Johnston R.A. All Things Medieval: An Encyclopedia of the Medieval World

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wholesome only when cooked and served with spices to balance these qual-

ities with heat and dryness. Many medieval recipes were created from medi-

cal assessments that a certain meat or ﬁ sh was cooling or dry and needed

balance from particular spices. Too much heat would bring on fever, while

too much cold would bring depression and cold illnesses.

Pork was cool and moist; beef was cool and dry. Pork must be spiced

heavily, while beef also needed moisture. Because birds ﬂ ew in the air,

they were considered warm and dry; they were not spiced, but rather were

served with a cooling, moist dish. Lamb was warm and moist, which could

imbalance the body, and its consumption was discouraged. (The traditional

British accompaniment of mint jelly with lamb could be a last holdover

from a medieval cooling recipe.) Fish was cold and wet, like the water it

swam in, and so ﬁ sh was served with a great deal of pepper and other hot

spices. Lampreys, a type of eel, were considered very cold and wet; they

were soaked in wine, roasted, and spiced so that they were as hot and dry

as possible.

Foods were often labeled unwholesome without regard to modern ideas

of bacteria or poison. A food might be unwholesome for a particular in-

dividual but not for others. Physicians ordered patients to follow restric-

tive diets that would not make sense to modern dieticians. A man with a

naturally melancholy temperament was told to avoid cool, dry beef, which

would exaggerate his cool, dry humor. Instead, he would be advised to eat

birds and take spices. A man with a hot temper would be advised away from

spices, which might lead to overheating diseases such as fever. A cowardly

man of cool blood should drink warming alcohols to put a hotter spirit into

him. Old men needed warming and should take spices; young men needed

a cooling, moist diet. Seasons also needed to be balanced. The cold of win-

ter required pepper and cloves, and meats had to be hot and dry (such as

chicken) or spiced.

Aristocratic households included a spicer who oversaw the preparation

of balancing sauces. In consultation with a physician, the spicer prepared

a meal balanced between hot and cold and between wet and dry for the

lord’s constitution. Some paintings of royal feasts show the king’s physi-

cian standing behind his chair, supervising what the king could eat. After a

meal, whole spices or spiced wines prepared for digestion, since the stom-

ach had to be kept warm. Candied ginger was a favorite dessert for the ar-

istocracy.

Diseases

Medieval medical books were ﬁ lled with accurate descriptions of dis-

eases. Most went by different names from today’s diseases, but some, like

leprosy and malaria, bore names that continue into the present. Diseases

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were named for saints, by description, or, at times, by what was thought

to cause them. Cancer, especially breast cancer, was known. Physicians be-

lieved cancer was caused by demonic crabs inhabiting the ﬂ esh, and they

tried exorcism but could not cure it. The word cancer comes from the Latin

word for crab.

There were many common ailments such as toothache, headache, stom-

achache, and wound infection. Irritable bowels, vomiting, diarrhea, and

lung disease were known. There were also many common wounds that

had to be treated surgically, especially on the battleﬁ eld. The most com-

mon ailment was childbirth, which is not a disease, but it had a very high

rate of mortality for both mother and child. Medical books discussed the

proper way to deliver a baby when its head was not positioned correctly

downward.

There were also many infectious diseases that came in epidemics. The most

famous is the Black Death plague of 1347. This disease broke out of Asia for

the ﬁ rst time and became a returning epidemic all through the Renaissance.

Many less famous epidemics came and went before it.

Saint Anthony’s Fire was an infectious disease characterized by red skin,

high fever, and sores. Sometimes the name may have described shingles, a

painful but not fatal sickness, but its more serious form involved infected

sores that quickly became gangrenous. Some victims lost limbs, and many

died quickly. The epidemic returned at least six times.

Smallpox and measles both caused fever and scarring blisters called pocks

(or pox), and both were treated by bleeding and careful administration

of diet. Smallpox came to Europe when Crusaders returned home from

Asia, and it spread during the 13th century. Diphtheria, an infection of the

throat, caused death by suffocation or dehydration. Cholera and dysentery,

infections of the intestines, also came in epidemics. Malaria was known as

well, and although medieval physicians did not know it was caused by a

parasite transmitted by mosquitoes, they were sure swamps transmitted it.

