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Physi­cian to the rich and pow­er­ful


High-end physi­cians in the Mid­dle Ages were uni­ver­sity ed­u­cated and their medicine was rooted in the writ­ings of an­cient Greeks such as Hip­pocrates and early me­dieval Arab physi­cians. They treated aris­to­crats and roy­alty, ex­plain­ing ill­ness as an im­bal­ance of the four hu­mours (or dis­tinct bod­ily flu­ids): black bile, yel­low bile, phlegm and blood.


It was widely thought that dis­eases were car­ried by smell so physi­cians would seek to pro­tect them­selves by mask­ing any stench. Posies were a pop­u­lar choice but or­anges were also used. Flow­ers also came in handy for treat­ing small­pox – as well as giv­ing pa­tients red food and drinks and wrap­ping them in red cloths, physi­cians would ground red roses with bam­boo juice.


There were some ex­treme cures for dis­ease. In­flamed lymph nodes within the armpit or groin ar­eas would be sliced open to al­low the pus to drain, while trepa­na­tion would see a hole drilled into the pa­tient’s skull so that blood build up could be re­lieved or in­tracra­nial dis­eases cured. Be­ing made to vomit – an­other way of bal­anc­ing the body – seemed tame in com­par­i­son.


Pa­tients would be asked to pro­vide a urine sam­ple and this formed a fun­da­men­tal part of a physi­cian’s di­ag­no­sis (to­gether with an ex­am­i­na­tion of blood and stools). They would com­pare the colour of the urine with a chart in a med­i­cal trea­tise, hold­ing the flask up to the light for a good look. Di­ag­noses would be looked up in a vade me­cum book.


Physi­cians saw no dis­tinc­tion be­tween medicine and faith, and dis­ease could also be at­trib­uted to ev­ery­thing from de­mons and sin to the stars and pun­ish­ment from God. Although they were recog­nised as a dis­tinct pro­fes­sional class in 1215, their treat­ments – be they blood­let­ting or herbal reme­dies – went handin-hand with prayer and relics. To the me­dieval world­view, all things had a spir­i­tual di­men­sion.


Physi­cians would al­ways charge high fees for their ser­vices, with renowned prac­ti­tion­ers in Eng­land typ­i­cally com­mand­ing 100 marks for their treat­ments (a mark be­ing a me­dieval unit of ac­count worth 160 pence). This would be the equiv­a­lent of some £48,000 to­day, with many physi­cians put on a re­tainer fee that at­tached them to a royal or noble house­hold.


Work­ing on the ba­sis that fire, wa­ter, earth and air con­trolled the hu­mours, physi­cians be­lieved the body would be ‘bal­anced’ by re­mov­ing ‘bad blood’ (they thought blood was static and stag­nated in cer­tain parts of the body). Ail­ments were there­fore treated by clamp­ing leeches to the pa­tient’s skin (some­times to the eyes). Over time, physi­cians them­selves were nick­named leeches.

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