Medieval Medicine Was Absolutely Horrifying

“A barber surgeon ties a cord around your upper arm until the vein in the crook of your elbow swells up blue and obvious. And then he takes a small blade called a flee, lines it up against that vein, and taps the back of it with a little wooden stick. So the blade goes in clean. Blood runs down your forearm into a shallow bowl with measuring marks on the side.

He’s watching the bowl, not you. He’ll keep watching it until he’s taken what he thinks the illness requires. And sometimes that’s a few ounces. And sometimes it’s most of a wine bottle’s worth. And if you go pale and start to sway, he might actually nod to himself because fainting was read as the body finally letting go of whatever was poisoning it. This was not punishment.

You came to him. You paid him. He was by every standard he and everyone around him understood, helping you get well. That single image holds most of what makes medieval medicine so hard to sit with. And we’re going to spend a long while inside it today. Bloodletting, teeth pulled with iron hooks, holes drilled into living skulls, wounds closed with a glowing brand, legs taken off with a saw while the patient is wide awake and held down by men whose only job is to keep him from thrashing.

None of it is gentle.”

“Any careful, educated physician opening your vein for a headache was reaching back to the idea that organized the entire medieval body. Four fluids, blood, flem, yellow bile, and black bile. The four humors, an inheritance handed down from the Greeks, from Hypocrates, and then Galen, and treated for well over a thousand years as basically settled science. Health was balance. Sickness was a humor gone out of proportion.

Too much of one fluid sloshing the system off. True. And of the four, blood was considered the master, the dominant one. The humor, Galen said, carried traces of all the others inside it. So if a person ran hot, flushed, feverish, agitated, the explanation was obvious. There was too much blood in them, and the cure followed just as obviously.

Take some out. Let the excess run into the bowl and the balance comes back. This is the part people miss when they laugh at it. These weren’t fools throwing leeches at problems for no reason. They had a complete internally consistent theory of how the body worked and every treatment flowed logically from it.

The trouble was that the theory was wrong at the root and a wrong theory followed with rigor and discipline and centuries of refinement just digs the error in deeper. They observed carefully. They kept notes. They argued in the universities about exactly which vein to open for which complaint. And they were dead serious about it because getting it wrong meant drawing the bad humor toward the sick organ instead of away from it.

A physician treating a problem on the right side of the body might insist on bleeding from the right arm. The literature on this is enormous and detailed and completely confident. And it didn’t stop at picking the vein. They timed it by the stars. Medieval medicine and astrology were braided together so tightly you couldn’t really pull them apart.

And the position of the moon told you when it was safe to cut and when it absolutely was not. One figure turns up over and over in the medical manuscripts. The zodiac man, sometimes called homo signorum, a drawing of a human body with each of the 12 zodiac signs assigned to a part of it. Aries governed the head, Taurus the neck and throat, Pisces all the way down at the feet.

And the rule attributed back to Tommy was that you never touched a body part with iron while the moon sat in the sign that ruled it. Moon in Aries, you leave the head alone. The physician would consult his charts, check the date, check the lunar position, and only then decide whether today was a bleeding day at all.”

“Some of the printed almanacs that came a little later marked out dozens of specific veins you could open according to the season and the phase of the moon. One calendar from the early 16th century laid out 54 of them. So this was not a back alley practice. Bloodletting was the respectable center of medicine taught at the great schools performed on kings and on peasants written about endlessly by the most learned men of the age.

It was the single most common medical act in the entire medieval world. Whatever was wrong with you, fever, gout, headache, a racing heart, low spirits, trouble sleeping, a skin complaint, too much desire, not enough desire. The answer kept circling back to the vein and the bowl. The methods varied depending on how delicate the case was.

The straightforward version, the one I started with was venice. Opening a vein directly, usually at the forearm or sometimes the neck with that lancet or flee, and letting it bleed into a measured bowl. A confident practitioner would take a serious amount. The old texts give recommended quantities that would make a modern doctor go white enough that the patient was meant to feel it, to lose color, to drift toward fainting, and that swoon was sometimes the goal rather than a warning sign.

The body had been relieved of its surplus. Job done. For finer, more localized work, there were leeches. And the leech mattered so much to this whole world that the word itself became the word for a doctor. In old English, a physician was a leech and a medical book was a leech book, a sign of how central this one slick little animal was to the business of healing.

You’d set them on the skin over whatever part needed draining, and they’d bite down with that small threejawed bite and start to feed. And the clever thing about a leech, though nobody at the time knew the mechanism, is that its saliva keeps the blood from clotting. So the wound keeps weeping freely even after the animal has had its fill and dropped off.

