The key to assessing patients’ health lay in the contents of their bladders. So wrote the physician Archimatthaeus when issuing advice to his fellow doctors back in the 12th century. “If the change in pulse indicates that the individual is sick, the kind of disease is still better indicated by the urine,” Archimatthaeus counselled. “While you look at the urine for a long time you [should] pay attention to its colour, substance and quantity, and to its contents.”
Conjure an image in your mind’s eye of a medieval doctor at work, and there’s every chance that leeches, quack potions and holes being drilled into hapless patients’ skulls will feature prominently. Considered, evidence-based and potentially effective advice like that offered by Archimatthaeus almost certainly will not. But then, medieval medicine rarely conformed to modern stereotypes.
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There’s no denying that our medieval ancestors did not have access to many of the medical interventions that we take for granted today – antibiotics, vaccination and general anaesthetics among them. It’s also true that, when the Black Death swept through Europe in the 14th century, the medical profession could do very little to halt its progress. What’s more, perhaps as many as 30 per cent of all newborns died shortly after childbirth. But take a closer look at the practice of medicine in medieval Europe, and what you’ll find is a rich variety of treatments and therapies that did alleviate suffering and that could cure illnesses. To fall ill in the Middle Ages was not a death sentence.
Rapid stair climbing
Perhaps one of the most surprising facts about medical knowledge in the Middle Ages is that there was a widespread appreciation of the importance of following a healthy lifestyle in order to avoid falling ill in the first place. Some of the key medieval ideas about lifestyle – such as the need to eat a moderate diet, get plenty of sleep and do regular exercise – were not dissimilar to our own. In 1315, the Valencian physician Peter Fagarola advised his sons, students in Toulouse, that “sufficient and natural sleep is to sleep for the fourth part of a natural day… if you will, walk daily somewhere morning and evening. If you cannot go outside your lodgings… climb the stairs rapidly three or four times.”
Those who didn’t have doctors for fathers could consult self-help manuals that described how to pursue a healthy lifestyle. These were highly popular, and circulated in written and oral form.
Prevention is better than cure was very much the mantra of the day, and it was this that made the body’s four humours so integral to medieval perceptions of wellbeing. Our ancestors believed that keeping the humours – blood, yellow bile, black bile and phlegm – in a state of equilibrium was the key to good health. They also believed that bloodletting was the most effective means to achieve that balance, as it removed excessive or corrupt humoral matter from the body. As a result, bleeding was the most common of all medieval medical treatments.
However, even bleeding was practised with caution. In 1150, suffering from the lingering symptoms of a severe cold, Peter the Venerable, abbot of Cluny, decided not to proceed with his usual bloodletting, “lest with the blood seizing hold of my body, bloodletting would be dangerous”.
Our medieval ancestors were also mindful of the relationship between their wellbeing and their immediate environment. They recognised the importance of clean air and water, and believed that plague and other diseases were transmitted via corrupt, pungent air and contaminated water. When the Black Death erupted in Pistoia, Italy in 1348, the civic government instructed that, “to avoid the foul stench which comes from dead bodies, each grave shall be dug two and a half armslength deep”.
By the 15th century, medical care helped many people to navigate the vulnerable periods of infancy and childhood and survive into adulthood. In fact, some people lived into old age – a life stage that, it was believed, required extra vigilance. The physician Aldobrandino of Siena wrote in his advice regimen that a person aged more than 65 “should avoid purging and bloodletting unless the need is very great; and take good food that is lightly cooked, and drink old red wine, and stay away from wine that is white or new”.
Of course, most people didn’t make it to a ripe old age in perfect health. They caught infections, they broke bones and developed chronic illnesses. When they did, a whole range of medical practitioners – from physicians and surgeons to apothecaries and other healers – were on hand to treat them. From the 13th century, budding doctors could study medicine at the emergent universities, especially those of Bologna, Montpellier and Paris. While some physicians followed university courses, others gained hands-on experience by serving and assisting an established practitioner.
Physicians left to surgeons the tasks of cutting into, or applying treatments to the body, themselves offering advice based on the patient’s case-history and the observation of pulse, urine and blood.
