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

Lepers were isolated in hopitals called 'lazar houses'.  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 go on a pilgrimage to a healing shrine, say a Mass, 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; Gibertus Anglicus recommends the cartilage of a stag's heart as a medicine to strengthen the human heart 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

  The significance of Islamic medicine

Case Study: The Black Death

YouTube

 Mr Cloke on medieval treatments, prevention of disease and healers

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 railed 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. 

  •   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. 

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

  •   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 Middle English 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”. 

Source documents on Medieval doctors

Source D

A woodcut in Fasciculus Medicinae ('A Bundle of Medicines') of a medieval physician visiting a plague victim, Venice, 1493.  Note the sponge soaked in vinegar, the tapers and incence-burner, and the role of the women.

Hospitals

  •   After 1100, inspired by the Benedictine rule which placed care for the sick as a primary Christian duty, the number of hospitals rose rapidly.  A 15th-century survey listed 1,103 ‘hospitals’ in Britain. 

  •   The majority were small.  Many had 12 beds, symbolising the 12 disciples of Jesus, but others as few as 5 or 6 beds. 

  •   There were some large institutions.  St Bartholomew’s Hospital in London was founded in 1123.  St Leonard's Hospital in York, founded in the 12th century, could care for over 200 people by 1370; it had royal patronage the right to collect special taxes in the local area. 

  •   30% of English hospitals were owned and operated directly by the Church, staffed by monks and nuns from nearby monasteries.  The rest were usually funded by charitable donations (which was believed both to heal disease and save the soul). 

  •   Hospitals also provided hospitality to pilgrims and travellers.  A large monastery would have a ‘hospital’ for guests, an ‘infirmary’ for the sick brothers, and a hospital nearby for lay people. 

  •   Some hospitals catered to specific groups:

  ◦   'Lazar houses' for people with leprosy, often located outside towns to prevent the spread of disease.  Many were founded in the 12th century by crusading orders like the Knights Templar. 

  ◦   Hospitals for the mentally ill, such as Bedlam in London. 

  ◦   A maison dieu in York took in only women, mostly poor widows. 

  ◦   Maternity or women's care (eg Mayor Richard Whittington funded a hospital room with 8 beds for unmarried pregnant women). 

  ◦   eg Bury St Edmund’s had at least six hospitals, serving lepers, the infirm, the old etc. 

Care in Medieval Hospitals

  •   Hospitals were usually run by religious staff – monks, nuns, a chaplain – who provided daily routines of prayer, simple diets, warmth, cleanliness, rest and spiritual care. 

  •   Nuns and “chaste widows living in God’s service” carried out the practical care: feeding, cleaning, washing bed linen, and ensuring warm, restful surroundings.  The nuns also dispensed herbal remedies, drawn from library books and passed-down traditions. 

  •   Wards were built around an altar, and patients joined in daily prayers from their beds; this was seen as part of their healing. 

Limitations of Medieval Hospitals

  •   Most English hospitals did not employ physicians or surgeons; religious orders in England were forbidden to cut the body. 

  •   Of the 1,103 hospitals in England, 345 were leper houses (lazar houses), and 742 were almshouses for the poor.  Thus most medieval hospitals did not treat the sick – many explicitly excluded sick people, and physical healing was seen as secondary to spiritual improvement. 

  •   Hospitals routinely excluded lepers, lunatics, epileptics, people with contagious diseases, pregnant women, infants, ‘intolerable’ and sinful people, and terminally ill patients (since prayer and penance were useless for the incurable). 

  •   European (notably the Hotel de Dieu in Paris) and Islamic hospitals were generally larger (and the Islamic Hospitals were better), and employed physicians and surgeons; there is no evidence that English hospitals did. 

The Inabilities of Medieval Treatment

Ultimately, medieval medicine was unable even to make a dent in disease.  It did not possess sufficient scientific knowledge even to know the true causes of the disease and it is telling that we often are unable to identify medieval diseases from the descriptions of the symptoms, which are too vague and/or irrelevant.  And, even where a disease was correctly identified, medieval science was unable to prescribe a ‘cure’ which would cure.

Most medieval medicine, therefore, was what we would call toady ‘palliative’ (easing the symptoms) or downright harmful (eg bleeding).

Epidemics

As a result, medieval England was swept by regular epidemics (see the full list here) against which medieval treatments were powerless.  Although it is usually impossible to identify the diseases from the vague descriptions, we can make the following observations:

  1.   Many were associated with times of hardship (eg famine or war) when people’s immune system would be weakened – most likely culprits are typhus (‘starvation fever’) or typhoid.

  2.   Many were associated with ‘murrain’ (animals disease) – most likely culprit is anthrax.

  3.   Dysentery (the ‘flux’) is associated with famine, but is particularly common in armies, and occasionally in monasteries.

  4.   After the Black Death there were regular repeat-outbreaks of the bubonic plague.

  5.   The list also records influenza, ‘spotted fever’ (probably typhus), syphilis and ‘sweating sickness’ (an unknown form of fever, probably viral).

Endemic diseases

At the same time, we are able to tell from chronicles, medical texts and archaeological records that there were a whole range of deadly diseases which were ‘endemic’ (constantly present), against which medieval medicine was powerless – notably leprosy & tuberculosis (bacterial diseases) and smallpox, measles, chicken pox, influenza and herpes (viral diseases).

Source E

As far as I can see, there are NO images of English medieval hospitals.  This 15th century Italian image – of Franciscan monks treating lepers?plague victims – may give an idea of what English hospitals were like. 
Most images used in your texbooks etc. show the Hotel de Dieu in Paris, which was utterly non-typical. 

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