MEDIEVAL MEDICINE: KILLER OR CURE?

In the modern imagination, quack remedies and painful, futile surgery awaited those unlucky enough to fall ill in the Middle Ages.

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 an potentialy effective advice like that offered by Archimattaeus almost certainly will not. But then, medieval medicine rarely conformed to modern stereotypes.

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, whent 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 illness. 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 lifesyle i order to avoid failing ill in the first place. Some of the medieval ideas about lifestyle - such as the need to eat a moderate iet, 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 ou will, walk daily somewhere morning and evening. I 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 we wellbeing. Our ancestors believed that keeping the humours- blood, yellow 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 relatioship between their wellbeing and their immediate enviroment. They recognised the importance of clean air and water, and believed that plague and other diseases were transmitted via corrupt, pungent air and contamined water. When the Black Death erupted in Pistoia, Italy in 1348, the civic government instructed that "to avoid the foul stench with comes from dead bodies, each grave shall be dug two and a half armslength deep".

Ageing population

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, an stay away from wine that 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 ilnesses. When they did a whole range of medical practitioners - from physicians and surgeons to apothecaries and other healers - were o hand to treat them. From the 13th century, budding doctors could study medicine at the emergent universities, especiacialy those of Bologna, Montpellier and Paris. While some physicians followed university courses, others gained hands-on experience by serving and assisting an establised 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 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) ofhis tract on the English sweating sickness to attack “unexperted 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 compre-hensive 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.

PANACEA OR POISON?

Would these 10 medieval medical practices have given you a new lease of life, or sent you to an early grave?

1. Bloodletting

Phlebotomy aimed to maintain or restore the humoral balance in the body by removing a moderate amount of blood. We know today that losing a small quantity of blood is usually not harmful, but nor is it beneficial. In the Middle Ages it was recognised that it was dangerous to draw blood from the elderly or the very sick, and that excessive bleeding, through injury or another cause, needed to be staunched. COULD IT HAVE WORKED? NO

2.  Charms

These magical remedies were not without benefit, since they sometimes incorporated medicinal plants and other therapeutic substances - and they could serve to reassure the patient. Nonetheless, the treatments usually contained fewer beneficial components than comparable non-magical recipes. COULD IT HAVE WORKED? NO

3. Family planning

Herbal treatments based on plants such as sage, rue and pennyroyal were administered to women seeking to induce an abortion, often in the form of a drink. Several of the plants in question are known today to act as stimulants, and to promote menstruation. It is known that a high dosage of pennyroyal can bring about an abortion.
COULD IT HAVE WORKED? YES

4. Couching for cataracts

Medieval surgeons treated cataracts by using a needle to dislodge the cloudy lens from its position in front of the pupil of the eye. People recognised that the procedure could be dangerous, and that specialist skills were required for it to work. Today, couching is seen as an ineffective method of treating cataracts that often results in blindness.
COULD IT HAVE WORKED? NO

5. Pharmacy

Apothecaries compounded medicines using a wide array of substances. While some materials were probably ineffective or even dangerous, others, such as ginger and senna, are used today for their medicinal properties. The pages of medieval pharmaceutical manuscripts may in fact contain remedies of which the benefits are as- yet unknown to modern medicine. COULD IT HAVE WORKED? YES

6. Counterfeit cures

Rogue practitioners sometimes marketed counterfeit medical remedies, especially during times of heightened anxiety about plague. These treatments prevented sick people from seeking more beneficial advice, and could prove dangerous, especially if a poisonous substance was sold to a patient.
COULD IT HAVE WORKED?NO

7. Astrology

Doctors paid attention to the movements of the planets and the signs of the zodiac to determine the appropriate time to treat specific ailments. The Zodiac Man image (shown above left), widely copied in medieval manuscripts, shows the signs of the zodiac associated with particular parts of the body. Ideas still exist today about the influence of celestial bodies, especially the Moon, on menstruation and other aspects of health. However, scientific research seems to have disproven such ideas. COULD IT HAVE WORKED?NO

8. Hospital care

Although medieval hospital patients were unlikely to be treated by a physician or surgeon, they benefited from the expertise of nursing staff, who were often women. Hospitals offered basic bodily care, in the form of food, drink and shelter. While this care did not encompass specialised treatments, it enabled the sick to regain strength towards their recovery.
COULD IT HAVE WORKED? YES

9. Theriac

This remedy, in which plant extracts were ground up with the flesh of vipers and other substances, was held as a powerful antidote to poisons, and believed to have many other healing properties. However, although theriac was expensive and highly sought-after, it is difficult to discern how this medicine would have proved effective or beneficial.
COULD IT HAVE WORKED?NO

10. Uroscopy

Examining urine was one of the only ways in which the medieval doctor could assess the internal state of the body. The urine was collected in a flask, and its colour, smell and consistency were assessed. Medieval medical manuscripts often contain diagrams showing the different qualities of urine and how these related to diseases and states of health. Urine samples are still analysed by doctors today.
COULD IT HAVE WORKED? YES

Written by Elma Brenner in "BBC History Magazine", UK, September 2018, excerpts pp.22-27. Digitized, adapted and illustrated to be posted by Leopoldo Costa.