ALL ABOUT MEDIEVAL MEDICINE

From bloodletting to prayer, discover how physicians, barber surgeons and holy men treated the Black Death and more.

MEDIEVAL MEDICINE IN HISTORY

Discover the development of medicine during the medieval period, from ground breaking texts to medical firsts.

THE JUSTINIAN PLAGUE (542)

25-50 million(number of estimated deaths across the empire) 10.000 approximate number of deaths each day in Constantinople during the plague. This was the first major outbreak in the world.

WRITING IT DOWN (7th. Century)

Greek physician Paul of Aegina creates his seven-volume medical encyclopaedia, incorporating his own knowledge with that of the ancient Greeks and Romans – it would remain popular for the next 800 years.

CHINESE MEDICINE (610)

Chao Yuanfang, an imperial court physician during the Sui Dynasty, compiles his Treatise On The Many Illnesses. He discusses more than 1,700 diseases, such as smallpox, which greatly influences medicine in China.

ISLAMIC GOLDEN AGE (754)

The first pharmacies are opened in Baghdad and they prove to be very popular, with many more founded throughout the Arab world – they would finally appear in Europe by the 12th century.

EMERGING EDUCATION (9th. Century)

The Schola Medica Salernitana is founded in Salerno, Southern Italy, and is believed to have been the first medical school of the western medieval world.

A GROUND BREAKING DISCOVERY (910)

Persian physician Rhazes becomes the first person to distinguish between smallpox and measles, recognising them as two different deadly diseases, and discussing their associated signs and symptoms.

PUBLIC HEALTH (11th. Century)

Infirmaries had been a part of monasteries since the 6th century but it takes another five centuries before public hospitals are opened, supported by the church, city authorities or through private funds.

INFLUENCING MEDICINE (1025)

Avicenna completes his encyclopaedia, The Canon of Medicine, one of the most famous medical treatises in Europe. In it he discusses the four humours, introducing it to medieval medicine from Greco-Roman.

ARRIVAL OF SURGERY (1150)

The surgical field emerges due to the establishment of the University of Paris, followed by other European universities such as the ones in Bologna and Oxford.

DEATH OF A KING (1199)

King Richard I of England dies after the Siege of Châlus, following a botched attempt by a surgeon to remove an arrowhead from his shoulder, with the wound turning gangrenous.

SPREADING THE KNOWLEDGE (12th. Century)

Starting in the 12th century, numerous ancient texts on astrology are translated into Latin, not only influencing medical practice but becoming a staple of European medicine.

A NEW DIAGNOSIS (1250)

Gilbert the Englishman, a priest and physician, finishes his Compendium Medicinae, in which he offers the first diagnosis of leprosy. It is subsequently translated into several languages.

PRACTICAL TEACHING (1286)

The first recorded autopsy takes place in Cremona, Italy, with dissections eventually becoming an educational tool in medical universities, such as the one in Bologna, over the next few decades.

THE BLACK DEATH (1347-c.1352)

25-50 million estimated number of people who died. Roughly 30-60% ovf Europe's population. It is thought the plague travelled anywhere between 1-8 miles a day.

A FATHER OF SURGERY (1370s)

English surgeon John Arderne composes his influential medical treatise on a range of topics, including treatment for the eyes and a cure for anal fistulas, based on his career experience.

NATURAL MEDICINE (14th. Century)

The Red Book of Hergest, a Welsh Medieval manuscript, is created and it includes a collection of herbal remedies attributed to Rhiwallon Feddyg, the founder of the Physicians of Myddfai.


LIFE EXPECTANCY IN ENGLAND (15th. Century)

21-year-old male aristocrat was estimated to live another 48.11 years between 1400 to 1500. This had risen 24.44 years the previous century, due to the Black Death. Meanwhile, the had been expected to live another 43.14 years between 1200 to 1300.


AN APOTHECARY - WESTERN EUROPE, 1100

An apothecary was a busy place in medieval times since it was where substances used in medicine were sold to patients, physicians and surgeons. Apothecaries were, to a great extent, the predecessor to modern pharmacists, mixing the smallest of quantities of herbs and spices to create treatments while offering medical advice and carrying out a small range of services.