A leech is a self-guiding instrument. No blade, no aim required. It finds the blood on its own. You needed several for any real effect, and they went wherever the physician decided the trouble was concentrated, around the eyes, inside the mouth, in soft and tender places. You would genuinely rather not host a leech.

A small, grim economy grew up around the leeches themselves, too, because you needed a steady supply of them, and they didn’t keep forever. In some places, people waded into ponds and marshes with their bare legs as living bait, standing in the shallows until the leeches fastened on, then peeling them off and collecting them.

A job that meant being bled yourself slowly all day in order to gather the animals that would bleed someone else. The creatures were kept in jars of water sold by apothecaries transported in containers and a good fat medicinal leech was a commodity with real value. After feeding on a patient, a leech was sometimes squeezed to make it disgorge so it could be used again sooner, or salt was used to force it to release its grip midfeed if the surgeon decided it had taken enough.

The whole apparatus of it, the gathering, the keeping, the selling, the reusing, built an entire small trade on the back of one bloodrinking worm. And that trade ran for centuries because the demand never let up. Then there was the method that sounds like something out of a torture record but was ordinary medicine. Scarification with cupping.

The surgeon scraped the skin with a small bladed instrument. Opening a row of shallow cuts and then set a heated glass cup over them. As the air trapped inside cooled, it contracted and the suction pulled blood up out of those cuts and into the dome of the cup. Lines of these down a person’s back across the shoulders, the skin rising into the glass.

Dry cupping pulled blood toward the surface without cutting. Wet cupping drew it out through the scratches. Either way, the patient sat there while their blood was coaxed up through their own skin. Now, the genuinely grim part, and there’s no soft way around it, is that for nearly everything it was used on, bloodletting did no good, and a fair amount of harm.

A person already weakened, already burning with fever, already bled thin by a wound or wasted by a long sickness, was made weaker by having more blood pulled out of them. We can say with real confidence that the treatment hurried people toward death, that it turned survivable illnesses into fatal ones, that the cure was sometimes the thing that finished the patient.

The most famous example sits just past the edge of the medieval world, but runs on exactly the same logic that had been unbroken for 2,000 years. George Washington in December of 1799 woke with a bad throat infection, and over the course of a single day, his doctors bled him again and again. By the most cited estimate, they drained somewhere around 80 ounces, roughly 40% of all the blood in his body in about half a day.

Some accounts put the figure even higher. He was dead by nightfall. The men around his bed were not quacks. They were the finest physicians available, doing the most respectable thing medicine knew how to do. And the most respectable thing medicine knew how to do was bleed a dying man until he had almost nothing left. The medieval patient faced that same confident logic just centuries earlier and with even less to fall back on.”

“Henri de Mondeville, one of the great surgical writers of the early 14th century who served two kings of France, actually left advice on how to handle a patient who panics at the sight of his own blood pouring into the bowl. Tell him Mandavville wrote that it’s for his own good because the imagination he believed ruled over the other faculties of the mind and a frightened man could make himself worse.”

“So the surgeon’s job was partly to keep you calm while he drained you, to talk you through it, to manage your fear of the very thing he was doing to you. There’s a whole bedside manner built around that. Stay still. This is good for you. Don’t look at the bowl.”

“There’s a story the historian Nancy Sarayi preserves about a medieval patient simply called Peter who agonized with his physicians over whether to put off his routine bloodletting. Frightened that delaying it might harm him and frightened that going through with it might harm him too. He wasn’t sick in any emergency sense. This was maintenance, a scheduled draining, the way you might think about a regular checkup, except the checkup involved opening a vein on a date chosen by the moon.

People built their health around it. Monasteries had bleeding schedules, regular days when the monks would be bled as a matter of routine, after which they’d rest and recover and eat a little better than usual for a day or two. The practice was so woven into ordinary life that being bled could be almost social, a thing the body was simply due for, like a season turning.

There’s something worth sitting with in how routine all of this was. Because the modern instinct is to picture bloodletting as an emergency measure, a desperate thing reached for when someone was already dying. It wasn’t. For a great many people, it was preventive, a thing you did on a schedule to keep yourself well, the way you might think of a seasonal habit.

The body in this view was always quietly accumulating excess, especially blood, and a sensible person let some out at regular intervals before it built up enough to make them sick. Spring was a popular time for it, the body supposedly thickening with blood after the slow, cold months.

The almanacs and calendars that ordinary literate households kept would mark the good bleeding days right alongside the saints feasts and the planting times, a normal part of running a life in the monasteries. This was formalized into a whole rhythm. The monks were bled several times a year on set days, the minutio, and it came with a small loosening of the usual discipline afterward.

