Meet a Historian: Robin S. Reich on Making Sense of Medieval Medicine: Humors, Weird Animal Parts, and Experiential Knowledge

Note from the Editor: I’m excited that I have our first (hopefully of many!) guest post to share with you and it is a fascinating topic to start with. The history of medicine (and the history of science more generally) is a captivating and important sub-field and a frequent reader-request, but also a place where non-specialists fear to tread because of the formidable demands in languages and expertise. So I am thrilled for Robin S. Reich to come and offer you all (and me) a primer on the complexities of discussing medieval medicine, presenting the contrast between its theory and practice but also encouraging us to think on the place of medicine in society.

Reich has her B.A. in History from Carleton College, M.A.’s in history from both Boston College and Columbia and is now finishing her Ph.D. in history at Columbia with a dissertation on “Materials and Science in Norman Sicily: Translation, transmission and trade in the central Mediterranean corridor” – which, if I may editorialize a bit further, is a fascinating dissertation subject if ever I have heard one! She also writes at her blog, Robin Writes, which is well worth checking out as well.

And with that, over to Robin…

’Abdullah ibn al-Fadl, Preparing Medicine from Honey”, from a Dispersed Manuscript of an Arabic Translation of De Materia Medica of Dioscorides, A.H.  / A.D. 1224 621, Ink, opaque watercolor, and gold on paper, H. 12 3/8 in. W. 9 in., A.H.  / A.D. 122. Metropolitan Museum of Art 57.51.21

When I tell people I study medieval medicine, their first reaction is usually something along the lines of “they had medicine in the Middle Ages?” It’s hard to approach medieval medicine because it is so different from what we now practice and trust as medicine, and because as a result we have a huge body of pop culture telling us that medieval medicine was utter nonsense. So not only do we have our own impressions of reading about this very foreign way of thinking, but we also have ingrained messages about the things we’re reading before we’ve ever read them. A major hurdle in approaching medieval medicine with an open mind is the idea of efficacy – did the cures we read about actually do anything, or did people spend 1000 years boiling lizards because they didn’t understand how evidence works? This is something of a bad-faith approach, because it’s trying to privilege our system of medicine over the one we are ostensibly trying to understand. The first question can’t be “did it work”, it has to be “what did they think they were doing?”

My first major foray into medieval medicine was an attempt to bypass this question altogether, and I think that same entry point helps other people too. I was interested in the Black Death, specifically how there could be a system of medicine surrounding a disease that was, at the time, incurable. I wasn’t worried about whether anything medieval practitioners were doing worked on the plague, because we know it didn’t, and, more importantly, they knew it didn’t. And yet they kept writing about medical approaches to the plague, and I had to wonder why. So I focused in on a specific author, ibn Qayyim al-Jawziyya, a jurist and physician living in Aleppo, Syria in the first half of the fourteenth century, who died about a decade after the start of the Black Death in the 1340s. He wrote a book in Arabic called al-Tibb al-Nabawi, or Medicine in the Tradition of the Prophet. The purpose of this book was to take the two major medical authorities in the Islamic world at that time – the Islamic holy works of the Qur’an and Hadith, and the works from ancient Greece and Rome such as those by Galen and Hippocrates – and make them agree on what medicine is and can do. In this book, there is an entire chapter devoted to the idea of contagion, that there are diseases that can travel from person to person. And in that chapter, ibn Qayyim uses both these types of authorities to argue that there is a bodily contagion, a literal transfer of disease, but there is also a psychological and a social contagion. These are the fear and anxiety of getting sick that can make you sick in other ways, and how you react to other people based on the belief that they can make you sick, and the harm you can cause by taking that belief too far. I was so stunned by this argument for is complexity, nuance, and wisdom. I even talked about it at the start of the COVID-19 pandemic, as a reminder that pandemics are social issues, not just medical ones. Ibn Qayyim really convinced me that medieval medicine had tremendous depth to it, and our pop culture understanding of it was superficial and unfair. So, I’m here now to try and give you a primer on medieval medicine so you can see a bit of this beautiful, confusing complexity as well.

Texts and Theories

When historians talk about medieval medicine, we’re mostly referring to the medicine reported in books explicitly on the subject of healing that were written in Latin, Arabic, or Greek from the tenth to fourteenth centuries in Europe and the Middle East. Sometimes we include texts from other languages, like Old English, Hebrew (we have a bunch of these from throughout Europe, especially Italy) or Syriac (a dialect of Aramaic used in Syria and what is now Iraq). Generally, texts from earlier periods, the sixth through ninth centuries are considered “Late Antique” and accepted as a separate tradition. We also tend to be unaware of texts from Africa, most of Central Asia, and almost all of South and East Asia. This reflects divides in our fields of study and can partially be blamed on the issue of languages. But it’s important to recognize that medicine written about in the Middle East, especially, drew a lot from Indian and sometimes even Chinese traditions, so these other traditions are certainly not irrelevant, just underrepresented.

