Category Archives: Medieval Medicine

Leprosy in the Middle Ages

This post was inspired by a conversation I had with Dr. Christopher Monk in the comments to a post a couple of weeks ago. Sadly, this post doesn’t deal with the issue we discussed.

If you’re like me, everything you know about leprosy comes from the Bible, a Sherlock Holmes short story and the film Ben Hur. None of that prepared me to learn how rampant the disease was in England in the Middle Ages, nor that it was considered to be extremely contagious. This was later discovered not to be the case.

It was due to this belief that lepers were expelled from their homes to live together in leper colonies or, in more urban areas, hospitals, where their movements were restricted. Lepers were known as lazars, after St. Lazarus, the patron saint of lepers. Lazarus was the man covered in sores who begged outside the gate of a rich man in a story told in the Gospel of St. Luke. He is not to be confused with the Lazarus who lived in Bethany and was raised from the dead in the Gospel of St. John, although the confusion was fairly common in the Middle Ages. Leper hospitals were often, unsurprisingly, known as Lazar houses. Lepers were also known as ‘Christ’s special sufferers’.

Although leprosy was declining in Europe in the fourteenth century, this was also the time when people were most hostile towards lepers and they were accused in many countries of conspiring with the Jews to poison wells, thus causing the Black Death.

Leprosy was presumed to be incurable, but doctors came up with treatments to make their patients more comfortable. Leprosy destroys the cell structure of the skin, nerve endings and lymphatic glands. It was difficult to diagnose, though, as the symptoms varied from patient to patient. These included sores (hence the belief that Lazarus was a leper), impaired breathing, loss of sensitivity in nerves and loss of eyebrows. These were also, however, signs of other diseases. Loss of feeling in toes and fingers was generally considered a good indication that someone had leprosy.

As with all medieval illnesses, doctors and patients believed that leprosy was caused by an imbalance in the humours and that different kinds of leprosy were caused by different imbalances. Elephantia was caused by melancholic blood; leonine by choleric blood; tyria (serpent disease) was caused by phlegmatic blood; and alopecia (fox disease) by blood corrupted by something external to the body. Gilbert the Englishman, a thirteenth-century physician, wrote that it was usual for more than one of these imbalances to be involved. Hoarseness was another sign and a recommended form of diagnosis was to ask the patient to sing.

As in most diseases the patient’s urine, blood and pulse could be used to make a diagnosis. With leprosy the hairs were also examined. If they were thin, pale and grey, it could be a sign of leprosy. I suspect that it was less useful as a diagnostic tool with older patients.

Charity and compassion are not modern inventions and many hospitals were established in the twelfth century, both by the wealthy and by monasteries. Among them were hospitals for lepers. They were run by monasteries and convents, and the patients were known as brothers or sisters.

The statutes of a leper hospital in Gloucestershire have survived from the end of the twelfth century and the inhabitants were required to live by a rule similar to that of monks and nuns. Interestingly, like monks, they could be expelled if they did not amend bad behaviour after having been called to account for it for a certain number of times. People in hospitals were expected to attend services in the same way as monks and to pray for the souls of the hospital’s founders and benefactors. Inmates generally wore a grey coat and a scarlet hat, making them very noticeable if they ever left the hospital precincts.

By the beginning of the fourteenth century there were more leper houses than there were hospitals for the sick in England. It was at this point, however, that leprosy began to decline.

You may be wondering what the photograph at the top of the post has to do with leprosy. I took it from the presumed site of the lazar hospital in Southampton looking back to the town’s main gate to illustrate how far away it was from the town. You can’t even see the gate in my photograph, as it’s about half a mile away. In the fourteenth century what you would have seen was partly common land and partly fields. You would also have seen two windmills. It was on the road north to both Winchester and London, so there would have been many opportunities for travellers to bestow their charity on the hospital’s inhabitants, which they did. As an aside, don’t worry about my safety/sanity as I took the photograph. It was just after seven on a Sunday morning and I was standing in the middle of a zebra crossing, having looked both ways before stepping into the road.

