The Medieval Physician


Somewhat confusingly, for me at least, the medieval surgeon didn’t usually deal with things inside the body. His remit didn’t really go much deeper than the skin. He removed things from it or amputated limbs or sewed up wounds. It was the physician who dealt with what was inside. Diseases were his responsibility.

His job was to diagnose what was wrong with the patient, and to balance the humours in order to restore him to good health. Like the surgeon, the physician was rather hampered by not knowing what went on inside the body. The only clues he had to what was wrong with his patient were what he could observe from the outside and what was secreted from the inside. Urine, blood and excrement could all be useful in making a diagnosis, but urine was probably the most useful. He would ask the patient to provide a flask of urine for examination. He was looking at its colour, its thickness, its contents and the amount excreted.

Once a diagnosis was made, treatment was prescribed. This most often related to diet. Different foods had different effects on the humours and the physician would prescribe the foods he thought necessary to restore balance. He could also prescribe specific treatments such as the gargles I wrote about at the beginning of this series, or he might bleed his patient.

Possibly the physician’s most important skill was the ability to tell when someone was going to die so they could ensure that the patient made a final confession and received the sacrament before death. The following selection of ways in which you can tell when a patient is going to die comes from the early Middle Ages:

  • If someone has pneumonia and blood comes out of his thumb he will die 7 days later
  • If there are 3 pustules next to the patient’s navel (one white, one pink and one livid) he will die that day
  • If the patient has a pain in his nose and there are thick red patches which aren’t painful on the side of the nose, and he wants vegetables, he will die in 25 days
  • If a patient has haemorrhoids, and pustules appear on the soles of his feet, he’ll die in 18 days

John of Mirfield, who died in 1407, collected together scraps of medical knowledge into his Breviary of Bartholomew. The collection was made for the staff of St Bartholomew’s Hospital in Smithfield.

John describes some symptoms that usually lead to death if they appear early in the disease. If the following signs appear later in the course of the illness, however, the prognosis is always death:
“The patient cannot bear to gaze upon a lighted candle and he sheds involuntary tears, whilst the eyes appear to squint and one seems smaller than the other: or the whites of the eyes appear bloodshot and the veins black, swarthy, or sallow, the eyes inflamed, and the eyeballs protruding or sunken, whilst the  whole aspect of the face is unsightly and horrible to look upon.”

Here is another certain way to tell whether or not the patient is going to die. The physician should rub the sole of the patient’s right foot with lard and give the lard to a dog. If the dog eats it and doesn’t throw it up, the patient will live. If the dog ignores it or eats it and brings it up again, the patient will die.

Helpfully, John also tells his readers how to discover whether or not their patient has died. They have to put a lightly roasted onion under his nose. If the patient is still alive, he will scratch his nose.

Medieval Medicine: A Reader edited by Faith Wallis


April Munday is the author of the Soldiers of Fortune and Regency Spies series of novels, as well as standalone novels set in the fourteenth century.

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Filed under Medieval Life, Medieval Medicine

29 responses to “The Medieval Physician

  1. I always knew wanting vegetables was a bad omen!Brilliant 🙂

    Liked by 7 people

  2. We thought the current medical establishment had it’s problems!! Thanks for the reminder of much its progressed!!

    Liked by 3 people

  3. Fascinating! I wonder how some of these ideas were arrived at. Presumably if the putatuve corpse did something other than scratch their nose they were still considered to be alive.

    Liked by 2 people

    • You’d hope so. Most medical ideas followed in the fourteenth century came from Antiquity. Medical practitioners weren’t encouraged to observe and draw their own conclusions. If it was good enough for Aristotle, Galen and Avicenna, it was good enough for them.

      Liked by 2 people

  4. Love the roasted onion! Really enjoying this series April.

    Liked by 1 person

  5. It’s amazing to think how far modern medicine has come but of course it had to start somewhere. Fascinating read as always.

    Liked by 3 people

  6. When taking a pulse isn’t an option in medicine yet, who would have thought patient reaction to scent is the next best thing. That’s actually quite clever!

