Medieval Medicine and the Treatment of Wounds
When one thinks of a culture from the past, we may think of it as "unsophisticated" when compared to our own. It's very easy for those of us in the twenty-first century to look at the stomach-churning medical treatments that were available to medical practitioners of the Middle Ages. Leeches plumped-up with a patient's blood, draining the blood of an ill person, cathartics, emetics and doctors and priests reciting prayers over the injured and ill in an effort to have God (or the gods) intervene and heal the loved one. Diseases we hardly see today ran rampant in the Middle Ages. Malaria, liver flukes (which causes liver abscesses), dysentery, tooth abscesses, jaundice (probably caused by hepatitis), pneumonia and anemia were common, everyday diseases that one took in stride in that period. Influenza could be fatal, and even the common cold could be debilitating. This isn't even taking into consideration the injuries sustained during the period. Fractures, lacerations (usually caused by swords and other weapons during the various battles that were fought), eye trauma, poisonings (either accidental or intentional) and childbirth were problems having to be dealt with daily. Throw in the Black Death and it's amazing that the human race survived at all.
All-in-all, considering the knowledge at the time, doctors* did rather well. Their primary role was to comfort the patient and try to encourage the restoration of health...not much different from today's health care providers.
Back in those days, the physician's understanding of the human body was based on the "humoral theory". A theory popularized by Hippocrates, it dominated medicine until the nineteenth century. The theory is based on the fact that all material in the universe, including the human body, was based on four elements: earth, water, fire and air. These humors must be kept in balance; if they are not in harmony, disease results. Even today, with this theory abandoned, the basic ideas are still in our vocabulary. When someone is in a bad mood, he is in "ill humor"; likewise, a person in a good or lighthearted mood is in "good humor".
According to the humoral theory of illness, most health problems could be blamed on an excess of humor; therefore, alleviating this excess would cure the illness. Bloodletting was the most common way of relieving an excess of humor. During the Middle Ages, there were three methods of bloodletting: leeching, venesection and cupping. In leeching, the physician would attach an annelid worm to that part of the body most affected by the patient's condition. The worms would suck off a quantity of blood before falling off. Venesection was the direct opening of a vein for the draining of blood. Cupping, still practiced today by some Eastern cultures, involved the application of heated cups over the skin. As the cups cooled, blood would be drawn to the surface of the skin. Regardless of the method used, the purpose was to reduce the excess of blood in the body to restore balance and health.
One man considered himself the successor of Hippocrates. He was Claudius Galenus, whom we know today as Galen. He was born in A.D. 130 during the reign of Hadrian (famous for the wall in northern England). Galen studied philosophy and medicine all over the Roman empire. He was 35 when he became physician to the emperor Marcus Aurelius.
Galen believed anatomy was essential for a doctor. His writings show that he was a master of dissection. He probably did not dissect humans in Rome, but he did write about the dissection of animals. He had long lists of medications for diseases, and thus is considered the father of Pharmacy.1
Galen emphasized the therapeutic aspect of pus; he understood that pus is a substance that requires elimination; however, unfortunately and above all by Galen's followers, this theory was exploited very narrowly. In fact, Galen's writings were used to advocate the formation of pus in order to promote healing of wounds. This concept continued to be considered valid until the end of the 16th century. 2
The Early Middle Ages (800 - 1200 A.D.)
The collapse of the Roman Empire in the 5th Century ushered in the Dark Ages. Though many people think that the Dark Ages were a period of societal deterioration and was without innovation, some amazing concepts developed; however, the development of medicine wasn't among them. The practice of medicine declined, and it fell to healers to look to the sick and wounded. It wasn't until the 9th Century that the true practice of medicine started on the road that evolved into the medical practice that we know today.
The Benedictines founded the cathedral schools during the reign of Charlemagne and he expanded their use. In 805 A.D. he ordered that medicine should be introduced into regular teaching programs.
It is recorded that the monastery of St. Gall in 820 A.D. had a medicinal herb garden, rooms for six sick people, a pharmacy and special lodging for a physician. This is probably our first example in Western Europe of a hospital. The Benedictine monasteries quickly expanded this trend and soon many monasteries in Europe had attached hospitals.