A bled monk was excused from the hardest labor for a day or two, allowed a little extra food, sometimes a little wine, permitted to rest and recover in a way the rule normally didn’t allow. So the bleeding day became almost a small holiday inside the grinding routine of monastic life, a thing some of the brothers may have quietly looked forward to.

The rare license to lie still and be fed. The blood ran into the bowl and then you got to rest. Some houses even had purpose-built rooms, places set aside for the procedure and the recovery that followed. The choice of where to open the vein was treated as a serious clinical decision, not a casual one, and the medical texts go on at length about it.

The great vein at the bend of the elbow was the common sight. But it mattered which arm, and it mattered which of the several veins there you chose, because each was thought to connect to different organs and regions through the body’s network of vessels. A surgeon learned veins to open at the temple for diseases of the head, veins under the tongue, veins at the ankle and the foot for complaints lower down.

Even in some prescriptions, the small veins of more intimate places, a physician treating a specific organ wanted to draw the corrupt humor away from it along the right channel, and pulling from the wrong site could, in the logic of the system, drag the bad matter toward the sickness instead of away.

So a learned doctor might overrule a barber’s instinct and insist on a particular vein in a particular limb on a particular day and feel he was practicing real precision medicine because by the standards of his knowledge he was. The complications were exactly what you’d expect when people open veins by hand with no understanding of what’s actually in the wound.

A clumsy cut could nick an artery or a nerve, leaving a patient with a damaged hand or a bleed that wouldn’t easily stop. The wound could fester. And the sheer cumulative effect of being bled regularly for years, drawing down a body’s blood again and again, left people weak, pale, prone to fainting, anemic in a way no one had a name for, run down by the very treatment meant to keep them healthy.

A person who felt tired and bloodless and faint would be diagnosed with an excess of some humor and bled again, which made them more tired and more bloodless. A loop that could run a long time before it broke. And when a patient finally collapsed and died, the death was rarely blamed on the bleeding. The illness took him.

People said the treatment was sound. The treatment was always sound. It’s worth slowing down on the bowl itself for a moment on the actual object because the bleeding bowls that survive tell you how normalized this was. They were everyday domestic items, often handsome, made of puter or glazed ceramic or brass, sometimes with a notched edge so the bowl could be braced against the arm or the throat to catch the flow.

And many were marked on the inside with rings or lines so the practitioner could measure exactly how much he’d taken. A household might own one the way it owned cups and plates. The barber surgeon carried his on his rounds. The blood collected in it was sometimes even examined afterward. Its color and its consistency studied for signs of which humor had been in excess.

So the bleeding doubled as a diagnostic. The bowl read like a urine flask for clues about the body’s inner state. A patient might watch their own blood being inspected and discussed. The surgeon turning the bowl in the light, nodding or frowning at what he saw, pronouncing a judgment on the state of their humors from the look of what had just come out of them.

And the people receiving all this care ran the whole span of society. Kings were bled, bishops were bled. The greatest figures of the age submitted to the flee and the leech as readily as any farmer and often more frequently because they could afford the most attentive physicians, and the most attentive physicians bled the most diligently.

Being well attended in medieval medicine often meant being bled and purged and dosed more aggressively, not less. So the wealthiest and most powerful patients sometimes got the most dangerous care of all, hovered over by learned men competing to demonstrate their diligence by draining a little more, prescribing a little more, intervening a little more.

The poor, who could only afford a barber’s quick bleeding now and then, or nothing at all, were in this one narrow respect, sometimes safer, simply left alone to either recover or not. The haunting part of all this is how much careful thought went into the wrong thing. A barber surgeon could spend years mastering the angle of the flee, the right vein, the correct day, the proper quantity, all of it skilled, all of it taken seriously, all of it resting on a foundation that simply wasn’t true.

And because the foundation felt so solid, because it had Galen’s name on it and a thousand years of authority behind it, nobody bleeding a patient had any reason to doubt that they were doing good. The confidence is the haunting part. They were so sure. Let me take you from the vein to the mouth. Because if bloodletting was the everyday horror that almost everyone submitted to willingly, the medieval tooth was a horror that came for you whether you wanted it or not. Everyone has teeth.”

“Everyone’s teeth eventually go bad. And there was almost nothing anyone could do about it except the one violent thing.”

“A rotting abscessed tooth produces a pain that has not changed in 800 years. The nerve is the nerve. The infection is the infection. A person today with that same throbbing, swollen jaw gets an antibiotic and a dentist and is comfortable again within a day or two.

