The Black Death

Treatments and Remedies for the Black Death

The medical practitioners of the fourteenth century deployed an enormous range of treatments against the plague, from the learned prescriptions of university-trained physicians to the folk remedies of village healers. None of these treatments was effective against the underlying bacterial infection, and some were actively harmful. Yet the variety and creativity of the medical response reveal much about the state of medieval medicine and the desperation of a society confronting a disease it could neither understand nor cure.

Bloodletting

Bloodletting — the deliberate withdrawal of blood from a patient — was the most common medical procedure in medieval Europe and one of the first treatments applied to plague victims. The practice was based on the humoral theory, which held that disease resulted from an imbalance of the body’s four humours. Since plague was often interpreted as a corruption of the blood, removing blood was thought to reduce the corrupt humour and restore balance.

Physicians typically bled patients from the vein nearest to the affected bubo. If a bubo appeared in the groin, the saphenous vein of the leg was opened; if in the armpit, the basilic vein of the arm. The amount of blood withdrawn varied according to the patient’s age, constitution, and the physician’s judgment, but it was often substantial — enough to cause weakness and fainting.

In practice, bloodletting was counterproductive. Plague patients were already debilitated by fever, dehydration, and the metabolic demands of fighting a severe bacterial infection. The additional stress of blood loss weakened their resistance further and may have increased mortality. Some physicians recognised this danger: Guy de Chauliac noted that bloodletting was harmful in many cases and recommended it only in specific circumstances.

Lancing of Buboes

The lancing (incision) of buboes was one of the most characteristic treatments for bubonic plague. The swollen lymph nodes, which could reach the size of an egg or an apple, were extremely painful and were believed to contain corrupt matter that needed to be expelled. Physicians incised the buboes with a sharp instrument, drained the pus and fluid within, and applied poultices to draw out the remaining infection.

The poultices applied to lanced buboes were varied and sometimes elaborate. Common ingredients included dried figs, roasted onions, garlic, butter, and various herbs. A widely recommended preparation was a poultice of dried figs, roasted onion, and theriac (a complex compound medicine), applied warm to the incised bubo. The intention was to draw out the corrupt humour and promote healing.

The lancing of buboes was painful and carried risks of secondary infection, particularly in the unsanitary conditions of medieval medical practice. However, in some cases, the procedure may have provided genuine relief by reducing the pressure within the bubo and allowing the body’s immune system to fight the infection more effectively. Modern medical practice sometimes involves the aspiration (draining) of buboes in plague patients, though under sterile conditions and in conjunction with antibiotic treatment.

Theriac and Compound Medicines

Theriac was the most prestigious and widely prescribed medicine for plague in the fourteenth century. Originally developed in the ancient world — it was attributed to Mithridates VI of Pontus and refined by the Roman physician Andromachus — theriac was a complex compound medicine containing up to sixty-four ingredients, including opium, viper flesh, honey, cinnamon, myrrh, saffron, and various other herbs, spices, and minerals.

The preparation of theriac was a lengthy and expensive process. The ingredients had to be gathered, purified, and combined according to precise recipes, and the resulting mixture was aged for years before use. The best theriac was said to come from Venice, which maintained a monopoly on its production and exported it throughout Europe at considerable profit.

Theriac was believed to be a universal antidote to poison and a powerful remedy against epidemic disease. It was administered orally, dissolved in wine or water, or applied externally as a poultice. Its actual effects were limited: the opium content provided some pain relief and sedation, but the other ingredients had no therapeutic value against plague.

Armenian bole, a red clay from the Caucasus region, was another widely used plague remedy. It was believed to absorb toxins and was applied to buboes or taken internally. The clay’s astringent properties may have provided some symptomatic relief for digestive complaints, but it had no effect on the bacterial infection.

Herbal Remedies

The herbal pharmacopoeia employed against the plague was vast. Rose water and vinegar were used to cool the patient and purify the air. Sage, rosemary, and rue were burned as fumigants or carried as posies to ward off miasma. Garlic, long regarded as a medicinal plant, was consumed in large quantities or applied to buboes. Wormwood, gentian, and various other bitter herbs were prescribed to stimulate the digestive system and restore humoral balance.

Some herbal remedies may have had incidental benefits. Certain plants contain compounds with mild antibacterial or anti-inflammatory properties, though none were effective against Yersinia pestis at the concentrations achievable through medieval preparation methods. The burning of aromatic herbs may have repelled fleas, providing some protection against flea-borne transmission, though this effect was unintentional.

Precious Stones and Exotic Substances

The wealthy had access to a range of exotic and expensive plague remedies that were beyond the reach of ordinary people. Emeralds, sapphires, rubies, and pearls were ground into powder and administered in drinks, based on the belief that their cold, dry qualities could counteract the hot, moist corruption of the plague. Gold and silver were similarly used, either in powdered form or as vessels from which the patient drank.

Unicorn horn (which was actually narwhal tusk) was considered one of the most powerful antidotes to poison and was valued at many times its weight in gold. It was shaved into powder and administered in drinks or applied to buboes. Bezoar stones — calcified masses found in the digestive tracts of goats and other animals — were similarly prized as antidotes and were set in jewelled mountings for use by the aristocracy.

These exotic remedies had no therapeutic value, but they served important social and psychological functions. They demonstrated the wealth and status of the patient, provided a sense of agency in the face of a terrifying disease, and reinforced the authority of the physicians who prescribed them.

Religious and Magical Remedies

Many patients turned to religious and magical remedies when medical treatments proved ineffective. Prayers to specific saints — Saint Roch, Saint Sebastian, and the Virgin Mary were particularly associated with protection against plague — were widely practised. Pilgrimages to shrines, the veneration of relics, and the purchase of indulgences were all employed as spiritual remedies.

Amulets and charms were widely used. These included religious objects (crucifixes, medals, prayer scrolls), astrological talismans (inscribed with planetary symbols and zodiacal signs), and natural objects believed to have protective properties (toad stones, eagle stones, and various minerals). Some amulets bore inscriptions in Latin, Hebrew, or Arabic, invoking divine protection against the plague.

The boundary between medicine, religion, and magic was porous in the fourteenth century. Many physicians were clerics, and the prescription of religious remedies alongside medical treatments was common. The belief that the plague had both natural and supernatural causes meant that a combination of medical, religious, and magical approaches was considered rational and appropriate.

The Limits of Treatment

The fundamental problem with all plague treatments in the fourteenth century was that none of them addressed the underlying cause of the disease. Yersinia pestis is a bacterium that can only be effectively treated with antibiotics — substances that were not discovered until the twentieth century. The mortality rates of the Black Death — thirty to sixty percent for bubonic plague, nearly one hundred percent for pneumonic and septicemic plague — reflect the inability of medieval medicine to combat the infection.

The most effective responses to the plague were not medical treatments but quarantine measures — the isolation of the sick, the restriction of movement, and the regulation of burial. These measures, based on empirical observation rather than medical theory, were the only interventions that genuinely reduced transmission and saved lives.