It could be imagined to be a place of wonder and hope with shelves packed full of jars and vials filled with powders and liquids. The air would be filled with the scent of exotic spices and some apothecaries would work hard to maintain a feeling of mystique.

They wanted people to feel both amazed and reassured that the sometimes off-beat ingredients (fat, flayed cats, hedgehog grease, bear fat and virgin wax were involved in treatments for throat infections) would do them great good and encourage a purchase.

The shops could be found across Europe, where streets were often named after them, especially when a handful existed side-by-side (Apothecary Street in London is one such case). For those who worked in them, there was much pressure, particularly as demands for cures grew and greater quantities of ingredients became necessary. Apothecaries could be blamed if a patient’s condition did not improve – but they were seldom thanked if it did.

It didn’t seem to matter that apothecaries did not have any formal training to begin with (examinations were introduced in the 15th century). Indeed, there were many cases where apothecaries would have dual roles, perhaps doubling as a barber or even performing surgery.

It was not unusual for medicine to be done ‘on the side’, either, since the shops would sell perfumes, items for food, wines for general consumption and even stationary. Neither, come to that, was it rare for apothecaries to give advice or even diagnose illness even though the law stated their role was purely to supply medicine. Few found themselves prosecuted.

Trading in beauty

As well as helping people back to health, an apothecary would make and sell perfume and other beauty products in much the same way as a modern-day pharmacy. Often ingredients would have a dual use. Tragacanth, a natural gum taken from the dried sap of Middle Eastern legumes, for example, was used in both a perfume and cough medicine.

Live animals

Typically, an apothecary would also have live animals at his disposal, although perhaps not always permanently on the premises (to aid gout, for instance, an owl was plucked clean, opened, salted, cooked and pounded with boar’s grease). Medieval cures for burns involved rubbing the slime of live snails on a wound and, once again, that also had some scientific grounding: the slime has anti-inflammatory, antioxidant and antibiotic

Treating patients

Although much of an apothecary’s work was selling raw ingredients and creating medicines to a recipe written in Latin, they would also be called upon to diagnose illness and prescribe treatments to help cure or relive an illness. It would appear the training, however, was not formal but passed down in an apprentice-like scheme over many years, and it could involve tongue scraping, tooth extraction and the use of knives (treated with sterilisation equipment, of course).

Raw ingredients

Behind the counter, in jars on the shelves lining the walls, was an assortment of herbs and spices used in the preparation of the medicines. There would be pepper, ginger, saffron, nutmeg and cloves, cumin, aniseed, rosemary, fennel and nuts among many others. Curing migraines, for example, entailed boiling barley, betony, vervain and other herbs before wrapping them in a cloth and applying to the patient’s brow. In this case, the apothecaries were not far off the mark – betony and vervain can be found in modern treatments.

Mortar and pestle

The best way to crush and grind herbs, spices and other ingredients was with a mortar and pestle. Apothecaries would have a number of them in various shapes and sizes, the smaller ones being particularly good for the grinding of fine powders, whether wet or dry, and larger ones for bulkier ingredients.

Weights and scales

In most cases, only tiny amounts of each ingredient were used and it was important to get the balance right. For that reason, the weights and scales of an apothecary were invaluable and they used the Troy method based on the weight of a grain of wheat: A Troy ounce was 480 grains or 31.1 grams and a Troy pound 5,760 grains.

Preparation area

Apothecaries would generally prepare the medicines using their ingredients out of sight of the purchaser, working to age-old recipes which they would refuse to divulge. They worried about potentially giving a rival an advantage by revealing their secrets so they would work diligently in a back room and hope their cures or treatment would work so that word would spread about their personal effectiveness.

Public-facing

Many apothecaries ran their own small shops such as the one pictured here, serving medicine to members of the public from behind a counter in the front section of dedicated retail premises. Visiting patients would trust the men to diagnose their conditions and they would buy products deemed capable of curing or relieving their ills. Sometimes an apothecary shop was based in the apothecary’s home.


