3.3: Medieval Public Health

In early medieval times (5th to 10th centuries), medicine was often practiced by monks, and hospitals run by monasteries. The concept of charitably caring for the injured, sick, and dying, was closely tied to the responsibility of the church - however the wealthy still employed private doctors. At the same time, Arabic countries had government-run hospitals. The most common causes of death was infectious diseases, which killed 75% of children before age 5 (Tulchinsky & Varavikova, 2014).

After the Crusades, leprosy spread across Europe and the Middle East, peaking during the 13th and 14th centuries. Nowadays, we know that leprosy is a bacterial disease, the cause of which was first discovered in the 1800s by a Norwegian doctor named Gerhard Armauer Hansen, (which is why it is also referred to as Hansen’s disease). Currently, leprosy is rare and treatable, and has a low risk of spreading between people (typically only with long-term contact and a depressed immune system). However, in the middle ages, little was known about the disease, and there was no cure. Despite a lack of knowledge about the disease, isolation of sick people was still considered the best practice in order to contain it - a tactic that is used to this day with communicable diseases (can be transmitted between humans). Unfortunately, this practice also led to a fear of people with leprosy, who were ostracized from the general society and were often only cared for by the few clergy who considered it their moral responsibility (The History of Leprosy, n.d.), (Contributors to Wikimedia projects, Leper Colony, 2023a).

As feudalism declined in the late medieval period (up to the 15th century) and people moved from rural farmlands to towns and cities, this created new issues of sanitation and crowding. Even as progress was made in medical education (universities were established across Europe and the printing press increased educational opportunities,) these towns and cities were beset with plagues of communicable diseases. Cholera, measles, and smallpox epidemics were exacerbated by poverty and unsanitary living conditions. Plagues, wars, and famines decimated the populations of the European and Asian continents. The causes of these plagues were largely unknown, and the “miasma theory” (handed down from ancient Greek doctors) was still the most accepted explanation. Miasma theory suggested that diseases were caused by “bad airs” - which were associated in different time periods with rotten food waste, wetlands, fog, or infected individuals (not necessarily from respiratory transmission) (Contributors to Wikimedia projects, Miasma Theory 2023e). Although the discovery of pathogens and wide acceptance of germ theory would not take place until the mid 19th century, some of the public health measures suggested by miasma theory were still effective. This is a great example of how societies can still take actions to prevent disease even if the disease is novel or little is known about it. Let’s take a closer look at one of the most famous plagues and the evolution of public health responses to it.