The leper hospital in Southampton, St Mary Magdalene (a common dedication for lazar houses), was set up by 1173. It was given its own lands by its founders, wealthy merchants in the town. As well as gifts from travellers, it was financed by revenues from these lands, legacies and a duty of a penny on each tun of wine imported into the town, a major wine importer. A tun was a little short of 1,000 litres. The area where the hospital was situated became known as Marlands. The patients would have grown vegetables, fruit and plants for medicines.

The hospital was on both sides of the road to the north and I wonder whether one side of the road housed women and the other men, or whether the patients were on one side and the staff on the other.

Lepers essentially left the world of the living to go into a lazar house. They went through a ritual burial, kneeling under a black pall, such as would be put over a coffin, while a mass was said over them. At the end their feet were covered with earth. Everyone knew that they would never return to their homes and families.

Sources:
A Dictionary of Medieval Terms and Phrases by Christopher Corédon and Ann Williams
Medieval Medicine by Faith Wallis
Medieval Southampton by Colin Platt
A Social History of England 1200 – 1500 ed Rosemary Horrox and W. Mark Ormrod
The Scourging Angel by Benedict Gummer
The Companion to Cathedrals and Abbeys by Stephen Friar

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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Spirituals and Spirits

I recently read a novel set in England in the mid-fourteenth century in which one of the characters routinely gets drunk on brandy and Madeira. I sighed. It’s not the first time I’ve come across this, the brandy, that is. I haven’t read a book in which Madeira has been drunk before. Madeira wasn’t permanently settled until the 1420s, so no one would have been drinking Madeira wine seventy years earlier.

Brandy is a slightly different matter, though. I’ve had characters drink brandy in one of my novels, The Mercenary’s Tale, set in 1366. It’s not referred to as brandy, though, and it’s distilled by an alchemist. Yes, what (much) later became known as brandy wasn’t a drink but a medicine.

Wine was first distilled towards the end of the thirteenth century and was certainly being distilled on a regular and competent basis in Avignon in the 1320s. It was believed to have medicinal properties, but no one quite knew how to make the best use of it. John of Rupescissa was a Franciscan friar and an alchemist. He was a Spiritual Franciscan, which meant that he embraced the ideals of poverty set out by St. Francis. The Spirituals thought that the order was moving away from its roots and wanted to return to them. In some, more powerful, quarters they were viewed almost as heretics. If you’ve read Umberto Eco’s Name of the Rose or Stephen O’Shea’s The Friar of Carcassonne, you’ll know that sometimes there really was very little difference between the Spirituals and the heretical Cathars.

By 1344 John was in prison in Avignon. The early years of the fourteenth century were not a good time to be a Spiritual Franciscan. He was allowed to continue with his alchemical experiments, though, and it was probably here that he learned about distillation. He was almost certainly the first alchemist to think about alchemy in terms of health. Alchemy was originally about turning substances considered impure, such as lead, into pure substances, such as gold. John thought about how his alchemical skills could help people to live longer. Along with many others he was expecting the Antichrist to arrive at any moment and he thought Christians would need to be in the best of health to deal with him, so he was searching for a medicine that would achieve that. In the “burning water” or the “water of life” (acqua vitae) created by distilling wine he found something that he thought could protect the body from illness and, for a while, aging.

He thought he had discovered something different from the four elements of fire, air, water and earth that were believed to inhabit all substances, and described it as the fifth essence of the wine, or quinta essentia in Latin. We still consider the quintessence of something to be its purest and most concentrated form.

His belief that alcohol could prolong life was not without foundation. He noticed that meat placed in the liquid didn’t rot. Wine would turn into vinegar fairly quickly, but distilled wine continued unchanged for a very long time. Something that seemed to be incorruptible also appeared to be capable of sharing that property with other substances.

John was also the first to discover that alcohol extracts the useful compounds from plants more effectively than water, which made them more useful in medicines. Somewhat more controversially, he developed medicines using metals such as gold, mercury and antimony.

Brandy didn’t properly become a drink until the fifteenth century. Is it possible that it was appreciated as an alcoholic drink in fourteenth-century England? Of course, but distillation was a fiddly and dangerous process and an alchemist who knew how to make the precious liquid would not have made it in large enough quantities for it to be used for anything other than to continue his experiments for the improvement of mankind and for medicines for a few local people. There certainly would not have been a ready supply to allow people to get drunk on it.

