Care of the sick during medieval epidemics

Leprosy is a chronic infectious disease against which it was not possible to defend effectively.

Leprosy
Origin: Mycobacterium leprae

Manifestations and consequences: Mycobacterium attacks primarily nerves. The skin and extremities remain insensitive. Skin lesions (hands, feet, scrotum) will appear, looking like ulcer. The sebaceous glands cease to function, the skin cracks. The integrity of the skin is breached, providing an entry point infection. Given the disruption of reading, the affected person does not feel high temperature, e.g. in the Middle Ages there was a fire burns. The next consequence of leprosy is blindness or visual impairment. The eyelids cease to move and the eye remains open. People with leprosy became helpless, blind, and disfigured human wrecks waiting for death for several years.

The spread of the journey: By touch

The Bible already writes about leprosy. Leprosy was known in ancient China, India, and Egypt. It is a disease that has been present since ancient times. The skin would weep and spread a strong smell of decaying wounds into the environment. This disease still exists today. However, treatments and care for patients have become sufficiently effective.

The military and hospital order of the Knights of St. Lazarus of Jerusalem, which was founded in Jerusalem, cared for the sick. The shelters where the sick were taken care of were called leprosaria. They were built outside of cities, as the sight of the afflicted was not pleasant to the human eye and the smell of festering wounds could be felt quite far beyond the walls of the buildings. Care for the sick consisted of providing basic necessities (within the limits of possibility).

The sick individual had to live outside of human society. His duty was to give passing warnings to stay away. This custom was preserved in Europe until the Middle Ages in the form of bells or bells. In antiquity, the sick had to go to the priest, who examined him without touching. If he recognized that he was healthy, the sick was forced to undergo purification rites that preceded his return to health. Lepers lived separately. Only on certain days could they leave their homes and go begging. They had to wear "Lazarus' garment" - a black cloak with the image of two white hands on the chest. The hands represented the symbol of God's burden that had fallen on the sick. Part of the garment was a black hat with a white border. Lepers were not allowed to enter shops or inns. The goods they wanted to buy were marked with a stick. They were forbidden to speak.

Plague
Black Death, still today associated with the image of a wicked curse, a terrible fatal disease that would suddenly strike anyone indiscriminately and without chance of salvation. It remains in our collective consciousness as an image of horror that once affected European countries with mass extinction. The plague decimated cities and villages, leaving the survivors in despair, exposed to hunger, poverty and fear. In our countries it has been absent for more than 20 years.

The Morová plague ran like a repeating pandemic, appearing on several continents and taking a significant number of lives. The disease claimed approximately 200 million human lives.

A brief description of the illness
Morpheus is an infectious disease of rodents and small mammals – rats, mice or squirrels. It is transmitted from animal to animal by fleas, which also transmit the infection to humans. Therefore, this is a zoonotic disease. The causative agent of the infection is a Gram-negative bacterium previously called Pasteurella pestis, and now named after its discoverer Yersinia pestis.

Bacteria can enter the organism through three routes:
 * 1) Breathing Pathways (an outbreak): creates lung inflammation, which is deadly
 * 2) The skin (infected by a bug bite): forms a lump
 * 3) Through the gastrointestinal tract: after eating infected food

My illness

 * Bubonic plague – also referred to as bubonic or nodular form – is characterized by high fever, chills, and extreme fatigue. headache, which can be so cruel that it is accompanied by psychotic symptoms. In a few hours a painful one will arise swelling of lymph nodes The swelling is called a bubo and is full of bacteria. The bubo can burst, which brings relief to the patient and can lead to healing, or it doesn't burst, the disease progresses further and the patient eventually dies. The disease is accompanied by changes in skin color, as there is a breakdown of internal organs. Bleeding. The result is darkening of the skin so typeical of leprosy.
 * Pulmonary Form – Symptoms: High fever, cough, stuffiness, pain in the chest, coughing up blood. No potatoes present. Pulmonary plague is spread by droplet transmission. More patients die of pulmonary plague than bubonic form.
 * Gastrointestinal form – Is the least common.

