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.

THE PIERCED HEART by Lynn Shepherd . A review by Adèle Geras

Lynn Shepherd has just sent me this piece she's written about THE PIERCED HEART....sorry it wasn't here in time for the first appearance of this post!

The Pierced Heart:

A sequel, a star, and a strange tale

by Lynn Shepherd

The Pierced Heart is my fourth novel, and the fourth to feature the Charles Maddoxes, my two 19^th-century private detectives. When I wrote my first book, Murder at Mansfield Park, way back in 2008, I had no idea of turning the idea of a ‘literary mystery’ into a series. It just seemed an enormously enjoyable ‘conceit’ to work with another great work of fiction, and give the reader the double pleasure of a satisfying murder, and the chance to revisit the world and words of the incomparable Jane Austen. But after Murder at Mansfield Park came out people started to say they’d love to see Maddox back, and in Dickens’ bicentenary year I sent his great-nephew, the younger Charles Maddox, to walk shoulder to shoulder with Dickens through Victorian London. Since then I have thrust sent him head-first into the emotional maelstrom which was the lives of the Shelleys in A Treacherous Likeness, and finally and most recently confronted him with his most fearsome foe of all, the Baron Von Reisenberg. Why so fearsome? Because this new book takes its inspiration from Bram Stoker’s Gothic classic, Dracula.

Vampires are, of course, the gift that keeps on giving – look at True Blood, or The Originals, or The Twilight Saga, or the latest Jonathan Rhys Meyers NBC series. The list goes ever one and on. And I’d like to think The Pierced Heart has its own contribution to make, not just by taking the Dracula story back to its literary roots, but by recasting the vampire theme in terms of the clash of science and superstition in the middle of the 19^th century.

And now we come to the rather strange tale of the novel’s fate in the UK.

I had a two-book deal in the UK for Tom-All-Alone’s and A Treacherous Likeness, and when that came to an end I felt my relationship with my publisher had run its natural course, and I wanted to move on. My agent loved The Pierced Heart, as did my US editor, so when it was sent out to UK publishers in the summer of 2013 I was in an optimistic frame of mind. As optimistic, in fact, as I had ever been since I took up this ego-bruising game. But even though two dozen or so houses looked at it, none of them said yes.

So what, you ask, is the problem? Is it a lack of coverage? No, I don’t think so, since Tom-All-Alone’s was a book of the year for both the Spectator and Sunday Express in 2012, the Daily Mail called A Treacherous Likeness “an absolute must”, and it was a historical novel of the year in the BBC History magazine list for 2013. Is it the quality of the writing? Again, I don’t think so – it’s had a wonderful quote on Twitter from Ian Rankin, no less, and a Kirkus star (“another tour de force from Shepherd”). There were some UK editors who just didn’t take to it, as there will always be, but other comments ranged from “this is very good stuff” to “read aloud on a long car journey and had the family hooked” to “a very enticing atmosphere of menace and mystery. All the elements one could possibly wish for in a novel of this scope.” 

All of which leads me to deduce, in a mixture of bewilderment and sad frustration, that the real problem here is that The Pierced Heart features the Maddoxes once more. I’ve made a huge effort to ensure the book can be read in its own right, with no knowledge of the preceding novels, but it’s the ‘sequel thing’ that seems to have been its downfall in the UK. But why? Why should that make the slightest difference to a publisher? Who cares what logo is on the spine, as long as it sells? 

In fact, you might even think (as I did, in my naïveté) that an established character would be an advantage, as much of the hard PR graft is already done. But apparently publishers don’t want to take on a series started elsewhere because they see themselves as ‘brands’. Now I may not know much about publishing, but I’ve worked in marketing and communications for over 15 years, and I know a brand when I see one. Brands are things people buy, so an author is a brand, if they’re successful enough, but the publisher is only ever the vehicle for that brand. And the proof of that contention is that no-one has ever bought a novel because they liked who published it. I don’t go onto Amazon or into WHSmith thinking ‘that last book from [insert publisher’s name] was really good, I think I’ll see what else they’ve done’ and I bet you don’t either. In fact, I doubt most people outside the industry could even tell you who publishes their favourite authors. Because surely the only thing that matters to readers – and has ever mattered - is the quality of the writing.

So what next for me? Perhaps a new direction next time - perhaps something that’s not historical. And maybe, just maybe, Charles Maddox could be back one day too, if I can find a UK publisher to take him on. After all, stranger things have happened…. 

UK readers can buy The Pierced Heart in sterling, from Amazon UK.

I've written about Lynn Shepherd's novels before on this blog and here is a link to my post about her book A Treacherous Likeness.

I am a big fan of her work, because what she does seems to be something especially designed to appeal both to fans of existing works of literature and also to lovers of a good thriller. She's created a detective called Charles Maddox (who will, I hope,  be played by Benedict Cumberbatch in any future screen adaptations) and Charles winds his way in and out of the world created by other works of literature. In Tom-all-alone's, he wound his way in and out of the events and characters of Bleak House. In A Treacherous Likeness, Shepherd wrote of  the comings and goings of the Shelley circle and especially the events surrounding the famous night when Frankenstein was conceived. 

It was obviously only a matter of time before she turned her attention to Dracula.  In The Pierced Heart, though, she goes one better. Not only is this a novel which addresses the matter of vampires, (very popular in the 19th century, as witness the illustration below)  it's also one that deals with many other interesting topics in a way which ups the entertainment value no end. 

Perhaps because vampires in various guises are now so popular, Shepherd adds something that's equally spooky and unsettling while being the antithesis of the supernatural: the scientific.  There's an author's note at the back of the book (which I urge you to read as I did at the very end so as not to spoil any of the fun you're going to have along the way, shivering and shaking...) in which she explains very thoroughly how scientific advances in the late 19th century fed into this story of  serial murder, bloodsucking, illusion, phantasmagoria and so forth.  

              (19th century vampire killing kit) 


The story starts with Charles, our hero, going to look at manuscripts on behalf of the Bodleian Library in a castle belonging to Baron Von Reisenberg. Even though we think we know precisely the kind of place we're going to see, and exactly what Von Reisenberg will be like,   Shepherd manages to make all she writes about seem both new and thrilling. Events, atmosphere, character are all conveyed so well that even the most jaded reader of Gothic will be excited. There are shocks, revelations, discoveries of a most gruesome sort and we are left reeling at the end of Part One.

Events then pass to the Journal of a young woman called Lucy.  The novel moves from her account of matters to what is happening to Charles.  His narrative takes place in London.  The Great Exhibition is on and is currently attracting thousands to look at the newest examples of scientific discovery. Meanwhile, the police are baffled by a  serial killer who rips the throat out of poor prostitutes....the stage is set for a non stop action packed eventful and thoroughly gory and sensational story of love, manipulation, sinister experiments, waxworks, graveyards, sea mists, darkness, illusion and of course, the folklore of vampires.

I do urge anyone who is interested in any aspect at all of magic, illusion,  mesmerism and of course the original Dracula, to read The Pierced Heart.  It's not published in this country (why on earth not, publishers? Beats me!) but you can get the US edition from Amazon.