In my own novel, the female protagonist is the daughter of an alchemist and she has learned how to distil wine and how to use it as a medicine, but, like the philosopher’s stone before it, the water of life had a reputation that made it sound extremely powerful and it became an object of desire for those who wanted its power rather than its alcoholic pleasures and she finds herself in trouble as a result.

Sources:
The Secrets of Alchemy by Lawrence M. Principe

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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Five Things To Do With Urine In The Middle Ages

Konstantinderafrikaner

This post has been a long time in the making. It has taken so long because I wanted to find proper sources for everything, but I’ve had to accept that if a respected historian says something in a television documentary it will have to do.

The respected historian I’m referring to is Ruth Goodman. She was in all of the historical farm series on BBC Two, but the series that I’m using are The Secrets of the Castle (about building a castle in the thirteenth century), Tudor Monastery Farm (set in 1500) and Tales from the Green Valley (set in 1620), all of which I watched for the third or fourth time in the last few weeks.  Although the last two are not strictly speaking about the Middle Ages, some of the uses people had for urine then were the same as they were in the fourteenth century.  I was originally inspired to write this post by something Ruth Goodman said in the Secrets of the Castle. She said that people in the Middle Ages used urine for everything. Whilst that’s an exaggeration, it isn’t much of one.

Urine was a valuable resource and it was collected. In the fourteenth century there were no indoor toilets, unless you lived in a castle or a monastery, and nobody who needed to get up in the night was going to go outside to the midden (the most basic form of toilet) or the necessary house (a slightly more sophisticated toilet, with walls and a roof). Even if it wasn’t icy, raining or snowing outside, the toilet facilities would be some distance away from the house and the darkness of night was considered dangerous. Instead of going out they used a chamber pot. This was emptied each morning into a storage pot, which was also kept as far away as possible from the house. The pot was covered and the urine left to ferment,  becoming amonia. I’m a bit shaky on the science, so that  might not be quite what happens. Whatever it is that goes on in the storage pot, there is a usable, but very smelly,  product after three weeks.

We saw one of the uses when we were looking at the production of cloth. Stored urine was used in the fulling and bleaching processes. Urine was pounded into the cloth, with with the feet or wooden paddles. The cloth was rinsed and then spread out to dry in the sun. Something similar was done on a domestic scale on washday. Contrary to popular belief, medieval people in general did wash their clothes and bedlinen. It was their underclothes that they washed, however. The outer layer was usually made from woollen cloth, which can be washed, but takes forever to dry, even in the summer. It made sense, therefore, to protect the woollen garments from things that could make them dirty, such as sweat, by not wearing them next to the skin. Garments that touched the skin tended to be made of linen, which could be washed frequently.  These were put into a tub and had the stale urine poured over them. After a bit of of a soak, they were taken to the river where they were rinsed, then beaten with a paddle to get the dirt out. When they were clean they were dried in the sun.

I wrote last week that tanning was such a malodorous process that tanneries were usually built beyond a town’s walls. One of the reasons why it was so bad was that this was another process that used urine. It was one of the substances used to remove hair from the leather. The leather was soaked in a vat of urine until the hairs could be scraped off. Thankfully, the later processes removed the smell, but being a tanner could not have been pleasant.

Urine was also used in dying, where it was a mordant: a substance that fixes the dye to the fibre so that it doesn’t wash out. Woad, for example,  was picked, chopped finely and moulded into balls. Once the balls were dry, they were ground into a powder, to which urine was added. The threads were dipped into the resulting mixture, which was green. When they removed from the liquid, they turned blue. The technique is still used today by some people who use natural dyes.

Medicine also made use of urine for diagnosing illnesses. Much as you can tell today from your urine whether you’re hydrated or not, or that you’ve been eating beetroot or asparagus, a medieval physician could learn much from the colour, smell or taste of his patient’s urine. That’s why you knew without thinking too much about it that the monk at the top of the post is a physician. His patients are bringing him flasks of urine for him to make diagnoses. Just as kings are always depicted wearing their crowns in medieval art (even if they’re in bed) so physicians are depicted with urine flasks.