Epidemiology timeline
The first plague epidemic appeared in 542 BC during the reign of Roman Emperor Justinian. It spread in Asia Minor, from where it spread to Europe. This epidemic allegedly lasted for 50 years and reportedly killed 100 million people.

The second wave of the epidemic, or pandemic, was the most devastating for Europe. It took place in several waves from the middle of the 14th century to the end of the 17th century. Up to 1/3 of the European population died. Most likely, the disease first appeared in China and from there spread to Central Asia. It was only a matter of time before the contagion reached Europe, as both continents maintained rich trade relations. In the Middle Ages, rats were part of human dwellings. They were also the obvious passengers of merchant ships. In this way the infection reached Europe. Infected rats were staying on cruise ships returning home to Sicily. Many of the crew members had already been infected from the Crimea, where the ships had sailed from. Therefore, in the fall of 1347, the plague begins to rage in Europe as well - Genoa, Venice, Pisa and other Italian cities. From there the plague spread to France. Boccacio writes in the Decameron: "...how many a rare man, how many a beautiful woman have breakfasted in the morning in the circle of the family, only to dine with their ancestors in the other world in the evening of the same day."

In England, where the plague arrived in less than a year, it was given the name "Black Death" due to the black spots on the skin. The plague did not pick its victims. Old people, children, rich and poor alike died. Whole families died out. In some cities or villages, it was possible to count more dead than living inhabitants.

Bohemia was spared the first onslaught (ie in the 14th century). The epidemic that raged in Italy was known here from merchants or traveling students. In addition, the infection affected us very unevenly. There were no mass exodus, as was the case in other countries. Even the lack of sanctuaries dedicated to Saint Rufus could be noted. St. Ruf was supposed to protect against the plague. In Prague, for example, there was no lower decrease in the number of students enrolled at the university. In Vienna, however, the university had to suspend classes.

In the Czech lands, the White Mountain period was the last time when the plague occurred on our territory. It appeared in our country in the years 1624–1626, 1631–1635, 1639–1640, 1648–1649 (then the plague order for Bohemia was issued by Ferdinand III in České Budějovice). The spread of the plague was related to the movement of troops and was an accompanying phenomenon of the war period. Another spread of the plague took place in 1689, and the plague came to our territory from the Balkans via Hungary and Vienna. The plague appeared in the Czech lands as early as the beginning of the 18th century. Doctors responded to plague epidemics by publishing professional literature as well as literature intended for all levels of society. Monarchs were also forced to deal with epidemics by issuing various decrees. Further informative information can be found in the publication Svobodný, Hlaváčková: History of medicine in the Czech lands.

The third plague epidemic byeare out at the end of the 19th century in China and spread to India. The infection did not reach Europe. The number of deaths was smaller compared to previous epidemics. However, this period was significant in that the French physician, Swiss-born bacteriologist Alexander Yersin (1863–1943) discovered and described the causative agent of the disease. The Japanese physician Shibasaburo Kitasato (1852–1931) independently reached the same results.

The consequences of the plague were unfathomable. There was economic and social decline. The number of inhabitants decreased markedly. Trust in the church has fallen, but also in doctors, who were unable to help the sick. Epidemics meant considerable emotional drain on families who had to face an infection that cruelly killed their dearest.

The course of the plague in London in 1665 was described by the writer Daniel Defoe (author of the well-known Robinson Crusoe). He was still a very small boy then, and when the plague byeare out, he went with his parents to the country, which was quite common. His paternal uncle, Henry Foe, remained in London throughout the epidemic. Based on his first-hand experience, he passed on information to his nephew about the events that accompanied the plague. The writer wrote them down in the book "Diary of the Plague Year".

What was the fight against the infection like?
States and cities defended themselves against infection by isolating people coming from infected areas. In Venice, the isolation lasted 40 days (forty is Italian for quaranta - hence the word quarantine). No ships from the affected countries were allowed into the ports.