You’ll notice that I keep talking about medical writing and medical texts. Historians have a bias towards written evidence, especially when it comes to medicine and science more broadly, I think in part because that kind of evidence is easier to interpret. We like writing and reading, it’s what we’re used to, so when we want to know about medicine we look for writings about medicine. We also do this because a lot of medieval medical texts became foundations for Renaissance-era and modern writings on medicine. In the thirteenth century, when universities began to establish themselves in places like France and England, they would put together reading lists that included specific works on medicine, and these reading lists evolved but were kept in use for hundreds of years, to the point that Avicenna’s Canon of Medicine, written in the eleventh century, was still being read in Europe in the seventeenth century as part of the university medical curriculum.

But it’s important to recognize that writing is one limited part of medicine. Even today, if you read a medical textbook assigned in a medical school, it won’t tell you much about what doctors do, because so much of their training is in their practica, their hands-on practice. In the same way, medieval medical texts don’t really tell us that much about what medieval doctors did. In fact, I argue that medieval peoples considered the actual practice of medicine inappropriate for writing – they used writing to discuss the theoretical aspects of medicine, knowing that the practical aspects were things that you had to learn in person. Extending this divide further, the people who were writing these medical texts weren’t necessarily practicing doctors. These writers were typically known as physicians, which meant people who were educated about the intellectual aspects of medicine. Practitioners were a separate category, and in many cases not very well respected by physicians. So, we have a doubly difficult time understanding what medieval medicine was, because the people who practiced didn’t write about it, and the people who wrote about medicine thought practice was beneath them.

The theory of medieval medicine most consistently centered on the theory of the four humors. It’s part of a larger systemic understanding of the world, in which all matter is made up of four fundamental elements: earth, fire, air, and water (insert Avatar joke here). The four humors are reflections of these same elemental influences on the human body, although there isn’t a direct correspondence between each element and each humor: the humors all represent blends of the elements. The humors are: blood, bile, black bile, and phlegm. Each of these humors has a set of qualities: hot or cold, wet or dry. Every individual’s balance of humors is unique, with some people having a lot more bile than everything else, for instance, and that unique balance is referred to as their complexion. This system mostly derives from the writings of Galen and Hippocrates, both Greeks of the Roman Empire who developed this system as a way of talking about the predictable actions of the body in a systematic way. Based on complexion, medical care could be suited to each patient, so the theory goes.

This so-called Galenic model or humoral theory is the foundation of medical writings within that entire large geography I described. There are some other major influences as well. Most important among these is what I mentioned earlier, the Islamic religious texts: the Qur’an, the central text of Islam that tells the revelation of the angel Gabriel to the Prophet Muhammed; and the Hadith, a collection of stories about the Prophet and his companions used to illustrate common problems and approaches to daily life. Within these texts there are many references to healing and disease, and so many Muslim physicians wrote interpretations of these references and built a further system of medicine from them. For instance, ibn Qayyim’s discussion of contagion deals in part with a particular hadith that says “there is no contagion, there is no evil portent, no ill-omened owl” – ibn Qayyim interpreted this passage to mean that one should not be superstitious, that the communication of disease from one person to another is not the same as the irrational belief that some individuals, places, or things are inherently unlucky and bring misfortune.

Medieval medical texts that set out to discuss medicine as a concept, or to describe a system of medicine, typically explain aspects of these systems. Avicenna’s Canon of Medicine is one of the most influential of these. Historians argued for a long time, up until as recently as the 1990s (and some still do) that, based on these writings, medieval medicine doesn’t really change for about 500 years, because these texts say the same things over and over. In reality, there are contentious arguments about medicine going on under the surface of these texts. A lot of them are commentaries, where the author will take an important text, excerpt quotes, and then write his* interpretation. This is a subtle form of argument – these authors rarely outright say that someone else is wrong. They are still using the same terms, but they are constantly challenging assumptions and accepted wisdom. A lot of these debates play out over specific sub-fields of medicine. For instance, there is a long tradition of the theory of diagnostics – how to assess a person’s health based on visual signs, but also based on the reading of the pulse and visual examination of urine. Even though almost every text on urine has the same title (on urines) and addresses the same topic, these texts really vary over time, as physicians argue about things like what sediment in urine shows.

(*yes, these authors were usually men, and I’m coming back to this point.)

