Thursday 2 July 2015

The Problem with Medieval Medicine - Gillian Polack

This last month I’ve been ill. Not seriously ill. Just a virus that goes on and on and on. A debilitating virus with nasty symptoms, but just a virus. The reason I can say this with such resigned aplomb is because of the wonder that is antibiotics. Without them, I wouldn’t be breathing now. This is the side of medicine we hear about a lot. The glory side.

We also hear (we the general public) quite a bit about the evil that is Medicine Past. I seem to spend a portion of my classes each year explaining that just because a system of medicine is not the one we’re used to, doesn’t mean it’s automatically just a series of placebos. 

Scientific method is a wonderful thing. It allows us to take an idea and test it. Does this medical compound reduce the symptoms of a disease? Yes! Does it harm humans? Not in a worrying way. Good! We have a potential medicine. If the answers are not so good, then we count it as a dead end, learn from it (“We don’t need to try this again.”) and move on. 

Modern medicines have mostly been created using scientific method. I have some problems with the assumptions of how medicine should be tested and used and how we perceive illness, but that doesn’t detract from lab testing and field testing and the wonder of the double-blind study. Modern medicine may not be everything we mostly think it is, but it’s not half bad. My vile chest infection is cured, after all, and without antibiotics I would not be breathing right now. Prior to clever scientists sorting them out, many people did die. The common cold was potentially fatal.

We don’t know about medieval medicine. Really, we don’t. It hasn’t been tested in the same way.
Every now and again I find medical people (often quite senior in their profession) who have an interest in the Middle Ages who do my workshops and attend my lectures. Every time, we discover something new. My favourite discoveries all came from the one course: the Western European test for leprosy in the Middle Ages would work (it entails blood and a silver bowl) and so does the test for diabetes (the scent of someone’s urine) and so does the treatment for kidney stones (sequential warm baths filled with relaxing herbs).

What this alerted me to was that we don’t know the whole of medieval medicine. We don’t even know the half of it. We haven’t tested it. We’ve just assumed that it wasn’t modern, therefore it was garbage.

Some medieval medicine certainly doesn’t meet modern medical needs. In daily life in countries such as Australia and the UK, for instance, we tend to separate religion from medicine in a way that was inconceivable in the Middle Ages. Our whole world view is different. The spheres move in both universes, but they don’t move in the same way nor, indeed, do they have they same forces propelling their movement. This means that the prayer element and what we see as the magic element of medieval medicine simply do not work for us.

Until very recently, this meant that scientists didn’t even bother checking medieval cures. “They won’t be useful,” was the vague consensus, “because they’re medieval and wrong.” 

This was a failure of scientific method. The baby was thrown out with the bathwater because of preconceived assumptions. No-one took a statistically significant selection of cures and tested them. And yet, in my classes, doctors were still pointing out that some of the principles for balancing the humours would work as modern recommendations for leading a healthy life. Balanced intake of food (not too much, not too little, the right types of food) and gentle exercise are really not that alien to modern thought.

The interesting thing is why our wonderful scientific method failed us in not being applied earlier to medieval medicine. Pharmaceutical firms look for more medicines and more ways of turning those medicines into money. Scientists question the universe and discover fabulous new things about our world every day. Why was it – until very recently- just assumed that the Middle Ages were an area where nothing good was to be found, medically? 

We carry around deep inside us cultural pictures of various periods. Every time someone says “Don’t get all Medieval on me” or “Go back to the Middle Ages!” they’re drawing on a set of pictures, and those pictures say “A time of filth and superstition.” They say a lot more, too. Romance. Adventure. Early deaths. Crusades. It all adds up. It adds up to a sense of period so very strong that when scientists were looking for ways of expanding their understanding of medicine, they turned to Ancient Egypt rather than to Medieval Europe. They often assume that medieval doctors were simply fakes, and that medieval diagnosis and treatment wasn’t worth investigating.

