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What were women's lives like during the 17th-century plague?
In 1665, bubonic plague ravaged London, killing tens of thousands. Scores of Londoners documented the outbreak but few reported on the experiences of women. Here – telling the story of the victims, the survivors and those charged with working with the dead and dying – Rebecca Rideal seeks to redress the balance...
The reviled nurses During the long, grim months of 1665, bubonic plague rampaged through the city of London. As thousands lay sick and dying, someone had to perform the unenviable job of nursing the afflicted through the last moments of their lives. That task invariably fell to women. When plague broke out, individual parishes were expected to enforce city-wide Plague Orders, which stipulated that two women be appointed to serve as ‘keepers’ (or nurses) to those found to be infected. These women were usually elderly or widowed parish pensioners living off charity, and could be coerced into the task with threats to their alms, food or pensions. One woman awaiting execution in Poole, Dorset took on the role of nurse in exchange for a reprieve. Theirs was one of the toughest jobs imaginable, but sympathy and admiration for the plague-nurses was, it appears, in short supply. As one of the few officials allowed entry to infected houses – working cheek by jowl with sufferers – they inspired fear and revulsion among a terrified population. To the physician Nathaniel Hodges they were “wretches [who] out of greediness to plunder the dead, would strangle their patients and charge it to distemper in their throats”. Nurses were also accused of “secretly convey[ing] the pestilent taint from sores of the infected to those who were well”. One nurse was, so the story went, crushed under the weight of goods she had stolen from a plague victim. And such a reputation was hard to shake. More than 200 years after the Great Plague had claimed its last victim, Florence Nightingale was lamenting the fact that nursing had traditionally been left to “those who were too old, too weak, too drunken, too dirty, too stupid or too bad to do anything else”. Yet look beyond such rancorous disapproval, and a more nuanced picture of plague-time nursing emerges. When under quarantine during an outbreak in 1636, an Edward Conway specifically asked for “two careful keepers” to be sent to attend to him and his friend. Meanwhile, the nurses’ skills in managing care were such that, towards the end of 1665, a William Godfrey asked that, along with three warders, “a nurse or two” be allowed to continue at the Westminster pest house to keep it secure. The nurse of Mr and Mrs Pearce was valued in such esteem that, when she contracted plague too, she was treated alongside them and “cured”. Samuel Pepys encountered a nurse who – far from being “stupid” – demanded “10s. per weeke” to take in a sick girl. And, contrary to what Florence Nightingale wrote, those who cared for the sick weren’t exclusively “old”, “weak”, and “drunken”. In fact, women of all classes were well-versed in the secrets of medicine. These included noblewomen like Lady Isham – who advised her nephew to “ware a quill as is filed up with quicksilver… about your neck” – and merchant’s wife Mrs Taswell, who gave her son “a herb called angelica, some aromatics and spanish wine” to prevent him catching plague. In the 1660s, London was home to at least 60 unlicensed female medical practitioners. It’s unclear if they all remained in the capital when plague broke out, but it is interesting to note that, during the outbreak of 1607, a nurse called Alice Wright did stay in the city and had “many flock to her every day” near Newgate prison. Read more | How the years after the Black Death briefly became a ‘golden age’ for medieval women The corpse inspectors When the plague-nurses could do no more for an infected patient, it was time for the ‘searchers’ to move in. Searchers were women given the task of inspecting corpses, and reporting, “to the utmost of their knowledge”, what exactly had killed them. The Plague Orders stipulated that each parish elect their own searchers, and that they be women of “honest reputation”. So why did this task rarely fall to men? It’s probably because women had traditionally taken charge of the deceased – washing, shaving and dressing a person’s corpse ready for burial. This was the grimmest of tasks. Searchers were given a checklist of symptoms to look out for on the dead, including the presence of swelling around the neck, carbuncles and tokens. They usually worked in pairs, received payment per body, and were required to identify themselves by carrying a red wand. Tragically, 1665 turned out to be an incredibly busy year for such women. During the Great Plague, searchers recorded no fewer than 68,596 plague deaths. Their raw data was the basis of the Bills of Mortality that, in turn, provided the only graspable way for contemporaries to monitor the progress of plague in the city. To this day, the Bills of Mortality form the bedrock of any study of early modern plague in London. This wasn’t a new vocation. Women had examined the plague dead since at least the 16th century – we know, from Richelle Munkhoff’s research into plague searchers, that a “Mother Benson” and a “Mother Sewen” were employed to “serche” for plague victims in the London parish of St Margaret Lothbury as early as 1574. Like nurses, the searchers often inspired revulsion among their fellow Londoners – an antipathy only increased by their ability to condemn an entire household to quarantine. It is perhaps this power that led to the belief that searchers could be easily corrupted. According to Thomas Dekker, writing during the outbreak of 1603, people could give “a little bribe to the searchers” to avoid quarantine. The Royal Society statistician John Graunt – who’s fame is based on the very data the searchers harvested – opined that they were unreliable and at the mercy of “a cup of ale, and the bribe of a two-groat fee”. But not everyone shared Graunt and Dekker’s misgivings. In fact, searchers could not only be treated with respect, but often held their positions for many years. Munkhoff’s research has revealed that one “Widow Bullen” performed the role of parish searcher for almost 30 years, paired for the majority of her tenure with a searcher named “Widow Hazard”, who served for 33 years. Read more | How 17th-century London reacted to the Great Plague The first to die “The masculine sex bears the greatest part.” So wrote the statistician John Graunt of a plague epidemic that swept England in 1603, killing thousands. Graunt was right: the 1603 outbreak did indeed send more men than women to their graves. But when it returned to wreak havoc in London in 1665, the exact opposite was true. The question is: why? Research by the historian Justin Champion has revealed that 168 more women died during the Great Plague than men. This number might seem immaterial, if it weren’t for the fact that – as Graunt’s words indicate – during the 17th century men usually died more frequently than women. The death ratio during the Great Plague switched from nine females for every 10 males to 10 females for every 9.9 males. What’s more, having examined three parishes in particular, Champion found an early pre-summer peak in female mortality that far outstripped that of men. In other words, women appear to have caught plague earlier. The reasons for this discrepancy are obscure. It could be that women’s proximity to the home made them more likely to not only contract the illness, but contract it earlier. Alternatively, it could be that the presence of nurses in the homes of the sick skewed the gender ratio, or even that more men fled the capital than women. The diarist Samuel Pepys and novelist Daniel Defoe (the latter in a fictionalised account) both wrote that women were sent out of the city before men. However, when he travelled to London during the height of plague, the schoolboy William Taswell tells us that he carried messages for households headed by women. Among them was Johanna, his family’s long-time servant and his childhood carer, who, we’re told, contracted plague shortly after his visit. Listen | Vanessa Harding describes the events of the 1665 Great Plague and explains how people at the time sought to cope with the disease The resourceful survivors For all too many Londoners, the Great Plague was a catastrophe with no silver lining. Even those who survived the epidemic had their lives utterly ruined – among them, for example, was Elizabeth Lingar who lost her husband and two daughters and was registered as needing poor relief in 1666. But some were able to move on. Betty Mitchell, the young daughter of a Westminster haberdasher, lost her fiancé to plague but married his brother. Others made a success of their lives in the post-plague years, with women of means having the best chance of prospering. Anne Maxwell inherited a lucrative printing business following her husband’s death in 1665 and went on to become one of the most prolific printers of the 1660s and 1670s. EXPLORE more on this topic | Women's history Then there are the many thousands of women whose fates have been lost in the mists of time. There are the two women Samuel Pepys bumped into, in the dead of night, weeping as they carried “a man’s coffin between them”; the young girl who, the doctor Nathaniel Hodges tells us, escaped plague-free from quarantine; and the mother who the preacher Thomas Vincent saw carrying the coffin of her child to the New Churchyard. Were these women able to rebuild their lives in the coming decades? We may never know. Rebecca Rideal is the author of 1666: Plague, War and Hellfire (John Murray, 2016) This article was first published in the August 2017 issue of BBC History Magazine
Post pandemic: how the years after the Black Death briefly became a ‘golden age’ for medieval women
In the 150 years after the Black Death halved London's population, women enjoyed new economic power in the city. Caroline Barron asks whether this era truly was a 'golden age' for English women
In April 1349, as the Black Death swept through London, Mathilda de Myms drew up her will. Her husband, John, had died the previous month, leaving his tenements to his wife and entrusting to her the guardianship of their daughter, Isabella. But the plague continued to ravage the capital, and Mathilda – wisely, as it transpired – decided to get her affairs in order. Shortly afterwards she was herself struck down. John and Mathilda had run a business making religious images and paintings. Mathilda’s will arranged for her apprentice, William, to continue his training with a monk in Bermondsey Priory, and bequeathed to him the tools he needed, together with one of her best chests in which to keep them. A brewery owned by Mathilda was to be sold to pay for prayers for her and John. That will underlines the devastating impact of the Black Death on thousands of families across the country; indeed, the disease subsequently took Isabella’s guardian. But the document also offers other insights – specifically, into opportunities that resulted from the soaring death toll. In this instance, Mathilda clearly had wealth of her own, and the freedom to write such a will. She was briefly an early beneficiary of a period of relative economic power for women created by the sudden dearth of skilled and trained men – an era that has been dubbed a ‘golden age’. Even before the plague afflicted London, the capital’s customary law offered women freedoms that they rarely enjoyed elsewhere in England, except perhaps in York. For example, a woman might enter into obligations on her own behalf, take on apprentices, run her own business, rent property, and sue (or be sued) for debt in the London courts. A woman – especially if she was a widow – could even write a will, as Mathilda de Myms did. But after the plague struck, sending London’s population plummeting to 40,000 from a peak of 80,000 in 1300, these opportunities multiplied. In fact, the mayor and aldermen, alarmed by a chronic shortage of manpower, began actively to encourage women to exercise their new economic rights. Eventually, the rights went further: from 1465, a widow of a citizen of London, who was living there with him at the time of his death, would be made ‘free of the city’ (a citizen) as long as she continued to live in London and did not remarry. City authorities were especially anxious to encourage the widows of London merchants and craftsmen to continue to run their husbands’ workshops or trading enterprises, to ensure that these businesses continued to contribute to civic prosperity and taxation. Thus it became compulsory for widows to train their late husbands’ apprentices, or to make proper provision for them. In the years following the Black Death, girl apprentices became prominent in surviving records. Though this wasn’t a new phenomenon – as early as 1276, Marion de Lymeseye was apprenticed to Roger Oriel, a paternosterer (maker of rosaries) – but in the half-century after the Black Death, from 1350 to 1400, numbers of female apprentices soared. Fathers sometimes specified in their wills that their daughters should be apprenticed to learn a trade. Robert de Ramseye, a fishmonger who died in 1373, left 20 shillings to his daughter, Elizabeth – for her marriage, and for “putting her to a trade”. Records are sparse – only 30 apprenticeship indentures from medieval London survive – but about a third of them relate to girls, many training in the craft of silkwork or embroidery. Their indentures, like those of boys, had to be recorded in the apprentice rolls kept at the Guildhall, and the terms of the indentures were the same, usually for seven years. Why the rise in female apprentices at this time? For boys, a completed apprenticeship opened the way to the citizenship of London, with all its attendant political and economic advantages and responsibilities. For girls, though, this was not the case – citizenship did not follow an apprenticeship, and most went on to marry. A female apprentice lived in the household of her master or mistress (not always the case with servants), and was placed almost completely under their authority. The master or mistress had specific obligations to feed, clothe and nurture the apprentice and, above all, to train her in the secrets and skills of her craft. An apprenticeship provided girls with patrons and business contacts, and secured their status within the working community. So parents from gentry families outside London knew that apprenticing daughters would provide them with the means to earn a living, and to run an independent household should that prove necessary. Unsurprisingly, then, most girls were bound by their father or brother, though one woman from Sussex bound herself as an apprentice to another woman in London. Read more: Beating the Black Death – did medieval medicine help people to survive? Sole traders Married women in London could choose to trade separately from their husbands as femmes soles. At the time when her husband, Thomas, was serving as an alderman, around 1380, Maud Ireland traded as a femme sole silkwoman. “According to the usage of the city [she was] bound to answer her own contracts,” and she was sued for