Medieval public health and the Black Death (c.1250–c.1500)

OCR Paper 1 pairs crime/punishment with The People's Health as the two thematic studies. The Black Death (1348–49) is the single most testable event in the medieval period: expect a source question (AO3), a significance question (8 marks) or a "how far" essay (12 marks).

Public health in medieval towns

Medieval towns were cramped, unplanned and lacking sanitation:

• Water supply: drawn from rivers and wells that were frequently contaminated by sewage.
• Waste disposal: "gong-farmers" emptied cesspits; butchers discarded offal in streets; pigs roamed freely.
• Miasma theory (the dominant medical belief): disease was caused by "bad air" (miasma) from rotting matter. Though wrong about the cause, it accidentally encouraged some good practices (removing rotting waste, ventilating buildings).
• Church role: hospitals (often run by monasteries) provided care for the sick and poor; the Church taught that illness was God's punishment for sin — leading to prayer and penance as "treatment".
• Galen and Hippocrates: classical medical theories taught through universities. Galen's four humours (blood, phlegm, yellow bile, black bile) dominated; treatment was balancing humours through purging, bloodletting, special diets.

Some positive provisions existed:

• London had a piped water supply by the 13th century (though limited).
• Some towns had public privies over rivers.
• Monastic hospitals provided basic care (food, warmth, prayer).

The Black Death 1348–49

The Black Death (bubonic and pneumonic plague, caused by the bacterium Yersinia pestis) arrived in England via the south coast in 1348. It killed approximately one-third to one-half of England's population (c.2 million people).

Causes believed at the time

• God's punishment: the most widely accepted explanation; led to religious responses (flagellants, confession, prayer).
• Miasma: "bad air" from rotting matter or planetary conjunctions.
• Jews blamed: in some European countries Jews were scapegoated and massacred (less common in England).
• Astrological: a conjunction of Saturn, Jupiter and Mars was blamed by the Paris Medical Faculty.

Actual cause (unknown at the time)

• Bubonic plague: spread by fleas on black rats (Rattus rattus).
• Pneumonic plague: airborne spread person-to-person.

Responses

Since the true cause was unknown, responses were ineffective or only accidentally useful:

• Prayer, confession, flagellant processions.
• Burning aromatic herbs and carrying posies (thought to counteract miasma — accidentally provided some protection against fleas).
• Quarantine: some towns quarantined ships and households (accidentally effective).
• Isolating the sick.

Long-term impact of the Black Death

• Labour shortage: surviving peasants could demand higher wages — undermined feudalism; contributed to the Peasants' Revolt (1381).
• Church authority weakened: God had not protected the faithful; some people lost faith.
• Medical change: some doctors began to doubt Galen; the Black Death created long-term pressure for empirical medicine.
• Public health: some towns passed ordinances to clean streets, but these were rarely enforced long-term.

Common OCR exam mistakes

1. Saying medieval people were completely ignorant of hygiene — some towns had water supplies and disposal systems; miasma theory accidentally encouraged cleanliness.
2. Confusing the cause (flea-borne bacterium) with the contemporary explanation (God, miasma) — the exam tests what people believed, not modern science.
3. Saying the Black Death caused the Reformation — it contributed to questioning of Church authority but the Reformation came 170 years later.