The Plague and the History of Healthcare Policy

The Black Death marked the beginning of public health, thus creating an outline for modern healthcare.
Raycene Nevils-Karakeci
Saint Sebastion Interceding for the Plague StrickenWalters Art Museum/Wikimedia Commons

The Black Death is known as the greatest disaster in human history. The Black Death is interchangeably referred to as the plague. To give a clearer idea of the plague definition, it is actually the sickness caused by the bacterium Yersinia pestis. Yesinia pestis causes three types of plague: bubonic plague, pneumonic plague, and septicemic plague. The Black Death is thought to have included cases of all three types of plague.

The Black Plague 

The 14th century pandemic is thought to have started in Asia before making its way to Europe and North Africa. Europe was devastated by the plague. Experts believe that about ⅓ of Europe’s population died from the Black Death.

The first wave hit Europe between 1347 and 1350, with several recurrences happening until about 1390. The disease is said to have made it in from Asia through trade routes, and then to have ravaged the European continent while being carried through human fleas and infected rats. 

The Spread of the Black Death
Source: Flappiefh/ Wikimedia Commons

History of Healthcare 

While modern science has told us what the Black Death was and how it spread, not enough was known about biology in the 14th century to understand how or why the illness was being transmitted.

People of that time understood contagion but not necessarily the means of transmission. For this reason, the Black Death was given religious attributions and resulted in a religious movement in which men flagellated themselves seeking penance for the sins that had brought such an illness upon society. In those times, any calamity, especially a pandemic, was thought to be a punishment from up above.

Despite the confusion about exactly what was making people sick, people in medieval societies did understand that they needed preventative and curative healthcare.

In addition to trying herbal treatments, religious rituals, and techniques such as bloodletting and boil lancing, quarantine was a common preventative method.

Having learned healthcare lessons from leprosy, the European population took the idea of staying away from the sick very seriously as the Black Death swept the continent. The word quarantine itself is derived from the Italian quarantina (there are disputes regarding the exact etymology) meaning forty days. 


A great deal of effort regarding healthcare administration was put into place all across Europe in efforts to prevent the spread of disease. Governments closed ports, banned infected and suspicious travelers, and either sent the sick or the healthy away in efforts to minimize contagion.

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If someone was suspected to be ill, they were placed under watch for a period of time, with their movements restricted. If someone was proven to be ill, it had to be reported and houses of the ill were identified.

Sanitation was also a huge part of governmental healthcare efforts to combat the Black Death. Homes of the deceased were sanitized, and their personal effects were burned.

Many of the early quarantine methods were developed in Venice, as it was believed that the disease was transported on the many ships that came in and out of the city. As efforts began to become regular in terms of managing transmission of the disease, many other cities adopted similar protocols. This was essentially the beginning of public healthcare policy. 

Municipalities were highly instrumental in the coordination of quarantines and health care provision. There was a consciousness that the sick needed to be provided for and that the general public needed to be protected.

The idea of sanitation was also something that these early administrations took interest in. In Italy, there was the burning of bonfires to clean the air.

All over Europe travel was restricted. Religious groups and the wealthy set up hospitals. The municipalities designated spaces to house the sick. This was the beginning of the welfare state taking action to protect citizens' healthcare needs, and civil society was forming to join the cause as well. Additionally, educating the public about how to live a healthy life was a concerted effort.

The Plague and the History of Healthcare Policy
Source: Public Domain/Wikimedia Commons

During those times, doctors instructed people to eat and drink in moderation, to get enough sleep, and to engage in purifying rituals. At the time, it was thought that purging, bloodletting, and bathhouses were the go-to methods in keeping the body clean.

While modern science has taught us a few things since then, cleanliness and containing contagion are still just as relevant now as they were then. 

Lessons From The Black Death

The book The Decameron by Giovanni Boccaccio tells the story of ten wealthy Florence residents who find refuge from the plague in the countryside.

While The Decameron is fictional, it gives historical context for what it was like to live during the plague, and to some extent what it was like to be around during the birth of public healthcare.

In Italy, quarantine and homes for the sick and symptomatic created an atmosphere of fear that must have felt much like what we are experiencing with coronavirus.

The only thing officials really could do at the time was enforce laws that prevented new cases. This is essentially what is happening centuries later, albeit with shorter periods of quarantine and more humane ways of treating the ill and their families. 

As we all wonder when borders will open, whether we will safely be able to return outside by summer, and essentially what our new normal may look like, it can help to turn to the past for answers.

The creation of measures to control a disease that is not completely understood, except in that it does not have a cure, is not new.

Hygiene, care for the sick, and limiting transmission are pillars of pandemic procedures that we can trace back to medieval times. Stopping the spread of a pandemic is key in freeing up resources to take care of the ill, and to keep society functioning as scientists do their best to find cures and vaccines that will not harm us.

While each government and healthcare system may have its own variation of protocols, it is important for citizens to take this time to evaluate concepts like the public good while weighing their individual rights. 

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