The Medieval World
Updated: 14 December 2009
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On the whole, during the Middle Ages very little was added to medical knowledge. They insist that medical practice was dominated by the superstitious beliefs of a people who were fighting to survive in a harsh society that allowed for little personal control over life events.
This essay will argue that the arrogance of twentieth century academics have succeeded in medical science "re-inventing the wheel" so to speak and, if a little more attention had been paid to the successes and not the failures of medieval medicine, both valuable time and money could have been saved.
In fact, a study of medieval medicine not only provides information on the actual tools of the trade but an historical perspective on the views of people regarding plagues and the cures proffered by doctors and folklore.
In short, medieval medical history furnishes us with more than a cursory glimpse at the people, it enables us to listen to the heartbeat of medieval society and, if we can put aside our twentieth century prejudices, it may even be possible to identify with a people whose insight was not as backward as many history books would have us believe.
Literature on this topic published before the mid 1980s seems to support the view of the inadequacy of medieval medicine. Terms such as "quackery", "superstition" and "blind faith" are frequently the descriptions applied to medical practices and to a certain extent this is not without justification.
To understand why, it is necessary to place medieval medicine within its social, religious, cultural and economic time.
The Middle Ages can be split into two eras: the Early Middle Ages and the High Middle Ages. The Early Middle or "Dark" Ages was a time of upheaval in Europe, characterized by fratricidal wars between the Frankish kings.
The wealthier Roman landlords of western Europe established their own system of self-preservation which became known as feudalism. The nett result of this was that one either owned land which was worked by vassals, or one was a vassal and worked someone else's land for them.
In return for this labour the landlord offered support and protection. These tumultuous "Dark Ages" were the precursor to the more peaceful High Middle Ages, during which the pillars of modern medicine were put in place.
With the cessation of the Viking invasions, the people of Europe were able to spend time in activities other than those exclusively associated with survival. Thus learning and the development of the arts was allowed to flourish. Schools and universities were established.
The Catholic Church made its presence felt in all facets of medieval life, and monastic and religious orders became the order of the day. With the development of the towns came craft specialization and so guilds and Mercantile law were conceived.
It was during this time that "barber-surgeons," "book doctors" and "cutting-doctors" were officially sought for advice and cures in matters of health. What then can we learn from the evidence available on medieval people and their medical practices?
Porter states that it is time to throw off the old attitudes that referred to all previous medical history as "prehistoric anecdotage". He says that the time of medical doctors writing for medical doctors about how wonderful they all are, is over and the time has come to "demystify" the situation and remove the covert propaganda that has until now passed for medical history.
In the place of this disinformation, he hopes to see a new "historical medical topography" which will seek to steep the reader/researcher in the complete medical and life experiences of the era being researched. Porter also asks that the hierarchy of folk medicine and official medical practices be removed so as to eliminate bias.
The right questions need to be asked of the data. Instead of asking questions about why people did certain things, the researcher must now begin to ask what the social mor‚s were. He does not want to do away with all traditional methods of studying medical history but rather increase the parameters which surround this study.
By placing medical statistics within social, political, religious and political context, Porter hopes to make use of parallel fields of enquiry which will then give a more rounded picture of the phenomena being studied.
As with all historical pursuits, one is continually limited by the issues of subjective reporting, and the actual sources available for study. Medieval medical history is based largely on the documentation kept by the religious orders, so one tends to see things in the light of religious standards.
To flesh out what we know we need to look at the literature of the day. Chaucer's Summoners Tale, for instance, provides a humorous look at medieval attitudes to issues of health and illness. Other useful information can be gleaned from the miracle lists painstakingly recorded to determine whether or not a subject was worthy of canonization.
Perhaps the most neglected of all areas is an analysis of the actual remedies prescribed. Inquiry into these may not just produce the useless information that it was once supposed to do.
Hospitals were only built towards the end of the High Middle Ages. Medical practice therefore occurred at the home of the patient and had to conform to social ideals. Illness was largely believed to be a punishment from God and so confession of sin was always the first option in attaining healing.
The relationship between the sick person and the doctor, especially in the cases of women, was governed strictly by the belief in the need for patient privacy. Doctors seldom, if ever, actually examined female patients, and birthing procedures were carried out via a dividing curtain which separated the doctor from the mother. He was not allowed to look at the woman.