They attributed it to bad air, leading to its name, malaria . Syphilis was an-

other serious infectious disease that was often fatal. It was misdiagnosed as

leprosy, but medieval physicians recognized that it was sexually transmitted,

while true leprosy is not.

Tuberculosis had been well described by the Greek physician Hippo-

crates in classical times, and it was one of the most pervasive infectious

diseases. Sometimes it was called the wasting disease (or later, consump-

tion), because patients wasted away to skeletons while coughing up spu-

tum and blood. The only known treatment was to go to a warm, dry

climate, but most patients could not afford this, and most died. Tuber-

culosis could also attack the spine or settle in the lymph nodes of the

neck. The medieval name for the lymph disease was scrofula, or King’s

Evil, and many came to believe the touch of a king could cure it. Most

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medieval kings had special days when they touched people who had

King’s Evil.

Leprosy was another common infectious disease. It was an incurable skin

condition in which white or red blotches broke out over the skin, leading

to rotting and either a distorted appearance or a loss of limbs. At times it

was overdiagnosed, since it was a disease people particularly feared. Some

diagnosed lepers may have suffered from other skin diseases, and reports of

lepers getting well may indicate these cases. There was no treatment for lep-

rosy. Lepers were isolated and were legally considered dead. In some places,

there was a ritual funeral for a leper, in which a priest said the prayers

for the dying and the family accompanied the leper to a grave, where the

priest threw some dirt on him. Even without this ritual, lepers could not form

legal contracts or inherit property. They lived in separate leper houses or col-

onies until they died. Strict quarantine may have helped stop the spread of

leprosy; the peak may have been around 1400, when France had as many as

10,000 leper houses. It became a less serious problem in the Renaissance.

Although medieval doctors had no theory that could account for in-

fectious diseases, they began to know by experience that some illnesses

could be transmitted by air or touch. Recurring epidemics of the plague,

throughout the 14th and 15th centuries, made this observation even more

important. Some physicians wore protective goggles and facemasks when

visiting plague victims. They recognized that rooms with an open win-

dow were safer than closed, stuffy rooms, and they recognized that gloves

should be worn when touching an object such as a patient’s urinal. They

also did useless things like keeping rose perfume near their noses. By the

time the plague had returned several times, 15th-century cities began pass-

ing quarantine ordinances. If a traveler came from a plague region, he had

to stay 40 days in an isolated place like an island.

Remedies

Medical works from the ancients had included ingredients such as ground

earthworms, dog excrement, and dried cicadas. However, most medieval

prescriptions seem to incorporate less exotic ingredients, like wine, vinegar,

and other herbs. Opium had been known since Roman times, but it was not

widely available. Some medieval medical books recommend it, particularly

those from the Byzantine East or the Arabic lands, where it was more likely

to be available.

Physicians took seriously their duty to prepare medicines for the sick.

They used a mortar and pestle to grind herbs and spices very ﬁ nely. An eye-

cup was a mixer for creating salves for treating eye infections. Physicians

may have had their own stock of spices and other ingredients or at times

may have drawn on the resources of the household.

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Prescriptions made by physicians were not available to the poor. The

poor used garlic and wild herbs as medicine. Earache was cured by dripping

warm goose fat into the ear. Vinegar stopped bleeding, helped toothache,

and treated burns and infection. As pepper slowly came down in price, it

too was used as medicine by common folk. Honey, a widely farmed sub-

stance, was used in salves for eye and skin problems. Although it was avail-

able in every region, it was too expensive for the poor.

The most important medicine in the Middle Ages was theriac, an anti-

dote to poison. Theriac could cure not only poisonous bites, but also other

diseases where poison could be involved; considering the mysterious na-

ture of disease, poison could be involved in infection, plague, epidemic,

or migraine. Theriac came to be a cure-all. There were many recipes for

theriac. The name did not indicate the ingredients, but rather the purpose.

Its most common ingredient was the ﬂ esh of a poisonous serpent, on the

grounds that it would counteract the serpent’s venom. It could include

herbs, honey, yeast, nut oils, spices, and the dried ﬂ esh of other poisonous

creatures such as scorpions. Theriac was supposed to be mixed carefully and

then aged for at least a year. Adults could ingest theriac, but it was consid-

ered too strong for children, who could only have it rubbed on their skin.

