Review: Medicine & Society in Later Medieval England by Carole Rawcliffe

Medicine & Society in Later Medieval England [1995] – ★★★★

“Magic was…an integral component of medieval medicine”, tells us historian Carole Rawcliffe in this book on the state of medicine in later medieval England. And, not only magic. Religion, astrology and even art were all tied up in the practice of medicine in the Middle Ages, and this non-fiction sheds much light on how the medieval society in England viewed illness, and its diagnosis and treatment. What was the difference between the medieval professions of physician, surgeon, apothecary and barber? Why the state of medicine in England at that time lagged behind other European countries? What was the general attitude towards women connected to the practice of medicine? And, what methods were used when no proper methods of anaesthesia and sanitation were yet available to the medical personnel? Relying much on the contemporary accounts, Rawcliffe proves to be an expert guide on these questions and many more, and her book is a scholarly, but also highly readable, journey into England’s medieval past.

In the Middle Ages, death was omnipresent. Epidemics, famine, wars, infant mortality and injuries are all just the tip of the iceberg in the ocean of the causes of death in medieval times. The average life expectancy was 29 years from birth (Florence, the 1420s), and illness was viewed both as a gift from God, and as a sin and punishment to endure, depending on the moral standing of a patient. Medicine was governed by Galen and Hippocrates’s teachings, including by the theory of the four humours: choler, phlegm, black bile and blood, which corresponded to the four elements making up the universe (fire, water, earth and air), as it was believed that the human being is merely the mirror-image of the world, governed by the same principles. This idea was then applied to both the diagnosis of an illness and its treatment, which means that health was equated with humoural balance, and healing methods were often concerned with either retaining or defusing heat. The application of the theory cannot be understated as one example by Rawcliffe states “…two men suffering from identical wounds in the arm, inflicted at exactly the same time, should not necessarily be given similar treatment. On the contrary, the surgeon would have to adopt a radically different modus operandi if, say, one were sanguine (blood-governed) in temperament and the other proved to be melancholic (black bile-governed)…” (Rawcliffe, Alan Sutton Publishing, 1995: 56, quoting the Science of Cirurgie, compiled in 1296).

Uroscopy (the examination of urine) and, to a lesser extent, the examination of a pulse were both used to make a diagnosis. And, this could be coupled with the chart on the patient’s planetary influence and the consideration of their immediate environment. Blood-letting (phlebotomy) was common as treatment, but also performed on perfectly healthy individuals and regularly, as it was deemed prophylactic, cleansing the body and ridding it of excess humours. Rawcliffe’s chapters then focus on the physician, surgeon and apothecary professions, and much detail is provided on each of them. It may surprise the readers to discover that, back in the day, a physician was expected to be well-versed not only in logic, grammar and astrology, but also in rhetoric and music, and it is these, together with his medical knowledge and experience, that dictated his reputation. A physician in the Middle Ages also considered himself “above” performing any surgery, which was often left to surgeons or barbers, who often had only rudimentary knowledge of it. So, the prestige that we now attach to the profession of a surgeon had yet to come. However, England’s medieval medicine was not all guesswork, incantations and spiritual guidance, and the merit of the book is that the author points out the sceptics of certain treatments along the way. Wisdom did at times prevail over planetary fabulas, and some physicians recommended sensible things to their patients, including a moderate diet and balance in all things, criticising the popularity of blood-letting.

One chapter of this book is titled “Astrology & The Occult”, and Rawcliffe then devotes two whole chapters to the position of women vis-à-vis the medical establishment. She writes that women played an ambivalent role regarding their involvement in medical matters and caring for the sick, though, more often than not, they were victims of much prejudice and suspicion.

At times, Rawcliffe’s narrative gets bogged down in all the little details, such as the financial affairs of the medical profession, but the author often manages to “rescue” her paragraphs with many exciting and interesting examples. The book also leans on the academic side, but that also has its advantages, and one of them is that the reader will get only what they have opened this book for – a thought-provoking insight into medieval medicine, rather cringey pop culture references or the author’s irrelevant biographical details, as it is so often the case with more popular history non-fiction (see my list of 7 Fascinating History of Medicine Non-Fiction Books).

⚕️ Together with the Crusades and the Black Death, the medieval state and practice of medicine are the most fascinating topics connected to the Middle Ages. Intelligent, eye-opening and well-illustrated, Medicine & Society enlights on this topic thoroughly, emphasising the sheer gulf between medical theory and practice at that time, as well as the difficulty of reconciling the spiritual (e.g. religious teachings) with the physical (e.g. scientific observations).