The rites of passage into birth and death were governed by the Church. Death was considered to be a public event and the patient, aware of this, conformed to public expectations. There were good deaths and bad deaths. Good deaths occurred when the patient, aware that he was at the end, would call for a priest who would provide the Holy Sacraments.
Having partaken, the patient would ask forgiveness of any sin from both those present and God. He was then expected to depart quietly from this world. A bad death happened if someone was murdered, or died suddenly or with much writhing and shouting. These people were deemed to proceed immediately to hell.
What then do we have in common with these unfamiliar ancient practises? The mere fact that all illness was seen as a punishment from God puts modern man on a par with his medieval counterpart. To this day people want to understand why they are ill.
Whether we go to the doctor, psychologist, psychiatrist, fortune teller or the medicine man, there does seem to be a universal need to understand the cause of the ailment. We are seldom content with just feeling ill.
We need to know the name for the sickness and the manner in which it was contracted. Medieval men and women were no different. Thus analysis of the structures of thought uncovers a mine of useful information about events and personalities of the era being studied.
Not only did the Church decide how best to administer treatments and to whom they should be administered but who could study medicine. A would-be physician had to be of legitimate birth but could receive a special dispensation if he was not.
The candidate had to turn to an honourable general practitioner and become his apprentice. Specialisation of any sort was discouraged. Doctors had become so much an accepted part of society that failure to consult one on issues of health was considered a sin.
If a doctor's operation was unsuccessful it was considered to be the doctor's fault and he was completely liable to recompense the patient or the deceased's family. This did retard the growth of medicine, as doctors were justifiably afraid to try any new techniques, or even any surgery at all.
Perhaps the movements in First World countries today to ensure patients rights to sue at the hint of any malpractice will have the same retarding effect on modern medical advancement.
Medieval theology took a very strong standpoint on the doctor-patient relationship and the question of a fee. Doctors were to treat the poor free of charge and to supply medicines at their own expense. Patients were to be treated even if it was against their wishes.
The physician's duty was to tell the patient in complete honesty the truth about his condition, thus enabling the patient to confess in case he/she didn't live. In 1215 Pope Boniface III prohibited any practices on the part of a doctor, such as extra-marital sex, alcoholic intoxication and disobeying the commandments regarding fasting, which might endanger the healing of the soul of the patient.
Medieval clinics were really established from about the twelfth century onwards, and this can be attributed to a number of factors. European society was becoming more affluent and thus had the funds to build health-care institutions.
Due to the prevailing peace and improved nourishment there was a population explosion. The result was increased contact between people in the towns, and thus the spread of infectious disease, and therefore the need for these clinics.
"Hospitales" were built by the Church as the laity became more involved in humane affairs. Civic groups pledged funds for the upkeep of the hospitals. These hospitals were accessible to both the privileged and the poor alike.
The most noteworthy aspect of the European hospitals was their religious orientation which deemed care of the soul more important than the care of the body. Patrons, patients and lay attendants were all united by common devotional exercises which aimed at their mutual salvation.
Due to the pre-eminence of religious fervour in these hospitals, few were attended by any resident physicians. They were largely called in on a consultative basis.
It was only in the eighteenth century that the value of a resident qualified medical staff was entrenched within the system, and in actual fact it was the medieval Islamic world who perfected the care of the sick by trained physicians.
Chaucer's Summoners Tale provides a useful comment on supposed medieval attitudes towards sickness, as opposed to actual attitudes. This tale links the body and soul in a "distinctly manifold process."
Both the Summoner and the Friar tell of Hell in explicit detail, the Summoner from the point of eternal pain and torment, the Friar from the point of evil in the form of malicious intent and the failure to understand the difference between what is meant and what is inferred. The Friar emphasizes the mind, the Summoner the body.
Both misunderstand the point of each other's tale. The Summoner criticizes the Friar for his spiritual hypocrisy because he keeps his distance from sick people, and when he does eventually enter the home of a sick man he is only able to give a long sermon on anger.
The Friar claims to have seen the dead child of the couple in whose home he is, lifted to paradise and says that his abstinence from food, drink, sleep and sex has resulted in these spiritual abilities - this is a lie according to his wife and proven by his portly waistline.
The Friar highlights the Summoner's lack of perception. Neither the Summoner nor the Friar exhibit any form of compassion for the ailing man. Chaucer is making a comment about the distance between what was advocated by the Church and what was the general practice.
