Matilda Bone (14 page)

Most people believed that sickness was a result of sin or witchcraft. Souls were considered more important than bodies and were cared for more attentively. There were a few hospitals, but they were shelters for the old and the poor, not centers for medical treatment. Practitioners worked on their own; I found no evidence that indicated the existence of a community such as Blood and Bone Alley, but since shoemakers and potters and weavers gathered together, I imagine that medical people did, too.

Medicine in the Middle Ages was based on Greek, Roman, and Arabic writings and relied heavily on practices that had not changed for two thousand years. Medieval physicians believed in the theory of bodily humors, a theory that had descended unchanged from the ancient Greeks. In the body, it was thought, were four humors—blood, phlegm, yellow bile, and black bile. The humors in balance meant good health. Too much of one or another affected a person's temperament—an excess of blood made a person cheerful; too much phlegm, sluggish; yellow bile, ill-tempered; black bile, melancholy—and led to illness. Treatment consisted mostly of procedures to expel the extra or corrupt humors: bleeding, enemas, diuretics.

Watercasting, or uroscopy (the examination of urine), was of vital importance. Ancient textbooks enumerated the many observations to be made—for example, taste, smell, color, and consistency—for it was believed that every illness or disease in the body was reflected in a person's urine. A physician took a patient's pulse, examined the urine, and made a diagnosis.

Medicines were made and prescribed by physicians and apothecaries. Some medicines were gross (snail shells and eggshells, herbs, and soap for gallstones), some dangerous (broth made from the rags of Egyptian mummies), and others magic (bezoars, stones from the stomach of a goat or cow, believed to counteract poisons). Remedies made from poppies, foxglove, and bread mold most likely were effective; they are the precursors of morphine, digitalis, and penicillin. Other useful practices—using cobwebs to stanch blood, setting and splinting fractures—probably grew from trial and error. Experiments with refraction and magnification led to the development of eyeglasses by the fourteenth century. Considering the reliance on ancient practices, the prohibition of dissections, and medieval practitioners' faith in superstitions, patients were lucky physicians got as much right as they did.

In the Middle Ages the categories of medical practitioners were probably very fluid, nowhere near as rigid as today's medical specialties. Most physicians did no surgery, believing it a profession of low status better left to barbers. Some surgeons were trained; some were closer to butchers than barbers. There were attempts at anesthetics, such as the "soporific sponge," soaked in opium and placed over the patient's nose and mouth, but in general these did not work. Most who had major surgery died. Most wounds festered; most diseases were fatal.

Barber-surgeons cut hair, pulled teeth, treated wounds, and amputated limbs. They advertised their status by wrapping bloody rags about poles in front of their shops. The modern red-and-white-striped barber pole is said to have descended from these early advertisements.

Other medical practitioners included leeches or bloodletters, who cut veins or used actual leeches to draw off excess blood or corrupt humors, and worm doctors, who believed all illnesses and diseases were caused by worms in the body and sought to destroy those worms without first destroying the patient.

Physical manipulation such as Peg did was often the work of specialists called bonesetters. In England for hundreds of years this work was the special province of great bonesetting families—the Thomases of Liverpool, the Suttons of Norfolk, the Taylors of Lancashire—some still in practice in the nineteenth century. Today such work is done by chiropractors, osteopaths, and orthopedists.

In the Middle Ages most medical practitioners were trained through apprenticeships or experience. Only the most learned, a very small percentage of medieval healers, attended schools. There were medical schools from at least the seventh century in North Africa and the Middle East, most notably at Baghdad and Cairo. The first medical schools in Europe were founded at Cordoba (Spain) by the seventh century and Salerno (Italy) in the tenth century. For a short time in the eleventh century both men and women were trained at Salerno; the most famous Salerno physician was a woman who has come down to us in legend as Trotula, or Dame Trot.

The most educated physicians were not necessarily the best. As Matilda discovered, healing requires more than knowledge and technique. Those like Peg and Tom and Margery who spoke to their patients and listened to the answers, who looked at them carefully, who touched them and developed relationships with them—these were the real healers, regardless of education and reputation.

Although there were relatively few women in the medical professions, they were represented in all fields. Censuses list women physicians, leeches, surgeons, barbers, and apothecaries. Most medical women, however, made up the least prestigious ranks—midwives, wisewomen, herbalists.

In the later Middle Ages merchants and craftsmen began to form themselves into bodies of recognized experts called guilds, which took on a regulatory function. In the fourteenth century so too did physicians. The regulation of medicine led to licensing. This restriction and control meant, on the whole, the regulation of women out of the medical professions. Medical schools did not again accept women until the mid-nineteenth century, and then not without a fight.

As I researched the medieval medical world for
Matilda Bone,
what struck me most about medieval medicine was how fortunate we are not to have to depend on it. Although four hundred years from now physicians might find today's medicine primitive, inefficient, and gross, still I think we are fortunate to have come far enough not to be faced with raven dung on a sore tooth or frog spawn in the eyes.

Books dealing with medieval medicine that I consulted include:

Erwin H. Ackerknecht, M.D. A
Short History of Medicine.
Baltimore: Johns Hopkins University Press, 1982.

Logan Clendening, comp.
Source Book of Medical History.
New York: Dover Publications, 1960.

Nancy Duin and Jenny Sutcliffe. A
History of Medicine: From Pre-History to the Year 2020.
New York: Simon & Schuster, 1992.

Guido Majno, M.D.
The Healing Hand: Man and Wound in the Ancient World.
Cambridge, Mass.: Harvard University Press, 1975.

Steve Parker.
Medicine.
Eyewitness Science series. New York: Dorling Kindersley, 1995.

David Riesman.
The Story of Medicine in the Middle Ages.
New York: Paul B. Hoeber, 1935.

Nancy G. Siraisi.
Medieval and Early Renaissance Medicine: An introduction to Knowledge and Practice.
Chicago: University of Chicago Press, 1990.