe to believe in this medication since so many people were dying from it still. However, many still believed its effectiveness since it took away quite a few symptoms of the plague. “The effect of theriac on reported plague symptoms is difficult to assess. Multiple ingredients, together with lack of standardization and disputes about proper constituents, as well as possible chemical interactions, make this a challenging, if not impossible, task” (Fabbri 267). Even with some of the backlash on the medication, Theriac was still a main source of medicine, but it wasn’t the only form of treatment. There was “ philonium magnum, requies magna, and athanasia” which were also treatments for the plague at the time (Fabbri 273). These were similar to Theriac in a way because they did the same purpose such as sedatives, used to prevents symptoms of the plague, and acted similar to muscle relaxers. This was also due to the amount of ways that Theriac was given. “Theriac and theriac-like opiates were not only given in oral form as electuaries and syrups, but also in rectal, topical, transmucosal, and inhalable preparations” (Fabbri 269). The difference between these and Theriac was that since Theriac’s main ingredient was opioids, it solved acute pains. Theriac was not only used in the 1300’s but was used up until late 1800s. The German pharmacopoeia still used Theriac until 1872 and 1884 edition of the Pharmacopée françfaise (Fabbri 280).

Now, although in this time historic medical practices were still an uproar, there was still some practices that had to be constricted such as bloodletting. Bloodletting was used to balance out the four humors when one was off. This procedure was used as a cultural practice but precludes the physiologic elements because it was considered a magical belief.

During this time period, physicians had an opportunity to succeed, gain credibility, and rein prestige over other physicians for immersing themselves into their profession and finding a cure to the devastating plague. However, they could to fail miserably and lose their credibility as an efficient medical practitioners, and ultimately lose their prestige throughout society. As a result to this competition against other physicians, they needed to act quickly, even if not directly with patients, in response to the plague, and had to do so in ways that preserve and secure their position in society.

Few physicians responded by writing ample number of plague tractates, where they detailed the causes of the Black Death, how it could be prevented, and even, cures or ways in which to assuage the effects of the plague.

Also, physicians wrote about the necessary preventative measures. Physicians warned the people to stay in the dry air with no corrupting vapors. These tractates also included on how to bathe and what your diet should be to prevent the plague.

It is represented in the kinds of writings that physicians wrote across Europe which attempted to explain the Black Death and provide the solutions to it. Early tractates were typically concerned about the plague’s causation and precautions against it. The cause and disease prevention were the main subjects of speculative medicine. As such, physicians educated in such departments gravitated toward the information and analyzed the teachings, and commented upon from earlier authorities who they studied from.

Work of Hippocrates and other accepted authorities did not provide the information for medieval physicians on how to fight against an epidemic as big as the Black Death had become. Their work did not prepare newer physicians for the task they had in front of them. Galen’s Theriac was the closest they had to a remedy however, it did not cure the plague. New remedies had to be developed quickly. The problem was that even though the most outstanding physicians and surgeons were still learning, these new remedies had be based in practical experiences with plague victims. The process of this having to learn new ways to combat this plague began in the early years of the Black Death and continued to evolve throughout the fifteenth century. Initially, the tractates seem to have been a way to assert dominance in physicians of learned medicine. The inability to adequately serve the European populations in time of plague caused a preference for physicians to write advocating practical measures for combating the plague instead of just explaining it.

Physicians had always had access to the observations of plague victims which means they had plenty of opportunity for discovering the best ways to care for the victims. However, it is evident that, despite the progress made, plague is still a deadly disease. “While modern scientific knowledge has generally enhanced our understanding of the medical world of the past, in the case of the plague it has been a hindrance” (Clouse). Thus, they continued interest in finding its treatment and sharing the findings through writing, which remained an important pursuit well after the Black Death itself.

It wasn’t until mid 1800’s, after the most recent breakout of the plague, for an actual cure for the Black Death was found in China. Researchers isolated that the Black death was actually a rod shaped bacillus that was responsible. It was found that Yersinia pestis was the cause of the plague and found that rats also showed plague symptoms that were similar to people, and those who were infected typically had flea bites. The big question is why did it take so long to find a cure? Overall, the first step was finding a cause of the cure before curing the plague. It took hundreds of years to find what caused the plague since nobody exactly knew how it was started. They found ways of dealing with the symptoms, but besides curing the symptoms, it was difficult to find the true cause. Once the cause of the Black Death is found, they next have to find a treatment that actually will work against that specific cause. Then, they have to test their cure in isolated areas to determine if it would actually work. Today, there would be an extra step and make sure the drug is safe to use through phases of drug testing. Back then there wasn’t processes such as this

To this day, the plague is still around but due to research based on past experiences we were able to safely prescribe a medication to patients. It wasn’t until mid 1800’s when the cure for the plague was found, in accordance, the law was passed for prescription drugs to become legal. The legalization of prescription drugs allows for people to quickly solve a medical problem that they have without intense medical treatment. Prescriptions come in multiple different forms. “Modern medicine has, indeed, similarly perfected inhalable, oral, transdermal, and transmucosal sustained release preparations for a variety of drugs, including narcotic analgesics.” This allows variability for patients and gives their input, as well as their doctors, to choose what is best for that person. Not only did the Black Death allow for medication advances but also hospitals.

The Black death revolutionized hospitals similar to how they are today. Hospitals use to be a place of hospitality rather than a place where you seek medical attention. When disease was based on the four humors, doctors would send them off with a way to cure it themselves. In a hospital, it is more relevant to be the one being helped rather than helping yourself.

The Black death helped the European people realize that the four humors were not the fault of cause of disease anymore. People started realizing that the four humors being out of balance was just too wild of a theory for the cause of the plague. With the amount of people that were being affected by this disease, it was later introduced that contagion was the real concern. Contagion introduced the concept of quarantine and the importance of it for the concern of the public health. Quarantine may sound like an intense punishment however, it was one of the most successful ways of controlling the spread of the plague. When scientists do not have an effective cure, isolating the disease for the safety of the public’s health is the best option. We find cases similar to this still in modern history. Ebola was a similar breakout and it shows us the fear that European people went through while facing the plague. The United States took actions of quarantine since we understood the concept of contagion. The Government’s best option was to quarantine the infected until a cure could be found.

In conclusion, the Black Death was an not only a devastating event in history but also one of the most beneficial. The impact on the medical field has developed the gifts we were given today through our health care system. While the Black Death was taking place, Galen’s medical knowledge led them into the right direction, but eventually allowed for us to learn from his knowledge. The results of the plague were devastating but was a push for the health system to find cures as well as advance its teachings and medical practices.  

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