The Summoner's tale preaches about suitable fasting and sorrow for sin and thus the invalid is forced to fast for an extended period. Sickness is related to self-knowledge. When one is sick, one is weak and it is through this weakness that a man will finally take heed of the message that God is trying to pass on to him.
The themes of sickness and health are parallelled with the passion and resurrection of Christ. The ultimate healing is the restoration of body and soul in the risen Christ. The tale is about the achievement of complete self-knowledge and about the failure of the Friar and Summoner to attain this.
It is both a comment on the values of the times as portrayed through the explanation of sickness as well as a yardstick by which the reader can measure the actual perceived performance of the clergy. The ultimate goal of medieval folk was total self-knowledge through Divine revelation in the form of a perfectly risen body.
Having established the prevailing view of sickness, let us take a closer look at English peasants and the effect that these ideals had on them. Of course, we need to remember that peasants were largely illiterate and so they were written about by others who imposed their subjective opinions upon their writings.
So it is difficult to formulate an accurate picture of these people. A practical way of attempting to overcome this problem is to take a look at the miracle lists that were painstakingly compiled as part of the canonization process, bearing in mind that the hagiographer who compiled the lists was intent on presenting a valid case for the canonization of his saint.
Two thirds of the miracles recorded seemed to involve the peasants and the poor urban class. Miracle lists are thus a source of information about the peasants, as well as a primary source of information on medieval Christianity.
At a deeper level they are most valuable in the presentation of health problems, parent/child and male/female relationships. Because the documents would be subject to rigorous inspection by the Church, the compilers would have attempted to be as scrupulous as possible in their compilations.
Thus, according to Theilmann these records may be accepted as the truth insofar as they reveal folk attitudes which, he says, must be accepted on their own terms. In other words, the historian must accept these folk lists as the truth because they were based on what the people believed to be true.
Peasants were always concerned with good health. The combination of hard work, inadequate diet and a lack of doctors led the English peasants to seek another means of attaining health.
Whilst the Church may not have intended the cults to cure people, for many this was either their first or last resort in times of crisis and, given the nature of the times, there were often crises. Children were often pulled out of moats and open wells or pools of water, and the saints invoked to resuscitate them. Overall, it seems that more than 16 percent of miracles involved recoveries from death.
The saints were often called on by the midwives during birthing procedures. Paralysis, blindness (due to the continual smoky interiors of their homes), ulcers, headaches and aching limbs were all the speciality of the saints.
The relationship between illness and psychosomatic causes was not a foreign concept to medieval people. This too formed a region of specialization by the saints. Perhaps healing occurred because the invocation of the particular saint resolved some sort of inner conflict - the medieval predecessor to the modern placebo or the resolution of the Oedipal conflict?
People also invoked the saints to aid them in the location of lost items, people or animals, and in the delivering of prisoners from unjust imprisonment. Was this then an indication of an effort to gain some type of control in a society in which they had little?
It seems that from life-threatening situations to the ridiculous, the saints delivered when invoked. Or did they? Even if incorrect, the peasants perceived the saints as powerful figures, capable of good and evil, as well as the forgiveness of sins. People often forewent the opportunity of medical assistance in favour of the saint's intervention.
Medical practitioners found that their hands were tied in preventing this and, with the outbreak of the plague, even prescribed prayer as a means of defeating the disease over which they had neither understanding nor remedy.
When prayer failed with the plague many people appear to have resigned themselves to the belief that the plague was in fact divine vengeance and therefore they were powerless to defeat it.
What then do these miracle lists tell of interpersonal relationships? It is impossible to ascertain whether parents felt guilty about leaving their children with inadequate care whilst away from the home.
The fact that so many miracles revolved around children could be seen as evidence of a love for children. Husbands are also recorded as invoking the saint's help in the safe delivery of their wife and child in childbirth.
There seems to be a lack of specificity in the sexual distribution of miracles. Compilers tried to present their saints in as favourable a light as possible, thus they may have considered miracles involving men as having more weight than those ascribed to women.
People were so intent on receiving the best help possible from the saints that if travelling to the various tombs of the saints was deemed necessary, this was undertaken. Consequently a picture emerges of a peasant class not limited to one village.
The authorities tried to discourage such pilgrimages as they believed that such mobility would result in the breakdown of social order, and that these pilgrims were potential robbers and beggars.
