Medical science in Medieval Europe was based upon the writings of the Third Century Greek physician Galen who believed that the condition of man both physical and emotional was based on the four humours - blood, phlegm, yellow bile, black bile - and that it was an imbalance in these humours, known as the dycrasia, that was the cause of illness and disease. For example, an excess of yellow bile caused warm diseases, a surplus of phlegm cold diseases.
Thus, while the Church taught that illness was a punishment from God requiring renewed devotion, penance, prayer, and His mercy physicians sought to restore the balance in the humours their preferred treatment being blood-letting, purges, and emetics.
Leeches were regularly used to drain the blood from the body but this was an expensive treatment and tended to be the preserve of the wealthy but it was thought improper however for those of noble birth to have their blood drawn by the lower-orders, a deed which could set a dangerous precedent. It was a dilemma resolved by the use of a personal physician, one often resident at Court who understood the courtesies and protocols of attending to the rich and did so under licence.
In the case of the poor no such niceties were required and cuts would be made in haste to the body for fear of contamination and the blood physically expunged with the diagnosis both before and after made according to the colour and the smell of the bodily fluids. As such, human urine and excrement became much inspected commodities in medieval society.
The teachings of Galen, which were to dominate medical thought well into the eighteenth century, also had considerable impact both socially and culturally. This was particularly so in the case of women.
According to Galen a woman’s womb is essentially cold so to prevent it from freezing over it has to be regularly lubricated with male sperm. It was only through frequent copulation that fluids could be released that would otherwise coagulate and poison the host body.
This freezing of the womb, the Green Sickness, was believed to affect a woman’s mood and an over emotional response to events or a tendency towards tears were considered an indication of illness. It was thought a woman who nagged displayed the frustration of not having had enough sex.
But in Medieval Society this was a licence to rape which though technically a crime was almost impossible to prove and why it was thought should a man be punished for merely assisting a woman in the facilitation of a natural and necessary bodily function, and if a woman became pregnant as the result of being raped then it must have been because God willed it.
After all, a child was a gift from God but then if so it a perilous and painful gift.
It is difficult to ascertain with any certainty the ratio of women who died in childbirth but it has been estimated by some to be as high as 1 in 4 with the death of the child even more frequent.
Male doctors rarely attended during labour which was considered a woman’s domain even though the women who assisted in the delivery had no formal training other than they had previously given birth themselves and were thought to understand better the processes of the female body.
Although there was little that remained unknown about the actuality of childbirth any complications would invariably result in the death of the mother, the baby, or both.
The safe delivery of a child would quite literally be in God's hands.
To treat the pain of childbirth rose oil would be rubbed into the skin and the mother given vinegar to drink. She would also be provided with a crucifix to hold as prayers were chanted for her safe delivery and that of the child.
Following the birth the mother would have to undergo ‘Churching,’ a series of rituals undertaken before she would again be thought fit to re-enter the community. These would vary from place to place but would often involve having her naked body washed before being sprinkled with holy water, followed by a private blessing, and constant prayer over a number of weeks. The trials of the new mother would not cease with the end of Churching for a period of confinement would follow as a fertile and resilient young woman would be vulnerable to kidnap.
Surgical techniques were always in advance of medical and biological understanding and surgeons could re-set bones and carry out operations such as the removal of a gall bladder or and indeed a Caesarian Section, very effectively.
Always present on the battlefield surgeons regularly bound up wounds using extracts from plants such as Mandragora to anaesthetise the patient and egg white to stem the flow of blood. They had no understanding of germs, however.
Medicine was first recognised as a profession in England in 1215, and Physician Guilds quickly began to emerge.
Prior to this anyone with an ailment that required treatment would have approached a herbalist, even though it could often be difficult to find one for practitioners of herbalism were always liable to be accused of witchcraft and as such were reluctant to treat any illness they thought too severe. If the patient recovered it could be considered magic. If they died they would often have to face the wrath of the patient’s family.
Herbs formed the basic ingredient of medieval lotions and potions, as indeed they still do in large part today. For example, coriander was used to treat cramp, dill to treat indigestion, and fennel to treat fever. An understanding of herbal remedies was highly regarded but also greatly feared for it was just as easy to poison as it was to cure.
Most monasteries possessed a herb garden and as a result became centres of both diagnosis and procurement
Similarly, most medieval hospitals were often affiliated to monasteries and were places of ritual and prayer where good order and regular diet were considered to have a beneficial and therapeutic effect. It was also possible in a hospital to be treated by a doctor but hospital attendance was neither free nor cheap.
