We’ve discussed the history of medicine
from Mesopotamia, to Greece and Rome, and
then the Arab World.
This timeline brings us to the Middle Ages,
which were disastrous not just for social
and political reasons, but also due to deadly
diseases.
We will now discuss one such disease called
the Black Death, a catastrophic epidemic that
hit Europe during this time.
The disease probably arrived from Central
Asia in 1347, and for the next 3-4 years it
ravaged Europe, killing up to 50% of the population,
or about 50 million people.
This was not the first case of plague epidemic
in history by any means.
The first documented plague epidemic was probably
the Antonine plague, which killed about 5
million people in the Roman empire over the
years 165-180 AD.
Another plague epidemic hit Constantinople
in 541, and it spread to the entire Eastern
Roman empire, killing 25% of its population.
With this plague, historians state that every
morning for several months in the capital
city, up to 5,000 corpses had to be picked
up and buried.
But the most devastating plague epidemic in
history seems to have been the Black Death
of 1347-1351, as the death toll is simply
unparalleled, making this an event which shook
human civilization to its core.
As we mentioned, the disease likely arrived
from Central Asia, and it was transmitted
by fleas.
Fleas live on rodents, and the rodent of note
in this case was rats.
It is believed that the rats and fleas travelled
on ships reaching Europe by sea.
The fleas were infected by a species of bacteria
called Yersinia pestis which was named after
the scientist who identified it in 1894, Swiss
microbiologist Alexandre Yersin.
The fleas would bite the rats, slowly killing
them, and then jump on the next available
species, which in 1347 happened to be humans.
Although we covered this pathogen at length
in the microbiology series, we will do well
to reiterate some of that information for
context.
Yersinia pestis can localize in different
targets in the body.
The most benign form of this plague, so to
speak, was the bubonic plague.
In this case, the bacteria set up shop in
the lymph nodes, which swell up to form the
well known buboes, which are huge vesicles
full of blood.
It is estimated that mortality from bubonic
plague was 50-60% if left untreated, which
of course was typically the case in those days.
Death would occur within a week.
Pneumonic plague was much more devastating
and rapid.
It usually killed within 24 hours, as it reached
the lungs and caused a devastating form of
pneumonia.
Mortality rate for this was 100%.
Equally devastating was the septicemic plague,
which caused blood poisoning and tissue necrosis.
This resulted in the blackening of the limbs
that gave the disease its name.
Again, mortality was essentially 100%.
If we fast forward to 2020, believe it or
not, there are still about 600-700 cases of
this plague per year throughout the world.
Recently, in 2017, a serious bout occurred
in Madagascar, with over 100 deaths.
Every year there are a handful of cases in
the US as well.
We have a vaccine against the plague, but
it is not used because of the extreme low
likelihood of contracting the disease anywhere
in the world.
Instead, rapid treatment with antibiotics
usually cures the disease in a couple of days.
However, antibiotics were still 600 years
in the future for the unfortunate inhabitants
of Europe at that time.
Bacteria were not known to exist in those
days, and would remain elusive for more than
500 years.
Against an invisible enemy, there was little
that the pharmacy of that age could do.
Typical treatments were, for example, cold
baths, which had the ability to reduce fever,
and were just a palliative remedy, meaning
one that alleviates symptoms without addressing
the underlying cause.
Herbal remedies, as well as unguents, which
are viscous ointments, could be applied on
the wounds and the buboes.
Much more common strategies involved rituals
and incantations.
In those days, priests and wizards were a
common alternative to state-of-the-art medicine,
when the latter did not work.
In a way, this practice has not completely
lost its popularity even today.
In the Middle Ages, the human life span was
about 30 years in the most developed societies,
and bacterial or viral infections were the
most common agents of death.
Aside from these then-mysterious infections,
other diseases also remained undiagnosed,
and standard forms of medical treatment included
the following.
First, there was bloodletting.
The surgical removal of some amount of a patient’s
blood was an attempt to re-establish equilibrium
among the four humours.
Next, there was skull trepanning, which meant
drilling a hole in a patient’s cranium to
release evil spirits.
Keep in mind that anesthetics were not invented
until the 20th century, so this was not likely
to have been an enjoyable procedure.
Religious beliefs often convinced people that
epidemics could be the work of the devil,
and unfortunately, sometimes non-Christians
were accused of being the devil’s emissaries,
entrusted with the task of bringing the disease
onto people.
Cases of execution delivered to suspected
agents of the devil are well-documented, and
a huge proportion of these executions involved
being burnt at the stake.
Given that no knowledge of microscopic pathogens
was available, how did the science of the
time attempt to explain these plagues?
A widely credited theory of infectious diseases
was the miasmatic theory, which actually dates
all the way back to Galen, who we are familiar
with from earlier in the series.
“Miasma” comes from the ancient Greek
word for “pollution”.
It was believed that decomposing organic matter
could emanate noxious vapours, often identified
with foul odors, which brought diseases to humans.
The theory seemed to receive corroboration
from the fact that groups of people living
in the same area tended to all get sick at
the same time.
Of course the theory was more complex than
this singular notion, as it defined sources
of pollution, specified optimal atmospheric
conditions, and evoked the alignment of planets.
It was believed for centuries that night air
was especially pernicious, and people were
often afraid to go out at night, especially
if the air was cold.
The miasmatic theory was not replaced by the
germ theory of disease until the 19th century,
after the development of microscopy, which allowed for the direct visualization of pathogenic agents.
Sadly, the type of superstition outlined in
obsolete theories like that regarding miasma
persists even today in certain parts of the world.
To be fair, these ancient superstitions didn’t
have exclusively negative ramifications.
In developing Europe, miasmatic theory had
the beneficial effect of inducing authorities
to improve the standards of hygiene in major
cities, thereby resulting in the production
of sewer systems, and the proper elimination
of waste.
Cleaner cities saw a drop in disease, even
if not for the reasons that prompted these changes.
Getting rid of so-called “miasms” also
did away with infectious bacteria and the
animals carrying them.
However, even with this significant improvement,
periodic epidemics and wars decimated the
population.
The discipline of pharmacy was clearly stagnating,
and it needed a jolt to move in a different
direction.
Where did this jolt eventually come from?
Let’s continue forward and examine how the
art of pharmacy made its transition from the
Middle Ages into the pre-modern world.