Medicines for the wealthy were based on spices. Spices were part of re-

balancing the body’s humors, and they had the added beneﬁ t of being

very costly and therefore presumed to be very effective. All spices had been

rated by physicians on a scale of one to four for how hot or dry they were.

Pepper and cinnamon were the hottest; they were emergency medicine for

cold and wet illnesses. Ginger and galangal were considered hot and wet

and were used for illnesses that appeared cold and dry. While a fever itself

might be hot, at times the physician decided that its true cause was coolness

in another part of the body, such as the stomach. So fever could indicate a

cooling illness. Overall, pepper and cinnamon were the most common me-

dicinal spices.

Nutmeg was a popular remedy for stomachaches or gas. It was not con-

sidered hot, but it was very drying. Roger Bacon, writing in the 13th cen-

tury, recommended cloves, nutmeg, and mace for the dangerous cooling of

old age. Because poison was considered a cooling process, spices were also

viewed as antitoxins for poisoning and were key ingredients in many theri-

acs. Pepper and ginger had both been used this way since ancient times.

The fact that these medicines were generally ineffective did not make

people stop believing in them. Sometimes they appeared to work, and for

common ailments, especially of the stomach, spices can help. Ginger helps

with nausea, but it cannot help with poisoning or cancer of the stomach.

Because spices helped sometimes, and because they were exotic, expensive,

and endorsed by the sages, medieval patients who could afford them con-

tinued to believe in their powers.

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Spiced medicines were not always taken by mouth. The cooling brain

disorders of epilepsy, mental illness, and vertigo had to be addressed by

putting medicine as close to the brain as possible, which meant into the

nose. Disorders of the eyes, which were considered cool and wet, were

treated by salves put directly into the eyes, and their remedies had to be hot

and dry, which often meant pepper. Pepper was also packed into the anus

to cure intestinal diseases. Gout could be treated by applying spices to the

skin of the afﬂ icted area.

Because spices were so costly, spicers were tempted to mix in cheaper

substances or say that domestic herbs were imported in order to drive up

the price. Spices were medicinal, so this practice was considered crimi-

nal. There were harsh penalties against falsifying or adulterating a stock of

spices. Physicians worked with certain trusted spicers—or apothecaries, as

they came to be known. In some cases, they worked together to keep prices

high, especially for wealthy patients.

From ancient times to modern times, and including the Middle Ages,

the chief culprit for the spread of infection was thought to be bad air. Bad

air was night air, which was cool and wet, as well as the air of certain places

where disease lurked. Bad air usually smelled bad, just as disease and death

smelled bad. Good air was dry, warm, and good smelling. People sought to

live in places of good air and avoid places with bad air.

Spices were a popular way of warding off infection caused by bad air.

When the plague broke out, the rich used mixes of spices, such as cinnamon,

Pepper was a central ingredient in

medieval medicine. It grew in the Far

East, where it was harvested and dried.

The pungent black berries seemed a

perfect agent for warming the body.

Classiﬁ ed as hot and dry, pepper had to

be mixed with some wet foods, and it

was the best medicine for any illness

considered to cool the body. Migraines

were caused by a cold brain, so pepper

was sometimes administered through

the nose. (Antonio De Azevedo

Negrão/Dreamstime.com)

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cloves, saffron, myrrh, and mace. These were carried around in pomanders,

burned in the house to fumigate it, or just strewn about the house. Poor peo-

ple carried sweet-smelling ﬂ owers or burned herbs and fragrant wood in their

homes to rid them of bad air. Onions had a potent smell and were obviously

healthful, so planting onions could also draw bad airs away from a house.

The word pomander came from French— pomme d’embre, an “amber

apple.” It was originally a lump of ambergris, a substance found in the di-

gestive tract of sperm whales. Ambergris has a pleasant, musky odor and

is solid, waxy, and ﬂ ammable. It has historically been used as incense, per-

fume, spice, and medicine. A lump of ambergris could be worn on a chain;

people believed that its healthful odor would ward off the bad airs of a

plague. During the Middle Ages, many pomanders were lumps of wax with

aromatic spices embedded in them; the wax was enclosed in a metal or pot-

tery container hung on a chain. Physicians often carried pomanders as they

made rounds to the sick.