Another measure to prevent the spread of the disease was the appointment of supervisors. Their task was to search for houses where the plague had occurred. Once they had discovered the plague, they ordered the bier to seal the house.


 * Watchers – At each "infected" house there were two guards - one during the day, the other at night. They watched to make sure no one left the house and no one entered it to spread the disease. If the residents violated the precautions, they were punished. The guards were responsible for taking care of all the activities that the family could normally take care of themselves, such as calling a doctor, going to the chemist, getting groceries, water, etc.
 * Search engines –They were to examine the body of the deceased and report to the doctor. They were bound by oath. They could not be called to other public work or employment, they could not keep a shop, nor could they work as laundresses.
 * Healing – Only those who belonged to the plague hospital were chosen to help the surveyors. The ranch hand and the medical examiner conducted the examination of the deceased together. The Healer was also to assist the overseer of the parish. He was paid a certain amount of money for each body examined.
 * Nurses - nannies – These brave women cared for the sick.

It is not without interest that the tasks of watchmen or nurses were mostly taken on by homeless people, beggars without money, and various thieves and thieves. The mother from the family certainly did not volunteer as a nurse. It happened more than once that after the sick person in question had died, the nurse stole something from his property. Literature also speaks of the fact that out of impatience she secretly strangled the poor dying man or otherwise helped him to the hereafter. Many nurses died in the course of their work.

It was made obligatory for every citizen to report diseases to the overseers. Another measure was the isolation of the sick by sealing the houses in which the disease was found and marking the doors with a red cross. The guards of the sealed houses kept watch to ensure that the prohibition of movement was observed. However, they were often deceived by the occupants of the house. Some houses had back entrances or windows to gardens, so the residents had no difficulty in secretly escaping at night. A watchman would then patrol outside an empty house for several days.

The problem was that healthy people had to stay in the house with the sick people. According to the regulations, it was not allowed to leave the infectious environment. But the clever man always managed, and whole families fled.

Nothing was allowed to be taken out of the sealed houses - clothes, various objects, dishes, daily necessities, etc. Some families behaved more or less aggressively. They simply beat or otherwise violently harassed the guards and then fled. Sealing houses was certainly not a reliable way to prevent the spread of the disease. Another negative aspect was that people who had to stay at home without being able to go out on the street were driven to despair and cry. From the houses, cries and screams could be heard of death terrified citizens who had to look the disease squarely in the eye as it wiped out their dearest ones, regardless of age. Everyone was dying, including newborns and nursing mothers.

During the plague, women also gave birth. When their moment came, there was no one on hand to help them, no midwife available. More often than not, a woman gave birth alone or the father helped deliver his child. According to statistics, infant mortality and the number of mothers dying in childbirth increased during plague epidemics.

The tubers that appeared on the neck, groin or elsewhere caused great pain. Many of the sufferers were unable to endure this torment and preferred to throw themselves out of windows or otherwise deprive themselves of life. Few were the fortunate ones who had the tuber burst, which brought with it considerable relief from the pain. It was recommended to smoke houses with: perfumes, incense, benzoe, resin or sulphur. At other times, people lit fires at home. But some people managed to set fire to the house. There was also plenty of ventilation.

In summary, there was no effective defence against medieval epidemics. Indeed, care for the sick consisted of providing basic needs, cooling during high fevers and emotional support. Mankind had to wait a long time for really good care.

The burial of the dead was usually carried out at night. No one was allowed to accompany their deceased family members. Plague hospitals were set up for the sick, but these were desperately few and only a fraction of the sick could be cared for. Even rich and pious women came to the rescue. They walked the streets and gave alms, even visited the sick, sent for medicine or provided food.

Related articles

 * Care of the sick by the Byzantine empire
 * History of nursing
 * History of nursing/Prehistoric times
 * History of nursing/Antiquity
 * History of nursing/Middle ages
 * Historical figures in nursing from the Middle Ages
 * Regular nursing
 * History of nursing/Modern age
 * History of nursing/19th century