Last, but by no means least, urine was used in alchemy. In the fourteenth century alchemy was a respectable science and it wasn’t always about turning lead into gold. In this case, however, it was. One path towards turning one metal into another was to turn one metal into the facsimile of another. The theory was that if you could imitate something you would understand more about how to create it.  Urine, specifially urine from a youth, was used in a process to create an imitation of gold. Just in case you want to give it a go, the recipe is one dram of lime and one dram of ground sulphur. They’re mixed together, then the urine is added and the mixture heated. When it looks like blood, it should be filtered. If you dip a piece of silver into the clear liquid, will take on the appearance of gold.

Sources:
Medieval and Early Renaissance Medicine by Nancy G Siraisi
Tudor Monastery Farm by Peter Ginn, Ruth Goodman and Tom Pinfold
The Secrets of Alchemy by Lawrence M. Principe

 

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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Anatomy of a Monastery – The Infirmary

Infirmary, Rievaulx Abbey (3)

Infirmary, Rievaulx Abbey

The infirmary was where monks went when they were unable to fulfil their duties because of ill health or advanced age. It was also the place to which elderly monks retired. Infirmaries usually had their own chapel, dormitory, refectory, kitchen and latrines. Some infirmaries even had their own cloister where its inhabitants could walk. The infirmary cloister garth was probably a herb garden for the pharmacy. In many ways, it was a monastery within the monastery, but on a much smaller scale.

All the monks stayed there at some point, since they had regular blood-lettings and they were allowed to convalesce in the infirmary for three days afterwards. With its special diet (including meat) and a fire, it was much more comfortable than anywhere else in the monastery, so spending any time there must have made a very pleasant change. The main part of the infirmary space would have been partitioned with wood or stone to make cubicles containing only one or two beds, which would also have made a stay there desirable. The infirmarian and his staff had to be careful, though, as it wasn’t unknown for monks to pretend to be ill in order to enjoy the comforts of the infirmary for a few days.

Sometimes the infirmarian was a physician, but more often a lay physician was employed by the monastery to work under him. He would have been assisted by a staff of monks.

Within the infirmary, there was a pharmacy where herbal remedies were made. It would probably have had a library, probably just a chest, of medical books.

Whatever our opinion of the state of medical knowledge in the Middle Ages might be, they knew as well as we do, that rest is important for the sick. In most monasteries, the infirmary was built far away from the main cloister, where healthy monks walked, worked and taught, in order to ensure that its inhabitants could have peace and quiet.

Care of the sick was important for those following the Benedictine rule. St. Benedict wrote, “Care of the sick must rank above and before all else, so that they may truly be served as Christ, for he said: I was sick and you visited me, and  What you did for one of these least brothers you did for me.” This care extended beyond the monks themselves. In Cistercian monasteries, there was a separate infirmary for the lay brothers and many monasteries provided another infirmary for lay people living nearby, either within the monastery or just outside. St. Bartholomew’s Hospital in Smithfield started in this way, like many other hospitals, in the twelfth century.

By the fifteenth century, the monastic population had decreased and large infirmaries were no longer needed. Some were converted in guest houses or lodgings for the abbot, but some were demolished so that the stone could be reused.

Sources:
The Companion to Cathedrals and Abbeys by Stephen Friar

 

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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Medieval Bodies by Jack Hartnell – A Review

bodies

Medieval Bodies is not what you might expect from the cover or from the title. Based on a podcast I heard in which Jack Hartnell was interviewed about his book, I was expecting something about medieval medicine and medieval illnesses. I was wrong, but in a good way.

It’s a book that looks at the parts of the body (head, hands, feet, skin etc.) and asks how such things were thought about in the Middle Ages. Each chapter is about a different part of the body, starting with the head and ending with the feet. Within each chapter, there’s a look at what medieval medical science thought about that particular body part and then there’s a consideration of what that part meant to people at the time, both physically and spiritually. The chapter on genitals, for instance, talks about medieval childbirth in reality and in art. I enjoyed the chapter on feet, which talks about some of the odd fashions in footwear in the fourteenth and fifteenth centuries.

Hartnell doesn’t just cover thoughts about bodies from Europe, but he also includes Jewish and Islamic writings and illustrations. Islamic works were being translated into Latin from the twelfth century, bringing long-forgotten Greek learning and philosophy into countries north of the Mediterranean. This wider knowledge is reflected in a change of ideas about medicine, while the church had to consider whether or not physicians and surgeons should be allowed to follow the teachings of the pagan Greeks.

