Somewhat confusingly, for me at least, the medieval surgeon didn’t usually deal with things inside the body. His remit didn’t really go much deeper than the skin. He removed things from it or amputated limbs or sewed up wounds. It was the physician who dealt with what was inside. Diseases were his responsibility.
His job was to diagnose what was wrong with the patient, and to balance the humours in order to restore him to good health. Like the surgeon, the physician was rather hampered by not knowing what went on inside the body. The only clues he had to what was wrong with his patient were what he could observe from the outside and what was secreted from the inside. Urine, blood and excrement could all be useful in making a diagnosis, but urine was probably the most useful. He would ask the patient to provide a flask of urine for examination. He was looking at its colour, its thickness, its contents and the amount excreted.
Once a diagnosis was made, treatment was prescribed. This most often related to diet. Different foods had different effects on the humours and the physician would prescribe the foods he thought necessary to restore balance. He could also prescribe specific treatments such as the gargles I wrote about at the beginning of this series, or he might bleed his patient.
Possibly the physician’s most important skill was the ability to tell when someone was going to die so they could ensure that the patient made a final confession and received the sacrament before death. The following selection of ways in which you can tell when a patient is going to die comes from the early Middle Ages:
- If someone has pneumonia and blood comes out of his thumb he will die 7 days later
- If there are 3 pustules next to the patient’s navel (one white, one pink and one livid) he will die that day
- If the patient has a pain in his nose and there are thick red patches which aren’t painful on the side of the nose, and he wants vegetables, he will die in 25 days
- If a patient has haemorrhoids, and pustules appear on the soles of his feet, he’ll die in 18 days
John of Mirfield, who died in 1407, collected together scraps of medical knowledge into his Breviary of Bartholomew. The collection was made for the staff of St Bartholomew’s Hospital in Smithfield.
John describes some symptoms that usually lead to death if they appear early in the disease. If the following signs appear later in the course of the illness, however, the prognosis is always death:
“The patient cannot bear to gaze upon a lighted candle and he sheds involuntary tears, whilst the eyes appear to squint and one seems smaller than the other: or the whites of the eyes appear bloodshot and the veins black, swarthy, or sallow, the eyes inflamed, and the eyeballs protruding or sunken, whilst the whole aspect of the face is unsightly and horrible to look upon.”
Here is another certain way to tell whether or not the patient is going to die. The physician should rub the sole of the patient’s right foot with lard and give the lard to a dog. If the dog eats it and doesn’t throw it up, the patient will live. If the dog ignores it or eats it and brings it up again, the patient will die.
Helpfully, John also tells his readers how to discover whether or not their patient has died. They have to put a lightly roasted onion under his nose. If the patient is still alive, he will scratch his nose.
Medieval Medicine: A Reader edited by Faith Wallis