a debt owed for white silk bought from an Italian merchant. Women were expected to make a public declaration of their sole status. In October 1457, Agnes Gower stated to the mayor and aldermen that she practised the art of a silkwoman and no other, and asked to be allowed to “merchandise” without her husband John, and to answer sole for her own contracts according to city custom. This was granted and recorded. Some of these independent London women were doing business on a large scale. Agnes Ramsey, daughter of the noted architect and mason William Ramsey, ran her father’s business after his death in 1349 (see sidebar, left). Mathilda Penne ran her husband’s business as a skinner for 12 years after his death; she trained her own apprentices and employed male servants and, possibly, a female scrivener to keep the accounts. Twice during the 15th century, the substantial bell foundry outside Aldgate was run by widows. The household and workshop of the bell-founder Johanna Hill, who died in 1441, comprised four male apprentices, two female servants, 10 male servants, a specialised bell-maker, a clerk and the daughter of a fellow bell-founder. Other widows continued to run the financial side of their husbands’ businesses, if not the trading or craft aspects; they pursued debtors, sorted out accounts and saw to the execution of their husbands’ wills. These women were active in maintaining their households, bolstering the welfare of their souls and managing the upbringing of their children, as well as other endeavours. Another Agnes, the widow of Stephen Forster (mayor of London 1454–55), saw to the rebuilding and reorganisation of the prison at Ludgate. Read more: Quarantine during the Black Death – how did we try to contain the most deadly disease in history? Crafty women These were remarkable women who made their mark in the commercial world of London and won respect within their social milieus. The records of the craft guilds and companies acknowledge the presence of women, but their role was not a formal one – rather, they shared in the religious, charitable and social aspects of company life. However, several crafts and trades recognised the contribution of women workers. In the early 15th century, for example, one-third of all brewers paying dues to the Brewers’ Company were women. Some of these were single, while others were widows or married women trading sole; one Agnes, whose husband Stephen was a draper, paid her dues independently throughout the 1420s. Though women were seemingly marginalised within these organisations, limited to social and charitable roles, they were able to make contacts with other workers within their craft. They could also achieve recognition of their credit-worthiness and could share in, and contribute to, the material resources of their societies. To offset the imposed limitations of their role within guilds and companies, and to supplement the formal craft relationships, many created important informal networks of friends, servants, apprentices, dependants and patrons. However enmeshed women may have been in the social and economic networks of London life, their professional advancement was still constrained. For example, there is scant evidence of a woman holding any public office in which she might have been placed in authority over a man – such appointments would be vigorously resisted. In 1422, the men of Queenhythe ward complained that John of Ely, the local measurer of oysters, had subcontracted his office to women “who know not how to do it; nor is it worship to this city that women should have such things in governance”. No doubt most Londoners shared the view of the men of Queenhythe; certainly, women never served as ward officers, common councilmen or, of course, aldermen. The delegation of authority to women was extremely rare, but it did happen: for more than 20 years following the death of her husband, Nicholas, in 1433, Alice Holford held the office of bailiff of London Bridge (see sidebar). Future gains The century and a half between 1350 and 1500 could reasonably be considered a ‘golden age’ for women in London – but it was short-lived. As the population swelled once more, an acute manpower shortage was replaced by a glut, and women were pushed out of the labour market. In 1570, the Drapers’ Company refused to allow a member to take on a girl apprentice “for that they had not seen the like before”. Women continued to work after that period, of course, but in largely informal and dependent positions. London merchants were transforming themselves into country gentlemen, and it was no longer suitable for their wives to be seen trading sole. Moreover, Protestantism created a specific role for women – as godly domestic teachers within the household. Throughout the 15th century, English society remained deeply patriarchal. The opportunities that had been available to women had been purely economic: women had no handles on power and no way of influencing political decisions. So the ‘golden age’ was golden only briefly, and was most apparent in the economic capital, London. Nonetheless, when given the chance, these women demonstrated their ability to do men’s work. In doing so they set an important precedent, to be followed by women in the two world wars of the last century, which led directly to the greater economic and political emancipation of women today. What were the symptoms of the disease known as the Black Death? And when did the first recorded quarantine take place? Test your knowledge with our Black Death quiz... Golden girls: four women who exploited the opportunities presented when the plague struck Agnes Ramsey, Mason Agnes, who never used her husband’s name, was the daughter of the famous architect and mason William Ramsey, who was killed by the Black Death in 1349. Though married to another mason, Robert Hubard, Agnes continued to run her father’s business, entering into a contract with the dowager Queen Isabella of France, widow of Edward II, to build her fine tomb at the enormous cost of £100. Alice Holford, Bailiff Alice took over the post of bailiff of London Bridge on the death of her husband, Nicholas, in 1433, and continued in office for over 20 years. The bailiff collected the tolls due from boats passing through the bridge, and from carts that crossed it into London. The task was a complicated one – charges varied according to the goods and the person transporting them – and Alice must have had some literacy skills. Johanna Hill, Bell-founder On the death of her husband in 1440, Johanna took full charge of their bell-founding business till her own death in 1441. Seven of her bells still exist as far away as Ipswich, Sussex and Devon. Johanna continued to use her husband’s mark – a cross and circle within a shield – but surmounted with a lozenge to indicate that the workshop was now under her authority. Ellen Langwith, Silkwoman Ellen, who died in 1481, was a London silkwoman. When her first husband, cutler Philip Waltham, died she was left to train their three female apprentices. She later married a tailor, John Langwith, but continued with her own craft. She was recorded as buying gold thread and raw silk direct from Venetian merchants, and in 1465 supplied saddle decorations and silk banners for the coronation of Elizabeth Woodville, wife of Edward IV. She was courted by both the Cutlers’ and Taylors’ companies. Caroline Barron is professor emerita at Royal Holloway, University of London, and a specialist in late medieval British history, particularly the history of women This article was first published in the June 2014 issue of BBC History Magazine
Spanish flu: the virus that changed the world
In spring 1918 a disease began to sweep around the planet – a lethal virus that infected a third of the world's population and left upwards of 50 million dead. Laura Spinney explores the devastating impact of the Spanish flu pandemic and how it compares to the Coronavirus crisis
The Spanish flu pandemic of 1918–20 infected a third of the global population and left at least 50 million people dead – a greater number, possibly, than the Second World War. Explore the dramatic effects of the outbreak here, including the ways in which the world struggled to come to terms with the disease – medically, socially and politically… How many people died from Spanish Flu? Why was it called 'Spanish Flu'? How did Spanish Flu spread? And who did it affect? Political aftermaths of Spanish Flu How does Spanish Flu compare to Coronavirus? Where did Spanish flu originate? One of the few certainties we have about the Spanish Flu Pandemic is that it didn’t start in Spain. We actually don’t know where it did start – but we know it didn’t start in Spain. The Spanish felt, and to a very great degree were, stigmatised by this. There is also no way of being certain where Spanish Flu originated, although the trenches of the First World War, where poor sanitation and disease was rife, are an often-cited contender. The filthy, rat-infested conditions undoubtedly affected the soldiers’ immune systems, making them more vulnerable to illness. It is thought the first cases were in military forts in the United States before spreading at an alarming rate to Europe. But yet the pandemic was called ‘Spanish Flu’ – again, a result of the war. Why was Spanish Flu called Spanish flu? Wartime censorship exaggerated the affects of the virus in Spain. While Britain, France, Germany and the United States censored and restricted early reports, papers in Spain – as a neutral country – were free to convey all the horrid details of the pandemic. This made it look much worse there, so the unfortunate name spread with the disease around the world. Monday 4 March 1918: the day Spanish Flu strikes the world Written by Dominic Sandbrook When Private Albert Gitchell awoke on Monday 4 March 1918, he felt awful. A company cook at Fort Riley, Kansas, Gitchell was supposed to be serving breakfast to hundreds of young American recruits, who were waiting to be shipped off to the battlefields of France. But when the doctors had a look at him, they realised that, with a temperature of more than 103, Gitchell was in no state to work in the mess. A few hours later, another man, Corporal Lee Drake, appeared at the infirmary with similar symptoms. Then another, Sergeant Adolph Hurby. Still the men kept coming: there were 107 by lunchtime and more than 500 by the end of the week. By the end of the month, no fewer than 1,127 men at Fort Riley had come down with flu – and 46 of them had died. In the next few months, as American soldiers flooded into Europe, they brought the deadly influenza with them. With vast armies surging across an exhausted continent, the conditions were perfect for a pandemic. This was one of history’s deadliest disasters. Across the world, some 500 million people had been struck down by flu by the end of 1920, perhaps 100 million of them fatally. Many governments banned public gatherings or buried the victims in mass graves. Reporting restrictions in the combatant nations meant that the disease’s progress in neutral Spain drew disproportionate attention: hence its nickname, Spanish flu. Only one populated part of the world reported no cases at all: the island of Marajo, at the mouth of the Amazon. How many people died from Spanish flu? The Spanish flu was one of the deadliest disasters in history. It lasted for two years – between the first recorded case in March 1918 and the last in March 1920, an estimated 50 million people died, though some experts suggest that the total might actually have been twice that number. The ‘Spanish flu’ killed more than the First World War, possibly more even than the Second World War – indeed, perhaps more than both put together. The pandemic struck at a critical juncture in the evolution of understanding of infectious disease. Well into the 19th century, epidemics were considered acts of god – a notion that dated back to the Middle Ages. Bacteria were first observed in the 17th century, but initially weren’t connected with human illnesses. In the late 1850s the French biologist Louis Pasteur made the connection between micro-organisms and disease, and from a couple of decades later German microbiologist Robert Koch furthered modern concepts of infectious disease. ‘Germ theory’ was disseminated far and wide, slowly replacing more fatalistic ideas. The dark history of quarantine practices By the 20th century the application of germ theory, combined with improvements in hygiene and sanitation, had made significant inroads against the so-called ‘crowd’ diseases that afflicted human communities, especially those inhabiting the great cities that had mushroomed in the wake of the industrial revolution. Throughout the 19th century, so many urbanites had been lost to such diseases – cholera, typhus and tuberculosis, to name but three – that cities needed a steady influx of healthy peasants from the countryside to keep up their numbers. Now, at last, they had become self-sustaining. By 1918, then, faith in science was high, and some scientists had even adopted a certain swagger. Twelve years earlier, this had prompted the Irish playwright George Bernard Shaw to write The Doctor’s Dilemma, in which an eminent doctor, Sir Colenso Ridgeon – a character based on Sir Almroth Wright, who developed the typhoid vaccine – plays god with his patients’ destinies. Shaw was warning doctors against hubris, but it took an outbreak of another ‘crowd’ disease – influenza – to bring home to them just how little they knew. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2017/02/GettyImages-515485220-sml-0e2a971.jpg" width="1063" height="1503" alt="Dr Robert Koch (seated), influential in developing ‘germ theory’," title="Dr Robert Koch (seated), influential in developing ‘germ theory’, and his student Richard Pfeiffer at work in the late 19th century. During the ‘Russian’ flu epidemic starting in 1889, Pfeiffer claimed to have identified the bacillus responsible – though flu is actually caused by a virus. (Getty Images)" /> When scientists thought about ‘germs’ in the early 20th century, they generally thought about bacteria. The virus was a novel concept; the first virus, discovered in 1892, infected tobacco plants and had been detected indirectly by its ability to transmit disease. Unlike many bacteria, it was too small to be seen through an optical microscope. Without having actually seen viruses, scientists debated their nature: were they organism or toxin, liquid or particle, dead or alive? They were veiled in mystery, and nobody suspected that they could be the cause of flu. What happened when Spanish Flu hit Britain? During the previous flu pandemic – the so-called ‘Russian’ flu, which began in 1889 – a student of Koch’s named Richard Pfeiffer claimed to have identified the bacterium that caused the flu. Pfeiffer’s bacillus, as it became known, does exist and does cause disease – but it does not cause flu. During the 1918 pandemic, pathologists who cultivated bacterial colonies from the lung tissue of flu victims found Pfeiffer’s bacillus in some, but not all, of their cultures, and this puzzled them. To add to doctors’ puzzlement, vaccines created against Pfeiffer’s bacillus seemed to benefit some patients. In fact, these vaccines were effective against secondary bacterial infections that caused pneumonia – the ultimate cause of death in many cases – but scientists didn’t know that at the time. They would realise their mistake too late. Why was it called 'Spanish flu'? The Russian flu had acquired its name because it was thought to have originated in Bukhara in Uzbekistan (at that time, part of the Russian empire). The pandemic that broke out nearly 30 years later will always be known as the ‘Spanish flu’, though it didn’t start in Spain. It washed over the world in three waves which, in the northern hemisphere, corresponded to a mild wave in the spring of 1918, a lethal wave the following autumn, and a reprisal in the early months of 1919 that was intermediate in virulence between the other two. The first cases were officially recorded in March 1918 at Camp Funston, a military base in Kansas. Within six weeks the disease had reached the trenches of the western front in France, but it wasn’t until May that the flu broke out in Spain. Unlike the United States and France, Spain was neutral in the war, so it didn’t censor its press. The first Spanish cases were therefore reported in the newspapers, and because King Alfonso XIII, the prime minister and several members of the cabinet were among those early cases, the country’s plight was highly visible. People all over the world believed that the disease had rippled out from Madrid – a misconception encouraged by propagandists in those belligerent nations that knew they’d contracted it before Spain. In the interests of keeping morale high in their own populations, they were happy to shift the blame. The name stuck. Could flu really kill thousands again? Understandably, Spaniards smarted at this calumny: they knew they were not responsible, and strongly suspected the French of having sent the flu across the border, but they couldn’t be sure. They cast around for a different label, and found inspiration in an operetta performed at the capital’s Zarzuela Theatre – a hugely popular reworking of the myth of Don Juan, featuring a catchy tune called ‘The Soldier of Naples’. The catchy disease became known in Spain as the ‘Naples Soldier’. But though the Spanish flu didn’t start in Spain, that country did suffer quite badly with it. In the early 20th century, flu was viewed as a democratic disease – nobody was immune from it – but, even in the thick of the pandemic, it was noted that the disease struck unevenly. It ‘preferred’ certain age groups: the very young and the elderly, but also a middle cohort aged 20 to 40. It preferred men to women, with the exception of pregnant women, who were at particularly high risk. These age and gender-related patterns were repeated all over the world, but the virulence with which the flu struck also varied from place to place. Inhabitants of certain parts of Asia were a staggering 30 times more likely to die from the flu than those in parts of Europe. In general, Asia and Africa suffered the highest death rates, with the lowest seen in Europe, North America and Australia. But there was great variation within continents, too. African countries south of the Sahara experienced death rates two or even three times higher than those north of the desert, while Spain recorded one of the highest death rates in Europe – twice that in Britain, three times that in Denmark. The unevenness didn’t stop there. In general, cities suffered worse than rural areas, but some cities suffered worse than others, and there was also variation within cities. Newly arrived immigrants tended to die more frequently than older, better-established groups, for example. In the countryside, meanwhile, one village might be decimated while another, apparently similar in every way, got away with a light dose. Why Spanish flu isn't a 'flu' at all... On 28 September 1918, a Spanish newspaper gave its readers a short lesson on influenza. “The agent responsible for this infection,” it explained, “is the Pfeiffer’s bacillus, which is extremely tiny and visible only by means of a microscope.” The explanation was timely, because the world was in the grip of the most vicious flu pandemic on record – but it was also wrong: flu is caused by a virus. Unfortunately, it wasn’t just one Spanish newspaper that had misidentified the causative agent of the disease. The idea that flu was caused by a bacillus, or bacterium, was accepted by the most eminent scientists of the day, who would find themselves almost entirely helpless in the face of the scourge. How did Spanish flu spread? And who did it affect? The flu seemed to strike with an element of randomness, and cruelly so. Because adults in the prime of life died in droves, unlucky communities imploded. Children were orphaned, elderly parents left to fend for themselves. People were at a loss to explain this apparent lottery, and it left them deeply disturbed. Attempting to describe the feeling it inspired in him, a French doctor in the city of Lyons wrote that it was quite unlike the “gut pangs” he had experienced while serving at the front. This was “a more diffuse anxiety, the sensation of some indefinable horror which had taken hold of the inhabitants of that town”. It was only later, when epidemiologists zeroed in on the numbers, that patterns began to emerge, and the first elements of an explanation were put forward. Some of the variability could be explained by inequalities of wealth and caste – and, to the extent that it reflected these factors, skin colour. Bad diet, crowded living conditions and limited access to healthcare weakened the constitution, rendering the poor, immigrants and ethnic minorities more susceptible to infection. As French historian Patrick Zylberman put it: “The virus might well have behaved ‘democratically’, but the society it attacked was hardly egalitarian.” Portraits of a plague: the 19th-century pandemic that killed 12 million people Any other underlying disease made a person more susceptible to the Spanish flu, whereas prior exposure to the flu itself modulated the severity of a case. Remote communities without much historical experience of the disease suffered badly, as did cities that were bypassed by the first wave of the pandemic, because they were not immunologically ‘primed’ to the second. For example, Rio de Janeiro – capital of Brazil at the time – received only one wave of flu, in October 1918, and experienced a death rate two or three times higher than that recorded in American cities to the north that had received both the spring and autumn waves. And Bristol Bay in Alaska was spared until early 1919, but when the virus finally gained a foothold it reduced the bay’s Eskimo population by 40%. Public health campaigns made a difference, despite the fact that medics did not understand the cause of the disease. Since time immemorial, whenever contagion is a threat humans have practised ‘social distancing’ – understanding instinctively that steering clear of infected individuals increases the chance of staying healthy. In 1918, social distancing took the form of quarantine zones, isolation wards and prohibitions on mass gatherings; where they were properly enforced, these measures slowed the spread. Australia kept out the autumn wave entirely by implementing an effective quarantine at its ports. Exceptions proved the rule. In 1918 Persia was a failed state after years of being used as a pawn in the ‘Great Game’ – the struggle between the British and the Russians for control of the vast area between the Arabian and Caspian Seas. Its government was weak and nearly bankrupt, and it lacked a coherent sanitary infrastructure, so when the flu erupted in the north-eastern holy city of Mashhad in August 1918, no social distancing measures were imposed. Within a fortnight every home and place of business in Mashhad was infected, and two-thirds of the city’s population fell sick that autumn. With no restrictions on movement, the flu spread outwards with pilgrims, soldiers and merchants to the four corners of the country. By the time Persia was again free of flu, it had lost between 8% and 22% of its population (that uncertainty reflecting the fact that, in a country in crisis, gathering statistics was hardly a priority). By way of comparison, even 8% equates to 20 times the flu-related mortality rate in Ireland. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2017/02/GettyImages-514877124-sml-17b6bb7.jpg" width="2008" height="1808" alt="Schoolgirls in Tokyo don protective face masks to guard against flu transmission during the outbreak. The use of such masks by the Japanese public boomed during the 1918–20 epidemic and subsequent disease outbreaks, and remains common in Japan today. (Getty images)" title="Schoolgirls in Tokyo don protective face masks to guard against flu transmission during the outbreak. The use of such masks by the Japanese public boomed during the 1918–20 epidemic and subsequent disease outbreaks, and remains common in Japan today. (Getty images)" /> Where disparities in rates of illness and death were perceived, people’s explanations reflected contemporary understanding – or, rather, misunderstanding – of infectious disease. When Charles Darwin laid out his theory of evolution by natural selection in On the Origin of Species (1859), he had not intended his ideas to be applied to human societies, but others of his time did just that, creating the ‘science’ of eugenics. Eugenicists believed that humanity comprised different ‘races’ that competed for survival, and by 1918 their thinking was mainstream in industrialised societies. Some eugenicists noted that poorer sectors of society were suffering disproportionately from the flu, which they attributed to a constitutional inferiority. They had also incorporated germ theory into their world view: if the poor and the working classes were more prone to infection, reasoned the eugenicists, they only had themselves to blame, because Pasteur had taught that infection was preventable. The Black Death: the historians’ view The terrible consequences of this line of thinking are illustrated nowhere better than in India. That land’s British colonisers had long taken the view that India was inherently unhygienic, and so had invested little in indigenous healthcare. As many as 18 million Indians died in the pandemic – the greatest loss in absolute numbers of any country in the world. But there would be a backlash. The underpowered British response to the spread of flu fuelled resentment within the independence movement. Tensions came to a head with the passing into law in early 1919 of the Rowlatt Act, which extended martial law in the country. This triggered peaceful protests, and on 13 April British troops fired into an unarmed crowd in Amritsar, killing hundreds of Indian people – a massacre that galvanised the independence movement. The political aftermath of Spanish Flu The Spanish flu prompted uprisings elsewhere. The autumn of 1918 saw a wave of workers’ strikes and anti-imperialist protests across the world. Disgruntlement had been smouldering since before the Russian revolutions of 1917, but the flu fanned the flames by exacerbating what was already a dire supply situation, and by highlighting inequality. Even well-ordered Switzerland narrowly avoided a civil war in November 1918 after leftwing groups blamed the high number of flu deaths in the army on the government and military command. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2018/09/GettyImages-597915863-85df63b-scaled.jpg" width="2560" height="2027" alt="Influenza pandemic of 1918" title="A temporary hospital erected in Oakland Municipal Auditorium in Oakland, California with volunteer nurses from the American Red Cross tending the sick during the influenza pandemic of 1918. (Photo by Underwood Archives/Getty Images)" /> There were still parts of the world where people had never heard of either Darwin or germ theory, and where the population turned to more tried-and-tested explanations. In the rural interior of China, for example, many people still believed that illness was sent by demons and dragons; they paraded figures of dragon kings through the streets in the hope of appeasing the irate spirits. A missionary doctor described going from house to house in Shanxi province in early 1919, and finding scissors placed in doorways – apparently to ward off demons “or perchance to cut them in two”. Even in the modernised west, people vacillated. Death often seemed to strike without rhyme or reason. Many still remembered a more mystical, pre-Darwinian era, and four years of war had worn down psychological defences. Seeing how ill-equipped their men of science were to help them, many people came to believe that the pandemic was an act of god – divine retribution for their sins. In Zamora – the same Spanish city whose newspaper stated with such confidence that the agent of disease was Pfeiffer’s bacillus – the bishop defied the health authorities’ ban on mass gatherings and ordered people into the churches to placate “God’s legitimate anger”. This city subsequently recorded one of the highest death tolls from flu in Spain – a fact of which its inhabitants were aware, though they don’t seem to have held it against their bishop. Instead they awarded him a medal in recognition of his heroic efforts to end their suffering. This exemplifies how responses to the flu reflected gulfs in understanding. The 1918 pandemic struck a world that was entirely unprepared for it, dealing a body blow to scientific hubris, and destabilising social and political orders for decades to come. Laura Spinney is a journalist and the author of Pale Rider: The Spanish Flu of 1918 and How it Changed the World, (Jonathan Cape, June 2017). This article first appeared in issue 4 of BBC World Histories How does Spanish flu compare to Coronavirus? In an episode of the HistoryExtra podcast recorded in spring 2020, Laura Spinney expanded on how the Spanish Flu pandemic statistics stack up against the early data recorded about Covid-19. “You might have seen a figure floating around of a case fatality rate of 3.4 per cent, which refers to the proportion of people who catch the Covid-19 infection who go on to die of it," she explained. "The number that’s often quoted for the Spanish Flu fatality rate is 2.5 per cent – but it’s a very controversial figure because the numbers are so vague. "We think that (probably) 50 million people died of Spanish Flu, but there was no form of reliable test at the time, so we can’t be sure about that and that just throws all the numbers out. “So it’s really difficult to make the historical comparisons, even if you have accurate data now. On both sides of the equation, if you like, it’s a moving target." Read a transcript of the podcast here Discover more about pandemics through history Coronavirus: what might we learn from pandemics in the past? Epidemiology: the history of disease and epidemics (via BBC Science Focus) Everything you need to know about the Black Death Black Death quarantine: how did we try to contain the most deadly disease in history?
"Far too little, too late": what happened when Spanish Flu hit Britain?
A century ago, a devastating pandemic killed countless millions worldwide. But how did Britain cope when Spanish Flu reached its shores in 1918? Robert Hume says it was a tragic case of far too little, too late...
