Diseases ravaged the lives of millions of people throughout the Middle Ages. A combination of bad diet, poor hygiene, inadequate sanitation and an ill-informed understanding of medicine left many people vulnerable to fatal infections.
Given many fantasy stories have a medieval setting, diseases would arise in a secondary world. As we’ll see, this presents interesting opportunities for the fantasy writer.
This article will begin by looking at the circumstances in which diseases can manifest and spread, before turning to look at specific diseases which claimed the lives of many Europeans during the Middle Ages.
The causes of disease
For people living in cities and bustling towns, sewage disposal was a problem. Most used a latrine, which was the most basic of toilets—often a crude frame or shed above a pit or cesspool—usually shared by a number of families. For the rich, latrines looked something like this:
Cesspools filled over years which created health problems, the main one being the contamination of water sources. There’s even a tale of one poor bastard known as Roger the Raker who fell through the rotted floorboards of his latrine to drown in his own excrement.[i] People, naturally, sought ways to empty their cesspools. In 1347, two men were fined for dumping sewage in their neighbour’s cellar.[ii]
To give you a clearer idea of the state of affairs, here’s a quote from King Edward III:
“When passing along the water of Thames, we have beheld dung and lay stools and other filth accumulated in diverse places within the city, and have also perceived the fumes and other abominable stenches arising therefrom, from the corruption of which great peril to persons swelling within the said city will, it is feared, ensue.”[iii]
It’s safe to say people weren’t too fussed about washing their hands after stepping out of the latrine. Soap did get some recognition in the latter part of the Middle Ages, though. In the fifteenth century, a white soap was produced, made from fern ash, unslaked lime, oil, tallow, and bean flour.[iv]
One big problem for people trying to wash themselves was access to clean water. Most water came from rivers, lakes, streams, springs and wells, all of which could be contaminated either by cesspools or people disposing waste. Butchers, tanners and dyers all dumped their shit in watercourses. It was the most convenient method of disposal.
Understanding of medicine
Nobody during the Middle Ages had an understanding of disease and infection which comes close to ours. That’s not to say medieval people were ignorant, though.
Smell guided many people’s judgements. A foetid smell was a bad sign. The spreading of germs was unknown, so too how blood circulated around the body.[v]
The role of God played a big part in disease. Many people perceived the afflicted as being punished for their sins, something known as ‘divine judgement’.[vi]
Others turned to astrology to find answers for medical problems, with references made to planetary movements triggering disease. There were even some bizarre numerological methods, one being the Sphere of Apuleis, which involved assigning a numerical value to each letter of a person’s name and subtracting thirty from the total. A determination was made as to whether the patient will live or die depending on the result.[vii] Science.
The Great Plague
“Go quickly, go far, and return slowly.” Guy de Chauliac, advice on avoiding the plague.
The Great Plague (known as the Black Death from the nineteenth century onwards) first struck English soil in or around 1348. It wiped out between forty and fifty percent of the population.[viii]
Discussing mere statistics does not give an insight into what life would have been like during such a time. Historian, Ian Mortimer, envisages it vividly:
“In the fields lie dead and rotting sheep, five thousand in one alone, according to Henry Knighton … You look around and see ravens flying through deserted streets, and half-wild dogs and pigs eating corpses abandoned on the edge of a village … The doors of houses left blackly open.”[ix]
To those who witnessed the effects of the plague, it would have seemed like the end of days, the abandonment of mankind by God. Nobody could help; doctors, monks, nuns or priests. Men and women buried their spouses and children, often without any religious service—there was no time for that, and often few monks left alive to perform it.
The papal physician, Guy de Chauliac, noted the symptoms. The first sign was a fever and spitting of blood. Some people died at this stage within a matter of hours or days. If unfortunate enough to survive longer, boils and black buboes formed at the lymph nodes at the groin and armpit. Survival beyond this point was very unlikely. It was spread through coughing and sneezing and, famously, through infected rats.
