Medicine in the fourteenth century was primitive in comparison to modern standards of medical practice. Most medical practice and knowledge of the time was based on the works of Galen and Hippocrates, who had lived over a thousand years earlier. Their writings of observational medicine were very accurate at the time but by the medieval period, most of their observational practices had been lost and so rendered their medical writings pretty much irrelevant.
However this was not realised at the time and so their writings were treated as a medical rule. Quite simply it was believed generally by physicians and teachers at the time that Galen’s theory of the 4 humours could not be improved upon. 2 At the time their was no understanding of the existence of bacteria and the need for sterilisation of medical equipment. This unfortunately lead to many people being in a worse physical state after their treatment than before due to high levels of infection. Often Barber Surgeons would come to town and perform basic surgery such as tooth pulling and amputations, using the same tools throughout the course of the day, with nothing more than a quick wipe in between procedures. 3
As previously mentioned the basis of most medical knowledge at the time came from Galen’s Theory of the “Four Humours”. The theory was that the body comprised of 4 major elements. These were Blood, Black Bile, Yellow Bile and Phlegm. It was understood that if these were not in perfect balance then the body would suffer and the patient would be ill, leading to one of the four conditions which were being Melancholy, Phlegmatic, Choleric or Sanguine. 4 To restore the patient to full health it was understood that these four elements needed to be rebalanced. This generally occurred by “purging” of the patient, more commonly known as Bloodletting.
This could be done in three ways. Opening of a vein, which often lead to the patient bleeding to death; Cupping, which was just piercing the skin and collecting a small amount of blood in a cup; or the use of Leeches. The phrase “Leech” was Anglo-Saxon for “healer”. 5 A patient could also be purged via the use of natural laxatives. 6 Medical knowledge initially developed differently throughout the world. The Arabs were leaders at the time in medicines and herbal remedies. They adhered to the teachings of Galen and Hippocrates, but were also infamous for being fore-runners in the testing of new medicines. This was largely because of the fact that the Koran taught Muslims to take care of their fellow ill man, yet prohibited dissection, so the Arabs could only really advance in the field of medicine.
At the same time the Indians and Chinese were rapidly becoming infamous for their advanced Surgery techniques. By 1300 the Indians had developed a form of Skin graft called the “Indian Graft” which is still in use of today. At the same time the Chinese had developed advanced forms of acupuncture to help alleviate pain. By approximately 1400 due to trade routes stretching from the far east all the way to Europe, medicines and medical procedures were becoming very centralised due to the growing ease at which knowledge was being spread. Physicians of the time were taught in the growing number of Universities spread across Europe. Primarily the Universities were focussed in Northern Italy and Southern Spain but there were 2 Universities in England, one in Oxford and one in Cambridge. Despite they were still very few and far between and qualified physicians were very rare commodities.
Because of this they charged large fees and were generally only accessible to the higher classes. 10 During a physicians training, he would never actually come into direct contact with a patient. All they would learn would be the works of Galen and how to treat a patients as opposed to understanding the nature of the patients ailment. There were some exceptions to this such as the medical school in Bologna, which became infamous for the fact that it specialised in hands on teaching of surgery. 11 The average commoner only had access to medical knowledge via two different routes.
Firstly there was the Barber Surgeon, who would arrive in a town each market day. He would be able to perform basic tasks such as the pulling of teeth, setting of bones and amputations. This would generally take place on the street surrounded by viewers and all the filth that accrued in the street. As you can imagine this wasn’t a particularly clean process, and barber surgeons were infamous for spreading of germs and disease through the use of infected equipment. This use of dirty equipment also lead to high numbers of people surgeries becoming infected. The second option the commoner would have would be to visit a local wise woman.
This would often be a learned older lady who had a fair grasp of various medicines. She could recommend treatments depending on the ailment according to ancient books known as “Leechdoms”; which would have lists of medicines dating back as far as Anglo Saxon times. A problem many Wise Women faced was if their medicines did not work, then they were open to the accusation of witchcraft. 12 Medical knowledge at the time was split into three main fields. These were Medicine, Surgery and Bloodletting. Medicine was chiefly made up of Herbs and Animals; however there was some use of minerals too, such as Ash.
Most knowledge of medicine recipes at the time was written down in ancient texts, often dating back as far as Galen. Obviously medicine was a continually improving field, with most advancement taking place in the Arabic world as previously mentioned. Most of the older remedies generally appeared to have no logical reason, yet people believed in them due to the fact they had been written down and lasted for so long. An example of this is John of Arderne, who recommended that someone who suffered from Epilepsy should have the crumbs of a roasted Cuckoo blown up their nose as a cure. 13
Surgery in this period was very gradual in terms of its advance. This was largely down to the fact that Western Religion (Catholicism) was against the practice of dissection. Because of this fact very few were prepared to take the risk of finding out more about the human body. An example of one person who did have a good grasp of specialist surgery is an Italian Physician called Mondino Di Luzzi, who became much respected in the world of Medicine. 14 It wasn’t really until the fifteenth century that surgery began to advance more rapidly as the church realised it was essential to allow further study into the human anatomy.
