UK Press Features

Medical secrets of the Middle Ages

The Times – October 03, 2006

As someone brought up by parents interested in alternative medicine, I’ve spent much of my life in flight from it — refusing to believe anything medical if it hasn’t been said to me by a doctor in surgical scrubs and surrounded by gleaming stainless-steel instruments. Recently, when researching a 16th-century novel, I found myself fascinated by how far modern conventional medicine has come. Below, I chart the differences — and some similarities — between then and now.

DOCTORS

In the 1530s, there were three types of medics. Gentlemen physicians offered learned, rational or astrological explanations for illness. They provided herbal remedies (provided by apothecaries or herbalists) in the form of purgatives (suppositories), clysters (enemas) and pills, sometimes coated with gold to make them work better — for “inward” ailments. Surgeons were lowly tradesmen,who set bones, amputated limbs and performed the only operation on internal organs they then knew — the removal of kidney and bladder stones. Finally, midwives were licensed by the Church and had the duty not just to deliver babies but to persuade mothers to divulge the names of the fathers, so the latter could be encouraged by the parish to marry.

THEORY

Unlike today’s practice-oriented treatments, medicine in the 16th century was based on a single all-encompassing theory: the notion that health depended on balancing the four humours — or liquids — in the body, which were thought to correspond to the four elements — fire, air, water and earth. The liquids were blood (the source of vitality), phlegm (colourless body secretions from semen to sweat to tears — a lubricant and cooler), choler (or yellow bile, the gastric juice) and black bile (or melancholy, a dark liquid never found pure but which was reckoned responsible for darkening other fluids). Blood made the body hot and wet, choler hot and dry, phlegm cold and wet, and black bile cold and dry.
Illness was said to occur when one humour was retained in excess — “becoming plethoric” — or putrefied. The clerk Bartholomai Sastrowen remembered that his father was “rather rash” and “when the choler got the upper hand, he could not control himself”.

PREVENTION

Treatment of an illness consisted of analysing a patient’s urine to decide which humour dominated. Remedies would then be prescribed to rebalance the body by siphoning off whichever fluid was corrupted or in excess, whether through bleeding or purging or vomiting.
There were two Classical models for prescribing antidotes — the Greek Hippocrates advocated conservative cures such as waiting and watching, bed-rest, tonics, care, calm and hope; and Galen, a self-publicist from Roman times, preferred violent purges or drastic blood-letting. The rich employed physicians on a permanent basis to offer detailed advice, such as avoiding the food of the poor and to go horse-riding, which was more beneficial than the sweaty labour of the peasantry.

CURES

Many diseases of the 16th century were caused by the curses of poverty — dirt, bad hygiene and malnutrition. These reduced resistance to the epidemics of syphilis, smallpox and tuberculosis brought to medieval England by war and travel. The modern diseases of affluence — from obesity to cancers brought on by overindulgence in alcohol or tobacco — were little known.

Syphilis was thought to have come to Europe with Columbus after his return from America. The acute form that afflicted early sufferers ate away noses and genitals, twisted limbs, and often killed in its early stages.

In the 16th-century William Clowes wrote in De Morbo Gallico that “this pestilent infection of filthy lust” which “increaseth daily” could be cured by: (1) perfect amendment of life (2) punishment and (3) submitting to Clowes’s cure, based on mercury. Patients were shut in a “stew”, a small steam room, for 20 or 30 days at a time. They were coated from head to foot in a mercury-based ointment, swathed in blankets, and left until the sweat poured down. Disgusting secretions issued from their mouths and noses; sores filled their throats, tongues, cheeks, lips and the roofs of their mouths. Their jaws swelled and often their teeth fell out.

The modern cure is penicillin (typical UK treatment is ten days of procaine penicillin). Syphilis, in its current, chronic form, is on the rise again in England. According to the British Medical Journal, since 1996 the number of diagnoses in England has more than doubled.

Pulmonary tuberculosis was called consumption in the 16th century because it appeared to “consume” its victims. It accounted for around one fifth of all deaths. Tubercular infections of the lymph nodes in the neck caused a disease known as scrofula. At that time there was no cure, though scrofula was thought curable if the king touched the sores. Samuel Johnson was among the thousands who queued for this cure.

Today, active TB is still widespread in the developing world and kills two of every three people affected if not untreated. Generally, it is treated with several antibiotics, called antituberculants, taken in various combinations in order that resistance is prevented.

Mental health: in the 16th century people considered truly mad were those who tore their clothes, disobeyed their natural masters (parents or social superiors), or wandered around naked. The many tribulations of women’s lives — miscarriages, the deaths of children, infertility — were often ascribed to mental troubles but visions, trances and hallucinations were not as feared then as now since they could form part of the religious experience.

Elizabethan practitioners thought frenzy and madness “proceed from the inflammation of the phlegms of the brain”, so changes in diet might be prescribed. They also blamed hysteria on “too much abstinence of Venus”, and, as late as the 19th century a typical “treatment” was massage of the patient’s genitalia by the physician and later vibrators or water sprays to cause orgasm. If society decided that London lunatics were too unpredictable or violent to roam free, they would be shut up in Bedlam, the fee-paying mental hospital, where they might have their heads shaved or be chained.

As an example of modern treatments, the Labour peer Lord Layard said recently that cognitive behavioural therapy was key in tackling mental troubles from anxiety to schizophrenia.

Insomnia: historically, extended and troubled sleeplessness was treated with a syrup of poppy, whose base ingredient was opium, then as now a powerful soporific.

Today, doctors try to avoid prescribing strong sedatives such as temazepam and alternative methods are often preferred, such as lavender, used in the 16th century to avert plague, or valerian, used in the 16th century for cooking soups and medicinally for treating “crampe and other convulsions”.

There were some other cures that are unlikely to be regain popularity. Hair falling out: rub scalp with burnt doves’ dung or the ashes of little frogs. Lice: comb hair with an ointment of mercury and swine grease. Colds: turnip up the nose. Headaches: a garland of verbena round the head, or “set a dish of tin on the bare head, put an ounce and a half, or two ounces, of molten lead therein while he has it on the head”. Teething in children: brains of a hare rubbed on to gums. Epilepsy: mistletoe “taken in the month of March and the moon decreasing”. Chilblains: a hot mouse skin rubbed on them.

Portrait of an Unknown Woman by Vanora Bennett is published by HarperCollins at £15

ENDS