Unlike the herbalists, or ‘Wise Women,’ the new medical profession was legitimate and had the endorsement of the Church along with the power of its prayers.
Those who became doctors were University Graduates and often used their knowledge of numerology, astrology, and the movement of the planets in their diagnosis of what ails a man, and these newly qualified physicians would be busy in a world where illness was commonplace with new each season bringing its own problems.
The winter months were cold and unforgiving especially for the worse off in society whose clothing would be threadbare at the best of times. In truth, the only way to keep warm was to be in close proximity to a fire or in physical contact with each other but this was easier said than done.
The Royal Forests were off-limits to commoners and wood for burning was a much sought after commodity. In the autumn it was common practice for the nobility to allow, for a small fee, the collection of branches and twigs that had been blown to the ground by the high winds. The trees themselves however remained inviolate.
The colds and coughs caused by the bitter winter months were as common then as they are today but at a time when there were no drugs available for immediate relief and it was difficult to remain either dry or warm it was not uncommon for people to die of them.
The summer was no less beset with problems. The rough wool which was the standard wear for peasants and town dwellers alike lead to skin lesions which often left the flesh bloodied and raw. Doctors would treat these with balms and lotions based on the old herbal remedies but they could do little about the summer heat and poor sanitation that lead to the rapid spread of unspecified diseases for most of which there was no treatment and were invariably lethal.
The food eaten was also was also a regular source of illness mainly a result of dietary imbalance (medieval diets were not high in protein) and it not being washed before consumption. Fruit such as apples and berries would be eaten as treats but raw vegetables were avoided as they were considered to be unhealthy. The wealthy and the nobility ate predominantly meat supplemented by cheese and fine wines. They did not consume vegetables, cooked or otherwise, as this was considered to be peasant food and beneath them. Likewise, the poor were unable to eat meat unless it was poached and they survived on thick bread made of barley and rye, soups made with ingredients such as cabbage, leeks, onions, parsley, and garlic. A rabbit if illicitly garnered was considered a treat, anything larger a reason for celebration.
But food was always scarce, especially in winter, and a failed harvest would invariably bring famine in its wake.
Rivers and lakes were used as open sewers and as such water was rarely drunk even when made more palatable by the addition of honey instead beer was brewed and drunk throughout the day.
All whether rich or poor suffered from deficiencies of diet and gastric problems were an everyday occurrence to which warm herbal drinks were believed to hold the remedy, either that or a hot poultice on the stomach.
Many of the remedies to commonplace illnesses would appear bizarre to us today: toothache for example, was believed to be caused by a worm within the tooth trying to gnaw its way out. The cure was to hold a lit candle as close to the tooth as possible without burning the skin but also making the tooth so hot that the worm would be killed.
Headaches were believed to be caused by evil spirits and in the case of persistent headaches a process known as trepanning would be undertaken whereby a surgeon would drill a hole in the skull to release the malignant spirit.
If it was felt that a portion of the brain was diseased then a cut would be made in the skull and the diseased portion removed.
Another commonplace in Medieval European pharmacopoeia was Powdered Mummy, a mixture of crushed bones, often of animals but sometimes of executed criminals mixed with treacle and seasoning. It was mostly applied externally but could also be consumed. It was believed to contain the remains of mummified ancient Egyptians but was usually manufactured much closer to home. Doctors used it to treat various ailments including gout, abscesses, and ruptures.
The existence of mental illness would not be diagnosed for many centuries and though melancholia was recognised as being caused by an imbalance in the humours anything from a stammer to what we would recognise now as schizophrenia were believed to be a curse from God, and would often be referred to as the Devil's Affliction. Masses would be held and prayers said for such people but there were no institutions to care for the mentally ill. They would be made to wander the countryside as beggars to be avoided, mocked, or taken advantage of.
The only treatment for perceived problems of the head was ‘trepanning’ or the boring of a hole in the skull to release evil spirits.
The most feared affliction in Medieval Europe was leprosy, this disease of physical waste and decay terrified people as the leper was perceived to be death in life as if the maggots were eating the flesh of their victims whilst there was still breath in their body. No one wished to encounter a leper and so they were forced to live in isolation and there were more than 2,000 leper colonies in France alone.
Fear of leprosy was soon to be supplanted however, by something far more terrible and frightening.
In 1347, a plague arrived in Europe from the East. It was believed to have been carried upon the backs of the Mongol Hordes, at the time ravaging the Crimea. It was to sweep across Western Europe leaving a trail of death on an unprecedented scale - no one had ever experienced anything like it.