Most surgical knowledge of the time however, was picked up in the field of battle. This was due to the high number of sustained casualties that doctors had to deal with. The main issue surrounding surgery at the time was the lack of an efficient anaesthetic. This lead to Surgery generally being the last form of action taken against any ailment. People such as John of Arderne did try to develop useful anaesthetics using such things as opium and heroin, but these rarely worked and generally a patient had to be tied down or held down whilst a physician worked on them.
As you can imagine this lead to a drastically high number of patients dieing from shock. 15 Bloodletting at the time was a favourite procedure of most physicians. This was because, and I quote “It clears the mind, strengthens the memory, cleanses the guts, dries up the brain, warms the marrow, sharpens the hearing and curbs tears….. Promotes Digestion, produces a musical voice, dispels sleepiness, drives away anxiety, feeds the bloods, rids it of poisonous matters and gives long life….. it cures pains, fevers and various sicknesses and makes urine clear and clean”16
As you can see with physicians genuinely believing all of this, then bloodletting seemed the miracle cure for almost any ailment. Due to the high use of bloodletting it became a precise science and there were tens of various bloodletting points all over the body. Various illnesses corresponded with a certain bloodletting point. 17 Despite the advances in medical understanding there was still a real belief in the supernatural. Religion played a big part. Many people saw that an illness was the punishment of God and that only God could lift this punishment from the people.
In times of severe illness such as the plague religious extremism was rife, with groups such as the flagellans walking from town to town whipping themselves and asking forgiveness from God. 18 Also because of the belief in Illness being the will of God, many religious leaders saw advances in the medical field as heresy. The only medical knowledge the church officially recognised was the writing of Galen. They renounced anything else. This ultimately lead to the church hindering rather than helping their people. 19 Another aspect that played a large part in Medicine was Astrology.
It was taken very seriously at the time as a rapidly advancing science. There was a genuine belief that the movement of the planets affected someone’s physical state. It was believed that you could only operate on someone when their planets were in the correct alignment and it was certainly impossible to ever operate when the moon was in conjunction with a person’s particular star sign. All major physicians would consult an Astrologist prior to carry out any treatment. 20 Partly, I believe to distribute the blame if it all went wrong.
Superstition also played a part in religion in many ways at the time, as superstition stills plays a part nowadays. In fourteenth Century Europe it was genuinely believed that whether a person would live or die could be determined by placing a bird of prey at the end of their bed. If the bird looked at them then they would live, if the bird looked away, the patient would die. 21 During this particular period there was approximately 1200 “hospitals” in England and Wales. However only about 10% actually cared for the sick.
Most “hospitals” were actually set up to care for the elderly, poor or lepers, but they didn’t actually offer any particular medical help. People who were suffering from an infectious disease never were permitted into a hospital in the fear that they may quickly infect the other hospital patients. The primary role of Hospitals at the time was to allow rest and the administration of medicine as opposed to actually trying to cure someone’s illness. Hospitals of the time were often very religious and were generally runs by Nuns who acted as nurses, although you could have common women working in them as “lay-nurses”.
In most wards you would find an alter at which to pray. Usually you would be praying for the person who has funded the hospital. 22 Its interesting to note that established Hospitals only began to appear in western Europe around the high middle ages. Hospitals as an idea were not new and had been used by the Romans and even as far back as Sri Lankans around 500BC. 23 Finally its relevant to point out that women were common in Medieval medicine despite not being accepted into other fields at the time.
However they were not allowed to become qualified physicians and only really were permitted to practice on other women and children, primarily in the role of a midwife. There were some exceptions to this rule as early as the eleventh century in the famous school of Salerno which sanctioned women to learn and practice medicine on the same level as men. The reason this was permitted is as follows “In the fourteenth and fifteenth century, women did practice in the city [Salerno]. Women do, in fact, seem to have been tolerated in medical practice as in no other profession.
One reason for such tolerance is that caring for the sick was regarded as charity and came within the scope of those who were in orders, nuns as well as monks”. 24 To conclude it can be seen that medicine of the time was quite primitive, yet there was some degree of understanding of the body and advances were made, if nothing else than via the method of trial and error. Medicine continued to advance slowly, but not for another 500 years did medicine really start to resemble the medical world we see of today.