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Bile, Blood and Phlegm: a walk through history's plagues

Pandemics and plagues and the way the world reacts to them has shaped human history. The world has shown resilience, determination and brilliance in the face of mass medical illness hundreds and thousands of times before, but what about in a divided 9th century Britain or an uncertain Tudor England? Continue reading and step into the shoes of characters of the past and find out how medicine and our services have changed through various epidemics.

Imagine you are an Anglo Saxon peasant or a medieval serf, or maybe a merchant in a major Tudor town. You are going about your day when you hear the news that the plague has come to your town or village. What do you do? Do you run to another town, do you hide in your home, do you go to the church, or just go about your day - God’s Will will be done. The time period that you live in will decide what your choices are and the treatments and support you might receive. Let’s start with the prevailing medical theory of these times. This was Humorism, the belief that the body was made up of four humours: Black bile, Yellow bile, blood and phlegm. If you were unwell it was believed that you had an imbalance of one or more of your humours. The resulting care you received would be based on balancing these humours. The balancing of the humours was not always a pleasant experience. It would involve bloodletting, sweating, vomiting and pooping! Another way of balancing them was to smear parts of your body with- at the pleasant end- oils, and- on the less pleasant end- dead animals or internal parts of animals or poop. You might even have to eat some of these treatments.

Today, we know that bacteria and viruses can cause you to get ill. We are also aware that certain ways of living can make illness more likely. The idea that germs cause illness is quite old but didn’t become our leading theory until the 1850s. Before this, one of the leading theories was miasma. Miasma theory is based on the idea that disease is spread by bad air or “miasmas”. The bad air came from decaying natural material and bad smells. This is why plague doctors wore masks with a long beak-like nose. The nose was filled with sweet-smelling herbs and flowers. This was also part of the theory that plague was god’s punishment for sins. God and the church were a massive part of people's lives. God was all-knowing, and was not always happy, and would punish people with illness or physical deformities. Now let’s see what would have happened to the Anglo Saxon. The earliest known plague to come to Britain was in 664 AD. It may have lasted up to twenty-five years. It was believed at the time that it was a punishment from God for sinful behaviour. This was backed by the fact that there was a solar eclipse (or was it an earthquake? People can’t seem to decide). This would have made it obvious to you that the plague was a punishment. So what would you do? If you were wealthy you might move to a town without the plague. But not everyone was able to move about freely. You might pray, hoping God would forgive your sins. If the praying didn’t work, and you or a family member got ill, what would you do? Well, I would keep praying, as you never know, it might work. If you want medical treatment there are no doctors as we would know them. You could go to the local læce or leech. The leech would use a mixture of treatments. They would-be based on Greek and Latin medical texts. He would also use Teutonic magic and herbal medicine. The problem with the leech is that he would require payment. So if you didn’t have money there was not much you could do apart from praying or using what medical knowledge you had. Let’s drop in on a medieval serf. So you are a serf, which means that you work for your lord and are unable to move or work for another lord without your lord’s permission. This means you have little opportunity to change your life. So what happens if the plague comes? The most well known and devastating plague was the black death. This came to England around 1348, and took 500 days to spread across the country, lasting four years. What you or anyone at the time would not have known is that it was caused by a bacteria called Yersinis pestis. The bacteria lived in the fleas of rats. The rats (with fleas) would travel around the world with traders along the Silk Road. What you thought might have caused it would not have changed much since your Anglo Saxon forefathers. It was believed to be a punishment from God or, according to a contemporary, to be caused because three planets were in conjunction, which released a lot of “bad air”. This may seem to be two completely different ideas, but God was all-powerful, so would have been able to prevent misfortune. The plague can show itself in three distinct ways. Here is a rundown; Bubonic plague The most common type, named after buboes that are swellings of the lymph nodes in your neck, armpit and groin. You would have a fever and joint pains. This type was passed by that pesky flea.

Pneumonic plague The spread of this type was not through the flea but either from someone with pneumonic plague or by someone with bubonic plague which had travelled to their lungs. It was passed through coughs and sneezers. This made it much easier to spread. With this type, the symptoms are a fever and a wet cough. The Cough would also start to bring up blood. Septicaemic plague The rarest version. You get this type after having one of the other types long enough for it to spread to your blood or get infected through your bloodstream. The main symptoms are high fever and purple skin patches. It is also the most deadly version. So what are you going to do then? The Black Death has come. Your lord has left to live in one of his more rural houses. Meanwhile, as a serf, you are stuck where you are. Some officials have stopped doing their jobs as they are scared of catching it. People have stopped tending to their work; no caring for livestock and crops. People are leaving towns deserted. The question is: what can be done to stop it spreading? What are the high-ups doing to help. Who is in charge? Well, it’s the king. King Edward III, whose daughter had died in France of the plague 1348, is forced to act. He cancels parliament, organises burial pits further out of London, and gets the mayor to clean up the streets, believing this dirt was spreading the plague. Hold on, this is London. What about where you live? Well let's hope that these procedures spread around the country because there are no persons whose responsibility it is to help stop the spread. What happens if you get the plague? Like in Anglo Saxon times medical care is not free. Let say you have caught the plague and you are lucky enough to have the money for treatment. This is what the doctor might do to help rid you of the plague. The first stage of treatment would be bloodletting. The bloodletting would be on the side of where the buboes are. Letting blood was done with a leech or would use a fleam to nick a vein. Fleams look like mini scary axes that were used to cut the vain with a little wack. If the buboes were particularly bad then sweating was used. This involved stripping the patient naked then wrapping a blanket and drenching them in cold water. Both of these “cures” were meant to draw out the bad blood from the patients, thus balancing the humors. Your doctor might decide to try another treatment to help reduce the swelling. The treatment would depend on the look of the swelling. If the swelling was white and deep, it would be coated in oil of liles or camomile. This seems like a quite nice treatment. If your bubos are red and sticking out then the doctor would lance it with a tail feather of a young pigeon. The feather would be held against the swelling to help draw out the baddness. Now, this is where it gets a bit gross. If your swelling has gone black and has gone deep then we would need that pigeon again. The doctor would cut open the young pigeon and hold in on the bubos while it was still alive.