The Bubonic Plague, or Black Death, was to reach the shores of Britain the following year.
The Black Death, or Yersinia Pestis, was to be the most lethal pandemic in human history. It spread across the continent wiping out more than a third of the human population, perhaps as many as a hundred million people. The population of Florence, for example, was reduced from 120,000 in 1347 to less than 50,000 by 1351.
The Italian poet Giovanni Boccaccio described events:
"The condition of the people was pitiable to behold. They sickened by the thousands daily, and died unattended and without help. Many died in the open street, others dying in houses made it known by the stench of their rotting bodies. Consecrated churchyards did not suffice for the burial of vast multitudes of bodies, which were heaped in the hundreds in vast trenches."
There were various forms of the Bubonic Plague but all were fatal and the mortality rates were close to 100%.
The first symptoms would be a high temperature, general nausea, and vomiting. This would be followed not long after by a swelling of the lymph glands in the groin and under the arms, the so-called buboes. This was accompanied by severe skin discolouration, hence the name Black Death.
The unfortunate victim would often be dead within 48 hours of first contracting the illness, drowning in his own blood and bile.
The Black Death spread carried in the fleas of black rats. It was transmitted from human to human upon physical contact or the merest droplet from a person’s mouth, but this we know in hindsight the medical profession at the time had no such conception. They believed it was the result of foul and putrid air caused by the stench of human waste and rotting corpses. They called it the miasma and so to cure the illness it was first necessary to eradicate the putrefaction.
At the height of the Black Death, King Edward III wrote to the Lord Mayor of London:
"Cause the human faeces and other filth lying in the streets and lanes in the city to be removed with all speed to places far distant, so that no greater mortality may be caused by such smells."
If foul smells were the cause then sweet smells must be the solution.
People carried flowers on their person, hung them around their neck, or held them to their nose. But flowers made little difference neither did the cleaning of the streets of human waste, the burying of the victims in deep pits, or the burning of their clothes.
The medical profession was at a loss to find a solution and a myriad of cures were tried:
The Water and Vinegar Treatment saw the patient stripped naked and washed in rose water before having vinegar rubbed into every part of his body. He was then put to bed. If he was still alive days later then the treatment had worked. If he was not, then it had not.
The lancing of the Buboes, the tell-tale swellings on armpit and groin, became common practice.
These were cut open to allow the disease to leave the body. A mixture of tree resin, the roots of white lillies and human excrement were then applied to the cuts.
Medicine was also tried and a typical recipe would read thus:
"Roast the shells of newly laid eggs. Ground the roasted shells into powder. Then chop up the leaves and petals of marigold flowers. Put the marigolds and egg-shells into a pot of good ale. Add treacle and warm over a fire. The patient should then drink every morning and every night."
None of the solutions worked and it soon became evident that the doctors were clueless what to do. As a result, people began to turn to witchcraft. But the suggestion that you should place a live hen next to the swelling to draw out the pestilence and drink a cup of your own urine twice a day was no more effective than the prognostications of the increasingly bemused and terrified medical profession.
Soon these same frightened doctors began to refuse to treat plague victims.
As the Black Death spread ravaging the country and reaping its harvest of human souls the Christian Church began to lose its spiritual authority. They had promised that with greater devotion and through the power of prayer the cure would come. They had declared that it had been God's Will, but they could not explain why, and as thousands of priests, monks, and nuns died they were to show that they were just as vulnerable and frightened as everybody else.
Members of Religious Orders could not be found who were willing to succour the dying, or perform the Sacraments, or to give the Last Rites. Eventually, the Church declared that anyone who was present, even a woman, could say a prayer for the dying.
Neither the Medical Profession nor the Church, were able to understand or cope with the greatest tragedy that had ever afflicted mankind, and a morbid fatalism, best reflected in the children's nursery rhyme:
"Ring around the rosy, a pocket full of posies, atishoo atishoo, we all fall down."
Overwhelmed a traumatised country began to witness the breakdown of the social order as husbands left their wives, properties were abandoned, mothers refused to tend to their children, labourers failed to turn up for work, and Church Services went unattended.
In Avignon, meanwhile, Pope Clement VI survived the plague. He had been advised by his physician Jean de Chauliac to sit between two fires to breathe in the pure air. By doing so he had inadvertently found that heat was a way of both preventing and combating the plague, though no one knew this at the time.
It would take centuries for the Medical Profession to recover a reputation shattered by its impotency in the face of human tragedy.