    Liked by 2 people

    • It’s not as daft as it seems at first. A few things I’ve read indicate that they did know something about a pulse, but I’m not sure what. I’ll do some digging. There might be a post in it.

      Liked by 2 people

  7. I’m not sure my dog would eat anything I rubbed on my foot first. I’d certainly get that WTH? look from her.

    Liked by 2 people

  8. I find it interesting about bleeding. Many people seem think that people could be bled to death with leeches, but I knew someone who kept some, and they seemed to think that was nigh on impossible.

    Apparently, a leech will only take about a tablespoon full of blood, and then drop off. You’d need to literally have hundreds on you, or have a problem with blood clotting for them to do you any real damage.

    Liked by 2 people

    • I don’t know how much leeches were used for bleeding in the Middle Ages. Usually it involved opening a vein, which could cause the patient to bleed to death if the physician or surgeon didn’t know what they were doing or made a mistake.

      Liked by 1 person

      • They’d have to be quite spectacularly incompetent to allow that though. I mean surely surgeons had enough common sense to know how to stop bleeding and make an effort to do so.

        Personally, I don’t know of many cases of people who bled to death. Probably because the physician or surgeon would have been in serious trouble if they had allowed that to happen to someone important .

        Liked by 1 person

        • It was another three hundred years or so until William Harvey worked out how blood circulated, so medieval surgeons and physicians were working a bit in the dark. If you don’t understand why blood moves as it does, stopping someone from bleeding to death might not be straightforward.

          Liked by 1 person

      • I know. They must have been right often enough for these things to become accepted knowledge.

        Liked by 1 person

  9. Losing the Plot

    I’m trying hard not to laugh, it’s not funny, but it is ridiculous

    Liked by 1 person

  10. Pity that “churgury” & “physicke” were so long separated. Ancient healers likely joined the two than medieval healers, who slavishly gave each separate spheres. Only a portion of the ancient treatises of Galen and his ilk survive. Medieval folk probably never thought to wonder if there was more.

    Physicians also studied astrological signs. Confluences of the heavens carried great weight when diagnosing. Surgeons were not likely to have had much education in astrology, a revered “science” of the time.

    Surgeons often learned their trade in the one activity that seems to have spurred so much real medical progress; warfare. They’d return home, set up “tonsorial parlors” in their homes (nothing fancy, maybe just kitchen tables, hot fires & the goodwives’ knives), treating scalps, giving shaves, pulling teeth, amputating appendages, slicing out the tongues of scolds, etc.

    I’ve heard that common people usually relied on folk remedies and surgeons,
    leaving the physician for a last-ditch effort when all else failed. I’m willing to bet they actually fared better than the well-off, who, by convention, relied more upon “learned” physicians from the onset of symptoms.

    Remember the ailments of Henry VIII and Edward VI, whose doctors’ efforts probably did little toward healing. I think their treatments were a series of very bad (and terrified) guesses.

    Compare Henry’s festering leg to the skull found at the Towton battle site, which showed remarkable signs of having been previously healed of a terrific head wound, allowing the soldier to fight again. Speculation is strong that this soldier was probably treated by combat surgeons. This is not to say surgeons always had spectacular results, but given the circumstances, I’d have to guess that their craft garnered better empirical data.

    Perhaps internally, surgeons were at a disadvantage, I believe, but no more so than the doctors.

    Liked by 1 person

    • There probably wasn’t much change in treatments from the fourteenth century to the sixteenth, when Henry VIII and Edward VI, although I don’t know much about Tudor times. They really weren’t encouraged to think for themselves or to observe.

      Liked by 1 person

  11. The long-term unwillingness to question the medical teachings of the ancients has always struck me as odd, particularly where it didn’t tally with observation. It’s probably linked to a reverence for writing, scholarship and books, but seems to have persisted after increases in literacy, printed texts, and the willingness to question other types of authority.

    Liked by 2 people

  12. Pingback: Five Things To Do With Urine In The Middle Ages | A Writer's Perspective

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