THE ANATOMY OF A PHYSICIAN - WESTERN EUROPE, 1215

EDUCATED MEN

High-end physicians in the Middle Ageswere university educated and their medicine was rooted in the writings of ancient Greeks such as Hippocrates and early medieval Arab physicians. They treated aristocrats and royalty, explaining illness as an imbalance of the four humours (or distinct bodily fluids): black bile, yellow bile, phlegmand blood.

A BUNCH OF POSIES

It was widely thought that diseases were carried by smell so physicians would seek to protect themselves by masking any stench. Posies were a popular choice but oranges were also used. Flowers also came in handy for treating smallpox – as well as giving patients red food and drinks and wrapping them in red cloths, physicians would ground red roses with bamboo juice.

CUTTING TREATMENTS

There were some extreme cures for disease. Inflamed lymph nodes within the armpit or groin areas would be sliced open to allow the pus to drain, while trepanation would see a hole drilled into the patient’s skull so that blood build up could be relieved or intracranial diseases cured. Being made to vomit – another way of balancing the body – seemed tame in comparison.

HISTORICAL TREASURES - SCOURGE - PLAGUE IS PUNISHMENT AND SUFFERING IS THE CURE EUROPE, MID-14TH CENTURY

The act of self-mortification, or flagellation, had been common practice for holy men since the earliest decades of Christianity. As the Black Death ravaged Europe across the mid-14th century it erupted into a mass movement, powered by hysteria and the belief that this vile epidemic was a divine punishment.

The first outbreaks of public flagellation occurred in Northern Italy in 1260 and the practice was soon carried to the rest of Europe, particularly Central Europe and the Low Countries, where communities cowering under the shadow of pestilence adopted it as a desperate act of public contrition.

The most common tool of cleansing was the scourge, a whip with three tails that was often knotted or barbed with iron to inflict maximum pain, and worn on the waist.

The flagellants or penitents would march in a line two-by-two from town to town, robed and hooded in red crosses.

Those at the front of the procession carried crucifixes and banners aloft, and they sung hymns begging for forgiveness. Twice a day the flagellants would stop in a town square in front of the church, form a circle, strip to the waist, remove their shoes and flay themselves until they bled The Dominican friar Heinrich von Herford (1300-1370), recalled, “Using these whips they beat and whipped their bare skin until their bodies were bruised and swollen and blood rained down, spattering the walls nearby.

I have seen, when they whipped themselves, how sometimes those bits of metal penetrated the skin so deeply that it took more than two attempts to pull them out.”

Finally, they would pray. The routine would be repeated a third time in the evening.

For townsfolk frustrated by the impotence of their priests and prayers, flagellation offered visceral answers, eye-catching spectacle, and even supernatural healing.

The French chronicler Jean Froissart (1337-1405) wrote of their audience that, “Some foolish women had cloths ready to catch the blood and smear it on their eyes, saying it was miraculous blood.”

The practice soon peaked and quickly declined as papal bulls made flagellation heresy and secular authorities moved to restore public order following a series of grisly massacres of Jews by flagellants.

However the belief underpinning flagellation – that sickness was a punishment for sin – endured well into the Renaissance.

CONSTANT COMPANION

Hung from the belt, the scourge was used at least three times a day for 33 days (one day for each year of Christ’s life) of suffering, with additional penance meted out for breaking the order’s rules, such as talking out of turn or communicating with the opposite sex.

A SCOURGE FOR ALL

Though flagellants were penitent pilgrims, self-mortification was adopted by the faithful from across all social strata, and scourges could be as simple as knotted rope or as elaborate as leather whips with iron barbs. This one, found at Rievaulx Abbey in Yorkshire is made from plaited copper alloy wire, ensuring its survival against the centuries.

STING INTHE TAIL

Knots or metal barbs tore at the flesh to create wicked, jagged wounds which repeated lashes would open further. These would then be washed in a mixture of wine and vinegar to help prevent infection.

WHATWOULD JESUS DO?

Flagellation as an act of penance has its root in the Bible. Under Roman law those non-citizens condemned to crucifixion were scourged with whips barbed with small pieces of metal or bone, and in undergoing the experience the flagellants are following in Christ’s footsteps.