Apothecaries complemented the work of physicians by supplying the medicines that they prescribed to patients. Medicines were compounded from plant, mineral and animal substances, ranging from the everyday to the exotic. An English version of the popular advice book the Secreta secretorum instructed that patients should “take somtyme an electuary of a wood called Aloes and of Rubarbe, whiche is a precyous thynge… and this shall do the [you] moche good”. Electuaries were medicinal pastes sweetened with sugar or honey, making their ingredients palatable and easy to swallow. What wasn’t quite so palatable was the cost of some of these ingredients – rare substances such as powdered gold, sandalwood and bezoars (stones that formed naturally in the intestines of oxen and other animals) could be eye-wateringly expensive.
Some medical practitioners specialised in surgical procedures such as tooth-pulling and cataract surgery. In the 13th century, the Italian Benvenutus Grassus produced a popular account of his method of treating cataracts. Grassus advocated the practice of couching, in which the surgeon used a sharp instrument to move the cloudy lens to the bottom of the patient’s eye. Grassus instructed practitioners to use a gold or silver needle to “touch the diseased matter… and dislodge it from its position in front of the pupil. Then push it well,” he counselled, “holding it there until you have said four pater nosters.”
Other practitioners were deployed at moments of medical emergency, especially on the battlefield. On 18 April 1471, four days after the battle of Barnet, John Paston II, of the Paston family of Norfolk, was able to report to his mother that his brother, also John, had survived an arrow injury to his lower right arm. John II confirmed that the wound had been dressed, and reassured his mother that, “he tellythe me that he trustythe that he schall be all holl [well] wyth-in ryght schort tyme”.
Osteological studies of skeletons from battlefield sites testify to the violence of medieval warfare. These studies also reveal that some of the soldiers had recovered from significant earlier injuries – in a number of cases, presumably, as a result of medical intervention.
For all medieval doctors’ influence and effectiveness, there’s no getting away from the fact that they operated in a predominantly Christian society – one in which recovery from illness was widely linked to religious devotion. A church council of 1215 instructed sick people to seek the support of a priest before visiting a physician, because “sickness of the body may sometimes be the result of sin… when the cause ceases so does the effect”. Parish priests, monks and nuns all played an important role in treating the sick, often possessing considerable medical knowledge.
Hospitals usually followed a monastic rule and made a point of offering their patients spiritual as well as physical care. Patients’ spiritual and emotional wellbeing was regarded as especially important in institutions that offered treatment for long-term chronic conditions such as leprosy. Thirteenth-century statutes for a hospital for leprous women at Rouen, France instructed that the prioress “should be sensitive, recognising and showing pity towards the infirmities of the sisters”.
Many of our medieval ancestors were quite content to place their trust in qualified medics and experienced members of the clergy. Others sought more radical solutions. Leaf through the pages of medieval medical texts and you’ll come across charms – remedies whose potency was derived from words. The creators of charms often invoked saints and biblical figures to convey the legitimacy of these treatments. A charm against fever, attributed to the 15th-century Florentine alchemist Bisticius, involves writing holy words on three sage leaves. The leaves should then, Bisticius advised, be “eaten on three days on a fasting stomach, one on each day”. As such, the patient was literally consuming the healing benefits of the words.
Certain other remedies advised people to use human blood and tissue as medicinal ingredients. Unsurprisingly, church and government officials took a dim view of such practices: in the early 15th century, the midwife Perrette de Rouen was imprisoned in Paris for obtaining the body of a stillborn child in order to use its flesh to treat leprosy.
The medical profession was every bit as appalled as the authorities by the quack cures being peddled by rogue practitioners. In the mid-1480s Thomas Le Forestier, an elite French doctor in London, used the dedication (to King Henry VII) of his tract on the English sweating sickness to attack “unexperte men” for “deceyving al the world with falseness”.
Yet, for all the “unexperte men”, and for all their “falseness”, there’s no changing the fact that our medieval ancestors had a comprehensive knowledge of their own bodies and the medical options available to them. Just like us, they wanted to live long, healthy lives – and, just like us, they were determined to use all the tools at their disposal to make that happen.
Elma Brenner is Wellcome Collection’s medieval and early modern specialist. Her publications include Leprosy and Charity in Medieval Rouen (Boydell & Brewer, 2015)
LISTEN AGAIN For more on the history of western medicine, listen to the BBC Radio 4 series The Making of Modern Medicine at bbc.co.uk/programmes/b00k9b7r
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This article was first published in the September 2018 edition of BBC History Magazine