by Ian Mortimer
Complicated such systems might be, sophisticated even, but the resultant gamut of medical knowledge is far from adequate. Consider the medical practice of John Mirfield, a priest and adviser at St. Bartholomew’s Hospital, London, at the end of the century. He advises his fellow physicians that, if they wish to know whether a patient might survive or not, they should follow this procedure:
Take the name of the patient, the name of the messenger sent to summon you, and the name of the day upon which the messenger first came to you; join all their letters together, and if an even number result, the patient will not escape; if the number be odd, he will recover.3
Such numerological practices are not peculiar to Mirfield: variant methods include the Sphere of Apuleis, wherein one assigns a numerical value to each letter of a name and subtracts thirty from the total to determine whether the patient will live or die. Considering that the standardized spelling of names has yet to be introduced, this is extraordinary: a practice of introducing sufficient random variables so that the whole matter is one of chance, or, as Mirfield would rather have it, divine providence. Other diagnostic advice of Mirfield’s includes this:
Take the herb cinquefoil and, while collecting it, say a paternoster on behalf of the patient. Then boil it in a new jar with some of the water which the patient is destined to drink; if the water be red in colour after this boiling, then the patient will die.4
One is tempted to be cynical. In fact, in this case, one cannot help but be cynical. Following the first procedure, 50 percent of his patients are doomed. Following the second, perhaps all of them. Given such diagnostic skills, the absence of physicians across much of England is not wholly unfortunate.
These ideas about causes of illness and diagnosis might be astonishing but they reveal an important point. Medieval people are not ignorant, in the sense of having no knowledge. It is simply that their knowledge is very different from our own. They probably have as much medical “knowledge” as we do, only it is based on astrology, herbology religion, a little direct experience, philosophy, fundamental misconceptions about how the body works, a lot of hearsay, and a large measure of desperation. When you extend this form of understanding to the physicians and surgeons, and combine it with the ability to charge fees, you realize that medical practitioners have colossal amounts of information at their disposal and a wealth of experience. Unfortunately not much of it will help you in your sickness, and some of it is seriously dangerous, if not lethal.
Medicine as taught in the leading Christian universities is heavily influenced by the teachings of two men from the ancient world, Galen and Hippocrates. Whether your aspiring Bachelor of Medicine chooses to study at an English university or goes abroad to one of the great continental ones (for example, Paris, Salerno, or Bologna) he will be led to believe that the entire universe is made up of four basic elements: fire, water, earth, and air. He will be taught that these are mirrored in the four basic humors of the body: choler (or yellow bile), phlegm, black bile, and blood. The ideal is to keep these four humors in balance. However, as a result of illnesses, miasmas, and old age, it is inevitable that these humors will eventually go awry and you will grow sick. When there is too much choler, or yellow bile, you grow “choleric” in temperament. Too much phlegm makes you “phlegmatic.” Too much black bile leads to “melancholia,” and too much blood makes you “sanguine.”
All very straightforward, you might think, even if somewhat misconceived. However, “straightforward” it certainly is not. One of the reasons why humoral theory continues to hold such sway is because it is so involved and complex. Its numerical harmony (the four elements, the four humors, etc.) allows for endless refinement and invented complexity. If two men are identically injured—let us say, with a sword cut to the lower arm—a physician will treat them differently according to whether they are sanguine in temperament or melancholic.5 Alternatively, if two men are sick with the same disease they may receive wholly different treatments due to variations in the appearance of their urine. The physician will ask each man for a sample and judge it according to its color, scent, and cloudiness.
Urine which is milky on the surface, dark at the bottom and clear in the middle is a sign of dropsy But ruddy urine in a dropsical patient is a sign of death … urine which is red, like blood, is a sign of fever caused by too much blood; blood should be let immediately when the moon is passing through the sign of Gemini. Green urine, coming after red, is a sign of inflammation, a mortal sickness . .. saffron-coloured urine with thick, smelly and frothy substance is a sign of jaundice.6
A physician may also inspect the feces and the blood of the patient. Some physical diagnoses require the physician to taste the patient’s blood. You might find it alarming to think that your doctor will not actually need to see you in person but might make a diagnosis based on the position of the stars, the color and smell of your urine, and the taste of your blood.