These arguments are mostly being played out between people who write in the same language, but still over really large distances. As a result, there are some divides in written medical tradition based on language, but not so neatly based on geography. For instance, there are prominent medical writers in Spain and Baghdad who are writing in Arabic, but there are also medical writers in Spain and Germany writing in Latin, and these two conversations don’t easily overlap. We don’t really know to what extent these writers could read or were otherwise aware of conversations going on in other languages. The conventional wisdom around medieval medicine is that there wasn’t a whole lot of activity in Latin (and, by extension, most of Europe) between the 6th and eleventh centuries, and then a bunch of important works from Arabic were translated into Latin in Spain and southern Italy and that sparked a revival of Latin medicine. But I think there are a lot of problems with this explanation, and most of them have to do with the fact that writing about medicine is not the same thing as knowing about or practicing medicine. Just because a culture wasn’t writing about medicine doesn’t mean it wasn’t practicing it.

Practice and Pharmacology

Practice is an aspect of medicine that is almost entirely excluded from these writings. The idea of theory and practice as separate realms of medieval medicine goes back, once again, to Galen, who explicitly divided medicine this way in his writings. But this divide really becomes cemented in the work of Constantine the African. In the late eleventh century, Constantine translated the work of North African physician ‘Ali ibn al-Abbas al-Majusi into Latin, and he imposed a chapter system that divided the books into two sections: theory and practice. In Constantine’s translation, as in al-Majusi’s original, all the writing was about theoretical aspects of medicine – there was no description of practice. But even within that theoretical approach, there was a divide between issues surrounding how the body works (what the humors are, how they interact) and how we can know how they work (diagnostics, surgery). So, even before we get to the mechanics of doing medicine, there is already a conceptual divide between these two categories of theory and practice.

There are some medical writings in Latin that predate translations from Arabic in southern Europe that express a different branch of medicine. These are not necessarily so theory-focused – they are often collections of cures. We also have surviving Classical medical texts in Europe that didn’t need to be translated from Arabic to be available in Latin. But more compelling than any focus on writing, we have other kinds of evidence of medical practice, physical evidence.

Physical and material evidence of medical practice is a pretty big category. It can take the form of implements used in medical practice, like surgical tools, or it can be those used in pharmacology, like spoons for measuring drugs. It can be medical paraphernalia like birthing scrolls. It can be drugs themselves, surviving in shipwrecks, in evidence of human excrement from latrine pits, or in written records like pharmacists’ receipts or import records. It can be human remains, both on their own and how groups were buried. But this kind of evidence is so much more complicated to interpret than explicit writings about medicine, and it runs into new and different problems.

One example I like to turn to is about medieval leprosy. Throughout the medieval world, people with leprosy were often removed from society, placed in leper colonies or leprosaria, and approached with a combination of fear and awe. But for a long time, and arguably even still, medical historians have questioned whether medieval peoples could actually distinguish Hansen’s Disease (the modern name for the disease that causes leprosy) from other skin conditions. Because medical texts don’t make it clear that they could. Just describing the symptoms of leprosy in these limited texts, it sounds a lot like late-stage syphilis. But studies of grave sites in leper colonies show that almost everyone buried there indeed had advanced Hansen’s Disease, which is apparent in the bones, particularly the bones of the face, which develop distinctive pitting on the upper jaw and degradation of the nasal cavity. This suggests that medieval understanding of these diseases in practice was a lot more sophisticated than theoretical writings suggest.

Pharmacology is an even more complex issue, because that’s where the whole pop culture issue comes into play. Were medieval peoples really eating weird animal parts? Probably some of them. Did they do anything? Maybe, it’s not clear. We have a lot of evidence that most medical treatment was dietary. The whole humoral approach to medicine meant that medical care was largely about the maintenance of good health, not about the treatment of disease. Our system of modern medicine is more interested in curing disease than preventing it, although that is something that a lot of medical professionals are trying to change. Medieval medicine is the opposite. Pharmacological texts, pharmacists’ receipts and inventory lists, and books of cures show a lot of thought being put into how to eat right for one’s own body, and how to correct that diet as new problems arise. Now, we have to take a huge caveat to this, which is that only certain classes could actually choose what they ate. People with some degree of monetary income, i.e. people not just living on subsistence farming, had the ability to make a lot of choices about how much and what kinds of protein they ate, or whether to include imported spices or cheeses in their diets. And these were the same kinds of people who were more likely to have access to medical texts telling them what to eat, such as editions of Dioscorides’s De materia medica, one of the most consistently influential pharmacologies of the medieval world.

But a lot of medieval dietary recommendations are also about how to use local herbs or other vegetation and when. Arabic texts often dictate diets based around really common ingredients like onions, garlic, and honey. Italian ones devote most of their page real estate to common herbs like sage and laurel. These are things that could easily be integrated into the daily meals of any person of any social stratum. It’s also important to recognize that these texts might not have been instructing these lower class people what to eat, so much as taking lower class eating habits and using them to instruct upper classes. When these texts do deal with curing ailments, it’s for things like persistent stomach troubles (have some cinnamon or cumin), and not so much cancer. We have corroborative evidence that these vegetal medicines were in use, in the form of trade records, but these are also pretty limited sources – they don’t tell us everything being traded, and they don’t cover the things that could have been grown at home or picked in the wild.