There are colour illustrations on almost every other page, making this a book to be browsed as well as read. I enjoyed it very much, although it, of necessity, deals with each subject superficially. Any book with ‘medieval’ in its title already has to spread itself thin, since the Middle Ages lasted more than a thousand years. Medieval Bodies compounds the problem by going beyond the bounds of Europe.

 

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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The Medieval Antiseptic

Bee

At the beginning of last year, I read a statement that honey was spread on wounds in the Middle Ages. That seemed an odd thing to do and there was no source given in the notes of the book. It didn’t even say what putting honey on wounds was supposed to achieve or whether that was a sensible thing to do.

I searched through some of my more likely books, but could find nothing about it at all. I have three books about medicine in the medieval and renaissance periods and none of them mentions honey in their index.

More recently I was reading the magazine produced by the gin club I’m in and there was an article about bees. Apparently honey is a good ingredient for some cocktails, but that wasn’t what I found interesting. Towards the end of the article it said that honey “naturally produces the antibacterial substance hydrogen peroxide in small amounts. In nature this protects the honey stores from bacteria…”. So there it was: an antiseptic that was used in the Middle Ages.

A few weeks after that, I was listening to a podcast I follow and the interviewee was talking about the stockpiling of honey during times of war in the Middle Ages, the inference being that it was taken on campaign to be used on wounded soldiers. She also spoke about a reference to honey being used by a doctor on a very important patient – Prince Henry, soon to be Henry V.

When he was Prince of Wales, Henry fought in the battle of Shrewsbury in 1403. An arrow struck him in the face, penetrating six inches, and he was taken to Kenilworth Castle where John Bradmore, a court physician who was in prison under suspicion of counterfeiting coins, worked out a method for extracting it. Not surprisingly, other physicians were wary of removing the arrow, since the chances of killing the young prince were high. Given that counterfeiting was punished severely, Bradmore must have thought he had little to lose. He also had a plan.

I won’t go into the details of the plan and how it worked out; you might be eating. Suffice it to say that the arrow was removed and Henry survived. What matters is that Bradmore wrote a treatise about what he had done called Philomena, in which he recorded that he poured honey into the wound.

It has taken over eighteen months, and a variety of unexpected sources, but I now feel that I can refer to honey being used on wounds in my novels rather than to some unnamed ointment.

 

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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The Medieval Physician

Konstantinderafrikaner

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.

Sources:
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.

Available now:

TheHeirsTale-WEB

 

 

 

 

 

 

 

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Medieval Hospitals

God's House Tower

God’s House Tower, Southampton

Hospitals might not be something that you associate with the fourteenth century, but most towns had one, if not two. Many were founded in the twelfth century and were the result of both the First Crusade and what might be considered a spiritual revival at that time.

Hospitals were religious institutions. Monasteries and convents had always had infirmaries where sick and elderly members of the community were cared for. From the twelfth century that care was extended formally to the community beyond the walls of the abbeys. Hospitals were usually staffed by monks and nuns, but sometimes a physician was employed as well.

Medieval hospitals took many forms. They could be hostels for pilgrims, hospices for the dying, almshouses for the aged poor, or a hospital for the sick poor. They were founded as acts of charity.

The hospital set up in  Jerusalem after the First Crusade in 1113 was a model for later hospitals. It had room for 1,000 to 2,000 beds with 150 staff. It cared mostly for poor people who were sick and for wounded Crusaders. It provided the ideal of what a hospital should be for many centuries. In the hospital the poor, the wounded and the sick were considered lords and those who looked after them their servants.

Hospitals were mainly for providing hospitality, which is where the name comes from. They were often called a Maison Dieu or Domus Dei. In English they were called God’s House. The hospital was a house because it was always part of a religious community, a household with God at the head. There are the remains of one near where I live dating back to the twelfth century. A God’s House was essentially a large hall where people could lie along the walls in beds. It had a chapel for prayers and mass.

In a hospital there would probably be a fire. Patients might have to share a bed, so the chances were good that you would catch something worse than the reason you were there in the first place. On the plus side, the floor and the sheets would be washed often, and mutton was prescribed, regardless of the illness. The inmates would probably be bathed as well as having their hair washed and their beards trimmed regularly.