Dirtiness and Cleanliness
How do you define cleanliness? Most people, when asked this question, tend to define it in terms of personal experience. They know when their kitchen work surface is clean because everything which makes it dirty has been cleared off and it has been wiped down with detergent. What they are thus defining is the completion of a cleaning process, not a state of cleanliness itself. Medieval people do much the same thing, only using different processes. To regard a medieval kitchen as “dirty” because it has not been wiped down with modern detergent is to apply our own standards inappropriately. It is like someone from the distant future telling us our kitchens are dirty because we have not wiped them down with some superdetergent invented in the twenty-third century.
Cleanliness operates on several levels. For us, the most important is probably that of eradicating certain germs. Germ theory has, however, only been around since the late nineteenth century, so medieval people are a long way off understanding what germs are, let alone how they spread. Instead, complementing the idea that illness is a consequence of God’s direction and care for the soul, they have a sense of spiritual cleanliness. This includes a theoretical range of smells which are, literally, heavenly. When saints die there is supposed to be a smell like the breaking open of many perfume bottles: the odor of sanctity7 For most people this form of cleanliness, this saintly sweetness, is far more important than whether they have washed behind their ears or not. If a man is spiritually clean, and without sin, he is far less likely to have to go through the purifying fires of illness and seek redemption through God’s mercy. He will smell sweet to those around him. He will be without the stench of sin. In the modern world we have no equivalent to this form of cleanliness. Instead we have antibacterial wipes.
Once you start to break up notions of cleanliness in this way, you begin to realize that there are many varieties of cleanliness. Domestic cleanliness, culinary cleanliness, public sanitation, and personal hygiene can be added to spiritual cleanliness. All of them are of great importance, even if some of them are very difficult to control—especially public sanitation. When you hear modern people idly refer to the Middle Ages as dirty, spare a thought for the fourteenth-century housewife working hard, with her sleeves rolled up above her elbows, sweeping the hall floor clean, wiping down the tabletop, scrubbing her clothes and those of her husband and children, rinsing the cutlery, and scouring the pots and pans. Picture her looking up with concern as a rain cloud approaches just after she has laid the sheets out on the grass to dry. Of course there are some houses which are not so well attended, but foul-smelling homes have connotations of sinfulness, corruption, and decay. No one wants that sort of label; rather, they want the opposite: cleanliness and respectability. In a community in which everyone knows everyone else, the cleanliness of your home may be more than just a matter of common decency. It may be an important aspect of your personal identity.
The relationship between cleanliness, identity, pride, and respectability requires individuals to pay attention to their personal appearance as well. Areas of attention i
nclude the face, teeth, hands, body, fingernails, beard, and hair. Can you imagine a nobleman turning up at court, unwashed, in dirty clothes, not caring about what the king or his peers think of him? And can you imagine the king choosing a man to be his ambassador whom he cannot trust to keep himself clean? An ambassador who stinks will bring disgrace on the whole kingdom. In real life, men and women represent one another: dependants, relations, allies, and friends. Their appearance reflects the status and dignity of their social network and the esteem in which they and their friends are held. If you smell like the fetid air of a miasma, people will shun you like the plague and regard you as immoral, sinful, and perhaps mad. If you smell less savory than the common man, how can you hold your head up high in aristocratic society? If you wish to be reckoned important, and capable of mixing with your social superiors, you will do all you can to avoid smelling of the dunghill in the yard and endeavor to smell as sweet as the lavender scattered among the fresh rushes in your hall floor.