This kind of practical knowledge punches a hole in the argument that medicine moved from Arabic into Latin, because we can see that medieval medicine wasn’t quite so contained, and it didn’t necessarily move in a straight line. Maybe a specific articulation of a medical idea moved from Arabic to Latin, but practices like what spices to integrate into your diet moved around in more complex and perhaps circuitous ways.

There’s a final major aspect of medieval medicine that we haven’t addressed yet, and it’s the assumption about gender. As with today, medieval medical texts assume that a patient is male – specifically, that he doesn’t menstruate and can’t get pregnant or lactate.* Female bodies are dealt with as a special aside in most medieval medicine, mostly in texts on gynecology and obstetrics. This reflects a double bias in medical writings. There is the bias I already mentioned, against practitioners, and then another bias against female practitioners in particular. Because most physicians (medical writers) were men, due to structures that educated men to write and think about theory and then gave them the option to make a living doing that, physicians don’t tend to know a lot about women’s bodies as medical subjects. As a result, we’ve gotten some pretty odd interpretations of the female reproductive system, like the wandering uterus (a theory that says that the uterus moves around the body), that treat women’s bodies as essentially ruled by unpredictability and randomness, and these don’t so much represent medical wisdom of the time as they do the limits of a specific class of educated men’s understanding of women’s bodies. We have some indications that women were typically cared for by other women, and in the rare cases that women write about women’s bodies, they convey a much more sophisticated understanding of those bodily systems than standard medical texts do. For instance, Hildegard of Bingen’s Causes and Cures (written in twelfth-century Germany) devotes almost half of its page space to a detailed monthly calendar of the menstrual cycle. We also have the Trotula, a compendium of medical cures for women from twelfth-century Salerno in southern Italy that prescribes fascinatingly mundane treatments like inserts for vaginal tightening. These and other sources that more directly report what women were doing with their own and other women’s bodies, rather than men’s theoretical suppositions about female bodies, indicate a dedicated and systematic approach to women’s medicine, but it is still hard to access what women’s healthcare really looked like and what that meant for female quality of life. 

(*here I am using female and woman interchangeably, based on a medieval European and Middle Eastern dominant cultural understanding of those concepts. This is not meant to be a judgement of what constitutes gender identity, nor about the relationship between gender and sex.)

Humor and Humors

So, did medieval medicine not have any weird stuff, then? Yeah, sure it did, the same way modern medicine occasionally has weird stuff. There are instances of manuals instructing you to prepare a mineral for ingestion by cooking it in dung, or seemingly-unnecessary anal probing (although probably not actually unnecessary). What’s more, we’re getting more evidence that, yes, cures prescribed in medical manuals did actually work. The most famous one is the 2015 Bald’s Leechbook study, wherein researchers recreated an eye salve that was capable of curing MRSA (antibiotic resistant staph infections). The problem is, we still don’t fundamentally understand enough about medieval medicine, how it was practiced, and how the writings we have related to how it was practiced, to make claims about whether it was an effective system as a whole.

But there are a lot of incredible things we can learn from medieval medicine. As evidence of a society, it reveals aspects of aging, family relationships, gender, and class that we don’t otherwise get to see much of. As a medical philosophy, medieval medicine offers a counterpoint to our curative, individualistic approach, instead taking healing more as preventative and diseases more as social issues. We don’t necessarily learn about new specific cures or procedures by studying medieval medicine, although there are situations like the Leechbook example where we can, but that’s not really the point. The limitations on modern medicine are not in our ability to experiment, but in our perspectives on what kinds of methods are available. Studying a very different medical system helps us broaden those perspectives and explore new or forgotten possibilities.

There’s only one thing left: leeches and bloodletting, real or no? Real, but not what you think. Bloodletting, leeches, cupping, and cautery were all popular methods of balancing humors, but they were only practiced by the elite. Cupping has been making a comeback in recent years, and leeches never really went away. None of these were done frequently. There are mentions in rules for monastic orders about bloodletting, which suggest that bloodletting was basically an excuse to get a vacation from strict monastic life, because the multi-day recovery period saw the monk in question lying in bed, with a friend chatting all day, eating all the rich foods he normally denied himself. We also get fantastic stories like one episode from Tristan and Isolde in which the lovers try to sneak in a quickie while the king (Isolde’s husband/Tristan’s best friend) is sleeping next to Tristan in bed, after all of them have had their blood let. Tristan tries to jump to Isolde’s bed, only to burst his letting wound, fall on the floor, and start to bleed out everywhere. This wakes up the king, who is delighted to find he has caught the couple in their deception. Maybe the weirdness is not so much in medieval medicine as it is in medieval humor and romance?

