• Adrian J. Boas

On Medical Care and Miracle Cures

Updated: Sep 29, 2018

Gerardus Cremonensis "Recueil des traités de médecine" 1250-1260

Nobody likes to be in hospital, except perhaps doctors, nurses, hypochondriacs and suffers of Munchausen Syndrome. I myself have done my best to avoid residency in them, and with the exception of the first few days of my existence, I have to date only spent a single week in hospital, after few misinformed persons thought it might be a good idea to blow themselves up in the middle of a crowded public street. That brief stay was enough to strengthen my determination to avoid future hospitalisation. The treatments, the noise, the odours, the décor, the dress code, perhaps above all, the hospital food, are things I do not like to contemplate. But if one considers what it would have been like to be hospitalised in the pre-anesthetic past, hospitalisation today (with the exception of those who are in a great deal of pain) is unpleasant perhaps, but not really so bad. In the Middle Ages, along with the dungeon, the hospital rated perhaps second only to the cemetery as a place to be avoided at all cost.

In the 1160s, the Jerusalem hospital, probably the largest medical institution in the kingdom, perhaps in the entire Latin East, was estimated to have beds for between 900 to 1,000 patients, and in an emergency, during a plague or after a battle for example, could possibly put up as many as 2,000. But it was rather short on staff, with only four doctors - a fact that might explain the alarming mortality rate. One German pilgrim, John of Würzburg, recorded that on some days, up to 50 patients were carried out for burial. At that rate the entire hospital would have been cleared of patients in just three weeks, which suggests that either the source was exaggerating (quite a reasonable assumption), or there was an equally large flow of new patients arriving to take their place (also a reasonable assumption). It also points to the fact that, in spite of the acquaintance of Frankish doctors with classical medicine, and the works of Dioscorides, Hippocrates, Galen, and the more recent Avicenna, which were preserved through Arabic translations, medical knowledge remained rather rudimentary.

Certainly, much of the medical treatment was dubious. Perhaps, rather than being the reason for the high death rate, the small number of doctors was what kept the it from being even higher. The four doctors visited the sick twice a day. With between one and two thousand patients, these must have been extremely brief visits, and examining 250 to 500 patients a day does little to promote a good bedside manner or a thoughtful prognosis. In these very hasty visits they checked urine and pulse and carried out blood-letting. When necessary they attempted various other treatments and applied diverse medications, some of which were certainly curious. Along with the use of syrups, oxymel (a mixture of honey and vinegar), electuaries (medicines mixed with honey or molasses) and other medicines, they applied treatments such as lithotherapy - the therapeutic use of stones. This was based on the belief that different types of stone possessed different humoural properties; hot, cold, moist, dry; and that these could be used to counter excess of the opposite humour in the patient. The patient either wore the stone as an amulet, or it was given as either topical application or taken internally, presumably in ground form. It was a harmless technique, though with debatable effectiveness. Less so are some of the other medical techniques recorded.

The Syrian Muslim, Usamah Ibn Munqidh, an important source, although one who, not being a great admirer of the Franks, should be read with care, occasionally saw some good in Frankish medicine. He recorded the positive results of some treatments such as rubbing vinegar into the injured leg of a knight which caused the wounds to heal. He even adopted their treatment of scrofula which involved applying burnt leaves of glasswort soaked in olive oil and strong vinegar and fire-softened lead soaked in butter. But more often he describes their failures, such as when a Frankish physician performed a crude amputation, with dire results, and the use of trepanning in the treatment of what he referred to as an imbecilic woman. In that case the physician, believing that the devil has penetrated through her head, took a razor, and cut a deep cruciform incision on her head, peeling off the skin to expose the bone, then rubbed it with salt. The woman, not surprisingly, immediately expired.

Considering this, a statement said to have been made by Napoleon may have been an accurate one - that in the next world doctors will have more to answer for than generals.