For sexual dysfunction, physicians also recommended spices. A high li-

bido was hot and dry, while fertility was hot and wet. For increasing sex-

ual desire, physicians prescribed pepper, cinnamon, and nutmeg. Medieval

newlyweds could be served a drink much like eggnog, seasoned with cin-

namon and nutmeg. For fertility, ginger was best, since it was rated as both

hot and wet. Cloves were second best. Physicians warned against taking too

many spices because they might dry and heat the constitution and produce

both excessive desire and other types of disease, such as fever. The cold-

est and driest herb was agnus castus, native to the Mediterranean. Some

monks, who wanted to dampen sexual desire, used this as seasoning.

Surgery

Surgery was not considered on par with real medicine, although some

physicians and surgeons argued that the two could not be separated. While

most people who were seriously injured simply died, battleﬁ eld surgeons

began to form useful practices for saving lives where possible. The basic sur-

geon’s kit began with his bag to carry the instruments. He carried a sharp

knife for cutting veins or doing other surgery, a probe to examine wounds,

and a cup for drawing out infections. Some medical books discussed sur-

gical methods, so we know how some surgeries were performed, but they

were not routine procedures. Wounds often became infected, and it was

difﬁ cult to control for a good outcome.

Military surgeons dealt with many head wounds at tournaments. They

became adept at identifying which skull wounds could be bandaged and

healed and which were fatal. They learned to bore a trephine hole into the

skull to relieve inner pressure from blood or other ﬂ uid. Sometimes they

used a short piece of silver pipe to press into a wound containing a barbed

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arrow; this caused the arrow to be enclosed in metal, and the barbs would

be released. They also dealt with serious wounds in which intestines spilled

out; they learned how to clean them, replace them into the abdomen, and

keep the wound open with a drain until it healed. They treated gangrenous

wounds with amputation. The patient had no painkiller, and the wound

was cauterized afterward.

In the case of women who died in childbirth, sometimes surgery was at-

tempted to rescue a live baby. However, male doctors were not permitted

to attend at births, and midwives only rarely attempted surgery. Stones in

the bladder could be cut out by being pressed to the surface so that a small

incision and scoop could remove them. A stone caught in the urinary tract

of the penis could similarly be pushed closer to the surface and removed

with a small cut that would heal. But surgery was rarely used to treat other

diseases. Methods of stitching the patient and keeping the site from infec-

tion were primitive.

Cataracts, a common eye afﬂ iction, were treated by traveling cataract

surgeons who popped the bubble in the eye with a needle. Vision returned

immediately, but the long-term outcome was not good; the patients even-

tually went blind.

By 1300, there were advances. Some teachers from a school of surgery

at the medical school of Bologna established a similar surgeon’s college in

Paris. One of its leading surgeons instructed doctors to use waxed thread

to hold blood vessels together to stop bleeding in a serious wound. Surgi-

cal sites and wounds began to be sutured. Some began to instruct that a

wound should be washed in wine, which was a simple disinfectant. They

had no understanding that bacteria cause infections and die in alcohol, but

they considered wine a healthful, clean liquid, and those who tried it found

that infection was less common.

Guild -trained surgeons and the rare university surgeons were mostly in

large towns and cities. University-trained surgeons, in fact, could refuse to

actually do any surgery. In small towns, surgery was usually performed by a

barber, because he had the tools. Barber surgeons removed teeth, opened

abscesses, did bleedings, and eventually set bone fractures and did simple

operations, such as for stones in the bladder. Barber surgeons in England

began their own guild in 1302; it was chartered by the king during the

15th century, recognizing their right to practice and train in surgery. They

conducted their own lectures and dissections.

Medical Training

The innovation of medical schools at universities began a transition

from ancient into modern practices. One of the best-known works of the

old medical tradition of Europe was the “Leechbook of Bald,” written in

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Anglo-Saxon around the year 900. Bald collected the classical knowledge

available in his time but largely recorded many folk remedies. Some of these

remedies are shockingly wrong, such as applying dried human feces to a

cancerous wound. Bald recommended warding off a poisonous spider bite

with a drink of ale, raw egg, and sheep’s turd. Some remedies were charms

to speak over the sick or rituals to enact using dirt from a grave or cow’s

milk, but without any real medicinal intent. Some were home remedies that

may have helped, like pennyroyal tea for an upset stomach. Such traditional

compilations preserved some useful herbal knowledge, but they were su-

perstitious and unscientiﬁ c.

