“Often the confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies,” states a powerful quote from Henri de Mondeville. As a French medieval surgeon, Mondeville made many contributions to anatomy and surgery, while also being the first Frenchman to write a surgical treatise. This was known as La Chirurgie, translated to surgery. Many surgeons of the Middle Ages, such as Mondeville, made tremendous discoveries about human anatomy and many major bodily functions. Within Europe, specifically, medical practices became more prominent due to many deadly contagious diseases, such as the plague. The practice of medicine within the Middle Ages derived from many Greek and Roman traditions. Specifically, Hippocrates, considered the “father of medicine,” described the body’s contents with four humors. These are phlegm, yellow bile, blood, and black bile. He also stated that individuals were controlled by the four major worldly elements, such as fire, earth, water, and air. The ancient areas of the world believed that the body could be cleansed by cupping, bleeding, and leeching. These practices continued through the medieval period. In the year 65 A.D., a Greek physician, Dioscorides, wrote De Materia Medica, which was a major source of medical information utilized by the Romans, Greeks, and other archaic areas of the world. This pharmacopoeia dealt with over 600 plants that could be potentially used for medical remedies. Since its creation between 50 and 70 CE, many influential individuals utilized this text as a major source for medical information. Religion also shaped medical practices. In the second century, Aelius Galenus, also known as Galen of Pergamon, used much of the information of Hippocrates in his work. To continue his research on bodily functions and fluids, he performed numerous human and animal dissections, demonstrating that the arteries carried blood instead of air. These specific thoughts, given the name Galenic theories, assisting in medicinal work until the sixteenth century. Dioscorides’ work created the basis of practiced herbal medicine until 1500. As early as the twelfth century, medical schools throughout Europe started developing as medicine became a widespread topic. One of the most common forms of medical treatment was bloodletting (Fig. 1). This was used in order to rebalance the four humors. Medieval physicians would use leaches and other sources to drain and release the blood. Many commoners of the medieval period had a vast knowledge of the natural remedies present with the use of herbs. Monasteries in Europe held gardens where mandrake, chamomile, sage, and many more were grown. Medieval physicians also worked through the process of diagnosis through the checking of a pulse and the inspection of urine and other bodily fluids. Magnus Aurelius Cassiodorus, a Roman scholar, and statesmen, wrote that “for a skilled physician, the pulsing of the veins reveals to his fingers the patient’s ailment just as the appearance of urine indicates it to his eyes.” Another common treatment was offering dietary advice to promote good health. One of the oldest universities in the world, the University of Bologna in Italy, opened in 1088 (Fig. 2). This educational institution helped to educate many physicians from the medieval period through textbooks and lectures. In many Italian universities, the access to another major textbook, Practical Medicine According to Trota and Treatments, become one of the most vital and early texts in the history of gynecology. Written by Trota of Salerno, it is a part of the Trotula ensemble. This group of textbooks, dating from around 1200, spread through medieval Europe. Another university was the school of Salerno in southern Italy. It was believed that it was founded by an Arab, a Jew, and a Christian. The medical faculty at Salerno allowed women to receive an education, which was rare during the time. Another archaic medical school is the Montpellier medical school in France (Fig. 3). It traces back to the tenth century, but it wasn’t founded as a university until 1289. The school allowed whoever had a medical license to instruct, regardless of background or personal religion. In 1340, the Montpellier university included the school of anatomy.
