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Medieval Medicine: How People Survived in the Age of Bloodletting

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Nervous about your next trip to the dentist? Be grateful you live in the 21st century. In the Middle Ages, a toothache could only be remedied by having your local barber yank the tooth from your mouth without anaesthetic. On the plus side, you could get your hair cut while you were there.

Healers in the Middle Ages: Where Did People Go for Treatment?

Here's a brief overview of the various types of healers in the Middle Ages.

The "Wise-Woman"

There were trained physicians in the Middle Ages, but their skills were reserved for the rich.

The common folk instead relied on their local "wise-woman," who would use her knowledge of herbs to concoct various ointments and broths for treating anything from headaches to painful joints. She could also be called upon to deliver babies.

Such methods shouldn't be sniffed at. These treatments were the product of knowledge passed down through generations, and many of them were quite effective. Some are still in use today.

Unfortunately, village folk saw the skills of the wise-woman as being magical rather than an early form of science. This was fine at first, but from the 14th century onward, the church began to take a dim view of "magic," which resulted in many wise-women being accused of witchcraft and burnt at the stake.

Louisa Mabree, a French midwife, is burnt alive in a cage filled with black cats.

Louisa Mabree, a French midwife, is burnt alive in a cage filled with black cats.

Barbers

People nowadays are reluctant to even get a haircut from a barber. In the Middle Ages, you not only had to go to a barber for a haircut but for surgery as well.

Barbers had a lot of experience treating wounds, setting bones and performing amputations. There's evidence that they successfully removed organs as well.

A barber-surgeon removing a boil from a man's forehead.

A barber-surgeon removing a boil from a man's forehead.

Doctors

Physicians received their training at the famous medical schools of the Middle Ages, such as the universities in Salerno, Italy, and Montpellier, France. Only the rich could afford their services, and many physicians went on to serve in the courts of kings and noblemen.

Their most common method of diagnosis was to examine urine, and their preferred method of treatment for most ailments was bloodletting (draining the patient's blood).

So for all their knowledge, they weren't particularly sophisticated. Doctors in the Arab world were far more knowledgeable and, more importantly, open to new ideas. The doctors of Europe were a little too attached to Ancient Greek and Roman theory, although they had begun to employ more advanced methods by the Renaissance Period.

The Schola Medica Salernitana, founded in the 9th century in Salerno, Italy, was the first and most prestigious medical school of the Middle Ages.

The Schola Medica Salernitana, founded in the 9th century in Salerno, Italy, was the first and most prestigious medical school of the Middle Ages.

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Medical Theory During the Middle Ages

Medical schools of the Middle Ages were built on a foundation of knowledge inherited from the Ancient Greeks, specifically Hippocrates (born in 460 BC), who is regarded by many as the father of modern medicine (doctors still take the Hippocratic Oath).

Another influential figure was Galen, a Greek, born in Turkey, who rose to become the most renowned medical philosopher in the Roman Empire. He served as personal physician to Emperor Marcus Aurelius.

Galen's many contributions include discovering that urine was produced in the kidney and that arteries carried blood. Doctors also used his writings to understand human anatomy, although Galen learned about anatomy by dissecting animals, which made his writings extremely unreliable.

The Four Humours

The concept of the four humours was inherited from Hippocrates, and formed the basis for all medical theory in the Middle Ages.

This was the belief that the body was made up of four fluids; black bile, yellow bile, phlegm and blood. These all had to be kept in balance to ensure good health. To some extent, there was (and still is) a general obsession with the number four: four elements, four seasons, etc. Each of the four humours was associated with a particular season, element and organ of the body. For example:

Blood — Spring, Air, Liver
Yellow Bile — Summer, Fire, Gall Bladder
Black Bile — Autumn, Earth, Spleen
Phlegm — Winter, Water, Brain / Lungs

These designations dictated which humour a particular ailment was attributed to. For example, illnesses that caused sweats and fevers were linked to yellow bile, due to its association with heat. Conversely, an illness that caused chills was supposedly the result of an excess of phlegm.

Mood changes were also attributed to an imbalance of humours. For example, an excess of yellow bile caused anger and irritability, while black bile caused melancholy.

The concept of the four humours remained the primary basis for medical theory until the 19th century when French chemist Louis Pasteur developed Germ Theory, which posited that illnesses are caused by microbes rather than an imbalance of fluids.

A 16th-century illustration of the four humours: Flegmat (phlegm), Sanguin (blood), Coleric (yellow bile) and Melanc (black bile).

A 16th-century illustration of the four humours: Flegmat (phlegm), Sanguin (blood), Coleric (yellow bile) and Melanc (black bile).

The Influence of Religion

Religious institutions were extremely powerful during the Middle Ages, and medical theories had to be sanctioned by the church. Galen's writings were only allowed because he kept referring to a "creator."

But religion also played a positive role. Monasteries cared for the sick and dying, although there wasn't much the monks and nuns could do for their patients aside from providing prayer and comfort.

Grisly Medical Procedures

Here's an overview of some of the most gruesome medical procedures of the Middle Ages.

Bloodletting

A medieval doctor's go-to cure for almost every ailment was to drain the blood. Seizures? Drain the blood. Headaches? Drain the blood. A case of the sniffles? You guessed it; drain the blood.

It was believed that blood was the most likely of the four humours to be in excess and therefore needed to be drained to restore balance.

