All Things Medieval

The medieval candidate for surgery could be described with four Ms: Male, military, moneyed, and mangled.

Most surgery developed around the war games that gradually grew more rule-bound and civilized but never ceased to be nearly as deadly as real war. Tournaments had one great life-saving advantage over war: a refereed time-out. There were lots of reasons why surgery didn’t happen on battlefields, and they’re too depressing to go into. But on a tournament field, conditions were perfect: everyone was rich, fighting was voluntary, and they could plan ahead for casualties.

The medieval surgeon’s bag contained some very sharp knives, a probe for examining wounds, and a cup to drain infections. Additionally, he carried silk thread and a needle, a short silver tube, and an iron instrument for cauterizing a wound (we might also call it a small branding iron).

The silver pipe was for removing barbed arrows, though these were more of a battlefield hazard than a tournament one. Removing a barbed arrow by pressing the pipe into the wound, enclosing the barbs in metal, was perhaps the simplest medieval surgery.

Silk thread was for stitching up ugly gashes, including trying to tuck intestines back into place. Abdominal wounds like that were among the serious wounds that had a *possibility* of successful surgery. Dirt had to be cleaned off the tissues, and after the wound was stitched, they learned that they needed to leave a drain hole for a while. (I’ll be keeping my eyes open for what they used as a drain tube in the days before latex or plastic. Will let you know if I find.)

Infections were a huge problem. One medieval theory held that the infectious wound was self-cleaning, so it should be kept warm and encouraged to swell and ooze. Another common practice was to use wine as a disinfectant.

At tournaments, head wounds were extremely common. Surgeons often tried to save a knight’s life with a trephine hole, bored with the sharp knife or with a small drill. This drain relieved pressure on the brain as the wound healed. While many or most patients died anyway, there’s evidence from buried skulls that some survived long enough for the trephine hole to close up with new bone as the patient went on with life.

There were two known elective surgeries: for cataract and for bladder stones. The cataract surgery was done by traveling amateurs and while it helped immediately, it later led to complete blindness. Stones were most likely treated in a monastery, where medical care was superior. The idea was to position the stone closer to the surface, perhaps trapping it in a fold of skin, and then make a very small cut or scoop to remove it. This sounds pretty reasonable until you imagine positioning a stone in the bladder or urinary tract without an ultrasound.

Theriac was more of a concept than a single recipe. It was a cure-what-ails-you brew with multiple ideas of remedies. Its focus was on counteracting poison, but “poison” was as loose an idea as “toxin” is in alternative medicine today. Maybe you actually ingested poison or were bitten by something venomous, or maybe you received an elf-shot or breathed bad air. Poison could be thought of not as a class of harmful chemicals but as an agent of sickness, however it was received.

Theriac began with the flesh of a poisonous serpent, on the grounds that the snake could neutralize its venom. One of the top magic principles was that like cures like, so the creature that delivered poison could also cure it. It might well also include a dried scorpion, another famous poison delivery system.

From there, the list of ingredients varied. In past essays (last August) I talked about various herbs; their herb-lore was extensive, if sketchy. Some herbs absolutely had an therapeutic effect, while others perhaps just resembled a body part or followed some other magical-logical link. Honey, spices, nut oils, and even brewer’s yeast might go into the theriac next. It’s likely that wine was the liquid element. Individual methods would dictate which herbs and liquids were cooked before it was considered properly mixed.

picture of man mixing theriac

The key to theriac was its uniquely long aging process. Theriac sat, probably corked, for at least a year. Judging by other brews that aged for three to nine days, it was probably strained at the end to remove the sludge and pieces, and the resulting liquid was stored in a fresh bottle.

After that, theriac was the ultimate cure-all for anything poison might have caused: actual venomous bites, infection, migraine, or epidemic. It was probably employed for cancer, too. Adults could drink a little bit of it (probably mixed into wine or ale). But theriac was considered too strong for children. A sick child was treated only by rubbing it onto the skin.

We can only guess how much early medieval doctors thought of insanity as an illness or as a devil-infliction. In Bald’s Leechbook, some remedies for mental illness sound like they are definitely intended for a physical problem, and it is called madness, insanity, or frenzy. Other remedies are for “night goers” and those who are afflicted by the devil. Was this some type of psychosis? It would make sense that mania would be viewed as a physical ailment of frenzy, while psychosis was seen as caused by a devil. But we don’t know.

In entry 41, Bald begins with a general herbal drink for “all the enemy’s temptations.” (Pollington, Leechcraft) There’s no further elaboration about what these might be, but the preparation of the drink lets us know that it’s looking past heartburn and pocks, to something vaguer and more threatening. Seven herbs are to be placed under the church’s altar; they remain in place until nine masses have been sung. Then they are crushed into holy water, and the patient must drink this on an empty stomach in the morning. Additionally, holy water is to be sprinkled on his food. There’s a salve in 41, too; like the drink, the herbal butter-salve must go under the altar for nine masses. The patient is anointed with this salve in symbolic places: temples, forehead, head, chest, ribs.