MEAT TEN MEN AND WOMEN WHO HAD A LASTING IMPACT ON MEDICINE IN THE MEDIEVAL WORLD 

PAUL OF AEGINA - BYZANTINE C.625-690

Paul was one of the most prominent physicians of the Byzantine period. He studied medicine in Alexandria, Egypt and was also exposed to Arabic medicine through his travels to the Middle East. He wrote The Epitome of Medicine, comprising of seven books on various subjects including hygiene and toxicology, combining the work of Hippocrates and Galen with new medical procedures, such as cauterisation. It was highly influential and remained as the standard guide for medicine and surgery for 800 years.

AL-ZAHRAWI - SPANISH 936-1013

Widely hailed as ‘the father of modern surgery’, Al-Zahrawi was the greatest surgeon of the Islamic Golden Age. In roughly the year 1000, he completed his 30-volume illustrated medical encyclopaedia Al-Tasrif, which was intended for medical students. Documenting Al-Zahrawi’s almost 50 years of medical experience, it discussed human anatomy and the pathology of diseases among other topics. It was influential on the development of both Islamic and European medicine and surgery, remaining as the standard textbook in medical universities for 500 years. Aside from his encyclopaedia, Al-Zahrawi holds the distinction of introducing around 200 new surgical instruments to the medieval world.

ANNA KOMNENE BYZANTINE - 1083-1153

Byzantine princess Anna Komnene studied medicine from an early age, eventually developing a reputation as a good physician. Her father, Emperor Alexios I, placed Komnene in charge of a large hospital, as well as an orphanage, in the capital Constantinople. While in this role, it is believed that she treated thousands of patients and she was also known to teach medicine in various other hospitals. Interestingly, Komnene was deemed to be an expert in gout and treated personally treated her father when he suffered attacks.

IBN ZUHR - SPANISH 1094-1162

Ibn Zuhr was considered the most renowned physician of Muslim Spain. Born into a family of physicians, he trained in medicine from an early age and was introduced to the works of Hippocrates and Galen by his father, who made him swear the Hippocratic oath. He notably wrote the Kitab al-Taysi, focusing on clinical descriptions and diagnosis of diseases, at the request of his contemporary Averroes, to serve as a companion the latter’s medical encyclopaedia, Colliget. Also known for introducing animal testing to evaluate new medical procedures, Ibn Zurh’s work contributed greatly to the development of surgery in the medieval world.

IBN AL-NAFIS - SYRIAN 1213-1288

Ibn al-Nafis made one of the biggest medical discoveries of the Medieval world when he correctly described pulmonary circulation, with blood moving from the right side to the left side of the heart through the lungs. This contradicted the traditionally accepted view of Galen, where blood seeped from the right to the left ventricle through the chamber walls – it would take European scholars another three centuries to prove Ibn al-Nafis correct. He also predicted the existence of coronary and capillary circulations, 400 years before they were discovered, proving that he was a physician far ahead of his own time.

AVERROES - SPANISH 1126-1198

Averroes, a physician at the royal Almohad court, was celebrated for his insight and knowledge in the field of medicine. He created a number of medical works, the most important of which was his first, the encyclopaedia Book of Generalities About Medicine, which he wrote in 1162. Also known by its Latin name, Colliget, it was split into seven books which discussed a range of topics, including anatomy, hygiene and therapy. The Colliget was focused on the theoretical bases of medicine and summarised the work of Galen, earning Averroes recognition in the Latin medical world.


GUY DE CHAULIAC - FRENCH C.1300-1368

After studying medicine in Montpellier, Paris and Bologna, Chauliac practiced as a physician in Lyon and served as the personal surgeon to three Popes of the Avignon Papacy. He wrote the Chirurgia Magna, in which he discussed a variety of medical treatments and surgical procedures, largely influenced by the work of Galen. The Chirurgia Magna quickly became one of the most important surgical textbooks in the Medieval world and remained as such for almost 400 years.

In "All About History", UK, 2019, issue 71, excerpts pp. 12-26. Digitized, adapted and illustrated to be posted  by Leopoldo Costa.