How was Britain affected by the Spanish flu pandemic of 1918? Robert Hume considers the key questions: How did Spanish flu arrive in Britain? How did people protect themselves against Spanish flu? How did Britain officially respond to Spanish Flu? How did the British media respond to Spanish Flu? How many people died from Spanish flu in Britain? Spanish flu in Britain: an introduction “Soon after the war ended, there was a strange kind of flu,” recorded John Pears Jackson, who farmed near Keswick, and died in 2005, aged 98. “Many thousands of people, in England alone, died, including a lot of men and women in Cumberland, some of whom I knew. With none of the drugs and antibiotics we have today, doctors were powerless, and strong men and women were dead in the course of a few days… People drank whisky… and dosed themselves with all kinds of medicines. One farmer I knew swore he cured himself with paraffin oil.” Margaret Pitt, then a pupil at Milton Mount College in Gravesend, recalled being offered something milder to drink: “The school was warned [of] the coming epidemic, so they tried to get us all home early before the Easter holidays. Telegrams were sent to our parents… Our trunks were packed and sent off. Then we all came down to the main hall ready for our journey, in coats, hats and gloves, and our hand luggage. The nurse and her assistant were there with thermometers to see if we were developing the virus. I think about half of us were sent back to bed, some were very upset as they were anxious to go home. I was one of those who had to go to bed. We were given plenty of drink… milk.” Why was Spanish Flu called Spanish flu? The British Medical Journal referred to the sickness – characterised by shivering, headache, sore throat and fever – as ‘Spanish flu’ because it was first recorded in Spain. Offended by the slander, Spaniards named the illness the ‘Naples soldier’. The German army called it ‘Blitzkatarrh’, and British troops referred to it as ‘Flanders grippe’ or the ‘Spanish lady’. One recent study suggests it originated in China, and was transported by labourers heading for the western front. Other investigations concluded that its epicentre was a military camp – either in Kansas, or Étaples, northern France. Some claimed that mustard gas and battlefield fumes were responsible; others that it was a German biological weapon. It’s estimated that somewhere between 25 and 100 million people died worldwide in what is, in absolute terms, the worst pandemic ever recorded. Only St Helena in the South Atlantic and a handful of South Pacific islands did not report an outbreak. Whereas, today, flu is especially dangerous for the very young and the elderly, in 1918 it mainly affected young adults. Those aged 75 and above had the lowest death rate of all. How did Spanish flu arrive in Britain? Troops travelling home by boat and train at the end of the war took the flu into the cities, from where it spread to the countryside. The disease swept across Britain in three waves: mild in spring 1918; devastating in autumn 1918; and moderate in early 1919. The port of Glasgow was the first place to record the flu, in May 1918, an unusual time of year for the sickness to appear. Young women, especially those working in factories, were worst affected. It reached London in June. By late August it seemed a spent force; but in October it returned with a vengeance, and reached every corner of the land. The speed at which influenza struck defied efforts to deal with it. In July, a woman in Leicester stopped a doctor in the street, and while they were talking she collapsed and died. The brother of William Hall from Rosley, Cumbria, recorded in his diary: “We did not know he ailed anything until the morning of the day he died.” The infection spread at an alarming rate. On 14 February 1919, poet Robert Graves returned from Limerick to his home in Hove, accompanied by “the Spanish Lady”. Within a couple of days, almost his entire household had contracted the flu. Throughout Britain, a shortage of undertakers and grave diggers led to bodies lying unburied for days, and many funerals taking place at night. How did people in Britain protect themselves against Spanish Flu? Local authorities and the press did offer some useful advice. The Bexhill-on-Sea Observer advised readers to avoid crowds by catching a later train home, sitting outside the bus, and wearing an extra coat. In Brighton, publicans were urged to thoroughly wash the outside lips of drinking glasses in running water, while a pamphlet recommended people to “give up shaking hands for the present, and give up kissing for all time”. A number of constructive measures were taken. In Rotherham, posters were displayed in prominent parts of the town, and health visitors and school nurses distributed leaflets from door to door, encouraging people to keep dirty handkerchiefs out of the reach of children. The Borough of Hackney recommended that victims stay isolated, go to bed the moment symptoms appeared, and gargle with potash and salt. In Keswick, Cumbria, the Medical Officer arranged for a free supply of “disinfectant mixture”. Every morning, formalin was sprinkled on the floor of Brighton’s public library and post office, and tramcars were fumigated in Doncaster. 10 facts about the Black Death The focus – if there was one – lay in minimising the risk of infection through contact. Hundreds of elementary schools were closed during the height of the epidemic. Cheltenham Boys’ School took the reverse step of locking staff and pupils inside the building. Election candidates in Sunderland abandoned house-to-house canvassing, and turned down requests to take voters to the polls. Recognising the value of fresh air to stem the spread of influenza, cinemas were required to be ventilated in London for 30 minutes every three hours. Those in Wolverhampton were ordered to ban children, and remove all carpets. For three consecutive nights, a Walsall cinema showed a 15-minute public information film that featured Dr Wise and a foolish patient. However, some of the advice was useless. One government official simply encouraged people to “clean [their] teeth regularly”, while the News of the World suggested readers “eat plenty of porridge”. Dr Robertson Dobie of Perthshire noted that hardly any of his flu patients worked at the local jam factory – where they lived in a sugary atmosphere all day – and prescribed jam and sweets. “In two months,” he predicted, influenza “will be a thing of the past.” Often, recommendations proved difficult to put into practice. “Terribly overcrowded and insanitary conditions rendered any attempt to cope with the disease futile,” recognised a health report in Rotherham. Where up to seven people occupied one small bedroom, isolation, ventilation and cleanliness were impossible. Although the town had an isolation hospital, space was available only for the severest cases. It was hard to “keep warm” and “eat good food”. “We might as well ask for the moon… the luxury of sitting in front of a roaring fire with all the windows open is not for rationed people”, rebuked the Bexhill-on-Sea Observer on 16 November 1918. Could flu really kill thousands again? Too few copies of the public information film were available. Local authorities had to apply in writing to borrow it, and prove that flu was already rampant in their area. The lack of internal plumbing made it hard for Brighton publicans to rinse glasses thoroughly, while dozens of people continued to squeeze into the town’s trams because there were no resources to build any more. When action was taken, the reasoning behind it was sometimes questionable. Physiologist Sir Leonard Hill recommended the deep breathing of cool air and sleeping in the open. Several isolation hospitals apparently placed patients in “soaking wet beds and sprinkled them regularly with cold water to keep them completely sodden”, hoping it would stimulate their immune systems. Meanwhile, at the George Hotel, Nottingham, Sister Veitch offered flu victims electric shock treatment. Many key ways in which the disease was spread were not addressed. Schools in London only closed if staff absenteeism made it impossible to keep them open. Secondary schools remained open throughout, as did churches, on the grounds that during a crisis people should turn to religion, not be excluded from it. It was a case of business as usual in Britain’s factories, too. Those in the Black Country relaxed their no-smoking rules, believing that cigarette smoke would prevent infection. Public parades and pageants were also allowed to go ahead. Armistice celebrations on 11 November meant tens of thousands taking to the streets. The authorities’ reluctance to act, and confusion among doctors – who called influenza “the obscure disease” – left the door wide open for quack remedies such as Thompson’s Influenza Specific, which claimed to “act like magic”; and Dr Williams’ Pink Pills for Pale People. Eating raw onions – as did the inhabitants of Saffron Hill – was also believed to keep “the dreaded scourge at bay”. Baffled doctors in Manchester prescribed an age-old tonic: whisky. View oEmbed on the source website How did Britain officially respond to Spanish Flu? Although recognised as contagious, the disease was not mentioned in parliament until late October 1918, and was not made ‘notifiable’ to the authorities until the third wave struck in early 1919. Even if it had been, there was no strategy for tackling it. Britain had no National Health Service until 1948, and there was only a patchwork of institutions to deal with health issues. The central board of health merely had power to give ‘advice’ to local authorities, and the Local Government Board kept a low profile, issuing the occasional memorandum. Therefore, the British response was a decentralised and uncoordinated one. Every town had to rely on its own resources and existing facilities to cope with the outbreak. The result was the proverbial “much talk, but very little do”. Other factors compounded the country’s difficulties. The epidemic could not have struck at a worse moment. The First World War had diverted a vast number of medical staff: some 52 per cent of doctors were at the front. Those not in military service – doctors over 50 years old and often lacking up-to-date training – were run off their feet. At Kingston-upon-Thames, one doctor reported: “From early morning till late at night I have done nothing but rush from one flu patient to another.” Having been called to 35 flu victims in one street, a Nottingham doctor simply told flu sufferers to pass his prescription on. At Bookham, Surrey, the only doctor was himself a victim. The medical profession didn’t fully comprehend the severity of the disease. In the summer of 1918, the Royal College of Physicians announced that Spanish flu was no more threatening than the still well remembered ‘Russian flu’ of 1889–94. The British Medical Journal accepted that overcrowding on transport and in the workplace was necessary to help the war effort, and implied that the inconvenience of flu should be quietly borne. Individual doctors tried to play down the severity of the disease to avoid spreading anxiety. In Egremont, Cumbria, where the death rate was appalling, the medical officer asked the rector to stop ringing the church bells every time there was a funeral because he wanted to “keep people cheerful”. How did the British media portray Spanish Flu? The press did likewise. The Times suggested that the illness was probably a result of “the general weakness of nerve-power known as war-weariness”, and the Derby and Chesterfield Reporter, 12 July 1918, declared that it was “not really a matter for alarm”. The Manchester Guardian scorned protective measures: “Women are not going to wear ugly masks.” What’s more, masks would steam up people’s glasses, and be of “doubtful usefulness at mealtimes”. The Sussex Daily News joked that influenza was no more than “an ingenious attempt” to sabotage the forthcoming general election, while Hanningtons department store in Brighton declared that the best way of treating influenza was spending money at their sale. Other countries, no less affected by the war, made more rigorous efforts than Britain to deal with the flu. In the United States, schools, churches and cinemas were closed, and public gatherings were banned. Health departments distributed masks, shops were not allowed to hold sales, and funerals were restricted to 15 minutes. It was forbidden to travel by train unless you carried signed certificates that you were clear, and overcrowding was reduced by introducing flexitime at work. Parts of Arizona outlawed handshaking, and in San Francisco drinking fountains were sterilised with blowtorches every hour. Meanwhile, Canada built an emergency hospital for flu victims in Vancouver. In France, schools, theatres and churches were closed down, extra staff were recruited to clear rubbish tips, and spitting in the street became a criminal offence. Train passengers in Spain were “generously sprayed with foul-smelling disinfectant”. Australia succeeded for a while in imposing a national quarantine. Passengers had to stay in isolation before being allowed to enter the country. Read more about the history of medicine How did people in the past treat illness, injury and disease? What medicines did they use? Beating the Black Death: did medieval medicine help people to survive? Ask the medieval doctor: 6 ailments and their treatments When was the first caesarean? How many people died from the Spanish Flu in Britain? By the summer of 1919, when the flu pandemic subsided, 228,000 people had died in Britain. Letters to newspapers condemned the government’s slowness to demobilise doctors at the front, the authorities' “timidity” to act, and “armchair complacency”. A correspondent in the Hackney Gazette of 8 November 1918 had complained: “Schemes for checking these terrible visitations need to be thought out and prepared beforehand,” while another observer had remarked in the Perthshire Advertiser, 26 October 1918: “We possess much more stringent laws in regard to the health of animals than to that of human beings.” The crisis hastened the Local Government Board’s replacement by a new Ministry of Health. Meanwhile, scientists attempted to identify what had brought Spanish flu. Existing wisdom that the disease was caused by a bacterium was wrong. Only in 1933, with the invention of the electron microscope, did a team at the National Institute for Medical Research in London demonstrate that an extremely infectious virus (H1N1 A) caused influenza, and that droplets shed by coughing and sneezing transmitted it from person to person. Fifteen years earlier, the priorities of war, determination to play down the seriousness of the illness, and limited medical knowledge resulted in a state of inertia, and allowed Punch to quip that those citizens who “insisted on having influenza”, did so “at their own risk”. Dr Robert Hume is a writer and former head of history at Clarendon House Grammar School, Ramsgate, Kent This article was first published in the January 2018 edition of BBC History Magazine
From debates about colonialism to lessons from previous pandemics, a panel of historians discuss how the past has shaped 2020 – and how the events of this momentous year should change our understanding of the past
From debates about colonialism to lessons from previous pandemics, history has repeatedly made the headlines this year. We invited historians Kerri Greenidge, Tom Holland, Suzannah Lipscomb and Michael Wood to discuss how the past has shaped 2020 – and how the events of this momentous year should change our understanding of the past.