There was another kind of hospital in medieval towns, but here the patients were not expected to survive their sickness. Until the arrival of the Black Death halfway through the fourteenth century, leprosy was probably the worst disease you could get. It wasn’t just the disease we know by that name today, but any disfiguring skin disease including eczema, psoriasis and lupus was considered to be leprosy.

Lepers were excluded from society, as it was considered to be extremely contagious.  Hospitals to house lepers were set up not within towns, but on roads into them. Leprosy was also considered to be incurable, so lepers weren’t expected to leave once they’d arrived. Ian Mortimer’s book, The Time Traveller’s Guide to Medieval England, has a very disturbing and distressing description of leprosy in the fourteenth century. Suffice it to say that it wasn’t uncommon for the fingers, toes and noses of sufferers to fall off.

There was a leper hospital a mile and a half away from where I’m writing this. Like God’s House, it was established in the twelfth century and was called the Hospital of St Mary Magdalene. In 1347 it received a grant of land from Edward III. It was supported by revenues from land that had been given to it on its foundation and by legacies. It also benefited from a tax of one penny on each tun of wine imported into the town, a not inconsiderable sum, given that Southampton was one of the main ports through which wine arrived from Bordeaux in the fourteenth century. Despite that, I doubt it was a pleasant place to inhabit.

Sources:

Medieval and Early Renaissance Medicine by Nancy G. Siraisi

The Time Traveller’s Guide to Medieval England by Ian Mortimer

Medieval Southampton by Colin Platt

Medieval Medicine: A Reader ed. 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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TheHeirsTale-WEB

 

 

 

 

 

 

 

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The Medieval Surgeon

Fletcher

Fletcher

I know this photograph doesn’t show a surgeon; I don’t suppose many re-enactment groups have one. The photograph of the fletcher shows the cause of many injuries requiring the surgeon’s skills: arrows.

These days surgeons are the top of the heap when it comes to medical practitioners, but it wasn’t always the case. In the Middle Ages it was the medical experts in the universities who held sway and surgeons were mere practitioners like physicians and midwives.

In theory there was a big difference between surgery and medicine, but in reality there was probably not much difference until the thirteenth century. Only surgeons were supposed to suture wounds, use a knife and set fractured bones, but physicians often did all these things, just as surgeons also prescribed for diseases and gave dietary advice. Both practised bloodletting.

Many surgeons couldn’t read. They learned their skills by being apprenticed to an experienced surgeon and watching what the master did. The apprentice had to learn where and how to cut the skin; how to apply salves and ointments; and how to tie bandages. Surgeons used tools such as knives, mallets, borers, claw-bats, trepans, hooks, forceps and chisels.

Both physicians and surgeons were somewhat limited by their lack of knowledge of what really went on inside the body, since dissection of the dead was prohibited. There was a very strong belief that the whole body of a dead person had to buried in order for it to be raised at the resurrection of the dead. This was one of the reasons why the punishment of beheading someone and removing the head to display it as a warning elsewhere was so terrible. I do wonder, though, how this belief was reconciled with the practice of venerating bits of saints’ bodies. How were they supposed to be raised on the Last Day when their bodies were spread across Europe in the form of relics?

An autopsy was carried out in Italy in 1286 in the hope of discovering which part of the body was affected by an unknown disease that was killing people in the area, but it was a very rare occurrence.

In about 1306 Henri de Mondeville wrote a book called Chirugia (Surgery) in an attempt to elevate surgeons from their lowly position. His book contained detailed pictures and text of surgical procedures covering anatomy, amputation, cautery, lancing boils and embalming the dead. It was a learned and theoretical book in an age when few surgeons could read.

From the mid-fourteenth century there were moves in parts of Europe to ensure that physicians and surgeons were licensed … and that they weren’t women. It was also during this time that surgery and medicine began to become even more separate.

One of my reference books, The Medieval Surgery, contains black and white line-drawings taken from a (probably) thirteenth-century text about surgery by Roger of Salerno. Most of the illustrations (and presumably the text, which isn’t supplied) are very disturbing for a twenty-first-century reader.  Some of the illustrations show the surgeon sticking his finger into a wound to explore it; extracting something from the patient’s forehead with forceps; removing an arrow from the head of a patient; and removing scrofulous sores with a hammer and chisel – all without the aid of anaesthetic.