Robin Reich is a (near) PhD in medieval history. She writes a blog on history in pop culture – While her dissertation will be embargoed for the next 3 years to avoid self-plagiarism, you can find some of her work forthcoming in the collected volume Neomedievalism from University of Toronto Press and on (

59 thoughts on “Meet a Historian: Robin S. Reich on Making Sense of Medieval Medicine: Humors, Weird Animal Parts, and Experiential Knowledge

  1. Good evening, and nice to see the first of the “Meet a Historian” posts. I don’t know much about medicine, or medieval history of such, so please pardon me if these are dumb questions, but I did have two I wanted to ask.

    1) I know someone with hemochromatosis. And from what I understand, bleeding is an effective treatment for the condition, as the newer blood takes time to accumulate dangerous concentrations of iron. Now I heard from him that bleeding in medieval times was possibly a reaction to this, especially a kind of late medieval period post the Black Death, because apparently hemochromatosis does make you resistant to the plague (something about how the shuffling of iron away from the lymph nodes which makes it hard for the Y.Pestis bacteria to replicate) and the disease became more prominent and prevalent in Europe after the Black Death, corresponding to more use of bleeding as a treatment.

    It seems reasonable, but lots of things are reasonable which turn out not to have actual historical basis. Is there any connection between hemochromatosis and the practice of bleeding? And if so, is there any connection between a rise post black death and therefore more bleeding after the 14th century?

    2) The only medieval medical personage I’ve ever read is the Rambam, and even that was secondary to his theological writings which I’m far more familiar with. I’d have to comb through my collection to make sure I’m quoting it right, but I could swear he’s got something in there where he talks about his new and improved method for testing for diabetes: get some urine from the person you’re testing, and sprinkle it near an ant hive, if the ants congregate around the piss then there’s sugar in it and the patient has a very serious problem. This is way better than the “method that fools use”, namely directly tasting the urine for sweetness. After all, who wants to actually drink piss?

    At least to me, that seems like an issue of practice, not theory. And granted, I’m working from a sample size of one person who is very much an eccentric in other areas of his life, but you said, and I quote

    “But this divide really becomes cemented in the work of Constantine the African. In the late eleventh century, Constantine translated the work of North African physician ‘Ali ibn al-Abbas al-Majusi into Latin, and he imposed a chapter system that divided the books into two sections: theory and practice.” I just wanted to ask if this divide was more pronounced in the Latin speaking (writing) parts of the medieval medical world as opposed to places outside the language bubble, or am I completely inventing something here?

  2. Excellent guest article, and (I think) my first time spotting a typo! Int eh title of Dr Reich’s dissertation, should that be Norman Sciliy instead of Normal?
    Really interesting to consider the subject less as an exploration of practice medicine but more as a way to see another perspective on health. In a society where cures for various diseases simply did not exist, a different way of living with them must be necessary. And we might consider that this might be the case in the future as our own medicine grows ever more powerful, are we likely to change the way we regard healthcare and health as the diseases which used to kill us become treatable?
    Also very interesting about womens health which is still bedeviled with the legacy (and continuation) of misogyny. My own spouse has a chronic health condition and people with their condition often seem to have very lengthy periods before diagnosis as they are disbelieved, their concerns minimised and their symptoms overlooked. Not entirely surprising to see this is a millennia long tradition, but certainly disheartening. One wonders if the massive influx of women into the ranks of GPs and specialists in the last fifty years will change this in the next fifty.

    1. What’s the condition? Couldn’t it be that the condition itself is hard to distinguish from more innoccous conditions?

      For example someone who complains of backpains with no discernable causes would be told to change sleeping positions. Some would consider that minimisation, not necessarily bigotry on the doctors part.

      1. . . . dude, do you realize that you just leapt straight to assuming that the bigotry isn’t as big of a problem as people say, and that the conditions in question are probably ones whose cause is hard to diagnose, so the doctors aren’t at fault? You’re not exactly doing a great job of disproving the point.

        I have a friend who spent two years suffering from massive stomach pain when she ate — pain so bad that she lost 25% of her body weight from not being able to eat, and she wasn’t obese to begin with — and doctors told her it was psychosomatic, that she was in pain because she was depressed (ignoring the fact that her life was great, then the pain started, *then* she got depressed because constant pain), and suggesting she should be happy about the weight loss. I have friends who have back pain who get told they should exercise more, with the doctors ignoring the fact that the back pain is *why* they can’t exercise (often it has curtailed the activities they used to do).

        There’s an enormous difference between “well, here are some possible causes, so let’s try these fixes — those didn’t work? Okay, let’s look deeper and try some other things” and “if what I recommended didn’t work, then clearly you didn’t do it right or the pain is all in your head.” The latter is the problem we’re talking about. And there is *abundant* evidence for it being all too common.