Physicians recommended bloodletting but rarely performed it themselves; that was left to the barber, who would simply slit the patient's vein so the blood could pour out into a receptacle.

Of course, there was no method for determining how much blood needed to be drained, so barbers usually just waited for the patient to pass out.

The church condemned the practice and forbade monks from performing it.

Bloodletting: The proposed cure for almost every medieval malady.

Bloodletting: The proposed cure for almost every medieval malady.

Trepanning — A Hole in the Head

Prescribed for severe headaches and mental illness, this horrific procedure entailed drilling a hole in the patient's skull. This supposedly allowed whatever malign forces were causing the illness to be released.

As you'd expect, most patients did not survive.

Trepanning: I need this like I need a hole in the head.

Trepanning: I need this like I need a hole in the head.

Surgery During the Middle Ages

There was no anaesthetic or disinfectant, so patients were given alcohol or herbal remedies to dull the pain, and wounds were treated with boiling oil (or cauterised). Patients had to be restrained during surgery, but would usually pass out from the pain anyway.

A patient is restrained while his leg is amputated. The fire will be used to cauterise the wound.

A patient is restrained while his leg is amputated. The fire will be used to cauterise the wound.

Common Medieval Ailments

When you think of medieval afflictions, the two that most readily come to mind are plague and leprosy.

The plague devastated populations throughout the Middle Ages and the Renaissance Period. The most famous case is the bubonic plague, or the "Black Death," which tore through Europe during the mid-14th century, causing death and suffering on an apocalyptic scale.

The bubonic plague attacked the lymph nodes, causing them to swell and form the "buboes" that gave the plague its name. There were other types of plague: the pneumonic plague, which attacked the lungs, and the septicemic plague, which attacked the bloodstream.

There was no cure for the plague. In hindsight, we know the cause; the Yersinia pestis bacterium was discovered by Alexandre Yersin (a student of Louis Pasteur) in 1894. It was carried by rodents and spread via flea bites, and the squalid conditions of medieval cities allowed rats to thrive, contributing to the spread.

The Plague of Florence in 1348.

The Plague of Florence in 1348.

Leprosy was the other dreaded villain of the Middle Ages. It is famously biblical in nature, as it is referenced in the Bible multiple times as a punishment for sin.

Lepers were forced to isolate themselves from society, living in designated leper colonies and carrying small bells with them to warn people of their approach. Of course, leprosy was not as contagious as people of the time believed; and it became less prominent from the 14th century onward, perhaps due to greater immunity in the population.

The ruins of a leper colony on the Greek island of Spinalonga.

The ruins of a leper colony on the Greek island of Spinalonga.

Saint Anthony’s Fire was a notorious medieval ailment. Caused by the ingestion of rye grain contaminated by fungus, it brought about burning sensations, sores, convulsions, and eventually the spread of gangrene throughout the limbs. An outbreak of Saint Anthony's Fire in France during the 10th century caused an estimated 20,000 to 40,000 deaths.

The name comes from a hospital established in France and dedicated to the saint, specifically for the purpose of treating this illness. Certain herbs were used to try and cool the burning, and gangrenous limbs were amputated.

Pilgrims suffering from ergotism (Saint Antony's fire) approach the abbey in Sologne, France.

Pilgrims suffering from ergotism (Saint Antony's fire) approach the abbey in Sologne, France.

The Dawn of Modern Medicine

The most critical factor in the advancement of medicine was the invention of the printing press by Johannes Gutenberg in 1436. This was one of the most significant events in the history of humanity, allowing for the rapid spread of knowledge throughout Europe and beyond.

Furthermore, the church's waning influence meant that great thinkers could develop new theories and distribute their ideas via the printing press without having to obtain the permission of the Pope.

This allowed for the rise of influential figures such as:

  • Andreas Vesalius (born in Belgium in 1514) developed advanced knowledge of human anatomy at a time when many physicians were still relying on the flawed science of Galen.
  • Ambroise Paré (born in France in 1510) came up with new and improved methods for treating wounds during surgery, concocting ointments that were more effective than boiling oil.
  • William Harvey (born in England in 1578) discovered circulation and demonstrated that blood was pumped from the heart (medieval physicians thought the liver produced it).

Death rates were still high throughout this period as surgeons had yet to discover ways to prevent and control infection spread. But gradually, the field of medicine emerged from the darkness of the Middle Ages and entered the era of the scientific method.

Andreas Vesalius' work was critical in advancing knowledge of the human anatomy, although he was vilified by some for questioning the writings of Galen.

Andreas Vesalius' work was critical in advancing knowledge of the human anatomy, although he was vilified by some for questioning the writings of Galen.

References

Bovey, Alixe. 2015, 30 April. Medicine in the Middle Ages (British Library). Retrieved from https://www.bl.uk/the-middle-ages/articles/medicine-diagnosis-and-treatment-in-the-middle-ages

Schoppert, Stephanie. 2017, March 16. 8 Medical Practices From Medieval Times That Will Turn Your Stomach (History Collection). Retrieved from https://historycollection.com/medieval-medical-practices-sure-turn-stomach/3/

Goldiner, Sigrid (Department of Medieval Art and The Cloisters, The Metropolitan Museum of Art). 2012, January. Medicine in the Middle Ages. Retrieved from https://www.metmuseum.org/toah/hd/medm/hd_medm.htm

Advances in Medical Knowledge (BBC). Retrieved from https://www.bbc.co.uk/bitesize/guides/zyscng8/revision/2


This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

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