You have been praying and you have had the best treatment that you can afford. What now? Will you get better? People did survive the Black Death but the chances are that you won't. The Black Death devastated the populace. It's not known how many died, but it could have killed 75-200 million people in Eurasia. Contemporarys did note that other outbreaks over the medieval period killed fewer people in each outbreak. Here come the Tudor times: We all know the Tudors were a lively bunch. They enjoyed weddings and chopping off people's heads. You have gone up in the world; you are now a merchant in a nice town. Things have been up and down, there seems to be a new queen every week and the less said about how to pray the better. The real worry is sickness. Medical ideas and treatments have not advanced much from the houmors and miasma of the medieval period. The plague is still a fear with epidemics across Europe. In England, along with plague and the other epidemics of the time, there was a scary new illness. It is called the English sweat or the sweating sickness. This illness was not seen before 1485. Doctors of the time were aware that the sweat was different from other diseases. It was distinct due to the sweating and the speed of the symptoms. It was split into two stages: the cold and the hot stage. The symptoms of the cold stage are a sense of anxiety, cold shivers, giddiness, headache, and severe pains in the neck, shoulders, and limbs, then exhaustion. The hot stage saw sweating, headache, delirium, rapid pulse, and intense thirst and pain in the heart. At the end was exhaustion and collapse or the need to sleep. It is still unknown what caused the sweating sickness as it disappeared in 1551. We therfore have to rely on the knowledge and writing of those that were around during the period. Which are not always reliable, being based on the prevailing theories of the period. So what are you going to do? What are your options and what is the government doing? As a merchant, you are of the middling class, which makes you safer from the sweating sickness, as it seems to affect the noble classes and the very poor classes worse, unlike plague. Over the Tudor period, measures were introduced to help with public health, but not all at once. A lot of measures originated in Italy and then slowly spread to the rest of Europe. This could be because Italy was a melting pot of people coming from the east and peoples on their way east.

If there was a chance of an epidemic coming to a town the senior public figure would be in a difficult position, as declaring an epidemic would cause panic. The worry for the officers was that the wealthy residents would leave as they were more likely to have the money and ability to live elsewhere. With the wealthy would go a large amount of income for the town. The offices would want to avoid this. As a merchant, you might be able to afford to leave the town but you also would not have money coming in. Your choice would be to stay and save the money for after, or leave and hope that the epidemic would not last so long that you run out of money.

Another way for those in charge to try to prevent the spread of the epidemic was to only help support towns affected that were isolating. This would hopefully motivate those in charge to keep the isolation in force, thus preventing people from moving about the country spreading the epidemic. If the disease had arrived, then the town would have to isolate. This would be bad news for you as you now can’t leave if you were going to. You would have less trade as there would be fewer people travelling between towns and less movement in the town. Then within the town, there would be one of two options if someone got sick. If the town had one then the sick would be moved to a pest house which was like a hospital but just for contagious diseases like plague or smallpox. This was not always possible as the pest house might not be able to hold all the sick. The other option would be to isolate sick people and their families in their own home. They would then be isolated for 40 days. This would be the option if the town didn’t have a pest house. You could take matters into your own hands. You could cut yourself and your family completely off. As a merchant, this would likely affect you and your business negatively. You would have to close your business and no longer be part of your community. Your local community is a lot more important than it is now. This may also affect your personal relationship and friendships. It seems that most people didn’t take this route but pulled together as a community helping friends and neighbours.

A good thing to happen during the Tudor period is that the government was more involved in dealing with public health matters. They implemented local health boards. These were set up to help pay for measures to contain and combat epidemics. These measures included fumigation of places where the sick had lived. To burn any clothes and blankets used. The health board was also able to ban mass gathering. These measures would be useful in controlling the epidemic but not every town was able to implement them as a lot would depend on the wealth of the town. Also during the worst of epidemics, even wealthy towns could not enforce the preventive measures. Even as a Tudor, things are not looking good if epidemics come to town. You have little options apart from hoping for the best and praying (if you can remember which way was currently the right way).

Whether you are Anglo Saxon, medieval or Tudor, epidemics were a part of life. They could be a scary uncertain time. Epidemics affected everyone, rich and poor, good and bad. With little useful medical care and knowledge, the outcome was often sad on a personal level. For society at large, it was also tragic. But it also led to changes in how society functioned. Eventually, we would develop a medical theory that actually works, and can cure or prevent diseases that once would have been fatal. You no longer have to be wealthy to enjoy health care in much of the world. Here in Britain, we have universal health care which means that health care is free and available to all. It would definitely be better to be sick now rather than then.

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