If this wasn’t hint enough that some of the targeted ailments are signs of mental illness, the next line in the same entry says it outright: “To cure an insane man.” There are two drink instructions, but neither needs holy water. They are both ale-based, with specific herbal ingredients that are quite different from the first drink. The full cure requires more: drip a few drops of a cold bath into the drink, then put the man into the cold bath three times. Give him a meal of holy bread, cheese, garlic, and cropleek, with the first drink; put the salve all over him, and “when he is better,” make him drink the second one. I think both of these drinks are purges; the second one is called a “strong purgative drink.” One of the ingredients may be from the castor-oil plant.

Entry 61 has a salve for “elvish kin, nightgoers, and with whom the devil has intercourse.” Since the early Germanic idea of disease included attacks of these kinds, Bald could be talking about any disease. However, again the salve instructions show us that it’s for something vaguer and more threatening than usual. Thirteen herbs are to sit in a bowl under the altar until nine masses have gone by; then they are boiled in butter and sheep fat, with holy salt added, and when it’s strained off, the plant matter has to be thrown into running water. The salve goes on the face and eyes, as well as on anything else that stands out as sore. Additionally, the patient is “smoked” and the sign of the cross made over him frequently.

For “frenzy,” perhaps meaning mania, there was just a light drink, but it required very special preparation. It began just before dawn, singing the litany in church, and then proceeding outdoors while singing the Credo and Pater Noster. On arriving at one of the eight named plants (including radish), he must walk around it three times. These plants required twelve masses!

Radishes were a good enough solution by themselves, for a woman’s madness. She was to fast for a day and eat radish roots at night; this remedy protected people from violent attack for at least one day.

For moon-madness, there was one simple treatment. Make a whip out of a dolphin’s hide. Beat the mad person. This was guaranteed to work, and there is a translator’s note: a later hand had added to the manuscript the word AMEN.

I’m passing over many remedies in Leechcraft that follow a sensible, generic pattern: “take these 3 herbs and boil them in wine, let the patient drink it.” “Boil this herb in butter, mix in another herb, apply to wound.” Many of them sound plausible. Another generic pattern is a long list of herbs to be ground together and mixed into butter as a heal-all salve. This, too, sounds at least plausible. There are simply so many of these remedies that unless readers wanted to know about a particular ailment, such as breaking up stones in the bladder, I don’t want to write about them. Of course, the risk of seeking out the interesting ones is that it may distort the overall picture of traditional medicine in the early Middle Ages.

Remedies for dangerous bites stand out from general wound care. There is more attention to snake bites in the Herbarium, which was compiled in Anglo-Saxon from Latin sources. Bald’s Leechbook is more interested in bites of spiders and dogs. However, the Herbarium addresses rabies in particular: the bite of a mad dog. It probably didn’t work, but it’s interesting.

The remedy is in an entry for the herb ashthroat, which may be the herb now called verbena or vervain. It is first prescribed for hardening of the arteries, stones in the bladder, liver disease, and wound care. Its use in snake-bite and spider-bite is unremarkable, following the generic pattern of boiling pounded twigs and leaves in wine, and applying it to the wound.

For the bite of a mad dog, the verbena (probably crushed) is mixed with an equal amount of wheat seeds. This mixture is laid into the open wound. The wheat is there to absorb moisture, probably to draw out the venom. When it appears to be swelled up with moisture, it is removed from the wound and tossed to the chickens. This is a test: will the chickens eat it? If the chickens refuse to touch it, the procedure must be repeated with fresh verbena and wheat until all toxicity is gone.

I don’t know what to make of this test. They seem to assume that chickens can sense the infection in the grain. Or is this just a test of how successfully the wound is being drained at all? Will chickens avoid grain that has gotten blood on it? This seems unlikely to me; the chickens I’ve known don’t mind picking each other bloody. Has anyone in the last 1000 years tried it, or has this chicken lore died out? My father, an amateur chicken farmer, didn’t know either. The internet is only interested in whether chickens can get rabies (answer: no, but isolated cases happen).

Other Herbarium entries recommended for the bite of a mad dog are used in conventional ways, just laid into the wound plain or infused in wine. Only this one treatment has the chicken test.

Bald’s Leechbook suggests using houndstooth, or houndstongue, to treat dog bite. This plant is toxic to cattle because its natural insecticides are so powerful. It has a long history in herb lore; it was regularly used in medicine into the modern age, decocted into various brews and teas. But it’s likely that its use for dog-bite is mostly due to its leaves being shaped like a dog’s tongue. Natural magic’s first principle was that anything shaped like the body part or attacker could help with the ailment.

Toothache must have been a frequent problem in medieval times. With our standard of dental care, we lose awareness of just how chronic and potentially dangerous tooth problems can be. From chronic minor tooth pain (the sort that gets “referred” to other teeth so you don’t know where it’s coming from) to lethal infections, teeth were a never-ending problem.