        1. I was taking exception to the assumption that it’s due to misogeny and not the type of condition, doctoral malpractice happens all the time (unfortunately) but I doubt it’s due to sexism.

          1. How many women with chronic illness do you know, and what was their treatment schedule like? Of the 5 in my life I can think of, all of them have been questioned as crazy for thinking they had a chronic disease (one of them was chronic pain, and the others were all immune system fuckery). The most charitable reading of all this is that the received wisdom only understands men, and that received wisdom is more important than we think for effective medicine. This is less the “make me a sandwich” variety, and more the system is built to misunderstand women (for reasons which should be clear from the above text).

            If you’d like someone who actually looked at some statistics on the question, rather than lived experience, [look at this](

        1. So far as one can determine gender from nyms, the willingness to start arguments with complete strangers seems to manifest itself in each and every gender around here.

      2. The condition is Fibromyalgia, co-morbid with Ehlers Danlos Syndrome.
        The Fibromyalgia was triggered by an injury (its often an injury or period of sickness that kicks it into high gear) and manifests as chronic pain and chronic fatigue along with a handful of other symptoms like “brainfog”. For years it was treated as just backpain with the other symptoms being largely ignored. We had to continually push until we eventually got to a rheumatologist who diagnosed it in about 10 minutes. They also diagnosed Hypermobility which was then re-diagnosed as Ehlers Danlos later on (the two are virtually the same, it wasn’ a misdiagnosis as such).
        Throughout was the attitude of GPs not believing the scope and severity of the symptoms and how thoroughly different they were to before the injury and how much they were affecting my spouses life.

  3. The section on ibn Qayyim and social contagion mirrored interestingly a passage in a Kafkaesque novel I’m currently reading, where the protagonist is talking to a emergency services PR representative at the scene of a huge chemical fire in London, who refuses to give a direct answer to whether the smoke is dangerous:

    “It *makes* the event less harmful. No one should go out there and stick their head in the smoke. Police and fire service advice is to stay away. We’re clear about that. But do you know what could cause more harm? Much more harm? *Worry.* Worry can impact your health in a dozen ways. Worry can shorten your life. Worrying about this event is much more likely to cause harm than the event itself. By reducing worry, we are directly reducing the harm associated with the event. […] we are not concerned with the cloud of smoke as much as we are with the cloud of psychological consequences the event has created. The emergency services can deal with the combustion incident, while a public relations department can address the action of the event on the minds of the public. […] Our intervention here is essentially *therapeutic*.” (*Plume*, Will Wiles, pp. 116–17)

  4. I am reminded if the post on polytheism, where it starts with an admonishment to remember that people actually believed their religion and thought the rites and rituals had a demonstrable efficacy. Presumably medicine was approached in the same way, regardless of what people wrote in fancy books. People cared about their health and wanted some level of control over it, doing something was better than doing nothing. Though I wonder if the placebo effect (is that still a thing?) played a role in generating positive outcomes.

    1. It’s hard to sort out placebo effect from reversion to mean, which is another way that medicine “works.”

      Though I’ve heard an atheist doctor describe the most effective treatment at the time of the Crusades for a wound: find the weapon that inflicted it, pray over it, and destroy it — and thus keep your hands AWAY from the wound, giving it a chance to HEAL.

      1. That sounds like it was more based in sympathy than what your thinking, sympathy is the rather common belief that things are invariably connected.
        For example pricking a doll made to look like someone would hurt them.

        This wasn’t the only application however, something that was symbolically related or came into contact with the wound could be used to treat.
        I.E. the king had the power to remove scrofula (the kings illness) which developed into a more general belief about healing hands.

        In relation this seems to just be an extension of the magical thinking at the time, by destroying the source of the wound you’d be symbolically reversing the damage which’d help you heal.
        It’s important we remember the rules medieval people believed in, infact these where ideas closely related to early science and now modern quackery.

        The main source of information is which details british folklore on fairies and by extension folk magic.

      2. To be fair surgery was fairly advanced in the Middle Ages. The difference between theory and practice again. Though lacking anesthesia and antiseptics surgeons successfully treated wounds, fistulas and even cataracts.

        1. Though going by the video I mentioned, and wikipedia, there was some anesthesia or attempts at it? Strong alcochol, opium, other narcotic herbs. Plus knowledge of keeping wounds clean and extensive topical use of honey.

  5. Glad to see the first guest writer here! Excellent job explaining the difference between practical and theoretical medicine. The practical side seems like something archeology is well-suited to bring to light, despite its underrepresentation in written sources. Have finds of medical tools or bones of patients helped elucidate how medicine was actually practiced for most people of late?