“If … you are beginning to feel feverish, lift up your arm and start tapping around your armpit: if something makes you wince, prepare for the final hours of your life.”[x]
When we hear the term ‘leprosy’ we think of the horrific flesh-eating illness which turns the living into the walking dead (known today as Hansen’s Disease)[xi]. Back in the Middle Ages, any kind of skin disease was classed as leprosy, including eczema, dermatitis, or psoriasis. This wasn’t through ignorance, but rather fear.
One of the first symptoms of leprosy was a numbing of the extremities, before complete paralysis. This causes ulcerations and after a few years, fingers and toes rot away. All body hair falls out, penises putrefy and at some point the bridge of your nose collapses, leaving a gaping wound. Eyeballs may become ulcerated too, causing blindness, and ulcers can form in the throat, affecting speech. Medieval lepers were left deformed, stinking, crippled and blind.[xii]
It’s understandable why people were terrified of catching it, and it was contagious, spread through skin contact, coughing or sneezing. Extreme measures were put in place to prevent the spread. Lepers had to wear a covering cloak and wherever they went had to ring a bell to warn others of their coming. No sympathy was afforded. The affliction was seen as divine judgement for a sinful life.[xiii] Just imagine how this must have felt. Shunned by your family and friends and left to fend for yourself at a time of great need.
This disease came in various forms. One was known as the ‘King’s Evil’, an infection of the lymph nodes in the neck causing them to swell to grotesque sizes. Another type is pulmonary tuberculosis which provokes an increasingly violent cough. The disease eats away at your resistance until at last you succumb to exhaustion and die.
TB could be contracted in different ways. The most common was drinking infected cows milk. It was also transmitted aerially through talking, coughing, sneezing. The only effective remedy was to keep up your strength.[xiv]
Besides the three big hitters above, other diseases included malaria, though this affected only those living in swamplands.[xv] There was a fatal disease known as the ‘sweating sickness’, which was most likely a form of influenza.[xvi] And there were other more bizarre illnesses too, such as a widespread and repugnant sickness which made men emit ‘a sound like dogs barking, and suffered almost unbearable pain while it lasted.’[xvii] This could have been a form of tonsilitis.
Diseases and fantasy
Perhaps the most well-known fantasy disease is greyscale in George R.R. Martin’s A Song of Ice and Fire/Game of Thrones, a sickness very similar to the plague.
Disease is a great source of conflict. Attitudes of characters may change toward sufferers and the lives of characters may alter because of diseases.
It should not be forgotten how desperate and helpless the families of the afflicted must have felt. Who doesn’t love a story of a daring mission to obtain a cure to save the life of the one you love?
Exploring these diseases in more detail may unlock some original ideas for you to feature in stories of your own. And remember: always wash your hands.
What are your experiences of diseases in the fantasy genre? Do you think they’re underused? Annoying? Would you like to see more of it? Comment below!
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[i]Pg. 104, ‘Life in the Middle Ages’, M. Whittock (2009).
[ii]Pg. 104, ‘Life in the Middle Ages’, M. Whittock (2009).
[iii]Pg. 114, ‘Life in the Middle Ages’, M. Whittock (2009).
[iv]Pg. 112, ‘Life in the Middle Ages’, M. Whittock (2009).
[v]Pg. 190, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[vi]Pg. 190, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[vii]Pg. 192, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[viii]Pg. 202, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[ix]Pg. 203, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[x]Pg. 201, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[xi]Pg. 204, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[xii]Pg. 204, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[xiii]Pg. 204, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[xiv]Pg. 206, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[xv]Pg. 207, ‘The Time Traveller’s Guide to Medieval England’, I. Mortimer (2009)
[xvi]Pg. 119, ‘Life in the Middle Ages’, M. Whittock (2009).
[xvii]Pg. 121, ‘Life in the Middle Ages’, M. Whittock (2009).