The High Middle Ages (1200 - 1400 A.D)
During the 13th and 14th centuries, medical teaching had progressed to the point where university degrees were required to practice medicine, graduating the first true "physicians". The 13th century was a time of the birth of the great universities, the two greatest being the ones in Bologna and Montpellier.
William of Saliceto (1210 - 1280) was instrumental in setting up the first school of surgery. He recommended the use of knives instead of cautery during surgery and taught that pus was a bad thing, not a good thing.
Guy de Chauliac (1300 - 1368) was the most influential surgeon of the 14th and 15th centuries. He developed four conditions regarding the treatment of wounds: 3
1. Remove foreign bodies from the divided parts
2. To bring together the divided parts
3. To unite the parts drawn together
4. To conserve and preserve the tissue.
It is interesting to note that today, 600 years later, the same techniques are used for the treatment of wounds.
Theodoric, Bishop of Cervia (1205 - 1298), recommended the use of wine to clean wounds, and wrote that sponges should be soaked in narcotics such as opium and held over a patient's nose to induce a "deep sleep"...one of the first recorded uses of preoperative anesthesia. 1 It was also during this time that the concept of cleanliness was beginning to evolve.
Then all hell broke loose in the middle of the 14th century.
In October 1347, a trading ship put into the harbor of Messina in Sicily. This was the beginning of an epidemic so appalling and destructive that it completely changed the social structure of Europe and left a permanent mark on human memory. The deadly cargo the ship carried from the East was a new disease, Yersinia pestis, also known as The Plague.
The diseased sailors showed strange black swellings the size of an egg in the armpits and groin. The swellings oozed blood and pus and were followed by spreading boils and black blotches all over the skin. The victim died five days later in pain. As the disease spread, another form with continuous fever and spitting blood appeared. These victims died within three days. With both types, anything which issued from the body smelled foul. Despair was the disease's companion and before the end "death is seen seated on the face". This disease spread with terrifying speed and could kill people within hours. 1
Within two years, the Plague ("pestilence" or "Great Death" as it was called at the time) had reached almost all of Europe. In some places, complete populations were destroyed. Twenty million people died...a third of Europe's population.
The doctors at the time thought a person's gaze or the stench of the disease could transmit it, and so they covered themselves with thick clothing and held a cloth to their noses. Some wore elaborate masks shaped like birds' heads which had holders for burning incense in the beads.
One thing that should be addressed is the lasting social effects of the Plague. Peasants found that for once there was not enough human labor and banded together for higher wages and even their freedom. They began to understand that a human life might be worth something intrinsically. In short, the foundation of modern thinking in many areas was laid at this time.
Since this was a new disease, there were no writings "of the ancients" they could turn to in order to heal the disease. The doctors of the time had to do something that had not been done for almost 1200 years. They had to make their own observations and do their own experiments. This allowed future doctors the freedom to think for themselves and question the ancients. Thus was some of the foundation laid for the Renaissance. 1
THE LATE MIDDLE AGES AND RENAISSANCE (1400 - on)
Knowledge and learning spread far and wide during the 14th century, but the work done then was only a prelude to the amazing advances to come. The use of guns became more widespread in battle, therefore the art of surgery also advanced. Wounds were treated with warm, not boiling oil. Amputations were closed with a skin flap instead of being cauterized.
Ambroise Pare (1510-1590) was one of the great surgeons of the Renaissance. He found that a mixture of eggs, oil of roses and turpentine allowed wounds to heal better than scalding oil. His contemporaries discovered the tourniquet and found that arteries that were tied did better than ones that were cauterized.
Sometimes, of course, more drastic surgery was required. Broken bones, grievous wounds, terrible abscesses, and things such as bladder stones required surgery. And generally speaking, surgery was conducted without the benefit of anesthesia, as most means of "putting someone under" was as likely to kill them as was the surgery. And surgery was not conducted in anything remotely resembling a sterile field; the concept of associating infection with germs or bacteria was entirely unknown during the Middle Ages. 4
So we can see that Medieval Medicine, viewed in the perspective of its day, worked pretty well. We in the twenty-first century may view medicine of the Middle Ages with horror. But the job of the Medieval physician was to bring comfort and hope to a patient and the patient's family...not much different than that expected of today's health care providers.
* in this article, the term "physician" or "doctor" is meant to imply a physician, midwife or any other healer