It is one thing to speak of the ideal of cleanliness and quite another to achieve it. Methods vary according to wealth and social class. At the bottom end of the scale, those who work with noxious materials are aware of the need to bathe themselves daily and so make use of rivers. London gongfermors end their working day with a dip in the Thames.8 Babies, wrapped in linen swaddling—ideally sweetened with rose petals ground with salt—are regularly given baths.9 People who do not spend their days up to their necks in excrement have baths less regularly; it is simply too labor-intensive and time-consuming to heat enough pots of water to fill a bathtub. But they do wash parts of themselves frequently. In the morning the first thing self-respecting men and women do is wash their hands and face: those parts of the body which show.10 This will normally be done in a basin of water. Monasteries usually have a stone lavabo or communal fountain and washing basins for monks to wash their faces and hands, complete with a towel cupboard nearby. In addition, every meal sees a washing of hands, both before and after, and this applies across all sectors of society: lords and ladies, all the servants eating in the hall, monks, merchants, and people eating at an inn. Thus most people wash their hands at least five times a day. Those who undertake long journeys are usually expected to wash their feet afterwards, in a foot basin. Monks bathe their feet weekly, and many self-respecting people do likewise. As for full baths, Cluniac monks have two a year, Benedictine monks four, and only the rich have more than this. Nevertheless, the regular washing of hands, feet, and faces means people are not all as filthy as you might imagine.11
For the aristocracy, and those rich merchants and their wives who ape the aristocratic lifestyle, taking a bath is a luxury as well as a means of washing the whole body. Bathing is, after all, a royal habit. In the previous century, King John used to have a bath every three weeks. Henry IV on the eve of his coronation, establishes the Order of the Bath, drawing attention to the noble ritual of bathing—purifying oneself both physically and spiritually—before becoming a knight. King Edward I has running water in his bathroom, controlled by gilt bronze taps. Edward III builds several bathrooms in his palaces, some of which have hot running water as well as cold.12 In such bathrooms, which are usually tiled, the lord has his wooden bathtub. This is lined with cloth. The tub is filled from the taps (in the case of the king) or pots of hot water. Rose petals, spices, herbs, and other fragrant things are added. Normally the whole bath will have a silken canopy, to keep away drafts, and the bath itself may be covered, to retain heat. The lord is given a large sponge to sit on, and his servants sponge his body down with warm rosewater.13 In some cases, the larger baths are for sharing. Two men, or a man and his wife, might share a bath. They might share some refreshments at the same time and listen to musicians play, while enjoying the warm fragrant water together. At such moments, life is sweet.
Luxurious bathing, especially when it involves members of the opposite sex, has undertones of licentiousness. Thus you need to be careful when going to public baths or stews. Of course you will find plenty of hot water and steam at the stews in Southwark—they specialize in steam baths—but the Flemish women who run them may offer to do much more than scrub your back. All the cleaning of bodies and clothes is done by women, so naked rich men being bathed by semiclad unmarried poor women is bound to result in a degree of temptation, on both sides. Especially considering that prostitution is tacitly permitted in most towns and cities. Needless to say, this sort of bathing spreads diseases rather than prevents them.
Given that public bathing establishments are more for pleasure than purity, how does the common man, woman, and child stop building up their own miasma within their clothes? Again, one has to stress that some people do stink. Older, less able people who cannot bathe themselves in a river, or wash themselves in a basin, are dependent on their caregivers, and, if they live alone, they might not wash at all. The single peasant who has just the one shirt and tunic to his name will see washing his clothes as part of the same process as washing himself. Given that men do not normally wash anything except dishes, this might be quite infrequent. At the start of the century, villeins only rarely wash their bodies, being almost wholly preoccupied with the cleanliness of their hands and faces and their internal, or spiritual cleanliness.14 For them, an unwashed smell indicates virility. An occasional clean shirt and regular delousing by their womenfolk is the extent of their toilet. But the growing sensitivity of men and women to others’ smells—especially in towns—is revealed by the regular use of perfumes towards the end of the fourteenth century, especially musk, civet, lavender, and rosewater; one ends up “smelling of roses,” literally. In summer, bathing in rivers is common; it is relaxing at the end of a long day to go down to the river with the rest of the manorial workers. It also relieves you of the irritation of insects living on your unwashed skin. The leading English physician John Gaddesden particularly recommends having a bath in salty or sulphurous water as a cure for such parasites. He believes it cleans the pores in which the lice breed.15
When lice and bedbugs are an irritating part of everyday life, and when you are at the same time trying to minimize your body odor, nothing is as important as fresh, clean linen. Gaddesden himself recommends frequent changes of clothes. In winter, when few people wish to bathe in a river or even strip off the upper body to wash under the arms in a basin, fresh linen is the most common form of cleaning. The linen soaks up the sweat. The body may then be scented, and once more you are presentable in public.
