Imagine waking up in 1348 with a swollen, painful lump in your groin the size of an apple. It’s hard, hot, and pulsing. You’re shivering, but your skin feels like it’s on fire. This was the terrifying start for millions of people across Europe and Asia. When we ask how did they treat the black plague, we have to look past the Hollywood version of doctors in bird masks. Honestly, for most of the 14th century, those iconic masks didn't even exist yet. People were desperate. They were dying within days, sometimes hours, of the first symptom appearing.
Medicine back then wasn't about germs or bacteria like Yersinia pestis. It was about "miasma"—bad air—and the balance of the four humors. If you were sick, your body was "out of whack." Doctors, priests, and even local barbers tried everything from cutting veins to sniffing bouquets of flowers to keep the "pestilence" at bay. It was a chaotic, terrifying mess of trial and error.
The Theory of Miasma and the "Bad Air" Fix
Medieval doctors were convinced that the plague was carried by "corrupt air." This wasn't a crazy thought if you consider the stench of 14th-century cities. Open sewers, rotting waste, and unwashed bodies were everywhere. They figured if the air smelled like death, it probably caused death.
To combat this, people were told to carry "nosegays" or pomanders. These were basically small balls of ambergris, musk, or heavy spices. If you could smell the flowers, you couldn't smell the plague. Simple, right? Except it did absolutely nothing to stop the fleas jumping off rats and onto human skin. Some people even went to the extreme of sitting between two massive fires. They hoped the heat would "purify" the air around them. Pope Clement VI famously sat between two roaring hearths in Avignon during the height of the heat in 1348. Surprisingly, he survived. It wasn't because of the "purity," though. The heat likely kept the fleas away from his person.
Bloodletting and the Humoral Mess
If the air wasn't the problem, the blood was. Or the phlegm. Or the bile. This was the Galenic system of medicine that had dominated for over a thousand years. When looking at how did they treat the black plague, bloodletting is usually the first thing people mention.
The idea was that the body had too much "hot" or "moist" blood. By opening a vein and letting a pint or two drain out, the doctor hoped to restore balance. In reality, they were just weakening a patient whose immune system was already crashing. They used lancets or leeches. Imagine being already dehydrated from a fever and then having a barber-surgeon drain your blood. It was often a death sentence.
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The Bubo Lancing Nightmare
The most visible sign of the plague was the bubo. These were the swollen lymph nodes. Some "doctors" decided the best way to deal with these was to cut them open. They would cauterize the wound with a red-hot iron or apply a "plaster" made of cooked onions, yeast, and butter. Sometimes they even used dried toad skin. They believed the toad would "draw out" the poison.
It was agonizing.
If a bubo burst on its own, the patient sometimes recovered. This gave people the false hope that cutting them open was the answer. But doing it with unwashed tools in a room full of bacteria usually just led to secondary infections like sepsis.
The Religious Response: Flagellants and Prayer
Because science couldn't explain why everyone was dropping dead, people turned to the divine. Many believed the plague was God’s punishment for human sin. This led to the rise of the Flagellants. These were groups of men who traveled from town to town, whipping themselves with heavy leather straps embedded with metal studs. They chanted and prayed, hoping their public penance would satisfy God’s anger.
Public authorities eventually hated them. They brought crowds, and crowds brought more fleas. By 1349, the Pope had to step in and ban the movement because it was causing more chaos than comfort. While the Flagellants were extreme, the average person just spent more time in church. Ironically, the crowded cathedrals became the perfect breeding ground for the plague to spread through respiratory droplets—the pneumonic version of the disease.
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Real Public Health: The Birth of the Quarantine
Not all treatments were useless "magic." As the years went on, people noticed a pattern. If a ship came from an infected port, the town got sick.
In 1377, the city-state of Ragusa (modern-day Dubrovnik) established a trentine. This was a 30-day isolation period for arriving ships. Later, Venice extended this to 40 days, calling it a quarantena. This is where our modern word "quarantine" comes from. They didn't know about bacteria, but they understood contagion. They locked people in their houses. They painted red crosses on doors. They burned the clothes and bedding of the deceased.
- Isolation: Keeping the sick away from the healthy.
- Sanitation: Though rudimentary, some cities tried to clear the streets of carcasses.
- Travel Bans: Blocking people from "plague-ridden" areas.
These were the only "treatments" that actually worked. They didn't save the person who was already sick, but they saved the neighbors.
The Weird Stuff: Vinegar, Gold, and Unicorn Horns
When you’re desperate, you’ll try anything. Wealthy patients were often told to drink "potable gold"—basically ground-up gold leaves mixed into a liquid. It was expensive and totally useless. Others were told to sleep on their sides so the "vapors" wouldn't settle in their lungs.
Vinegar was the MVP of the era. People washed their coins in it. They washed their hands and faces in it. Doctors would soak their cloaks in vinegar. While it didn't kill the Yersinia pestis bacteria inside the body, it might have been a decent enough disinfectant to kill some surface bacteria, providing a tiny bit of protection against secondary infections.
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Then there was the "Four Thieves Vinegar." Legend says a group of grave robbers in Marseille stayed healthy by dousing themselves in a special blend of vinegar, garlic, and herbs. When they were finally caught, they supposedly traded the recipe for their freedom. Whether it's true or not, people swore by it for centuries.
What Actually Happens in the Body?
We now know the plague comes in three flavors: Bubonic, Septicemic, and Pneumonic. The medieval world was fighting all three at once.
Bubonic was the "mildest," with a survival rate of maybe 20% if you were lucky. Septicemic (in the blood) and Pneumonic (in the lungs) were nearly 100% fatal back then. Without antibiotics like streptomycin or doxycycline, the body simply couldn't fight off the massive bacterial load. The "treatments" of the time focused on the symptoms because the cause was invisible.
Actionable Insights for Today
While we don't live in the 14th century, the history of how did they treat the black plague offers some pretty solid lessons for modern health and preparedness.
- Understand Contagion Vectors: The plague spread because people didn't understand the rat-flea-human connection. In any modern outbreak, identifying how a disease moves (airborne vs. surface vs. vector) is the first step to staying safe.
- Support Your Immune System: Medieval patients were weakened by fasting and bloodletting. Modern science emphasizes nutrition, hydration, and rest as the baseline for fighting any infection.
- Question "Miracle" Cures: Just as people spent fortunes on "unicorn horn" powder in 1348, people today fall for unverified supplements during health crises. Always look for peer-reviewed clinical data.
- Sanitation Matters: The shift from wooden houses to brick (which rats couldn't nest in as easily) and better waste management did more to end the plague than any medicine of the time. Keep your living environment clean and pest-free.
- Acknowledge the Psychological Toll: The plague wasn't just a physical disease; it was a societal trauma. Understanding that fear can lead to irrational behavior (like the Flagellants) helps us navigate modern health anxieties with more empathy and logic.
The way they treated the plague was a reflection of the limits of their world. They used the tools they had: faith, ancient texts, and observation. While most of it failed, the birth of organized public health—quarantines and health boards—is a legacy that still keeps us alive today.