  6. Cupping may be making a comeback, but it didn’t go away for long. I remember my mother talking, mockingly, of “bahnkes,” – the Yiddish term – being used in her community when she was growing up. That would have been early 20th Century.

  7. Very interesting article and a worthy first guest post. Potentially fruitful ground for the curious reader would be in comparing Mesopotamian medicine (for example Geller’s text Ancient Babylonian Medicine) to Medieval or Classical Mediterranean medicinal practice. One interesting thing about Mesopotamia is that because the evidence is archeologically excavated cuneiform tablets, we not only have medical texts analogous in a very general sense to what is in the article but also communications of practitioners discussing their treatment of people like the king and the common perception of physicians (who were thought to be cranks by some…). It’s interesting to see some practices that look like quackery but then comments that a rabies-like symptom equals death invariably.

  8. Bret: Here’s a historian coming to talk about medical history!

    Me: Oh GOD! Not history through time… I though I escaped secondary school history.

  9. “But studies of grave sites in leper colonies show that almost everyone buried there indeed had advanced Hansen’s Disease, which is apparent in the bones, particularly the bones of the face, which develop distinctive pitting on the upper jaw and degradation of the nasal cavity. This suggests that medieval understanding of these diseases in practice was a lot more sophisticated than theoretical writings suggest.”

    Wouldn’t most people who were banished to leper colonies, whether for Hansen’s disease, or mistakenly for other reasons, eventually contact leprosy anyways?

    1. “Wouldn’t most people who were banished to leper colonies, whether for Hansen’s disease, or mistakenly for other reasons, eventually contact leprosy anyways?”

      Not necessarily. Hansen’s Disease is not easily transmissible, as the bacteria is slow to reproduce and doesn’t hang out in the lungs (where it can be coughed out and made transmissible in an airborne fashion). From my limited understanding, nasal tissue and essentially being exposed to mucus from an infected person is the primary method of transmission, and even that isn’t super transmissible. On top of it, enormous segments of the population are flat out immune to the disease; this is also why it can run in families.

      But if you look at modern era leper colonies, like Kalaupapa, you do not see residents and associates of the infected universally catching the disease, in fact very few of them did. I suspect that transmission rates might have been higher for medieval leper colonies would be higher owing to closer together living conditions and generally worse hygiene, but to extend that to most of the inmates there catching it from the few who actually had hansen’s disease strikes me as unlikely.

    2. What Adam said, plus most people infected with the bacteria that causes Hansen’s disease do not develop symptoms. So even if you had an environment where transmission was somehow common, visible signs of disease would still be rare.

  10. There’s some reason to believe pre-modern women had a world of their own that we know little about because the men who did most of the writing were shut out. Medieval men men certainly knew they didn’t have the control they claimed. Their insecurities come out in fabliau.

    1. George Orwell tells the story of how when Sir Walter Raleigh was imprisoned in the Tower, he commenced writing a history of the world. An affray broke out among the workmen, resulting in the death of one of them. Raleigh was unable to discover the cause or exact course of the the fight, despite diligent inquiry, and he abandoned his history, realizing that historical truth was unknowable.

      Everyone has a world of his or her own. Even WASP males with ivy League degrees and six figure incomes inhabit their own world, which is but little reflected in the public records of our time, and will be little known to future historians.

      1. I can understand the sentiment (Rawley deciding to give up on history because he can’t attest a fact in his close personal space) but that is why archaeology etc are a thing. I too, and I’m sure we all have have personally seen events change their character after that event, eg the news reports things a bit different to that which we perceived.

        There is the bias of politics, perception, and who knows what else to contend with.

        Rawley/Raleigh was right and also wrong (in my opinion): If he’d kept up with his history we would have more evidence now to play with. That evidence might have given us more insight into the Elizabethan world of England or perhaps more – who knows?

        Where Rawley screwed up (apart from pissing off Bess n co) was conflating describing events and ideas with absolute facts. He didn’t realize that his perceptions, descriptions and so on would have value. He was an adventurer (pirate if you are Spanish) etc and not exactly a historian. Despite that, his thoughts in the form of a book would reveal something useful but probably not the original purpose.

  11. Interesting post, thanks. is a video on stuff from the Chirugia Magna, Guy de Chauliac, more about medieval wound treatments and other surgeries. They seem to have been pretty good at that: poppy juice or fume anesthesia, wound cleanliness with water and/or honey, stuff like hernia repair and cataract treatment, successfully removing an arrowhead from inside a skull with ad hoc invented tongs and surgical glue…

  12. Unrelatedly, did you change your blog software or settings recently, Bret? Notification emails started coming from a different address, and now it’s making me confirm subscriptions, which is annoying.

    1. I upgraded my WordPress plan in order to be able to use some add-ons ad plugins, which seems to have changed a few things. I have no idea why it would change the address the updates come from, but it clearly has.

      Not sure that it is something I can fix, honestly.