One of the most notorious illnesses of the Middle Ages was the plague (Fig. 4). The height of its severity occurred in the fourteenth century. As it demolished Europe, both the poor and rich fell alike to the disease, wiping out close to fifty million lives. In many areas where the plague was grievous, the Jewish population held a lower mortality rate than those who affiliated with Christianity. This was most likely due to the difference in sanitary traditions. While noticing the “peculiar” distinction, some Christians believed that the Jewish community was resistant to the plague, and many were accused of tainting water wells with the disease. As a result, Christians exiled, tortured, converted, and even killed the Jewish community. According to the Nuremberg Chronicle, in 1348, many of the Jewish residents in Germany were burned after the majority “confessed” to tainting the well. Since the plague was so sudden and new, physicians in the fourteenth century didn’t know how to treat the disease. Those that thought they knew how continued to spread the illness even more. Specifically, the way that medieval physicians dealt with buboes, the swelled lymph nodes of plague victims, shows this. Physicians recommended slicing the buboes and draining the pus of the disease. These medical professionals also advocated the collection and consumption of the pus, prolonging the disease. The corpses of many who fell to the illness lay in streets, as towns and cities are overwhelmed by the number of casualties and how to dispose of them. According to Giovanni Boccaccio, a fourteenth century Italian writer, many perished nightly and daily in the streets. One Florentine chronicler wrote, “all the citizens did little else except to carry the slain to be buried.” Florence, Italy was a hotspot for the plague (Fig. 5). The area had a population close to 120,000 in the year 1337. Around twenty years later, the number of residents was cut by two thirds. In 1340, a pestilence killed 15,000 individuals and the famine of 1347 took the lives of 4,000 more. In 1348, the plague claimed over half of the remaining residents, resulting in only 42,000 left in Florence (Fig. 6). A Florentine witness of the catastrophe described how the perished were thrown into plague pits, covered by a layer of earth, followed by more cadavers, “in the same way as they put cheese when they prepare lasagna.” During the second half of the fourteenth century, outbreaks of plague occurred from 1348, roughly every nine to eleven years. The true origin of the illness was caused by flea bitten rats from Asia, likely spread by trading ships from country to country. According to Agnolo di Tura, “some of the burial sites were so sparsely covered with earth that the dogs dragged cadavers forth and devoured many.” The renown birdlike mask worn by medieval physicians who were caring for the plague stricken held herbs, flowers, or spices (Fig. 7). A full body covering was also worn. There were three types of plague variations, pneumonic, septic, and bubonic. Pneumonic attacked the lungs, septic attacked the blood, and bubonic produced buboes, which would pop. Surgical procedures such as cauterizations, removal of cataracts, amputations, and dental extractions were also practiced by medical physicians in the Middle Ages. Trepanning, the perforation of the skull to relieve pressure from the brain was also done (Fig. 8). These physicians relied on opiates for anesthesia and wine for antiseptics. When a medieval citizen needed to be bled, the barber would be the source. Childbirth during the Middle Ages was taken care by the midwives. Hospitals were present for those who were extremely sick or dying. Numerous monasteries around Europe had hospitals attached to them, but it’s unknown if those were open to the public, as many were for monks. The doctor in a monastery was extremely loyal to prayer, the use of herbal medicine, and even the exorcising of demons. An example of this is the hospital of Santa Maria della Scala in Siena, Italy (Fig. 9). It was originally managed by the individuals involved with the chapter of priests in the cathedral. This health center was known for its support by affluent patrons involved with many works of art. Many other groups had hospitals caring for the sick that weren’t connected to any monasteries. Leprosy was another major disease that ravaged Europe. It was extremely debilitating, which caused an immense amount of fear in medieval society. After much research, it was determined that leprosy was not as contagious as it was believed to be. Those who had the illness were called lepers and were forced to live in the exterior of their village (Fig. 10). To prevent the spread of the disease, many held bells to warn individuals of their nearness. Some churches had leper squints, which allowed those with leprosy to view the Mass without encountering other attendees. Another common illness within the Middle Ages was known as “internal fire,” or better known as St. Anthony’s Fire. Though not as known as the plague or leprosy, the illness is just as life threatening. Both names include fire because those with the disease were struck with burning appendages. The infection was cause by tainted rye in ingested food. Those afflicted with the disease could become gangrenous and cause limbs to fall off. Many remedies were found to cure St. Anthony’s Fire, such as sage to