Medicine as practiced by medieval Europeans was much different from how it is practiced today; most major advances in medical science have occurred only recently, within the past 150 years or so, and many of the techniques used up until the 19th century seem excruciating and even barbaric to us today. Nevertheless, medicine was a serious study in medieval and early modern Europe, and practitioners of those times did they best they could with the accumulated knowledge they had access to.
Medicine in medieval Europe and Arabia was based on the theory of four “humors,” first explicated by the ancient Greeks. According to this theory, the body is composed of four substances, or “humors”: black bile, yellow bile, phlegm, and blood. Each of these humors was believed to have distinct characteristics and had to be maintained in proper balance for the body to function properly. As a result, much treatment was grounded in misguided efforts to restore the balance of these humors.
The body disposed of excessive amounts of any one humor through natural processes such as sneezing, sweating, crying, urinating, defecating, and the like. For proper bodily function, medieval doctors stressed the prevention of illness through exercise, a healthy diet, and a clean environment — advice that holds true today but is sometimes overlooked by modern medicine. In diagnosing a disease, medieval doctors would often examine the color of a patient’s urine or blood.
Medieval doctors often believed that their patients were ill because of an excess of blood, and the practice of bloodletting was widespread, thought to be a cure for almost any ailment. There were two principal methods of bleeding a patient: either by leeching (attaching a leech to that part of the body most severely affected by the ailment and allowing the leech to suck off a quantity of blood), or by venesection. This latter technique involved cutting an incision along a vein, usually on the inside of an arm, and allowing a substantial quantity of blood to flow off. To make the incision, doctors used a “fleam”: a narrow, half-inch-long blade.
Many people, primarily monks, submitted to regular bleeding treatments, whether they were sick or not, as a sort of preventive health measure; recovery from a bleeding often took several days.
Surgery was a last resort in treating an illness, and, because medieval doctors had only limited understanding of human anatomy, antiseptic techniques, and anesthesiology, surgery was extremely painful and often led to debilitating infections. In the early Middle Ages, surgeons were generally monks, because some monks were able to read Arabic — the language of most cutting-edge medical research of that day. However, in 1215, a papal decree barred monks from performing surgery, so the task fell to others, even simple farmers who were sought out because of their ability to at least successfully castrate their farm animals.
During surgery and other painful procedures, some efforts were made to administer anesthetics. One commonly used concoction was called “dwale”: a mixture of lettuce juice, gall from a castrated boar, bryony, opium, henbane, vinegar, and hemlock juice. This was stirred into wine before giving it to the patient to drink, presumably to make it more palatable. The hemlock alone would be enough to kill a man. A Swiss Renaissance physician, Paracelcus, was the first to use ether as an anesthetic; he is also credited as being the first to use laudanum, or tincture of opium. Morphine, a derivative of opium, is widely used today as a painkiller.
Eye cataract surgery was one procedure that was rarely successful. In early efforts, a doctor would poke a knife or large needle through the cornea, forcing the eye’s lens out of its capsule. Techniques from the Islamic world, which were more advanced, were later imported; syringes were then used to extract cataracts by suction.
Blocked bladders were another matter. The blockage of urine, caused by venereal diseases such as syphilis, was a common condition in medieval Europe, due to the absence of antibiotics. The use of a metal catheter first dates to the mid-1300s; such primitive catheters, and other methods for accessing the bladder, were likely as dangerous and even life-threatening as the condition itself.
A medieval version of an enema involved a tool called a “clyster,” a long metallic tube with one cupped end and one perforated end, shaped like a dull point. The pointed end was inserted into the anus, and fluid was then poured into the cupped end; a plunger was used to pump in these fluids. Usually, lukewarm water was considered sufficient to cure the patient’s ailment; occasionally other liquids such as vinegar or boar’s bile were injected through the clyster. The clyster was replaced by the more common bulb syringe in the 16th and 17th centuries.
Hemorrhoids were as common in medieval times as they are today; there was even a patron saint for sufferers of hemorrhoids, the Irish monk St. Fiacre. If prayers to the saint did not cure one’s hemorrhoids, a more practical technique involved the use of hot irons, applied by a doctor. Hippocrates, considered the father of Western medicine, suggested using one’s fingernails to dig out hemorrhoids. The 12th-century philosopher and physician Maimonides wrote a treatise on hemorrhoids and prescribed a less painful method still employed today: the sitz bath.
Although there is much that remains a mystery to modern medicine, we are fortunate to be living in an age in which the practice of medicine takes into account the comfort of the patient, and in which, for most common ailments, we stand at least some chance of successful recovery!