Even at universities, medical training emphasized authority over innova-

tion. The main task for a student at a medical school was to memorize the

traditional and accepted works: Hippocrates, Galen, and Avicenna. Some

schools featured dissections, but many did not expect students to observe

real patients.

Some medical books of the Middle Ages discussed ideas such as the

four humors and which foods to eat for certain diseases, and some mostly

Since medieval hospitals only cared for the poor, the heart of medical practice was

the home visit. A physician visited his patient each day and made a care examination.

He studied the patient’s pulse rate, skin, and urine. After the exam, the physician

held a consultation, often out of the patient’s hearing. He gave instructions for diet,

rest, and medicine. The sick person’s family and friends were responsible for carrying

out medical orders, while the physician himself rode to the next house. (National

Library of Medicine)

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rehashed Galen and Aristotle. Most included at least some eyewitness de-

scriptions of diseases and injuries, and some had practical manuals for diag-

nosing diseases and treating wounds. Some provided surgical instructions

or discussed the common problem of delivering babies safely for both

mother and child.

The leading medical writer of the Middle Ages was a Persian doctor

named Ibn Sina, better known in English as Avicenna. Combining Galen’s

teachings with Islamic medicine, he interpreted Aristotle’s system of the

four humors and added his own observations. Avicenna’s work came to Eu-

rope as interpreted by a rhyming poem written in Salerno, Italy, the home

of the ﬁ rst medical school in Europe, which was renowned for its work in

healing injured or sick Crusaders.

The physicians of Muslim Andalusia wrote medical books that were

eventually translated into Latin. The Koran prohibited dissection, so Ara-

bic medical writing lacked direct observation of anatomy. Male physicians

were prohibited from treating female patients and had to rely on the obser-

vations of midwives in writing about female diseases. Abulkasim, court phy-

sician for Caliph Abd al Rahman III, wrote a lengthy book on surgery that

described his observations and experiments. He operated on the thyroid,

removed kidney stones and tonsils, and extracted arrowheads. He described

many case histories. Abulkasim’s work became standard in European medi-

eval medical schools.

The Jewish doctor Moses Maimonides was originally from Andalusia

but was driven out when his family refused to convert to Islam. His medi-

cal books were written in Arabic while he was living in Egypt. He derided

superstition such as astrology and was an active, practical doctor who saw

thousands patients in the Sultan’s palace and in his home. He included his

own observations as he summarized the medical knowledge he had been

taught.

Most medical books dealt only lightly with surgery. The only inﬂ uential

medical book that came out of the Byzantine Empire was by Paul of Ae-

gina and was written around 600. Paul wrote extensively about surgery,

and his work was used in many medical schools. Another inﬂ uential surgery

textbook was the Practica Chirurgerie by Roger of Salerno. This work, writ-

ten around 1200, described diagnosis and treatment of head injuries, bro-

ken bones, bleeding, epilepsy, and goiter. Roger of Salerno recommended

cauterization to stop bleeding and iodine-rich seaweed to cure goiter. He

suggested treating a badly healed broken bone by breaking and resetting

it. He described suturing wounds and even blood vessels and recom-

mended allowing a wound to become infected and to heal with wet dress-

ings. It was probably nearly impossible to avoid infection during the time.

Other surgical experimenters and writers, though, recommended washing

a wound with wine to avoid infection.

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489

Medical schools at universities in Padua, Bologna, Salerno, and Paris

were the top schools. Salerno was founded in the 10th century, near the

famous monastery of Montecassino. It remained as a functioning medical

school until 1811. Salerno blended the medical traditions of Arabs, Jews,

Greeks, and Latins. It relied on the incorrect theories of Galen and Aris-

totle, but it rejected superstitious remedies and taught students anatomy

with dissection. The school issued the ﬁ rst modern anatomy book, based

on dissections of pigs, and stated that pigs are the animals most similar to

humans, although they do not look as similar as apes do.

Physicians who spent the required time studying, and who passed their

exams on the medical books, took the Hippocratic Oath. They became the

top echelon of medical practitioners. Some went on to innovate and teach

at medical schools, while others became court physicians who refused to

get their hands dirty but preferred to give orders to others.

See also: Food, Gardens, Hospitals, Plague, Spices and Sugar, Universities.