We live with assumptions. We create them in order to live, really. If we didn’t assume that there was air to breathe, we’d be in a spot of bother, so we don’t test air and gravity every single day just to feel safe about them. Some assumptions (like there being air) are very sensible. Science fiction writers test these things and explore what it would be like if… and this is why all fiction is important. It allows us to test assumptions safely and to explore the universe, with or without gravity and air.

Historical fiction enables us to explore history safely. It tells us stories of the past couched within safe parameters. It can also (unintentionally, for the most part) reinforce some of the less sensible assumptions. We know that people breathed in the Middle Ages. This is a sensible assumption. We do not know that people died from the prescriptions of their regular doctors. We certainly don’t know that all doctors were quacks. And no-one has yet tested a complete set of medieval medical cures to find out just what the standards were for the doctors who used them. I know from my students that some diagnoses were accurate and some cures useful and that others were less so. That’s not a proper inquiry, however, it’s random sampling by a non-scientist. 

My answer to general questions about medieval medicine right now is “I need more parameters for your question. What types of practitioners are you talking about? University-educated doctors or apprenticed doctors, apothecaries, midwives, something else entirely? What sort of illnesses? What region?”

 Even then, my answer will be a bit hazy, for I need to read more studies by modern scientists, analysing the usefulness of the work of all these people, cure by cure. Until I get those answers, I don’t know. None of us do. 

The one thing we do know is the assumptions about bad medicine in the Middle Ages are just that. 

I usually offer a pacifier, however. I point out that just after the Middle Ages, Nostradamus was very famous for his medicine (despite not being licensed to practise as a doctor) and that I have his recipe book and I offer his recipe for quince jelly. My mother made it recently, in the spirit of scientific inquiry. She says it’s very nice, but that she should have cooked it a bit longer.


Sue Bursztynski said...

Fascinating and enjoyable post, Gillian! Well, a lot of our medicine was built on early discoveries, wasn't it? The discoverers might have had different reasons for knowing their remedies would work, but work they did. I'm still glad I have access to antibiotics!

Gillian Polack said...

I am exceedingly glad I have access to antibiotics!

Elizabeth Chadwick said...

Wonderful article as always and again a reminder that one size doesn't fit all and that the Middle Ages was diverse and is often misunderstood. I would love to know the full process for the medieval leprosy diagnosis - it may come in very handy for my next novel!

Gillian Polack said...

From memory, you bleed into the bowl and then the diagnostician watches how the blood behaves. The blood of someone with leprosy reacts differently to the sides of a smooth silver bowl to the blood of someone without. Alas, I was looking into this years ago and I quite forget which one sticks to the side more!

Sue Bursztynski said...

Worth checking up. I would imagine you wouldn't do this test till you already suspected that the patient had leprosy from other symptoms.

Gillian Polack said...

Not necessarily. It's a cheap and non-intrusive test (just a bit of blood) and leprosy was something that needed to be diagnosed and handled very quickly, for it was untreatable and was considered infectious.

English Lady said...

A very useful perspective here. I think some people are starting to accord Medieval surgery a little more respect, because there are known examples of operations that did work.
For instance Henry V's surgeon left behind a detailed account of an operation he performed to successfully remove an arrowhead from his face for instance. This was so detailed the the instrument he used could be re-created (he even drew a picture) and tested. Emperical evidence at its finest.

Gillian Polack said...

There are more and more individual studies happening now, but it'll take a while to each the stage where we understand more than a few specific remedies.

Unknown said...

Very interesting insight into the state of Medieval medicine. I've researched 18th American South remedies for various illnesses and developed a deep respect for current medical practices as a result! One of my main characters was a healer/midwife in the late 18th century. Thanks for sharing!

Ruth Kaufman said...

Great post! One of my favorite research books is Medieval & Early Renaissance Medicine by Nancy G. Siraisi because it includes details on practice.

Gillian Polack said...

Siraisi's is one of my favourite books on the subject! I send students to it all the time, because it's so very accessible.