Therefore what becomes apparent from these miracle lists is evidence which seems to confirm information found elsewhere: an outline of medical problems, as well as the relationship between husband and wife, parent and child.
In other words a picture of medieval peasantry is formulated upon which information gleaned elsewhere can be included. Acceptance of saintly power provided tangible evidence of the power of God, and a source of revenue for the increasingly materialistic Church.
Over 2000 years ago, Polybius taught that the world is an organic whole, where everything affects everything. Plagues appeared to have had the effect not only of crossing time and culture but also of joining time and culture.
The Black Death of the fourteenth century gives insight to that plague and the many that have ravaged the earth since. These observations reveal people's perceptions of the risks, as well as their responses to them.
Foege defines a plague as a "disease or other condition causing high mortality or morbidity and often accompanied by social dislocation." The response to the plague is to a large extent determined by the people's perceived risk, both those afflicted and the decision makers.
This apprehension can be governed by the religious beliefs about disease, and the amount of control felt by the person. Confidence in the health authorities' ability to deal with the plague will determine how the people cope.
Medieval history is characterised by a fatalistic acceptance of disease. The people turned to fetishes, saints and doctors to intervene on their behalf.
If the patient lived, the fetish/saint/doctor was given the credit for the survival but if the patient died, the doctor was held responsible, or it was explained how the patient had failed to carry out the correct ritual associated with the fetish/saint.
Plagues throughout the centuries, and thus also in the fourteenth century, always resulted in some form of social regression. This degeneration is usually manifest through the mistreatment of individuals and the break down in social order.
The fourteenth century crisis saw the abuse of the Jews as they were believed to be the reason for the plague, and the rise in the bizarre Order of the Flagellants. The flagellants conjectured that the plague was a punishment from God and if they beat one another enough they would free society of the evil.
In understanding the spread of the plague, doctors realized the necessity for cleanliness and so twentieth century plagues are kept in check by the quarantining of the afflicted.
Years of analysing the various plagues has lead to the discovery of a system whereby disease and its spread may be controlled.
First, the outbreak needs to be assessed in terms of its determinants, distribution and effects. Constant analysis will then determine what the vulnerable points are and the applicable intervention.
The general public and authorities need to be provided with this information and given advice on action to be taken to prevent contamination, or control it should contamination have taken place. It is at this point that faith in the authorities and believing that they do have the public's best interests at heart is invaluable.
Possibly the South African spread of AIDS and TB can be partly attributed to the failure of the majority to believe in the Government, and the negligence of the authorities in the honest reporting of the true proportions of both these epidemics.
What then was the effectiveness of medieval "potions" and can modern medical science learn anything from the study of them? John Riddle has written a number of papers through which he convincingly attempts to put to bed the popular misconception that medieval medicine was of little use then, and can provide little insight for medicine now.
Since 1916 there have been muted requests made by liberal doctors to re-examine the chemical treatments used in the cure of cancer in past centuries, and especially during the medieval period. In 1955 the challenge was finally taken up.
The United States Cancer Chemotherapy National Centre (NSC) began cataloguing all the potential plant anti-tumour agents. Both technical literature and folklore was used to identify plants for listing. Over 3000 plants were catalogued.
Further research revealed that many of the plants identified by leading pharmaceutical and medical authorities of the Greco-Roman, classical Islamic and medieval periods were "discovered" in the 1960s and 1970s.
Before we can establish the usefulness of medieval medicines we need to clarify a point. Did the ancients have cancers and were they able to distinguish between benign and malignant growths?
The answer is yes. Since Galen (A.D. 129) and Avicenna (980-1037), good descriptions of these neoplasms have been recorded. Unfortunately, the lack of accurate measurements and a failure to record the exact preparations of the treatments has resulted in the loss of valuable information.
In A.D. 50-70 a drug made from autumn crocus was advocated as useful in the dissolving of pus-filled tumours and growths. This same plant was investigated in 1983 as an anti-tumour agent.
Not all medical authorities through the years have recommended autumn crocus as the remedy for cancer but division in the medical field over appropriate diagnosis and treatment did not die with these ancient authorities anyway.
The fact remains that this plant was used in medieval and ancient times as a remedy for cancer. Interestingly traditional modern medicine in Greece advises the internal taking of this plant for cancer sufferers.
