Medicine stands still, 1000-1500

Treatments

Cure and Prevention

The Theory of the Four Humours

Many physicians’ treatments in the Middle Ages were based on the Theory of the Four Humours and involved rebalancing the humours in the patient’s body by the ‘use of opposites’ (see Source A).

Each herb and food was thought to have different qualities, which could be used to rebalance unbalanced humours. Gaddesden, for instance, recommended lettuce for smallpox (which was caused by ‘blood that boils’) because it was a cold food. The Persian Muslim physician Rhazes recommended soup of yellow lentils for smallpox, but for the same reason – “let their food be such as reduces heat … their drink should be water cooled with snow”. Breast milk, on the other hand, was warm and moist, so it was useful for diseases caused by phlegm (such as tuberculosis).

Medieval doctors thought that, when the body failed to properly excrete the remains of food and drink, it would ‘corrupt the blood’ and unbalance the humours … so they would recommend remedies which involved sweating, purging or vomiting to expel the impurities. Poultices were much-favoured to draw out pus and, if necessary, doctors would use caustic substances to cause blistering.

Most of all, the medieval physician’s go-to cure was phlebotomy (letting blood); the Salerno Regimen advised that, of all the different cures, bleeding is best:

Of seventy from seventeene, if blood abound,

the opening of a veyne is healthfull found.

The usual way this was done was by opening a vein –  physicians would carry a ‘vein man’ to help them know which vein to let (see Source B) – but medieval doctors might also use medical leeches, or ‘a cupping vessel’.

Note that these principles were used for prevention as well as for cure – the Salerno Health Regimen was popular because it used the principles of the Four Humours to outline the rules for healthy living (see Source C).

Astrology

If you believe (as many people still do) that the stars affect the physical world, then you are going to believe that they affect the humours. Thus many physicians consulted astral charts to aid their remedies’ effect, particularly phlebotomy – 'vein man' images often included a recommended time or astrological sign for bloodletting.

Pestilential air

Physicians would prescribe (eg) fumigating houses with herbs, or the bedroom with lighted tapers, or (for tuberculosis) going to live in the mountains where the air was clear. To protect themselves when visiting patients, they would hold to their nose (eg) pomanders, oranges or sponges soaked in vinegar.

Contagion

Medieval ports practised ‘quarantine’ to prevent infected seamen bringing disease ashore. The Duke of Milan ordered that houses in which the Black Death broke out be bricked up, well, sick, dead and all.

Supernatural cures

Again, many people today will pray for a sick loved one, so we should not be surprised that medieval people – without access to modern medicines – should turn to God. Medieval medical books were full of prayers and charms against ailments such as toothache. Sufferers might light a giant candle in church to bring the problem to God’s attention, and many saints were associated with various diseases (eg St Roch might cure the Plague).

Where a disease was regarded as a divine punishment, remedies might include praying for forgiveness, sitting in a sewer, exorcism or – in extreme cases – a gathering where people whipped themselves (‘flagellation’) in a public show of contrition.

Medieval people believed in the 'doctrine of signatures' – the idea that God had marked plants with signs that showed their therapeutic uses (thus a walnut would be good for brain health, and lungwort, whose leaves look like diseased lung, good for chest problems).  This was closely linked to what we would nowadays call ‘sympathetic magic’, the idea that the properties of one thing can transfer to another – thus breast milk was nutritious because it was infused with a mother’s love; the life-force of newly-born puppies could help tuberculosis; the energy of dancing would drive out disease etc. One common example of this was ‘Touching for the King's Evil’, where the divine blessing of monarch could bless sufferers of scrofula. 

Jews and witches

Where a disease was blamed on an ‘enemy’, it is easy to understand why communities might attack the alleged perpetrator … though note that this was not a big issue in England:

  •   During the Black Death, in Europe whole communities of Jews were wiped out, though the Jews had been expelled from England in 1290, and accusations against Jews of ‘poisoning the wells’ even before this were rare.

  •   Again, whilst people were accused of ‘maleficium’ (harmful magic) in medieval England, they were taken before the Church Courts, where the sentence would be a penance; witches were not put to death in England before 1542.

