Category Archives: Medieval Medicine

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.

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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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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.

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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.

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Medieval Phlebotomy

A_chart_showing_the_parts_of_the_body_to_be_bled_for_different_diseases

For some reason I had assumed that bloodletting wasn’t very common in the Middle Ages, but my current reading about medieval medicine has set me right. Even in the early Middle Ages it was far from unusual.

Bloodletting is a logical consequence of accepting that illness is caused by an imbalance of the humours. As medical texts from the Greek and Arabic-speaking worlds were translated into Latin from the twelfth century onwards, it became even more important as one of the physician’s many skills. Bloodletting was carried out by both surgeons and physicians, even though it was technically a surgical procedure.

One of the purposes of bloodletting was to allow the physician to make a diagnosis. An instruction book, probably written by Maurus of Salerno in the twelfth century, told the physician what to look for in the blood he collected from his patient. The physician was to examine it before, during and after coagulation. He was to look for viscosity, hotness or coldness, greasiness, taste, foaminess and speed of coagulation. You’ll note that this required him to do a bit more than just look at the blood.

The main purpose of bloodletting was to treat diseases by restoring balance between the humours.  All the four humours were present in blood, so an excess of one of them could be removed by drawing off some blood.

The most common place for bloodletting was the arm, in which there were three major veins: the cephalic, the median and the basilic. If the diagnosis was that the patient was melancholic, however, a vein in the forehead was more likely to be cut. The veins in the thumb were associated with pains in the head and the vein between the ankle and the foot was linked to diseases of the genitals.

There were detailed instruction books available to physicians telling them how to tie the arm to prepare the vein and how to make the cut. There were also instructions about how to avoid nerves and arteries near the site of the incision. The manuals also told them how to limit the bleeding when they were finished.

The patient’s diet before and after the bloodletting was important, as were the seasons of the year, the phases of the moon and the time of day when the procedure was carried out. Charts like the one above, which showed where on the body cuts should be made for bloodletting, often included diagrams of astrological influences on the patient. Each sign of the zodiac had power over a specific part of the body and the diseases that affected it. In the fourteenth century, physicians would consult an astrological table to find out when there was a favourable alignment in the heavens for the exact procedure they were proposing. Knowing where the moon was in relation to the signs of the zodiac meant that the physician knew where to cut, since the moon and the other planets drew the humours to different parts of the body. The physician had to examine astrological tables and calendars to hand before he could decide what to do.

There were other things to think about as well. Was it better to remove a lot of blood in one go or to make a number of incisions over a period of time? Should the blood be taken from the afflicted area or from the opposite side of the body to encourage the blood to move away from the site of the disease?

Most medieval practitioners were aware of the risks associated with bloodletting. They were advised that blood should not be taken from small children, pregnant women, the old or the weak. Although they didn’t know what caused it or what it really was, they also knew about the risk of infection. They didn’t know how to prevent it, though, and there was little they could do once a cut became infected.

Despite this, some people had regular bloodlettings. In the late twelfth century,  Peter the Venerable, Abbot of Cluny, wrote a letter to a medical expert asking for help with an illness of long-standing and mentioned that he had put off his bi-monthly bloodletting. He was obviously someone who believed in the preventative efficacy of bloodletting, which was a common practice for those wealthy enough to be able to look after their health. Blood was a warm and wet humour, and bloodletting could make the patient cooler and drier, ready to face a hot summer.

Leeches were also used for bloodletting, but very rarely. I couldn’t even find them listed in the indices of the reference books I used.

Sadly, despite its popularity, bloodletting achieved nothing other than, in some cases, weakening the patient. It was many centuries, however, before the practice was challenged.

Sources:

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:

TheHeirsTale-WEB

 

 

 

 

 

 

 

Amazon

 

 

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Filed under Fourteenth Century, Medieval Medicine, Twelfth Century

The Humours

D for Dentist

The female protagonist of my current novel is a bit of a healer. She has learned all she can about medicine from people who are willing to share what they know and from the books she has to hand. Since she’s betrothed to the son of an earl, she lives in a large household and can see how the sick are looked after. She can also practise on them if the circumstances allow.

In reality, however, physicians were unlikely to share what they knew beyond their families and apprentices, and a woman who was to be married to the son of an earl would see very little of the father-in-law’s household.

There was a vast gulf between those who studied medicine in the universities and those who practised it in towns and villages. Universities trained up men to serve in royal and noble households. They read and discussed ancient and modern writings about medicine as part of their studies, but it’s questionable how much practical training they received.

Practical medicine was left to physicians, midwives, surgeons, apothecaries, dentists and barbers. You didn’t have to be literate to be a good physician. All you had to do was to watch and learn from someone who knew more than you did.

A physician’s main aim in caring for the sick would have been to ensure that their humours were in balance with one another.

The skin wasn’t considered to be an impenetrable barrier to the natural elements: earth, air, water and fire. These four interacted with the body. Each of them also had properties relating to heat and moisture. Earth was dry and cold, air hot and wet, water wet and cold, and fire hot and dry. As well as the external agents, the body was affected internally by blood, phlegm, yellow bile and black bile. These were the humours and a person could only be well if they were kept in balance. There were four of them to match the number of external elements, not because it made any real sense medically.

If someone was thought to have too much of a particular humour, they would be purged. Excessive heat could be removed by the use of cooling herbs. Fiery spices could drive out the cold. The idea of the humours came from Ancient Greece. Aristotle particularly valued hot, thin, clear blood, which he said led to courage and intelligence.

Phlegm was any colourless or white secretion that wasn’t semen or milk. It was mostly associated with the brain, but it was also connected with blood.

Yellow and black bile were said to come from the gall bladder, but were essentially the same thing. They were believed to purify the blood when they were functioning properly.

Blood was considered to be both a single substance and something that was mixed with the other three humours.

It’s not surprising, then, that blood-letting could be considered a cure for certain conditions. Nor is it surprising that the patient’s blood, urine or faeces were examined more closely than the patient himself. The only way a physician could discover what was wrong with his patient was by looking at what the patient secreted to learn what he could about the balance of the humours.

 

Sources:

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:

TheHeirsTale-WEB

 

 

 

 

 

 

 

Amazon

 

 

24 Comments

Filed under Medieval Medicine, Medieval Science