  13. A fascinating topic. Well done, Ms-for-the-time-being Reich.

    A couple of years ago I read the Old English cure for elf-shot from the Lacnunga and noticed that all but one of the herbs it calls for grow wild in my yard. So I planted some feverfew, the missing one, because one never knows!

    1. If you want to make sure your safe from fairies grow some rowan or holly, they can’t stand the stuff.

  14. Very interesting discussion. I would be interested if the discussion/research would include homeopathic medicine or medicine from groups such as Native Americans.

    1. Almost certainly not in the case of homeopathy, because that was invented in 1796, well into the modern era. Almost certainly yes in the case of Native Americans, though probably as a separate field, just as the medicines of Central, South and East Asia are studied separately from European/Mediterranean medicine.

    1. I thinks it’s where you copy yourself, publishing the same material multiple times. I think it’s to stop redundant papers or people republishing the same work to pad out their LinkedIn bio.

  15. Glad to see this first guest post . . . an interesting read!

    Here’s one more typo (I think):

    argument for is complexity -> for its complexity

    1. Meant to comment on the coincidence of a recent article on covid transmission that I just read this morning. The connection is that the article mentions that it took the involvement of research by a historian to uncover the source of an inaccurate assumption by the WHO and the CDC.
      (Sorry, I don’t know how to create links here, so I’m just providing the URL)

  16. Henry VIII had a curious hobby, pharmacology. He created medicines of all kinds including preventatives against the Sweating Sickness. The ingredients tended to be odd by modern standards and expensive. If they worked it was most likely placebo effect. On the other hand Henry fully grasped the connection between dirt and sickness. He made Felix Unger look sloppy.

    Dr. Reich seems to be saying medieval and early modern physicians weren’t stupid by any means but they were working from false theories and so dove down the rabbit hole. On the other hand people who actually treated the sick and injured, herbalists and midwives and the like, on the other hand were likely to have empirical knowledge of what did work even if they didn’t know why. That makes sense to me.

  17. But a lot of medieval dietary recommendations are also about how to use local herbs or other vegetation and when.

    I’ve heard of a medieval text discussing how you did not need to take extraordinary care of your life, only ordinary care, and its example was that even if your doctor told you otherwise, you could eat cheap and easily procured foods like eggs, instead of expensive and hard to get foods like — chicken.

    1. Chicken used to be much more expensive, even not so long ago. When I was young (I’m 65), it was something we ate on festive occasions, and we were a middle-class family.

      1. Yes, Adam Smith ranks meats in order of desirability/affordability, and it goes pork<beef<chicken. Unfortunately I can't give a precise cite, but I re-read Wealth of Nations recently and noticed.

      2. I (age 62) also remember when chicken was a luxury. My father was a doctor. It was only in the 1970s that it became cheap.

  18. [i]This system mostly derives from the writings of Galen and Hippocrates, both Greeks of the Roman Empire who developed this system as a way of talking about the predictable actions of the body in a systematic way.[/i]

    Mentioning Galen is correct, but Hippocrates predates Roman rule over Greece by a good while.

  19. It wasn’t just monks. Lay people got themselves bled when they felt under the weather. Since bed rest and good food were part of the treatment no wonder people felt better afterward! And of course you can lose a visually impressive amount of blood without ill effect. All in all it’s really not surprising that people believed in it for so long. And they did understand that losing too much blood was dangerous.

  20. Fabulous guest post from fellow Carl who is doing great work. Not to take away from what is here, but I just saw that another Carl, Sethina Watson, just had her book On Hospitals, looking at medieval European hospitals (full disclosure, I have not read it), published by Oxford. What is up with Carleton history grads becoming experts in medieval medicine? Coincidence?

  21. Herbalism and folk medicine lives on in central and eastern Europe. Many people hold it in contempt or don’t trust it, but herb brews are commonly found in pharmacies.

    1. remembers the labels on many bottles in the grocery store vitamin aisle

      You unduly limit the geographical scope.

  22. I’m also glad to see the ‘all science came from the Islamic world’ trope challenged. Muslim scholars were working from the same classical canon as Europeans and fell into many of the same errors.

  23. Hippocrates was hardly a “Greek of the Roman Empire”.

    My mother trained as a nurse in the 1940s and that training included the use of leeches.

  24. The post seems to be arguing the opposite, though.
    >I wasn’t worried about whether anything medieval practitioners were doing worked on the plague, because we know it didn’t, and, more importantly, they knew it didn’t.

  25. >The most famous one is the 2015 Bald’s Leechbook study, wherein researchers recreated an eye salve that was capable of curing MRSA (antibiotic resistant staph infections).

    This is a fundamental misrepresentation of the actual paper; they showed it killed some staph on animal cells in vitro, which is fundamentally different from curing MRSA.

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