The history of vaccination: from Edward Jenner to anti-vaxxers
As the world continues to adapt to the challenges posed by the Covid-19 pandemic, scientists are on the brink of discovering whether we have an effective coronavirus vaccine that will help return life to normal. Here’s everything you need to know about the history of the vaccine, from its discovery in the 18th century by physician Edward Jenner to the rise of anti-vaccination movements today
When were vaccines invented? From ancient times, the smallpox disease ravaged the globe, affecting all civilisations and walks of life. With a devastating mortality rate and no effective cure, millions died every year, and those who survived were left disfigured by deep scars – hence smallpox’s other name, ‘speckled monster’. It was a terribly successful killer, and might still be, were it not for English physician and surgeon Edward Jenner. During the 18th century, the traditional smallpox inoculation, ‘variolation’, was hazardous as it involved infecting a healthy person with a mild form of the disease in the hope of heightening immunity. Jenner – who, as a schoolboy, suffered a harrowing experience when he was variolated – strove to find a safer barrier against smallpox. From his medical practice in the town of Berkeley, Gloucestershire, he set about his research, no doubt with the advice of his mentor, John Hunter, echoing in his ears: “Don’t think, try”. Listen | Mary Fissell answers key questions about the history of medicine He noticed that local milkmaids suffering from cowpox, a far-less harmful affliction contracted from cattle, seemed immune to smallpox. Encouraged, Jenner wanted to test whether cowpox could be used to save lives, and there was only one way to find out. On 14 May 1796, Jenner took the pus from the lesions of a cowpox patient, milkmaid Sarah Nelmes, and transferred it to his gardener’s eight-year-old son, James Phipps. The boy fell ill over the next nine days but he fully recovered. Jenner then took the risky and ethically dubious step of infecting Phipps with a mild dose of smallpox to test his ‘vaccination’ – named after vacca, the Latin for cow. To Jenner’s delight, no smallpox developed and the vaccine was an overwhelming success. Coronavirus: what might we learn from pandemics in the past? Jenner’s vaccine spread, quickly replacing variolation, earning him acclaim from across the world – especially after 1803, when a special expedition sailed to the Americas to vaccinate thousands. The tide had turned – smallpox was conquerable. “Jenner was well respected for his discovery,” explains Professor Mary Fissell of John Hopkins University in a recent episode of the HistoryExtra podcast. “He actually requested the release of some English prisoners of war during the Napoleonic Wars, and Napoleon is said to have responded: ‘we can refuse that man nothing’. Vaccination was considered such an incredible gift to mankind.” The work to rid the world of one of its worst and most widely spread diseases would take centuries but, in 1980, the World Health Organisation finally announced its total eradication with the words “Smallpox is dead!” The history and rise of anti-vax movements Today, vaccination is a commonplace practice around the world. In recent years, however, anti-vaccination movements (known as anti-vaxxers) have become increasingly vocal in their opposition to the medical procedure, developing large platforms on social media and organising marches and demonstrations. Among these circles, the race to find a vaccine for Covid-19 has proved to be a particularly contentious issue. While medical experts tout a vaccine as the solution to the global pandemic, anti-vaxxers are concerned about the safety and effectiveness of such a vaccine – with feelings ranging from mild concern to outright hostility. In the UK, MP Chris Elmore, chair of Parliament's all-party group on social media, has expressed concern about the spread of anti-vaccination conspiracy theories, which he describes as a "ticking time bomb". Why was the 1918-19 pandemic known as Spanish Flu? According to Professor Fissell, vaccine scepticism is not necessarily a modern phenomenon. “As vaccination became a more accepted practice in the 19th century, the state started to want to make people get vaccinated,” she explains. “This created anti-vaccination movements, particularly among the British working class, who just didn't want the state ruling their bodies. There was a lot of conflict about whether or not they could resist. “It’s a template for, I think, where we are today in terms of people arguing that the state should not have the right to inject something into their bodies. But where are the limits of state power and state authority? This is a very profound political question. We may not always like the way it plays out on the ground in terms of the choices people make.” Mary E Fissell is professor in the Department of the History of Medicine at the Johns Hopkins University This article was first published by HistoryExtra in November 2020
How Covid-19 is forcing universities to change
Covid-19 has compelled history departments in UK universities to radically alter their teaching methods. Richard Toye explores the challenges that online teaching poses and how they can be overcome
What does the Covid-19 pandemic mean for those studying and teaching history at universities? What challenges does it present for academics and students? How successfully can these challenges be met, and does the crisis present any new opportunities? And can history itself teach us any lessons about how to understand what we have experienced during these complicated times? First, let’s consider what new and returning students can expect when arriving at university this autumn. The honest answer is that it is likely to be disorienting. When lockdown hit in the spring, academics did a brilliant job of making classes online at speed. But the crisis has had a big financial impact on universities, for instance through loss of rents from halls of residence, and is likely to hit recruitment. At the same time, institutions understandably want to offer as much face-to-face teaching as they can, while maintaining social distancing. This hybrid model – part in person, part online – creates serious logistical difficulties. So universities will be trying to do something entirely new, with fewer resources, and there of course remains the chance that a second wave of infections will again throw everything into doubt. It must be remembered, too, that disadvantaged students are likely to be hit disproportionately hard by all the disruption. How we can improve diversity within history education? So the reality is that, at a minimum, there will be teething problems and likely a certain amount of confusion. On the other hand, compared to some other disciplines (such as those that require lab work) the study of history at undergraduate level does not actually require students to be physically in one another’s company. However, the closure of archives has been a blow to those who need to do original, primary research – particularly third year students who are writing dissertations. Some archives are now reopening, albeit with restricted services, but there will be a generation of students whose opportunities in this sphere will be much reduced. This is a great pity, as there is nothing like getting one’s hands on original documents to help inspire a historical career. Navigating the digital world That said, the range of electronic resources that are available today is extraordinary – although there remains a great deal that has not yet been digitised. And this does not just mean the internet, which everyone can access. Students often do not appreciate that a significant portion of their fees go toward paying for subscription-only databases, such as the Oxford Dictionary of National Biography, and Early English Books Online. Together with the large number of e-books and journals that most UK universities also make available, this means that nobody studying the human past should want for the high-quality information they need. We should not, however, take it for granted that students are ‘digital natives’ who can navigate the virtual world without guidance. In other words, while lecturers are trying, in difficult circumstances, to convey historical content, they also need to communicate the technical and intellectual skills required to master electronic sources. Today’s technology, though a godsend in this crisis, cannot in itself solve all our problems – and can, in some instances, create entirely new ones. Online (or hybrid) teaching presents a series of social challenges that teachers and students will need to overcome together. The greatest of these is the problem of alienation: reduced human contact, and too much time spent in front of a screen, can sap the enthusiasm of even the most dedicated. Why is this? After all, certain forms of technology, such as smartphones and social media, are highly addictive. But no one has yet suggested that online meetings, lectures, or seminars fall into this category. A conventional university history seminar revolves around discussing the week’s reading, perhaps with some group activities and a student presentation thrown in. Sometimes it can be a struggle to get the conversation going, but at least everyone has the benefit of being able to read other people’s body language and facial expressions. These cues are much harder to interpret during a video conference, so simply transferring the seminar (or a part of it) directly online is a potential recipe for disaster. The students may be tempted to sit back, tune out, and hope that others will take the strain of participating. Remember, too, that they may be shield- ing, or have caring responsibilities, or perhaps just feel awkward about allowing strangers to see into their homes and bedrooms. Undoubtedly, large group seminars are a lot more difficult to manage than one-to-one student meetings, PhD supervisions and the like. Become a history student at home Many university teachers have thought creatively about how things might be done differently. One proposal is the ‘asynchronous’ seminar, which means allowing students to contribute online comments, moderated by the lecturer, over the course of a week. This has the advantage of flexibility, which may be helpful to those studying remotely in different time zones. It also creates a permanent record of the discussion, to which students can refer back. Yet the lack of a fixed deadline – a particular session in the week which must be prepared for – may lead to procrastination. It may also be harder than usual to establish when students are really not coping. Non-attendance at standard seminars is always a warning sign, but how long does a student have to remain silent during an ‘asynchronous’ seminar before the alarm is sounded? The fundamental key to teaching during the pandemic will be motivation. We tend to think of motivation as the property of the individual, a sort of innate quality: “she is a highly motivated person.” But, as we have seen, there are many possible obstacles to staying motivated, including technological frustrations, family duties, and social isolation and loneliness. It therefore becomes the lecturer’s responsibility both to try to keep learners stimulated and to promote group cohesion, for example by setting tasks for clusters of students to carry out together virtually. Above all, it is important to avoid creating new barriers to engagement. Normal lectures can be split into bite-sized online segments to avoid the onset of fatigue. A fount of inspiration In the new term, I will be experimenting with what I and my colleague Warren Dockter (of Aberystwyth University) call the Continuous Engagement Model. Students in my classes will receive a daily weekday email from me with an arresting subject line. “My most embarrassing mistake,” for instance, could head up a message about how I misread a question during an exam when I was an undergraduate and spotted the error when I was halfway through writing the answer. I would then give tips about how to avoid this. Some days there will also be a link to a short podcast I have created – in some cases a discussion with a colleague at another university. The point is not to deliver formal curriculum content but simply to pique the students’ interest and make them want to learn more. The email will conclude with a call to action – “Hit reply and let me know what you thought about today’s topic.” I’ll try to respond to as many of the replies as I can, even if it’s just a few words of acknowledgement. The aim is to build a sense of connection, so that the students know I am interest- ed in their views and want to know how they are getting on. Additionally, there will be a brief weekly online quiz so that students can measure their own knowledge. Ultimately, students will be motivated by arresting content and important intellectual questions – as long as adjustments are made for the pressures of crisis conditions. For five years, I have been convening an online course for the University of Exeter, delivered for free via FutureLearn, called ‘Empire: The Controversies of British Imperialism’. The latest run secured 11,000 sign-ups, perhaps in part due to the resurgence of the Black Lives Matter movement, as well as people having more time on their hands during lockdown. Consistently, we have succeeded in maintain- ing high levels of student engagement, as measured by the numbers completing all six weeks. This, I believe, is because participants are encouraged to debate a series of controversial themes: money, violence, race, religion, gender and sex, and propaganda. As the students inevitably start arguing with one another, they feel compelled to keep on going. To put it another way, the secret to online teaching, Covid or no Covid, is to make people care passionately about the subject matter. Let us hope that the pandemic comes to an end rapidly and that teaching can all be done in person again as soon as possible. But though much has been lost, the experience of living through coronavirus should teach history students an important lesson. There is no permanent condition called ‘normality’ to which we can hope and expect to return. Our everyday lives pre-lockdown may have seemed ordinary and mundane, but in fact they were the product of unique circumstances, and there is no law which says they must come back. We may think that safety and community are rights, but historically they have always been privileges. The destruction of our comfort zone should help us develop that most important of a historian’s skills: the capacity for empathy with those whose experiences are not our own. Richard Toye is professor of modern history at the University of Exeter This article was first published in the October 2020 issue of BBC History Magazine
Elma Brenner on medieval wellbeing: "People in the Middle Ages were absolutely focused on staying healthy"
In a recent episode of the HistoryExtra podcast, Dr Elma Brenner, Wellcome Collection’s medieval specialist, talks to Dave Musgrove about medieval medicine, health and wellbeing. Read the full, unedited interview below...