soothe the burning sensation. When the worst possible scenario approached, the amputations of limbs were performed. Not everybody died in these dreadful ways. Childbirth was an extremely common form of death of women in the Middle Ages (Fig. 11). If one didn’t die from childbirth itself, postpartum infections may set in. Since the age of death was relatively young for society, many children didn’t live to adulthood. Since war was also common, battle related images were extremely fatal and common. Religion was a main part of healing the sick. Many would look to Jesus and the Gospels. The concept of the healing touch, as done by Christ, was thought to be held by European kings, specifically from France and England. Many cures were believed to be done by the royals. In a specific example, the King’s Touch was thought to heal certain forms of tuberculosis. The top form of medical help was done through the prayers to the Virgin, Christ, and the saints. Different saints were to be prayed to depending on the ailment. Specifically, if one needed assistance in childbirth, Saint Margaret was to be prayed to. It was also believed that pilgrimage toward a shrine would result in healing. Again, the relics displayed in the shrine would be specific to the saint who heals that specific disease. Canterbury, an important pilgrimage site, was where people who held diseases received cures (Fig. 12). The thirteenth century windows in Canterbury portrays images regarding the cures of leprosy, blindness, madness, drowning, and even the plague (Fig. 13). Specifically, Canterbury was an important pilgrimage site for those with bleeding disorders and blood infections. This was possibly due to the blood shed by Saint Thomas Becket, who was the archbishop of Canterbury from 1162 until his murder in 1170. Those pilgrims who arrived at their specified destination could touch and even bring home relics, which could be used to heal those too sick to make the journey. The power of religious faith was a prominent form of medicine for the sick within the Middle Ages.
Medicinal practices in the medieval times were widespread regarding their processes and intent. Even though many aspects of medical topics were unknown, many were cured from their diseases. Medieval physicians made tremendous discoveries about human anatomy and major bodily functions. The Middle Ages opened the door to new topics of medical research and ideas. Within Europe, specifically, medical practices became more involved as time went on and helped develop what is known about medical practices today.
Fig. 1- A medieval illuminated manuscript shows the action of bloodletting and how it was done. It was believed to realign balance in the body in terms of the four humors.
Fig. 2- The medieval college, University of Bologna is seen above. The traditional architecture from the Middle Ages is seen, including the materials utilized for the walls of the buildings. A medieval architectural style is prominent.
Fig. 3- The Montpellier medical school in France is shown. While being dated back to the tenth century, the school wasn’t founded until 1289. The year of 1340 opened the door to the school of anatomy. The architecture of the school includes a cathedral.
Fig. 4- Many art pieces showing a first account of the plague survived today. In this specific illuminated manuscript, one can see individuals with the plague. It is thought that the three dogs in the image are present because as disease-stricken cadavers were buried in pits covered by a thin layer of dirt, dogs would pull the dead bodies out and devour them. They also appear to be licking the plague victims.
Fig. 5- The manuscript shows a first account of the plague ravaging Florence, Italy. On the left, death can be seen flying in as bodies lay on the ground. A recovering victim remains in bed. On the right, a medieval funeral procession is done for a fallen individual of the plague.
Fig. 6- Those with the plague victims seeking medical clarity are seen heading to the local church. The population of Florence continued to decline.
Fig. 7- A medieval plague doctor’s outfit is seen above. Though this manuscript is from 1656, it demonstrates similar styles of mask and outfit used for protection from the plague.
Fig. 8- This medieval manuscript demonstrates the action of trepanning, which is the perforation of the skull. As seen, the subject’s head is shaved bald, to make the skull more accessible.
Fig. 9a- The hospital of Santa Maria della Scala in Siena, Italy is seen above. It was once a civic hospital, but is now a museum due to the amount of art and history there.
Fig. 9b- The interior of the Santa Maria della Scala is shown. The art covered walls speak to the viewer of the history.
Fig. 10- The illuminated manuscript shows Jesus healing ten lepers. By this image, one can see the effects that leprosy did to the medieval society
Fig. 11- An illuminated manuscript shows a newly birthed baby in the arms of the midwife, as the mother lays in bed. Childbirth was extremely dangerous in the Middle Ages.
Fig. 12- One of Canterbury, England’s medieval cathedrals, the Canterbury Cathedral is seen. This was a possible area for pilgrims to travel to.
Fig. 13- A portion of the thirteenth century windows in Canterbury is seen. Here, diseases prevalent during the time can be seen in the stained glass piece
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