Bald’s Leechbook suggests chewing pepper for toothache. When Bald’s book was compiled in the 11th century, this traded spice from southern India must have been restricted to castle cooking and medicinal use. Would pepper help with teeth? It might; it has antibiotic properties.

Medieval herbal and traditional remedies come mainly from native Celtic or Germanic roots, not from the Greco-Roman tradition that they considered more scientific. And although only a few of the remedies include women in the actual recipe, they tell us something about traditional Europe’s attitude toward women. In a nutshell, women are good. They can mediate healing in ways that men can’t.

First, they produce milk. Breast milk turns up in five remedies, leaving it very unclear whether its use was “medical” in our sense, or magical. Other kinds of milk can be used in simple ways, as the base for active ingredients; “woman’s milk” is clearly a special ingredient, not just a base.

Bald’s book suggests using it as an eye drop or wash for growths on the eye, particularly the emergence of a “red sponge.” They’re almost certainly referring to a condition known as “Surfer’s Eye.” Every medieval fisherman can be considered a surfer, for these purposes. Being outdoors in the salt spray, with strong wind and bright sun, was very stressful for their eyes. Pterygium is a reddish or yellow growth that begins to cover the eye. It’s considered benign, but it can grow out over the cornea. It seems likely that many old fishermen, having survived storms and accidents, would be blind, and often from double-eye pterygium.

Pterygium in our time is treated with lubricating drops until it becomes urgent enough for surgery. Breast milk has some outstanding qualities, being sterile and filled with fat molecules. However, you’d think sheep’s milk (their most common dairy) would have the same qualities, and no other milk is recommended as an eye drop.

For “spots” on the eye, breast milk was used as a clean-up fluid after some rather nasty things were dropped into the eye. One of the ingredients has an uncertain translation; it could be sulfur. The other ingredients are burnt salt, and ink. They’re pulverized with a mortar and pestle and sprinkled into the eye, which is then washed up with a bit of wool dipped in water. Breast milk as eye drops come last, as a soothing wash.

Could breast milk have brought needed antibodies, as well as sterile water and fats? It’s possible, but it seems like giving them scientific credit in this case is too big a stretch. Breast milk probably is a good eye-drop at need. But after burnt salt and ink? Worse, there are two alternative eye drops suggested for the pterygium growth: hot pigeon’s or swallow’s blood. Again, it’s quite possible that blood would make a decent eye lubricant and perhaps help with disinfecting. When we see the requirement for pigeons and swallows, though, it sounds like magical thinking. “Birds have sharp eyes, so of course their blood is good for eyes.” The logic may have run a little bit differently, but not much. One of the basic principles of natural magic is that like treats like.

Breast milk also works as an ear-drop mixed with cilantro (coriander) juice. Like other ear-drops, it is first warmed in an oyster shell, which works as a tiny pitcher. Here again, we are left to wonder if its antibodies and white blood cells worked directly against infection.

As a fourth human-dairy product, the Lacnunga book has a very weird fever remedy: “take a snail, and cleanse it, and take the clean lather and mix it with a woman’s milk; give it to him to drink.” Just when we get to the remedy that suggests drinking the stuff, they include a snail.

Fifth and last, breast milk was a component of treating palsy of the face, perhaps what we’d call Bell’s Palsy. One way to treat the palsy was to source the problems to the ear; the mixture of cilantro/coriander and breast milk was again recommended. But for more extreme cases, the woman had to be nursing a baby boy, the leaves had to be dried before use, and the resulting mixture had to be applied to the paralyzed cheek with a blue cloth (and then dripped into the ear). There’s no other example of this “baby boy” reasoning, so we can only guess. Things seemed more magical if they crossed boundaries, so perhaps a woman’s milk being fed to a baby male seemed to combine something of both sexes.

Second, women can exert a powerful influence over nature by being virgins. Here, the “science or magic?” question is unnecessary. Let’s look at the prescription-virgin treatment for a cyst or swelling on the heart (and no, I don’t know how this would have been diagnosed without surgery). A cyst or swelling of some kind was called, in Anglo-Saxon, a wen.

“If wens ail a man at the heart: have a virgin go to a spring which runs straight eastwards and scoop one cup full out against the stream, and sing on it the Credo and Pater Noster and pour it then into another container; and….do likewise until you have three; do likewise for nine days; better will soon come to him.”

I think we can say with confidence that when this remedy was first used, Christian creeds and prayers were not the charms recited. Nine is not a significant number in Judeo-Christian tradition, but it is very significant in the Norse one. Odin hung on the world-tree, gaining secret runic knowledge, for nine days.  Many charms associated with Odin’s secret lore bring in 9’s. We’ll talk more about charms and runes in later entries.

What can we make of these remedies? If nothing else, it’s clear that women were considered a good influence on nature.

Source: Pollington, Leechcraft.