Note: this is an unedited transcript of a HistoryExtra podcast, which you can listen to here. David Musgrove, Content Director at HistoryExtra: I’m here with Dr Elma Brenner who is Wellcome Collection’s medieval specialist. She’s written a piece on medieval diseases for BBC History Revealed magazine, along with another piece she wrote a little while ago on medieval medicine for BBC History magazine, and that piece is now on our website. She also gave a lecture on disease and medicine in the Middle Ages as part of our free virtual Medieval Life and Death History Festival, which took place in May 2020. So she’s an expert on medieval medicine. We’re here at Wellcome Collection. So, Elma, first thing, you’d better just tell me about Wellcome, what it does and what it’s all about. Elma Brenner, Wellcome Collection’s medieval specialist: Yeah, we’re in a remarkable place, it’s a biomedical research charity, the Wellcome Trust, that funds all kinds of amazing and important projects. As part of that charity, there is a public venue, Wellcome Collection, which is based around a phenomenal collection of library and archive materials dating from the early centuries AD right up to the present day. And including a number of really important medieval manuscripts. DM: OK, so what we’re going to talk about today is medieval medicine, broadly. We’re going to pick up on some of the themes that you’ve talked about in the feature that you’ve done. But before we do that, can you just define the general period and sort of geographical spread of your research? Where do you focus on? EB: So I focus on the period, really, towards the end of the medieval period, the centuries between, roughly, really just before the Black Death in the mid-14th century up till the very end of the 15th century. And I look at Europe, particularly at France and England. But it’s really important to think about the global side of the Middle Ages and the fact that we can study all parts of the world in that period. 7 facts about the history of medicine 6 women in science history you (probably) didn’t know about DM: OK, thank you. Now, we know of some horrible diseases that people suffered from during the period, and you’ve written about them in the feature, so plague, leprosy, dysentery, pox. We kind of have this view that medieval people were running the gauntlet of a horrible demise on a daily basis. I’m sure that’s not the case, so can you just sketch out the health landscape for us a bit, just give us a sense about the general tenor of health and medicine during the period. EB: Yeah, as you’ve said, there were some terrifying diseases that we’re able to treat today and that in the medieval period, people didn’t have the medical means to treat them. But, at the same time, it’s clear that people had many mechanisms to stay healthy and they lived healthy and incredibly fulfilled lives. You just have to look at cultural outputs – like books of hours or sculpture in churches – to see that people had a thriving, cultural landscape; they celebrated life and they lived life to the full. At the same time, they were aware of these diseases and of the dangers and one of the key things that they did was to try to live a balanced and healthy lifestyle to ward off sickness. So, the key thing was to try to avoid becoming sick in the first place. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2020/02/GettyImages-528863458-df0a051-scaled.jpg" width="2560" height="1899" alt="A miniature showing doctors visiting a sick man in the 14th century. (Photo by Gustavo Tomsich/CORBIS/Corbis via Getty Images)" title="A miniature showing doctors visiting a sick man in the 14th century. (Photo by Gustavo Tomsich/CORBIS/Corbis via Getty Images)" /> DM: I find that fascinating and there’s a little quote that I’m taking from the feature that you’ve written: “Medieval people also believed that environmental factors and behaviour had an impact on health in terms of the quality of the air, diet, sleep and exercise.” That feels quite modern, doesn’t it? That feels like the concerns that we have today, you know, we’re always measuring how much sleep we get and how much exercise and how much fat we’re eating. So, they had the same concerns? EB: Absolutely, and it’s really strikingly modern to us, actually, that people were thinking about what happened to their bodies in terms of health. So, what went into their bodies and how their bodies experienced life, in terms of how much sleep they got, in terms of how much exercise they got. And really, what I find really striking is that these things make sense. So, there are also ideas that were both present in incredibly learned medical treatises by authors who wrote in Latin and Greek. But they were also held by people in small communities to whom these ideas trickled down, but also I think the common sense factor really played a big role. DM: We’ll come back to that. In terms of the medieval attitude to wellness, if that’s not an anachronistic term, one of the things that perhaps is a little different to now is the importance of the soul. And you make the point in your feature that perhaps the soul was more important than the body in terms of people’s understanding of their health and wellbeing. Tell me a bit about that. EB: That is something that is different from the way we live our lives today, certainly in Western Europe, most of us. I think we can safely say that most of us live in a very secular society and when we think about Europe in the Middle Ages, it is a deeply Christian society, although there were very important Muslim and Jewish communities as well. And in terms of the Christian context, there was a very big emphasis on preparing your soul for the life to come. And thinking about purgatory, a period when your soul would kind of be in transition and doing the requisite things to make sure that your soul achieved salvation. And this linked in to bodily health because people tended to think that when you became sick, this was a sign of some kind of intervention by God and so there must be something somewhat troubling going on with your soul. And so, it kind of made sense to primarily pay attention to what was happening with your soul. And then there was an expectation that naturally your body would then recover as a consequence. DM: And you talk a little bit in the feature about the use of religion and magic, I suppose, as cures, and you’ve got an example of sort of invoking saints to ward off demons. So, practically, what did people do to improve their soul health? EB: They did a number of things and this ranged from very orthodox religious worship to practices that were frowned upon by the Church, although interestingly were also practiced by some religious men and women as well. So, on the orthodox side, it was about prayer, it was about repentance and it was also about charity, so supporting charitable causes and showing your devotion in that sense. And on the less orthodox side, there were magical practices, particularly the use of healing charms, which were remedies based around appeals to the saints and to key religious figures, so Christ and the Virgin Mary and adopting ritualistic behaviour in connection with that. So, reciting religious words, inscribing them, possibly, on a piece of paper or a piece of parchment, attaching that to your body, or possibly putting it into a drink so that the words kind of melted into the drink and then you would drink it. And these were seen, these were seen as magical practices and, as I’ve said, many religious authorities did not condone them – but it’s pretty clear that they were very widespread. DM: So if you lived in a village, the local priest would have frowned upon that sort of behaviour if you were a local peasant and you drank a bit of manuscript with some words on? EB: I have to say it would depend on the priest. We see a real range of responses to this kind of thing and it’s clear that in some instances, priests were part of this system of magical religious beliefs. In other instances, you might find a manuscript, and we have a few of these here at Wellcome Collection, where there are magical remedies that have been very vehemently crossed out by someone. So initially they’d been written down because they were considered to be valid and important. Someone else came along, possibly after the Reformation, actually, and was deeply troubled by these and felt the need to erase the completely. DM: You mentioned the Reformation there, so does this attitude towards magic and magico-religious ceremonies change as the period progresses? EB: It does. After the Reformation they are bound up with the whole range of responses to Catholic ritual and there is the destruction of manuscripts and other kinds of artefacts that contain this kind of material. But it’s also clear that some of these forms of behaviour persisted; indeed they clearly persist right up until the 20th century in some instances. DM: And you also mention astrology and celestial observation. How did that figure in this part of the story? EB: This is another really key component for medieval medicine and it’s the idea that the movements of the planets, and particularly the phases of the moon, will influence the health of your body. And it’s to do with the way that blood pools within the body and the different zodiacal signs and a kind of linkage made between different signs of the zodiac and different parts of the body. And an understanding that at those particular moments in the calendar, it might be dangerous to treat that part of the body. Florence Nightingale: nursing by numbers 10 of the most surprising numbers in history DM: Was that a widespread practice; was everyone aware of these sort of zodiac signs and living their lives by them, in a way, or..? EB: It’s certainly clear that it was very widespread. It was also linked to overall understandings of the cosmos and the overall calendar of the year as well. So people’s attention to the seasons and their concerns about things like harvests. At the very end of the period, we do find expressions of concern by certain physicians about these ideas. So certain physicians were becoming sceptical, particularly if astrological beliefs might cause the delay in treatment of someone who had an urgent illness. A physician, at the end of the 15th century, might look at that situation and say, “I’m not so sure this is a good idea, I think we should intervene and treat them, regardless of astrology.” DM: Moving away from the soul and those aspects of it, if you actually did want to get some practical, medical treatment as closer to the way we understand it today, where would you actually go to get medical treatment? EB: This would depend very much on your socio-economic situation. So someone who was very wealthy would actually try to avoid going into a hospital. Hospitals were really there to cater for the sick poor, people who didn’t have any other option. A wealthier person would seek out the services of a medical practitioner. And that might be a physician who had been to university, it could be a surgeon who had more practical training and it could be other types of very, quite specialised practitioners such as people who specialised in areas like the pulling of teeth as well. DM: And monasteries? EB: Yes, absolutely. So monasteries were very important sites for medical knowledge and learning but also for medical practice. In terms of the knowledge side, because monasteries were sites for the creation and production of manuscripts and for education, real expertise developed among monks and nuns. And then they also, because of their community setting, because these were quite self-sufficient communities with a monastic infirmary, monks and nuns would become specialised in how to actually treat the sick and would have particular skills, like bloodletting. And this would permeate through into lay society, so into the parts of society outside the monastery. We know of a number of monasteries which offered services to people to come there and receive a particular kind of treatment. DM: OK, and so you talked about the socio-economic aspect to it. I imagine if you’re a high-ranking individual who’s ill, you would call upon the services of someone and they would come to you and you would presumably pay them. But if you were less exalted, you were just an every-day person, how would you access these medical resources? Who was the gatekeeper? Presumably you would have to pay, or would you not have to pay? EB: It’s likely that you would have to pay. There was a whole spectrum of medical practitioners, so you would be able to get hold of the services of someone that you could afford to pay. In certain instances, in a small, localised, community, quite often it would really revolve around the parish priest, potentially, who might, himself, have medical knowledge, who would have a network of contacts who would be able to come in. And it also might revolve around people in that community who had a number of areas of expertise. So you can think of, for example, the butchers trade. So a butcher might also have certain skills in barbary, in treating human bodies and performing certain things upon them, as well as obviously being able to engage with animal bodies as well. So it really depends upon the particular local setting. But the other important thing to mention is that in that kind of network of practitioners, women play an incredibly important role as well as men. DM: Do you want to talk a little bit more about that? What was the role of women in this process? EB: The most obvious role, which we know quite a bit about, was as midwives, so providing the expertise around childbirth and pregnancy. And that is the kind of knowledge that was learnt on the job. It wasn’t necessarily book learning at all, but that it was absolutely about expertise and it was absolutely about having a prominent place in the local community. Women also practised other kinds of medicine. So they were clearly involved in the process of bloodletting and also related practices like cupping, which was another way of kind of expelling corrupt matter from the body through the skin. 6 women in science history you (probably) didn’t know about 5 "bloody brilliant" 20th-century women DM: You’d better explain what cupping means… EB: Yeah, so cupping is something quite specific which is about applying a glass vessel and heat to the surface of the body and trying to draw out corrupt matter. And what’s really interesting is that there are manuscript illustrations of women engaged in this practice, so it does seem to be something that women did as well as men. DM: OK, and did that give a certain sort of level of agency and potency to women in local communities that they would otherwise not have had perhaps? EB: I think so. I think it’s an interesting one because clearly women would have been paid for these services and that’s an important type of agency that they would have. I think it’s also really interesting to think about it in the broader context of women’s economic role and the fact that women did practice crafts and they did engage in certain professions beyond the realm of medicine. And that their situation is not always visible from the records or from manuscript illustrations but that they were definitely there, engaging in the economic landscape. DM: Now I imagine that you would only seek the services of any of these people if you were feeling particularly poorly. Is there any similar example to, you know, if I woke up in the morning with a headache, I would take a paracetamol, I would take some self-care. I imagine that your average person would look to self-care first, was that a thing that they could do at all? EB: Yeah, I think people absolutely were focussed on staying healthy and if they had an ailment that they felt they could treat themselves, then they would have done that. They would also have drawn upon their family and community network and, in particular, they would have been able to get hold of remedies that they could treat themselves with. Particularly from apothecaries who were the pharmacists of the day, but also from household production of medicines. And late-medieval manuscripts tells us quite a bit about how medicines were produced and a sense of ingredients and processes that could be done in the kitchen. And so it would make sense to try to do that yourself rather than to pay someone else to do that for you. 7 bizarre cases in the history of medicine Medieval medicine: killer or cure? DM: And how effective were most of these remedies? Because we have this sense that, you know, medieval medicine is basically just a bunch of quack cures of things which have no scientific basis and would do more harm than good. Did these things work? EB: I think in many, many instances they did. And it’s really interesting to look at the ingredients of the remedies and to think about what we know today about the ability to treat illnesses. So one particular ingredient that comes up a lot is honey, which is definitely there to sweeten unpleasant-tasting medicines but we also know today that it has wound-healing properties and antiseptic properties. And so I think, you know, that’s just a small example of something that was an ingredient that we know today has an effective mechanism. And so I think we can say that a lot of the remedies did work. Certainly not all of them and certainly it’s really interesting to think about remedies that have incredibly convoluted or exotic ingredients. Theriac is a good example of that, which was a very kind of, a kind of cure-all medicine of the later Middle Ages that anyone who could, wanted to get hold of, particularly against plague. And it’s not clear that that would have worked. But it would have, we can also think about the placebo effect as well, which obviously is impossible to measure, but it’s something we can also think about today with some of the remedies that we take on a day-to-day basis like paracetamol. You know, that you take it, you’re reassured that you’ve done something and you start to feel better. Listen | Simon Bowman of the Royal College of Physicians discusses how the work of doctors has changed since the time of Henry VIII DM: Do we know what theriac was? What went into that? EB: It was a whole mixture of ingredients, some of which came from the East, so from outside Europe. It included things like snake’s venom to counteract poison, so a sort of like-for-like counteraction. DM: Are there any remedies or treatments that people took, that we are aware of, that we can say would definitely have been harmful? EB: There definitely are. Some remedies, for example, involve lead, which we know is not a good thing. For the treatment of the pox, which is roughly equivalent to modern-day syphilis, in the early decades of the 16th century, mercury was an ingredient which we again, know is not a good thing. Overall, however, the