There's a lot of concern about health care on both sides of the pond these days, with the recent worries about the National Health Service, and regime change in America bent on rolling back the benefits his predecessor put in place. In fact, one editorial to my regional newspaper had a headline that feared a return to the Dark Ages.
I write the Dark Apostle series for DAW books, dark historical fantasy about medieval surgery, which continues today with new release, Elisha Mancer. As a researcher into the history of medicine, all I could think was, they don't know much about the Dark Ages, do they? So here, for those who would like to make their comparisons more apt, is a basic primer to medical care through the 14th century.
1. Medical practitioners were highly educated professionals.
Aside from those who needed the midwife (a specialist even then), most patients sought one of three levels of care, depending, then as now, on their location and their level of income (about which, more later).
Physicians were considered minor clergy. They traveled to study at prestigious schools like Paris, Bologna and Salerno, where they learned from famous practitioners and memorized or transcribed important texts--often texts that were a thousand years out of date, such as the works of first century Roman physician, Galen, who passed along the theory of the four humors. Physicians generally worked with members of nobility, attached to the court of one monarch or cardinal or another, dispensing invaluable advice, such as the pope who died of eating too many ground emeralds on the advice of his doctor. Well, that advice was valuable to the gem merchant, anyhow.
Surgeons might also attend medical school, though their training tended to the practical. They often apprenticed to a master surgeon for seven years to develop their craft. Considered by the physicians as mere craftsmen, surgeons performed a variety of operations, from removing injured or diseased extremities to treating cataracts and the complaints of the knightly class, like anal fistula, a problem developing from too long in the saddle. They wrote and exchanged treatises on these specialized surgeries, and often maintained lively correspondence to share medical advances with their fellows.
As for barbers like Elisha, the protagonist of my books, they were considered the lowest form of practitioner. Like the surgeons, barbers apprenticed to learn their trade, but were much more plentiful, and thus accessible to a wide range of patients. Treating wounds, cutting hair, and bleeding patients on the order of the physician or surgeon, not to mention the occasional amputation or simple surgery.
2. Treatment depended on your finances.
Not everyone can afford to retain their own personal physician to prescribe emeralds or prepare a bath of mother's milk. Fortunately, many cities had charity hospitals where the poor could seek treatment from physicians and herbalists retained by donation. Alas, these institutions were often (then, as now) the source of as many sicknesses as they hoped to cure, and only the desperate sought them out, to be tended by nuns in large wards where they lay three to a bed and hoped for the best.
London is home to St. Bartholomew's the Great--the church, and its accompanying hospital, founded in 1122 by Rahere, King Henry's retired royal fool. Here in America, we have St. Jude's, founded by comedic actor Danny Thomas.
Tradesmen had another avenue to pay for their treatment. Many merchant and craftsmen's guilds offered group insurance to their members, covering medical care, or funeral expenses as the need arose. So the Middle Ages are perhaps the origin of what in America we term the dreaded "socialized medicine," in which people band together to care for each other. Not such a novel concept after all.
3. A humorous notion?
The four humors--black bile, yellow bile, blood, and phlegm--were said to travel through the body and to be accessible at certain points. Many illnesses were thought to be related to an imbalance of the humors, which could be cured by bleeding the patient to remove some of that particular humor being carried in the blood. Elaborate charts showed where to cut and during what season (because the humors could be more or less aroused due to the season, especially given a person's astrological sign). Although bleeding as a treatment has, thankfully, fallen by the wayside, the idea of the humors remains, whenever someone is described as Sanguine (too much blood), Bilious (too much bile), or Phlegmatic.
4. Alternative Medicine
Many people simply relied on ancient cures--charms, prayers and superstitions--to defend themselves from disease. Some of these cures depended on ideas of sympathetic magic--like spreading a special ointment on the weapon that caused a wound in the impression that this would cure the wound itself, or that the shape of a particular plant resembles the body part it is intended to treat. Others depended on effective herbs available locally or grown in one's own backyard. Willowbark, which contains Salicylic Acid, AKA Aspirin, was known to be good for a variety of aches and pains. In the absence of access to medical care, people made due with whatever they had on hand, and the advice of friends and neighbors. Fortunately, about half of all medical concerns will resolve themselves in relatively short order: either with the patient's unaided recovery, or with their death.
5. Honey, maggots and leeches
And of course, some of those old cures have returned to us today. Maggots, often used during the Middle Ages to debride wounds of rotting flesh, are being used once more for the same purpose--but they are now grown in special laboratories, and distributed in a dressing which prevents them from roaming about unsupervised, a great relief to the squeamish. Leeches have a unique enzyme for maintaining blood flow, and are handy for certain kinds of surgical procedures, especially the re-attachment of limbs and skin grafting. As for honey, it has antiseptic properties which make it handy for minor injuries and burns. But please, don't attempt any of this at home, especially this next one.
Finally, let me say a word about the most infamous of medieval operations, trepanation. Some will tell you that trepanation was performed to "let out demons" or other such foolishness. In fact, if you look at the surgical texts and records of the day, this operation was advised to relieve pressure on the brain from an injury (often received in battle), and survival rates, based on bone re-growth shown in skulls from cemeteries, were as high as 90% (with the caveat that a number of potential patients likely died before they ever reached the surgeon's care). The source for this slander against the medieval surgeon comes from a sociologist who saw a skull with such a piercing at an archaeological site, and was asked to speculate on why such an operation might be performed. From what we can tell, like many outsiders commenting on the treatments of others, he had no idea what he was talking about.
So perhaps the letter-writer has made their mistake, not in thinking we are returning to an earlier era of medical treatment, but in failing to recognize that the medicine of the Middle Ages had ever left us.
If you'd like to know more about the Dark Apostle series of fantasy novels about medieval surgery including sample chapters, historical research and some nifty extras, like a scroll-over image describing the medical tools on the cover of Elisha Barber, visit www.TheDarkApostle.com/books
E. C. Ambrose's blog about the intersections between fantasy and history or follow me on Twitter or Facebook
If you haven't started reading The Dark Apostle, pick up volume one, Elisha Barber, wherever books are sold, includingIndiebound, Barnes & Noble, or Amazon
The fourth volume, Elisha Mancer, from DAW books, is now available!