Going Deeper

The following links will help you widen your knowledge:

Source documents on Medieval treatments

Source B

This 14th century drawing of a vein man shows the key veins, and the illnesses bloodletting from them was believed to treat – eg “The cephalic vein in the head is good against headache and eye pain, and swelling of the face and eyes”, “The vein in the groin is good against abscesses in the testicles and kidneys” etc.

Doctors

Famous English Physicians of the Middle Ages include Gilbertus Anglicus and John of Gaddesden.

They were highly-trained – at Oxford University in the 14th century this involved 3-4 years studying Grammar, Rhetoric, Logic, Arithmetic, Music, Geometry, Astronomy and Philosophy BEFORE undertaking a six-year medical degree of reading, lectures and debates, finishing with an examination. At Oxford, the curriculum included Hippocrates, Galen, the Book of Fevers, the Antidotarium of Nicholas of Salerno, and the Ars Medicineae.

You could become a university-trained physician without ever meeting a real patient – it was ALL book-learning (though Gaddesden did heal some patients while he was studying). One image of the time shows patients queuing to see a physician, but most show the physician attending with his apothecaries upon a private (and wealthy) client.

They were very scarce – fewer than 100 for the 6 million people in England c.1300. They also appear to have been generally hated … and with good cause – medical books of the time devoted whole sections on fees and how to get the most out of the patient. Some patients tried to suss out the physician by first providing urine from their wife, or sheep, or even diluted wine, and medical books taught physicians how to spot a fake.

Apothecaries were not university-trained, but they served a seven-year apprenticeship under a Master Apothecary, after which they were accepted into the Worshipful Society of Apothecaries. Given that physicians were too expensive for most people, they would often diagnose and gives medicines ‘over the counter’.

Monasteries cared for the sick (see below) and would have a Herbalist, who would treat the brothers and people in the infirmary.

Quacks:  The Salerno Health Regimen riled against untrained healers – “Any idiot, non-believer, Jew, monk, actor, barber or old woman pretends to be a physician, just as any alchemist, soapmaker, bath-keeper, forger, or optician claims to be a physician. And thus, for money, legitimacy is replaced by artifice”. Nevertheless, there seem to have been many of them, and there is an amazing French poem from the 13th century which describes one of these charlatans at work.

Unlicensed quacks who were caught were tried and punished; in 1381 Roger Clark – who had tried (and failed) to heal a women by giving her a parchment with religious quotation – was led through the City on a horse without a saddle, the said parchment round his neck, with a urine bottle hung in front and another behind.

Women doctors:  Whilst at its highest level the English medical profession was wholly male – there are records of female physicians and surgeons in Europe (especially Salerno) but none in England, and in 1421 Heny V banned women from practising medicine and surgery – the lower you look down the ranks, the more women dominated:

  •   A few women operated as apothecaries, mostly where they inherited a business from their husband or father. There is a record of an Agnes of Godestone who was an Apothecary with the Grocers Company of London, and occasionally of a female apprentice to an Apothecary.

  •   In convents and abbeys, where the nuns did all the nursing, nuns ran infirmaries and dispensaries and, according to the 17th century historian John Aubrey "did cure their poor neighbours".

  •   There seem to have been women who practised as doctors without qualifications. John of Mirfield (14th century), a doctor at Saint Bartholomew's Hospital London, complained about ”worthless and presumptuous women who usurp this profession to themselves and abuse it – who, possessing neither natural ability nor professional knowledge, make the greatest possible mistakes thanks to their stupidity and very often kill their patients". Such women were labelled ‘empirics’, were lumped together with cunning women and witches, and were tried in court for medical malpractice.

  •   At village and household level, it would seem that – apart from the local blacksmith who would pull teeth – women acted as both healers and carers, and certainly as midwives. A translation of the Trotula – a series of texts ascribed to the famous female European physician Trota of Salerno (12th century) – explains: “[since] women do better read and understand this language than any other [person], and every lettered woman reads to other unlettered women and helps them and counsels them in their maladies without showing their disease to men, I have written this in English”.

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