overriding impression you get if you’re leafing through the pages of a late-Medieval recipe compendium with lots of medical recipes is that these are plant-based remedies with a number of plants that we might use today in cooking, that we also know are actually ingredients for modern-day pharmaceuticals, that we don’t think would have harmed the body. So the overriding impression is that these wouldn’t have harmed people. You do get interesting, occasional law suits, actually, from the later Middle Ages, against apothecaries or physicians, sort of claiming that the remedy was harmful. So there is some evidence for that kind of thing, but not much. DM: And generally speaking, do you think, did medieval people believe in the treatments that they took or were advised to take? Did they believe that they had efficacy? EB: That’s a really interesting question. So, on the one hand, yes, because we see these remedies being copied numerous times and in the early decades of printing, from the end of the 15th century, we get printed compendia that were clearly selling very well and there were lots of different versions of them and they were kind of popular, kind of, self-help books. On the other hand, within those collections, you get multiple different remedies for the same ailment. So you might have something like excessive bleeding, which is a quite common thing that understandably was very alarming and you needed a remedy. You might have seven different remedies to try to counteract that, which suggests an awareness that it might not work. Which is an important difference, I think, from modern-day medicine when we tend to have complete faith in pharmaceuticals and we go and buy something over the counter and we’re confident that that will work, we’re not shopping around for a different version of aspirin, for instance. A different attitude in the Middle Ages where you might try several different things, you’re quite open-minded, you’re ready to see failure. So that’s definitely one for the surgeon and the surgeon will take a look at it and provide you with some kind of dressing that might be infused with various plant extracts. And also with extracts such as silver, which we know does have antiseptic properties. DM: We ought to take a moment to just stop and think about some of the more unusual treatments that we’re aware of, which you do flag up some of them in your feature. So just give us a taste of some of the things which we would consider very unorthodox nowadays. EB: Well, the most obvious one is bloodletting because that was something that was the kind of knee-jerk reaction, both to an illness but also actually to a concern to stay healthy. So on the one hand, if you became sick, the physician would say there is an imbalance of the humours inside your body. So these were four different fluids that were understood to exist and circulate in your body and they needed to be in balance for you to be healthy and any sign of sickness meant that they were, they’d gone out of sync, possibly they had become kind of corrupted, so you needed to get that humour out. And so you would bleed someone, possibly quite a large quantity of blood. On the other sort of side of things, if you were someone who had the means to kind of follow a regime to stay healthy, you would regularly have yourself bled in order to just keep the humours balanced. And we know that this certainly happened in monasteries as part of the monastic life. I think this is quite alarming to us, we can’t see any benefit to your health to remove a quantity of blood. We do know, however, that donating blood is not that dangerous, that you can go along and donate blood and you can step up and go home, as long as you drink some fluid, you know, you’ll be OK. It’s just it doesn’t quite fit with our understanding of what’s good for you. 6 weird inventions in history Pig-chickens, beavers’ tails and turtle soup: 8 weird foods through history DM: Yeah, OK, I gave blood last week and I’m still alive, so, yeah. What did they do with the blood that they let? I often wonder that, did they find any uses for it? EB: They, usually it was disposed of. So some medical ingredients of the magical kind, actually, might include a quantity of human blood, possibly. An interesting variant of this is the blood taken from the little finger of a child sometimes comes up as something that you would put into your magical remedy. Apart from that, I think it is disposed of. However, other human fluids, particularly urine, did have a range of functions. So urine had a range of industrial functions including in the production of parchment, which is quite interesting. DM: Talking about some of these more unpleasant diseases, the bigger killers that we mentioned earlier, the plague, leprosy, dysentery, those sorts of things. I have a sense certainly that if you got such a disease then your chance of survival would be pretty low. You kind of think that, you know, you’re basically a goner. You had an example in the feature of someone who survived the Bubonic plague. How widespread was survival from these more unpleasant diseases? EB: So it depended. The mortality rates are pretty shocking, particularly for the Black Death, so the very first plague outbreak that hit Europe in 1347 and lasted for about three years. And that is, in some localities, it’s pretty clear that about two thirds of the population perished, which is terrifying. At the same time, about a third did survive and there would be a range of reasons for this, to do with your resilience, I think, your kind of ability to ward off the infection. Also about preventive measures that you took. The most basic preventive measure was to flee, so just to get out of a place of infection or to get away from a heavily-populated area and go into the countryside. And that’s a remedy that persists right up until the 17th century that, certainly with the Great Plague of London in the 1660s, people are getting out of the city of London. So people did survive and there’s a range of reasons for that. Other types of epidemic, such as the English Sweating Sickness which, kind of, there were two or three of these outbreaks from the 1480s onwards. These are less devastating, they strangely sometimes seem to affect particular groups of people, the Sweating Sickness seems to have been linked to young men, we’re not sure why that is still. So, on the one hand, if it does affect you, that’s terrifying, on the other hand, you may survive it. And communities clearly did continue, there’s been fantastic work looking at the social and economic aftermath of the Black Death. The disruption is vast but there is continuity none the less. DM: And we’re talking today when there’s the coronavirus in China, and across the world, seems to be spreading with alarming results. One of the responses to that is quarantine. I wonder is there any such thing as the concept of quarantine in the medieval period that we’re aware of? EB: It really comes a little bit later, certainly than the Black Death. But by the beginning of the early modern period, so the 16th century, this is something that is happening. And it is, particularly in Italy, so in major Italian cities like Venice and Florence, there is a process of quarantine. But earlier on, I think really it’s about a kind of response on the ground that isn’t able to incorporate that kind of practice. I think there is an awareness that it spreads very rapidly among heavily-populated areas and that it would make sense to kind of separate the infected. One thing that does happen is about sort of separating, on a local level, kind of enclosing people in their houses does happen. And there is also interesting evidence about getting rid of material objects that might be contaminated. So particularly cloth that is kind of burnt or taken away to a remote place and washed many times, this kind of thing. But not quarantine as we would understand it today. DM: Who would have orchestrated those sorts of measures though? Because there’s no public health body that would have said: “Right, we need to burn all this cloth or we need to get people to move away.” Would that just have been on individual agency or would there have been anyone sort of actively suggesting community response? EB: This is where public health becomes a thing, and you can definitely see it, and it actually precedes the Black Death, interestingly. From the very early 1300s, town authorities are doing things. We’re not thinking necessarily of national responses and I think in the Middle Ages, we don’t have national measures in the way that we do today. And certainly, some parts of Europe were not united countries at all: Italy and Germany. But on a more localised level, civic authorities, or in the Italian case, communal authorities, which was kind of a whole region, were doing things. And they were particularly trying to enact measures to remove anything that was kind of filthy or foul-smelling from the city, that they associated with contagious illness. And with the spread of illness through, kind of, infected air. Forgotten science: 7 of the strangest scientific theories in history Nazi super-cows and defamed Gods: 7 strange and forgotten moments in history DM: Modern medicine, we’re able to cope with lots of difficulties and illnesses and I assume that in the medieval period, there were things that would have struck people down that today we’re able to survive. I’m thinking of infection specifically. How important was infection as a risk to people in the medieval period? EB: So that’s actually one of the core terrifying risks really that, again, today, I guess we have antibiotics so we’re confident that we can treat infections. At the same time, interestingly, some of the work of the Wellcome Trust is looking at resistance to antibiotics, something that is, you know, increasingly something that we’re concerned about today. But in the Middle Ages, people definitely understood what an infection was and the word fever is used. And it’s to do with heat, it’s to do with, if it is, you know, a wound that is kind of foul-smelling and hot, an awareness that that is something that’s infected. However, they did not have the knowledge that we have today about how infections are spread and how, again, the treatments to get rid of them. And so an infection could be deadly. The mortality of women following childbirth was usually to do with an infection that kind of took hold after childbirth, sadly. DM: I’m a fan of Twitter and, on Twitter, I follow a feed called the Medieval Deathbot, along with 87,000 other people, so it’s a popular thing. EB: Great. I need to follow that. DM: But it’s a curious thing which basically summarises the ways in which medieval people died as recorded in coroners’ rolls. So there’s lots of violent deaths and things like that but quite a few are from sicknesses of various sorts. So clearly, you know, there’s 87,000 people who have an interest in this, what is it, do you think, that makes us interested in medieval medicine and illness? Why do we have a fascination with this topic? It’s a bit gory? EB: I think it’s about our own vulnerabilities, actually, and I think an awareness that… I think the coronavirus is an example of this. We’ve got huge anxiety about that right now. I think an awareness that, yes, we’ve got an amazing kind of infrastructure of modern medicine that can help us with so many things. But, in essence, we’re all vulnerable and there are things that we, that medicine can’t help us with. And a sense that people in the past, who had so many more challenges, did a great job in surviving. So I think there’s a positive story there for us, actually, in medieval medicine. But also, I think, there is a fascination with the gory and the terrifying and things that are shocking as well and there’s a kind of drama to it that I think we all take an interest in. DM: OK, now I'm going to try some quick-fire questions. If I’m an average Joe or Jolene in Medieval England, maybe living in a town, not got much money but I’ve got some symptoms, I’m going to ask you what I might do. So let’s see if this works. EB: OK. DM: I’ve got a headache because I’ve drunk too much beer the night before. What might I do then? EB: I think you know what that is, I think there would be knowledge about alcohol drinking and I think there would be received wisdom, from you or your family, about resting and drinking fluid. I think you wouldn’t seek any type of medical treatment. DM: I’ve broken my leg when I fell off my horse. EB: You would find a surgeon. So that might be someone who had been university educated, it might be someone who was much more practice based. You’d find a surgeon and you would ask them what to do. And they might do something, actually. They would probably try to do something to reset the bone and they would kind of heavily bandage it. They might operate, that would be deeply risky. I think the key thing about that is that there was very, very widespread awareness that that kind of operation was hugely risky, an awareness of infections. And that it might be better not to do anything of that kind. And so, you might then have an issue about your leg and your mobility in the aftermath. DM: I’ve eaten something that doesn’t agree with me and I’m nauseous and having trouble at both ends, what might I do then? EB: You would seek some remedies to help you with that. So there could well be some knowledge that your parish priest holds, actually, and your parish priest may have a book of remedies and might be able to look something up for you. You might go to an apothecary, a pharmacist, to make up that remedy for you. And then you would follow the instructions, hope for the best. If you worsened and if you were very poor, you might have to go into a hospital and receive care there. DM: What about if I’ve just got toothache? EB: So you would, there would be someone fairly locally who was expert in matters concerning teeth. And this would be someone who was, it might be a surgeon, it might actually be someone who really was, that was their thing, they were specialised. Quite often those people were itinerant, they travelled around offering their services. You’d get their advice, they might extract it. Right, but you might have to hang around for a bit before someone turned up who could help you out? EB: Yeah, although depending on your contacts, your economic ability, you might be able to get hold of someone as well, I think. DM: Would there have been any sort of effective pain relief that someone might have been able to take in the intervening period? EB: Yes, alcohol was used. Alcohol was, yeah, really interestingly in the kind of 14th, 15th centuries, knowledge increased about distilling alcohol to make it purer and that was used as an anaesthetic. And opiates also existed and some of the remedies that we know about were clearly opiates and were clearly used for those purposes, among other uses. DM: Two more. I’ve got a cut on my arm that just won’t heal and is going a green colour and smelling badly. EB: So that’s definitely one for the surgeon. And the surgeon will take a look at it and provide you with some kind of dressing that might be infused with various plant extracts. And also with extracts such as silver, which we know does have antiseptic properties. However, there would be no way of totally, sort of, providing a sterile cleansing of your wound. There was also not the knowledge that that was necessary and so you might actually be quite worried about that. DM: OK, finally, I’ve got a sudden pain in my chest and I can’t breathe. So in modern parlance, I'm probably having a heart attack. Would I be able to do anything about that or is that going to see me off? EB: Not very much, basically. You would seek medical help and there would be, I think there would be knowledge about instances of this kind of thing happening, there would be knowledge about getting someone to rest or to, you know, lie down. I mean, if it went on for a while, they might even perform bloodletting but there would not be a surgical intervention of any kind. DM: Thanks. Thanks, Elma, that’s good, putting you on the spot there and asking you some difficult questions. OK, so finally, just to finish, you alluded to that in a previous answer, do you think there is anything we can learn from medieval approaches to health and wellbeing? You talked about sort of the more holistic understanding of living a healthy lifestyle, is that something we should be taking note of? EB: Yeah, I think, definitely. I think about prevention really. And obviously, this is something that we’re aware of in terms of, you know, the dietary causes of diabetes, the dangers of smoking. But really that you can help yourself a lot and also that your body will have ups and downs and your life will have ups and downs. And you may not, I think it’s interesting, I think there’s also a connection with ideas about happiness and wellbeing and that I think these are things that we prioritise hugely and I think they were definitely factors in the Middle Ages. But there was also a real emphasis in the Middle Ages on survival and on doing what you could to keep yourself a float. And that that resulted in resilience and in many instances in people leading long lives, actually. DM: We didn’t talk about this at all, and perhaps we should have, but the modern concern of mental health and mental wellbeing is obviously key to us. Was that a concept then, in the medieval period? EB: It was, definitely. And one of the factors that you were supposed to kind of take care of yourself, for your health, was your emotional state. So to pay attention to what was happening to your emotions and to kind of care for yourself, if there was something difficult going on. I think this is also where religion plays a role and this idea about taking care of your soul and about seeking help for that if needed, about the kind of support network that could help you. But there was an awareness of this and it was also undoubtedly seen as an illness, if you had mental issues going on, that was categorised as an illness. Listen to the full podcast episode with Elma Brenner here Dr Elma Brenner is Wellcome Collection’s medieval specialist. To watch Elma's lecture on disease and medicine in the Middle Ages, recorded as part of our free virtual Medieval Life and Death History Festival, which ran in May 2020, click here
Black Death facts: your guide to "the worst catastrophe in recorded history"
HistoryExtra Academy late-medieval England course
The Black Death of October 1347 to c1352 was one of the worst catastrophes in recorded history – a deadly bubonic plague that ravaged communities across Europe, changing forever their social and economic fabric. But how much do you know about the Black Plague? How many died? Did the epidemic really eradicate a third of Europe's population? And did it afflict every town and village?