Yes, you say, all very well; but how clean is the linen? And how clean are your other clothes? After all, is not urine used in the fulling of cloth? The answer to that is yes, to a point: the practice of using urine continues until 1376.16 But fulling is only a means of processing wool. The cloth is dyed and washed before it is worn, and the washing involves soap. There are several varieties available. The best is Castile soap, available in cakes. This is made in Spain with Mediterranean potash, which is saltier, and thus harder and less caustic, than the northern European soft soaps. It costs about 4d a cake.17 Cheaper white, grey and black varieties for cleaning cloth are made in England. They come in liquid form, cost about 13s 4d a barrel in the 1380s, and are decanted into bowls for use. The washerwomen, leaning over their washtubs and washboards, or trampling clothes in a stream, tend to have their legs stained grey from the black soap. Obviously you cannot use black soap on white linen, so the more expensive white soap is necessary. Such soaps are powerful. You could not use the liquid soaps on your hands without damaging your skin—one glance at a washerwoman’s blistered hands, arms, and legs will put you off. These soaps are also widely available: Henry of Lancaster replenishes his soap supplies when he goes on crusade to Prussia in 1391. In some towns it is possible to hire washboards and washtubs: Henry does so when visiting Calais in 1396.18 If you have sufficient money, you can appear clean wherever you go.
Attitudes to hair are more complicated. Men expect their womenfolk to comb their hair for them, often beside a window, allowing them to see
any lice and to remove them. However, excessive combing of hair among men is frowned upon. Moralists write diatribes against the practice, castigating the Danes, who are supposed to be so vain that they comb their hair every day and have a bath every week. Women too come in for censure, largely because their personal grooming is seen as a display of vanity. Ignore such moralists: most people appreciate cleanliness. Besides, as women are not permitted to wear their hair down in public, it must either be styled or covered. Hence it is important for women to comb their hair so it may be dressed. Both sexes do wash their hair: brass basins are employed for this purpose. A mixture of spices is used, such as cinnamon, licorice, and cumin, rather than an irritating soap.19
Similar mixtures of spices are used for the teeth. In “The Miller’s Tale,” Chaucer’s characters chew cardamom and licorice. Aniseed, cumin, and fennel are sometimes recommended to women.20 The purpose is not to keep the teeth free from disease so much as to make the breath smell fresh. Clean-smelling breath is most important. Bad breath, it is believed, carries disease. The breath of menstruating women can make a wound go bad, and so can the breath of a physician who has recently had sex with a menstruating woman (or so the Nottinghamshire surgeon John of Arderne will tell you, apparently from personal experience). Similarly it is believed that the breath of lepers can give you leprosy; hence they are segregated from society. This means that almost all dental care is about smell, not about preserving the teeth. For this reason, the whole subject of dental care might make you squirm. Grinding grain between millstones means small particles of stone get into the bread, and the attrition of the teeth can be severe. The increasing availability of sugars means that dental caries is actually worse in the fourteenth century than it was in Anglo-Saxon times. Depending on where you are in the country, by the time they die adults will have lost between an eighth and a fifth of their teeth.21 Physicians will tell you that toothache is due to tiny worms eating into the enamel. Remedies include using myrrh and opium. If you cannot afford these, “take a candle of mutton fat, mingled with seed of sea holly, and burn this candle as close as possible to the tooth, holding a basin of cold water beneath. The worms [which are gnawing the tooth] will fall into the water.”22 Alternatively go to a tooth drawer, who will yank out the tooth for you. Then, like John Gaddesden himself, you may replace your own teeth with false ones.