Another plant used in the treatment of cancer was "nightshade". Although traditional medicine around the world still uses it, modern Western medicine does not. Another plant effective in the treatment of cancer has been the "squirting cucumber."
This same plant was eaten by medieval women who believed that it was an effective contraceptive. One wonders what the case of cancer would have been in those who regularly consumed this plant? Narcissus contains colchicine and an extract from the bulb is used in modern chemotherapy. This plant also contains properties which would clean up surface wounds, which is just what Galen recommended.
Constantine the African, a man synonymous with medieval medicine, observed that spurge acted to purge black bile and vicious humours. This would have been a valued observation in medieval science which believed that cancer was an excess of black bile. Spurge is used against cancer by the indigenous peoples of South Africa, India, and Finland.
An anonymous herbalist who lived in the fourth century A.D. wrote that "birthwood" was good for nasal carcinoma. In 1969, aristolochic acid from birthwort was found to have anti-tumoral qualities, and is now used in cancer chemotherapy. In the 1970s research found that compounds in cabbage inhibit chemically induced carcinogenesis in rats.
Cato the Elder spoke of the medicinal value of cabbage 2200 years ago. He said that it could be used as a poultice on all kinds of wounds and swellings, and an ulcer on the breast and cancer can be healed by the application of cabbage.
Any modern day mother who has had mastitis will assert the effectiveness of a cabbage leaf on the breasts to relieve the pain and cause the milk to flow.
Old wives tales? Seemingly not. Modern research is investigating the action of the cabbage components in the body as a prevention against cancer. The list continues but the main thrust of all these examples is that most chemotherapeutical agents were "rediscovered" without the benefit of history.
William Stone in 1916 suggested that the past was not completely filled with superstition and stupidities but possibly contained experienced judgements about medicine. He was right.
A study of women's medical practices reveals a number of interesting tensions within medieval society. Although women were not equally represented at all levels of medical practice they were ever present. Midwives were not the only female practitioners of the time.
Women did not only concentrate on women's diseases. It seems that they were becoming more and more proficient in their "trade" so that in 1421 legislation was passed prohibiting them from practising medicine, under the "payne of long emprisonement and a fine of forty pounds."
Although this was ultimately an ineffectual law, the evidence for attempting to inhibit women's medical practice still stands. (One wonders if this predominantly male field today has its roots in that medieval legislation?)
Although Green acknowledges that women's medical was not the exclusive realm of either male nor female practitioners, she does state that the potential for profit in gynaecological practice was not lost on medieval doctors.
Medieval society and security revolved around the women's ability to produce sufficient offspring. This ensured the continuation of the bloodline, especially important amongst the wealthy nobility.
The gynaecological practice, which still persists today, was begun then when men began to instruct women in correct birthing procedures. Medieval views on modesty would none the less have ensured a place in medicine for women even if it was as the assistant of the male doctor.
On the issue of effective contraception in the middle ages, much scathing literature has been written. Riddle and Bullough state that these claims are unfounded, and that contraception and many of the birthing procedures can provide insight into modern procedures.
Leboyer's advice given in 1975, on trying for as quiet and gentle a delivery as possible so as to decrease foetal distress, was common practice in thirteenth century France.
Misconceptions about childbirth are displayed in the twelfth century story about William of England. His hero acts as his wife's midwife in the forest, after a picnic, and lovingly cradles her head on his knees as she sleeps between the births of his twins!
Yet all was not dim ignorance on this issue. Biller states that the sheer volume of written material on medieval obstetrics is impressive. Much has been recorded on the regime of a pregnant women, difficult childbirth and the choice of a suitable nurse.
Squatting to give birth was considered the ideal position, and forceps were used to aid difficult presentation, or for the extraction of a dead foetus. When all else failed, cases were remitted to God and the saints.
David Herlihy, a social historian, suggests that the increase in the life span of women during the High Middle Ages could, along with improved diet, be explained by developments in childbirth techniques.
The study of medical history illuminates not only the medical practices of the era under the microscope but societal value systems and the manner in which they functioned. The people and their beliefs and fears come to the forefront when issues of health are at stake.
A look at medieval medical practices reveals that not only were the people afraid of plagues and disease as we are today but that they had a little more than just superstition and prayer with which to deal with their ailments.
Perhaps it is time for researchers and academics alike to put aside their twentieth century conceit and ask the right questions about our past, so as to ascertain the real answers.
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