–Following the outbreak of Covid-19, a disease known as coronavirus, stories about the Black Death are seemingly in the news more than ever. It is estimated that 50 million people died as a result of the deadly plague. But what caused the disease? Where did it start? And what were its symptoms? Here's your guide to the illness that ravaged Europe between 1347 and 1348... Questions answered by Professor Samuel Cohn and Professor Tom Beaumont James What was the Black Death? In the Middle Ages, the Black Death, or ‘pestilencia’, as contemporaries called various epidemic diseases, was the worst catastrophe in recorded history. Some dubbed it ‘magna mortalitas’ (great mortality), emphasising the death rate. It destroyed a higher proportion of the population than any other single known event. One observer noted “the living were scarcely sufficient to bury the dead”. No one could be sure what caused the deadly plague. When was the Black Death? The plague arrived in western Europe in 1347 and in England in 1348. It faded away in the early 1350s. What were the symptoms of the Black Death? Symptoms of the Black Death included swellings – most commonly in the groin, armpits and neck; dark patches, and the coughing up of blood. Read more | This medieval ‘apocalypse’ left a legacy no one saw coming Medieval observers – and their modern counterparts in 19th-century China and 20th-century Vietnam, observing more recent outbreaks – noted that different strains of the disease took from five days to as little as half a day to cause death. How many people died because of the Black Death? In Europe, it is thought that around 50 million people died as a result of the Black Death over the course of three or four years. The population was reduced from some 80 million to 30 million. It killed at least 60 per cent of the population in rural and urban areas. In fact, in some places such as a village on an estate in Cambridgeshire manorial rolls attest that 70 per cent of its tenants died in a matter of months in 1349, and the city of Florence tax records drawn up shortly before and after the Black Death suggest that its toll may have been about the same in 1348. Some communities such as Quob in Hampshire were wiped out; many rural communities went into decline (and were in time deserted). We know that some populations survived, but medieval people had no such knowledge – all they believed was that everyone would certainly die. The plague skipped over or barely touched some European villages, and may not have infected at all vast regions (such as ones in northern German-speaking lands). Given the state of record-keeping and preservation, we will probably never be able to estimate the Black Death’s European toll with any precision. “The very sight of her hands did almost turn my stomach”: a brief history of hand-washing Were medieval people cleaner than we think? What remedies were used to treat the Black Death? Medieval people believed that the Black Death came from God, and so responded with prayers and processions. Some contemporaries realised that the only remedy for plague was to run away from it – Boccaccio’s Decameron is a series of tales told among a group of young people taking refuge from the Black Death outside Florence. There was no known remedy, but people wanted medicines: Chaucer commented that the Doctor of Physic made much ‘gold’ out of the pestilence. The plague bacteria were identified in Asia in the 1890s, and the connection with animals and fleas established. Modern antibiotics can combat plague, but these are under threat from mutating diseases and immunity to antibiotics’ effects. Why did 17th-century plague doctors wear peculiar beaked masks? Kill or cure? 10 medieval medical practices and their effectiveness Where did the Black Death originate, and what areas did it affect? Breaking out in ‘the east’, as medieval people put it, the Black Death came north and west after striking the eastern Mediterranean and Italy, Spain and France. It then came to Britain, where it struck Dorset and Hampshire along the south coast of England simultaneously. The plague then spread north and east, then on to Scandinavia and Russia. View oEmbed on the source website How did the Black Death spread? Was it because of black rats transmitting the plague to humans via fleas? Not only textbooks but serious monographs on the Black Death and its successive waves of plague into the early 19th century in Europe go on about rats (usually “black ones”) and fleas without qualification. But what is the evidence? No contemporary observers described any epizootic [animal epidemic] of rats or of any other rodents immediately before or during the Black Death, or during any later plagues in Europe – that is, until the ‘third pandemic’ at the end of the 19th century. Yet in subtropical regions of Africa and China, descriptions of ‘rat falls’ accompanying a human disease with buboes in the principal lymph nodes reach back at least to the 18th century. As for fleas, unlike during the ‘third pandemic’, when plague cases and deaths followed closely the seasonal fertility cycles of various species of rat fleas, no such correlations are found with the Black Death or later European plagues before the end of the 19th century. The lethality of the Black Death arose from the onslaught of three types: bubonic, pneumonic and, occasionally, septicaemic plague. First-hand accounts of the Black Death: “Oh father, why have you abandoned me?” Who was most affected by the plague? Did the Black Death mainly affect poor people? Old and young. Men and women. All of society – royalty, peasants, archbishops, monks, nuns and parish clergy – was affected. No subset of people was immune to the Black Death. Contemporary chroniclers list important knights, ladies, and merchants who died during the Black Death. Many wealthy and well-fed convents, friaries, and monasteries across Europe lost more than half of their members, with some becoming extinct. Both artisan and artistic skills were lost or severely affected, from cathedral building in Italy to pottery production in England. Artists such as the Lorinzetti brothers of Siena were victims, and the English royal masons, the Ramseys, died. There were shortages of people to till the land and tend cattle and sheep. By the third or fourth wave of plague in the last decades of the 14th century, burial records and tax registers suggest that the disease had evolved into one that largely affected the poor. Which areas were worst hit by the Black Death? In 1348–49, some of the worst-hit regions were in mountainous and in relatively isolated zones, such as in Snowdonia in Wales or the mountain village of Mangona in the Alpi fiorentine, north of Florence, whose communications with cities were less frequent than places further down the slopes and closer to cities. The experiences of these isolated villages may have been similar to small mining villages in Pennsylvania or in South Africa, or Inuit settlements in Newfoundland under attack by another highly contagious pandemic, the Great Influenza of 1918–19, in which they experienced mortalities from 10 to 40 per cent – many times higher than in New York City or London. The story of the village that lost half its population to the Black Death Post-Black Death: a ‘golden age’ for medieval women? For reasons that are difficult to explain, cities such as Milan and Douai in Flanders, both major hubs of commerce and industry, appear to have escaped the Black Death in 1348 almost totally unscathed. In the case of Milan, only one household fell victim to the disease, at least according to chronicles, and the plague was successfully contained. Meanwhile, Douai chronicles, monastic necrologies, and archival records (recording, for example, the deaths of magistrates, and last wills and testaments) show no certain signs of the plague entering that city until the plague of 1400. Listen | Elma Brenner examines the state of healthcare in the Middle Ages and reveal some unusual remedies that were offered for people with injuries or diseases Did the Black Death result in the massacre of Jews or the blaming of other minorities? In German-speaking lands, France along the Rhine, and parts of Spain, municipal governments, castellans, bishops, and the Holy Roman Emperor accused Jews of spreading the Black Death by poisoning foodstuffs and water sources, and massacred entire communities of men, women, and babies for these supposed crimes. The accusations and massacres, however, were not universal between 1348 and 1351. Massacres did not arise in the British Isles (where, at least in England, Jews had been expelled in 1290 by Edward I), and no clear evidence pinpoints any such violence in Italy (except for the Catalans in Sicily). Nor are any massacres recorded in the Middle East. 7 bizarre cases in the history of medicine 10 dangers of the medieval period Where did the first ‘quarantine’ take place? The phrase ‘quarantine’ (the exclusion and isolation of those coming from infected regions, or of others suspected of carrying plague, to avoid them mixing with uninfected populations for a certain number of days) was coined in Venice in the early 15th century, based on a 40-day period of isolation (with Biblical resonances). But the city of Ragusa [present-day Dubrovnik] had beaten the Venetians to the punch in 1377 with a plague ‘quarantine’ of 30 days. By the early modern period, ‘quarantine’ often had been curtailed further. The period deemed necessary to isolate suspected carriers in Milan during its plague of 1557–75, for instance, had dropped to eight daysfor certain categories of suspicion. "Far too little, too late": what happened when Spanish Flu hit Britain a century ago? Were efforts to reduce the spread of the Black Death in vain? Cities that managed to keep plague beyond their borders were those that devised and implemented quarantine: border controls at city gates, harbours, and mountain passes; individual health passports (which identified a person and certified where he or she came from), and other related measures such as spy networks to signal when a plague had erupted in a foreign city or region. Ragusa was a pioneer in this regard, with its earliest ‘quarantine’ and its increasingly sophisticated measures to isolate the infected and control its borders during the late 14th and 15th centuries. Its last plague was in 1533, while in England it was 1665–56, in the Baltic region 1709–13, and Northern Africa and the Middle East the 19th century. Many Italian regions followed Ragusa’s lead, and after them, other regions of western and central Europe. Listen | Historian Jane Whittle on how the devastating plague of the 1340s significantly reshaped the economy and society of England Did the church recognise anyone who sacrificed their lives to help those afflicted during the Black Death? From October 1347 in Sicily to the early 1350s further north, contemporary chroniclers decried the abandonment of sick family members, and criticised clergymen and doctors who were ‘cowardly’ in reneging on their responsibilities to escape the plague’s vicious contagion. However, occasionally contemporary writers also praised those who stayed on to nurse the afflicted, and who often lost their lives in so doing. Curiously, the church did not recognise any of these martyrs during the Black Death with elevations to beatitude or sanctity. The first to be so recognised did not appear until the 15th century, and those who intervened to help those afflicted by the plague (that is, during their own lifetimes and not as post-mortem miraculous acts) remained rare even during 16th and 17th centuries. View Riddle on the source website How quickly did the Black Death spread? It is thought that the Black Death spread at a rate of a mile or more a day, but other accounts have measured it in places to have averaged as far as eight miles a day. It is thought that the Black Death travelled 30 to 100 times faster over land than the bubonic plagues of the 20th century; indeed, Scientists in South Africa, New Orleans, and other places affected by bubonic plague in the early 20th century devised experiments to clock their plague’s spread, and found it moved no faster than eight miles a year. It spread so slowly because modern bubonic plague was a rodent disease – and often one dependent on the house rat. These extreme differences in the spread of the Black Death and the bubonic plagues of modern times are seen despite the revolutions in transport with steam power, railway, and, by the early 20th century, automobiles. Listen | As COVID-19 dominates the news, Laura Spinney draws historical parallels with other pandemics in history and asks what we might learn from disease outbreaks in the past Was the Black Death a one-off occurrence? No. There have been three identified so-called ‘pandemics’. First, there was a significant international epidemic in the sixth century AD. Second, starting with the Black Death – its deadliest attack – plague later returned to Britain in 1361 (when it affected especially younger and elderly people); 1374, and regularly until it disappeared shortly after the Great Plague of 1665. Third, the disease broke out once more in Asia in the 1890s, and established new foci, where it is still found in animal populations today. Why was the 1918-19 pandemic that killed 50 million people known as 'Spanish Flu'? Will the Black Death return? In fact, the disease has never gone away. An outbreak in Surat in India in the early 1990s caused panic across the world. The death of a herdsman in Kyrgyzstan in 2013 from bubonic plague was wildly exaggerated in the media. Samuel Cohn is professor of medieval history at the University of Glasgow and author of Cultures of Plague: Medical Thinking at the End of the Renaissance (Oxford University Press, 2010). Tom Beaumont James is a professor of archaeology and history at the University of Winchester. This article is an amalgamation of two articles published on HistoryExtra in October 2015 and November 2014 Explore more learning from week one of our course on late-medieval England Video lecture: Faith and worship in late-medieval England – watching time 19 mins Black Death facts: your guide to "the worst catastrophe in recorded history" – reading time 9 mins The winter storms that rocked medieval Europe – reading time 6 mins The medieval church calendar: a guide to the holy days – reading time 5 mins Podcast episode: Margery Kempe: medieval mystic – listening time 53 mins The medieval church: your guide to religion and worship in the Middle Ages – reading time 8 mins
History quiz: how much do you know about the Black Death?
What were the symptoms of the disease known as the Black Death? And when did the first recorded quarantine take place? Test your knowledge with our history quiz on the 14th-century illness…
Put your knowledge to the test below, or read more about the “the worst catastrophe in recorded history” View Riddle on the source website How did you do? Share your result on social media to see how your Black Death knowledge compares to other HistoryExtra readers!