One of the procedures depicted in the book is the removal of a fistula. It’s on the patient’s face, between his nose and eye. The surgeon cuts into the fistula and inserts a feather dipped in egg white into the wound. Egg white was often used to clean the area of a wound before it was sutured or cauterised. In the case of this patient, it’s cauterisation. The surgeon inserts a rod of red hot iron into a tube placed on the remains of the fistula. It’s definitely not something I’d want someone to do to me. You can see some of the images from the manuscript here.

Sources:

The Medieval Surgery by Tony Hunt

Medieval Bodies by Jack Hartnell

Medieval and Early Renaissance Medicine by Nancy G. Siraisi

 

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.

Available now:

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Medieval Midwives

Cradle

I mentioned in the first post in this series, yes, it’s now a series, that there were different types of medical practitioners and that those who had a university education couldn’t necessarily be considered practitioners. For the next few posts I’d like to have a look at the practitioners and how they differed from one another.

We’re starting with midwives, if only because that’s where most people’s experience of medical practitioners began and still begins. In the early Middle Ages women giving birth would have been assisted by older women from their family, but it became more usual by the twelfth century to have a professional midwife in attendance, in towns, at least. Villages would not have been able to support professional midwives, although there would always have been women around who were more experienced than most at assisting at births.

Some references suggest that 1 in 5 women died whilst giving birth or as a result of complications following the birth. Since most women had 5 or 6 children, a pregnancy must have brought almost as much terror as it brought joy. There are many instructions about the care of pregnant women and we might look at them in another post.

Here is some advice about childbirth from an Italian medical text written between the end of the eleventh century and the beginning of the twelfth. If the woman was going to sneeze with force, she was supposed to hold her nose so that the strength went to her womb. She should be kept warm. Sweet-smelling things such as musk, amber, aloe, mint, pennyroyal, calementum and marjoram (depending on the wealth of the mother-to-be) should be held under her nose to make her womb ‘fragrant’. You begin to understand at this point why the pregnant woman might want to sneeze. The writer, Trota, somewhat surprisingly a woman, then gives some advice that she admits she doesn’t understand. She says that midwives do it, so it must work. The woman was supposed to hold a magnet in her right hand. Trota also admitted that she didn’t understand why having the woman drink powdered ivory or wear a piece of coral at her neck did any good, but recommended it. Her last recommendation was to give the woman a drink containing the white part of eagle dung or the dung of baby swallows.

It was believed that heat was a good thing when giving birth, so childbirth during winter was regarded as more dangerous. If the labour was difficult, the midwife was supposed to rub oil of roses or oil of violets onto the woman’s abdomen and sides – vigorously. She could also give the woman a drink of sugar and vinegar, or make her sneeze. Walking her slowly around the house was also recommended. Wealthier women could be put into a bath to make things easier.

Should the baby start coming out the wrong way, the midwife was to moisten her hand in a decoction of flax seed and push the baby back in and turn it the right way.

Sneezing was also prescribed if the afterbirth wasn’t expelled. It seems to have been quite a useful thing to do whilst giving birth. Alternatively, the mother could be made to vomit by being given a mixture of lye and powdered mallow seed.

Cesaerian sections were only carried out if the mother died. This was to allow the child to be baptised before it died, not to save its life. Death rates for babies were high as well and midwives were permitted to baptise a dying baby if a priest could not be found in time. Even healthy babies were usually baptised within 48 hours of birth.

Women didn’t just practise as midwives,  but also as physicians, although this didn’t please the authorities if they heard of it, even though they recognised that it was more seemly for sick women to be examined by other women.

Sources:

Medieval Bodies by Jack Hartnell

Medieval and Early Renaissance Medicine by Nancy G. Siraisi

Love, Sex and Marriage in the Middle Ages by Conor McCarthy

A Social History of England 1200 – 1500 ed. Rosemary Horrox and W. Mark Ormrod

 

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.

Available now:

TheHeirsTale-WEB

 

 

 

 

 

 

 

Amazon

 

 

23 Comments

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