Imagine waking up with a fever that feels like your blood is literally boiling. By lunchtime, you notice a hard, painful lump the size of an apple in your groin or armpit. It’s turning a sickly shade of purple. You’re terrified. It’s 1348, and the Great Mortality has arrived at your doorstep. Back then, nobody knew about Yersinia pestis or fleas. They just knew people were dying in droves.
People were desperate. When you're watching half your village disappear in a month, you'll try anything. Honestly, the treatments for the Black Death ranged from the mildly logical to the absolutely insane. Some of it was based on the "miasma" theory—the idea that bad smells caused disease—while other attempts were rooted in deep religious penance. If you lived through it, you likely survived because of luck or a weirdly robust immune system, not because the doctor rubbed a dead pigeon on your sores.
The "Bad Air" Theory and Aromatic Defenses
Doctors in the 14th century weren't stupid, but they were working with a completely wrong map of how the human body works. Most of them followed the teachings of Galen and Hippocrates. They believed the body was governed by four humors: blood, phlegm, yellow bile, and black bile. Illness meant these were out of whack.
Because they believed "corrupt air" or miasma triggered the plague, many treatments for the Black Death focused on changing what people breathed. You’ve probably seen the iconic plague doctor mask with the long beak. While that specific leather outfit actually became more common in the 17th century (shoutout to Charles de Lorme for the design), the logic behind it started much earlier. They stuffed those beaks with dried flowers, herbs, and spices like camphor, mint, and cloves.
If you weren't a doctor, you just carried a "pomander." This was basically a ball of ambergris or musk that you held to your nose in public. People also stayed indoors and burned incense or sweet-smelling wood like pine and cedar. Some even went to the extreme of sitting between two massive fires to "purify" the air around them. Pope Clement VI famously sat between two roaring fires in Avignon during the height of the heat, which probably actually saved him—not by cleaning the air, but because the heat kept the plague-carrying fleas away from his person.
Bloodletting and the Violent Reality of Surgery
If the air wasn't the problem, the doctors turned toward the blood. Bloodletting was the "go-to" for almost every ailment. The idea was simple: if your humors are unbalanced and you have too much "hot" blood causing a fever, you need to get rid of some.
They’d use a lancet to open a vein. Or they’d use leeches. For someone already weakened by a massive infection, losing a pint of blood was usually the final nail in the coffin. It’s kinda heartbreaking to think about—people being drained of their strength right when their body needed it most.
Then there were the buboes. Those swollen lymph nodes were the hallmark of the bubonic plague. Medieval surgeons (who were often also the local barbers) would perform "lancing." They’d cut the buboes open to let the "poison" out. Sometimes they’d apply a poultice made of onion, flour, and butter. Other times, they’d get weird. One recorded treatment involved taking a live chicken, plucking its backside, and strapping it to the swollen lump. They believed the chicken would "draw out" the venom. Spoilers: the chicken usually just died, and the patient got a secondary infection.
Religious Fervor and the Flagellants
Science and religion were totally intertwined back then. Many believed the Black Death was literally the wrath of God. If God sent the plague, then the only real treatments for the Black Death were spiritual. This led to some of the most visceral scenes in European history.
The Flagellants were groups of men who traveled from town to town, whipping themselves with heavy leather thongs tipped with metal studs. They did this publicly, singing hymns and crying out for mercy. They thought that by punishing their own flesh, they could appease God’s anger and stop the pandemic.
In reality, they probably made things worse. They moved from one town to another, likely carrying fleas in their clothes and spreading the bacteria even faster. Plus, they were creating open wounds on their backs in an era without antibiotics. It was a public health nightmare masquerading as a religious revival.
🔗 Read more: Oolong Tea Fat Loss: What the Science Actually Says About Your Metabolism
Diet, Vinegar, and Social Distancing
Not every treatment was gruesome. Some was just... dietary. People were told to avoid "moist" foods like lettuce or cucumbers. They were encouraged to eat "dry" and "bitter" things. Vinegar was a huge deal. People washed their hands, faces, and even their money in vinegar, hoping the acidity would kill the "seeds" of the plague. Honestly, this was one of the few things that might have actually helped a tiny bit, as the acid can be a mild disinfectant, though it wasn't enough to stop a flea bite.
One of the most effective treatments for the Black Death wasn't a medicine at all, but a policy: Quarantine. The word itself comes from the Italian quaranta giorni, meaning forty days. In 1377, the city of Ragusa (now Dubrovnik) established a "trentino" (30-day isolation) for ships arriving from infected areas, which was later extended to 40 days. They didn't understand the biology, but they understood the pattern. If you stayed away from people for 40 days and didn't die, you were probably safe.
Modern Medicine vs. The Middle Ages
It’s easy to look back and laugh at the chicken-strapping and the flower-smelling. But we have to remember they were terrified. Today, if you catch the plague (and yes, it still exists in places like Madagascar, the Southwestern US, and parts of Asia), the treatment is wildly different.
We use antibiotics. It’s that simple. Streptomycin, gentamicin, or doxycycline can knock the bacteria out if caught early. The mortality rate drops from 60-90% down to under 10% with modern care. We don't lance buboes anymore; we use targeted IV fluids and respiratory support.
Why the Plague Finally Receded
The Black Death didn't end because someone found a cure. It ended because it ran out of people to kill, and humans started getting smarter about sanitation. Better housing (moving from wood/mud to brick) meant fewer rats living in the walls. Better hygiene meant fewer fleas.
The "treatments" of the 1300s were a desperate attempt by a society to make sense of a microscopic enemy they couldn't see. They focused on what they could control: smells, blood, and prayer.
Actionable Takeaways for History Enthusiasts
If you're researching the history of medicine or looking for ways to understand how human society reacts to pandemics, keep these points in mind:
- Look for Primary Sources: Read the Decameron by Giovanni Boccaccio. He lived through the plague in Florence and describes the various social and medical responses in vivid, often horrifying detail.
- Acknowledge the Context: Don't judge medieval doctors by modern standards. They were using the most "advanced" science available to them at the time.
- Study the Long-Term Effects: The failure of these treatments led to a massive shift in how people viewed the Church and the medical establishment, eventually paving the way for the Renaissance and the Scientific Revolution.
- Stay Informed on Modern Zoonotic Diseases: The plague is a zoonotic disease (jumping from animals to humans). Understanding how it spreads from fleas to rodents to us is key to preventing modern outbreaks.
The history of the Black Death is a reminder of how far we’ve come. We moved from aromatic pomanders to molecular biology. We moved from whipping ourselves in the streets to developing vaccines. It’s a grisly history, but it's the foundation of everything we know about public health today.