Causes and effects of the Black Death

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Key points

  • In 1348 - 49, the Black Death swept across Europe, killing up to half of the population.
  • There were two main types of plague: bubonic and pneumonic.
  • Treatments and cures were based on both natural and supernatural theories about the cause of the disease.

Video about the Black Death

How did the Black Death get its name?

The term 'Black Death' was first used in English in the 1700s. At the time of the epidemic, most people would have called the disease 'the pestilence' or 'the Great Mortality'.

The term 'Black Death' specifically refers to the outbreak of the plague disease in the mid-1300s. Later outbreaks, like the one in London in 1665, have been referred to as 'the Plague'.

The Black Death arrives in England

The Black Death originated in Asia in 1346. It was spread to Europe by fleas on rats living on trade ships. In medieval times there was trade between Europe and Asia. The Crusades increased awareness of goods and produce that could be imported from abroad. This trade helped bubonic plague to spread from Asia to European countries.

Bubonic plague is believed to have arrived in the country on a ship landing on the Dorset coast from Gascony in France. The disease quickly spread throughout the country. The first recorded case of the Black Death in England was in June 1348.

It is now widely accepted that plague was caused by the , although this wasn’t understood at the time.

Types of plague

The man on the left with bubonic plague is shown with a fever, black finger tips and is vomiting. Woman on the right has pneumonic plague and is shown with a fever, headache and is coughing

Bubonic plague

Bubonic plague was spread by rats, which were commonly found in homes, villages and towns due to poor hygiene conditions such as raw sewage being routinely dumped in streets. If a flea that had bitten an infected rat jumped onto a person and bit them, it would transmit bubonic plague.

Bubonic plague had a of approximately 50%.

The symptoms of bubonic plague were:

  • Swellings under the armpits and on the groin, known as buboes
  • Fever
  • Vomiting
  • Diarrhoea
  • Fingers toes and parts of the skin sometimes turned black

Pneumonic plague

Pneumonic plague was spread from one person to another through coughing or sneezing which spread air droplets containing plague bacteria, affecting the victim's lungs.

Pneumonic plague had a near 100% mortality rate.

The main symptoms of pneumonic plague were:

  • Cough
  • Fever
  • Headaches
  • Breathlessness

Ideas about causes and treatments

Natural causes

The discovery that germs cause disease was not made until the 1800s. This meant there was a wide range of beliefs about what might be causing plague. Some of these were based on natural causes, such as caused by the waste and poor sanitary conditions in towns.

Medieval doctors believed that illnesses, including the Black Death, were caused by an imbalance in the . These were black bile, yellow bile, phlegm and blood. A patient diagnosed with excess blood would undergo treatments such as , which attempted to rebalance the humours by removing excess blood.

Supernatural causes

Other ideas were based on religious or supernatural causes. Some people believed God was the cause, as a punishment for people’s sins. would whip themselves to seek forgiveness from God. Others prayed to God for an end to the plague, seeking divine mercy.

believed the cause was the alignment of the planets. Others still believed in the ancient idea of trepanning, where doctors would drill a hole in a patient’s head to release bad spirits that were believed to have caused an illness. Some doctors burst the buboes of patients with bubonic plague. There is some evidence that this may have helped increase chances of survival.

An engraving of two men self-flagellating from 1485

Attempts to stop the spread

To try and stop the spread of Black Death, fines were introduced for people caught dumping waste in the streets. The idea was to deal with the bad smells, or miasma. This may have helped a little in that dealing with waste in the streets may have helped limit the number of the rats that were actually spreading the disease.

New jobs were created in London to try and clean up towns. Muckrakers were employed to remove the waste from the streets. often emptied into pits in the ground. These would often fill up and cause awful smells, so emptied cesspits. Surveyors of the payment collected rubbish.

Consequences of the Black Death

There are various estimates of how many people died during the 1348-49 outbreak. Most historians believe between a third and half of the population were killed by the Black Death. The population of England at the time of the Black Death is estimated to have been around 6 million, so that means approximately 2 to 3 million people died.

Despite the scale of the fatalities, there is evidence that there was some sort of organised response from local government. Mass graves of victims have been found from the Middle Ages. The way the bodies are carefully laid in side by side suggests bodies were treated respectfully and in a dignified way.

A result of the high was a shortage of workers. This led to rapid wage rises as landowners had to compete for workers by paying more. In 1351 a law was introduced to force wages to go back to the levels they had been at before the Black Death. This was one of the causes of the Peasants’ Revolt in 1381.

As no one knew exactly what caused the Black Death, they could do little to stop future outbreaks. There were further Black Death cases throughout the Middle Ages and beyond. There was another significant outbreak in 1665, particularly affecting London. This outbreak shows there had been no real increase in understanding about what was really causing the disease or how to prevent it.

It wasn’t until the work of Louis Pasteur and Robert Koch in the 1800s that it was discovered germs are the cause of disease. The plague bacteria was finally discovered by Alexandre Yersin in 1894. The bacteria was named after him; ‘Yersinia pestis.’

What do you think the response to the Black Death tells us about medical knowledge in the Middle Ages?

  • Although doctors in the Middle Ages did not know about germs, there were some attempts to treat or prevent the disease based on observation and natural remedies.

  • The four humours theory would not correctly diagnose or treat the Black Death, but it was an attempt to treat the disease by understanding how the physical body worked, which is the basis of modern medicine.

  • The belief that miasma was responsible for the Black Death meant there were efforts to clean up towns by employing gong farmers and muckrakers, which showed that the government was willing to try and address poor public health conditions.

  • Many people, including doctors, attributed disease to supernatural or religious causes in this period.

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