Anatomy of a Monastery – The Infirmary

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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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.

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, 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

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

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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The Humours

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.

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Catching a Cold in the Middle Ages

In the novel I’m currently working on, the hero catches a cold. This was partly to enable the heroine to visit him while he’s in bed (it’s a bad cold) and also to give him the opportunity to notice that she cares about him. Since she’s picked up a bit of knowledge about what to do with sick people, I thought I’d find out how she might look after someone with a cold.

Although it’s unlikely that my heroine would be aware of what the great medical minds of the Middle Ages thought about colds, I started with Medieval Medicine: A Reader. This book contains texts on medical subjects from the sixth to the sixteenth century.

I often read blogs while I’m having breakfast. If that’s what you’re doing and you’re at all squeamish, I recommend you come back later.

In the early Middle Ages, the main objective of someone treating a cold was to remove the mucus from the head (according to the Natural Remedies of Pliny). An infusion of cabbage leaves was recommended for this. A mixture of the juice of black beetroot and honey administered through the nose would also do the trick. In summer you could decoct clover by mashing it and boiling it in water. The patient would drink the result.

The writer also recommends gargles: one made of mustard, turnip seed, pepper, nasturtium seed, rocket, oregano and celery seed mixed with honey and hot water; and one made of mustard seed, sweetened vinegar, stavesacre ( a poisonous delphinium), hyssop heads and honey. I think honey might have been considered a bit of a cure-all in the Middle Ages, although it was more likely included in the gargles to disguise the taste of the other ingredients.

On top of this the patient was to avoid wine and baths and being out in the cold. In some ways this resembles the remedies of my childhood, in that we were given honey in hot milk and told to ‘wrap up warm’. In the days before central heating, not having a bath when you had a cold was a very sensible idea, so we didn’t.

By the thirteenth century things hadn’t changed much. In On the Properties of Things Bartholomew the Englishman suggested a decoction of roses in rain-water to be applied to the nostrils, except when there was a lot of sneezing going on. Alternatively, laudanum, frankincense, storax and castoreum might work.  Storax was a resin obtained from tree bark. Castoreum is secreted from the anal sacs of the beaver and was mostly used to induce vomiting. Somewhat surprisingly, it’s used today as part of a substitute for vanilla flavouring and to flavour cigarettes. Yes, I did suggest you read something else while you’re having breakfast.

On the Properties of Things was a very popular work and was translated into English and French in the second half of the fourteenth century.

My heroine probably has a couple of recipes for gargles and she has a herb garden at her disposal. I doubt that administering an infusion of cabbage leaves to him would endear her to the object of her affections, though.

 

Sources:

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.

Available now:

 

 

 

 

 

 

 

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