A medieval person got to live inside that pain. Sometimes for weeks, sometimes until it killed them. Because an untreated dental infection doesn’t just hurt, it can spread into the jawbone, down into the soft tissue of the neck, into the blood, and end a life. People genuinely died from their teeth. And the explanation they reached for across most of medieval Europe and far beyond it was the toothworm.

The idea is ancient, older than Rome, older than Athens, turning up in Babylonian and Sumerian texts thousands of years before the medieval period as a little worm that burrowed into the tooth and lived there, gnoring, and the pain you felt was the worm moving around inside. People believed this completely. It made a kind of sense. The pain came and went.

It throbbed. It felt alive. And a hole in a decayed tooth looked exactly like something had been eating its way through. So the treatments aimed at the worm. One of the most common was fumigation, burning the seeds of a plant, often henbane, and funneling the smoke into the open mouth, sometimes through a cone or a tube directed right at the bad tooth.

The smoke was supposed to drive the worm out or stupify it into falling loose. The reason it persuaded people so completely is that the henbane seeds when they burn and the smoke hits something cool can throw off tiny pale threadlike wisps that look to a desperate person staring into their own steaming mouth exactly like little worms dropping out.

The folk healer would point at them. There. That’s the worm. That’s the thing that was hurting you. We’ve got it out. And the patient, half mad with pain and wanting so badly to believe it, would feel a wave of relief that probably did take the edge off for a moment. The worm was, of course, never a worm.

It was plant fiber, seed husk, smoke condensing. But the show worked. People walked away believing the enemy had been pulled out of their head. Henbane, by the way, is a serious poison, and breathing its smoke does have an effect. It’s mildly narcotic and disorienting. So, the fumigation might genuinely have dulled the pain for a little while, even as it dullled the patient.

Whether that was worth filling your lungs with toxic smoke is another question. But a person in real dental agony is not weighing costs very carefully. When the smoke failed, and it always eventually failed, you were left with the only real option, which was to have the tooth torn out of your head. No anesthetic worth the name.

And medieval extraction was a brutal blunt force business carried out with a tool whose name tells you most of what you need to know about how it worked. The dental pelican. It came into use around the 14th century, and it was named for its shape, a curved iron claw on a handle that looked like the hooked beak of a pelican.

You hooked the metal claw over the top of the bad tooth, braced a bolster against the gum or the neighboring teeth as a fulcrum, and then you levered. You pried the tooth sideways, rolling it up and out of its socket through sheer mechanical force. No finesse in it at all. The leverage was enormous and almost impossible to control, so it was completely routine for the pelican to snap the crown clean off and leave the roots buried, or to tear out healthy teeth alongside the rotten one, to rip the gum, to crack the jawbone itself.”

“You held on to the chair or to your own knees or to whatever was nearby while a man wrenched at the inside of your skull with an iron hook and tried to twist a tooth out by the root.”

“Later there was the tooth key which worked on a similar principle, a claw that gripped the tooth and a shaft you turned to rotate it out. And it was, if anything, even more violent, capable of shattering a tooth into fragments inside the socket. But the pelican was the medieval workhorse. And for centuries, it was what stood between a person and the worst pain of their life. A grim thing to be the best available answer. Here’s a detail that makes the whole picture worse.

The men doing this were very often not anyone we’d recognize as a medical professional. The learned physicians, the university men who debated humors and consulted the stars, considered the mouth beneath their dignity. Pulling teeth was filthy manual work, and they wanted no part of it. So it fell to barbers who already kept sharp tools and a steady hand, and below them to traveling tooth drawers who set up at markets and fairs and worked on whoever came forward.

And some of these traveling men turned the whole thing into a performance. The tooth drawer would gather a crowd, sometimes with a musician alongside him, partly as a drawer, and partly, you suspect, to cover the noise the patient was about to make. He’d seat his customer in the open, get the pelican set, and yank fast and showy, and then hold the bloody tooth up over his head to applause.

Make a spectacle of the agony so it became entertainment. The worst of these men were outright frauds. They’d plant a shill in the crowd. Someone who’d come forward and have a tooth pulled with no pain at all. Miraculous, instant, no blood. Drawing the genuine sufferers in close. And then a real customer would step up having seen how easy it looked and get the full undiluted horror once the coins had already changed hands. Money in teeth.

And where there’s money and desperation and pain, there are always people willing to work the gap. And if you lived through the extraction, you were right back in the same danger that shadowed everything in this world. The mouth is a warm, wet, crowded place, thick with bacteria, and pulling a tooth tore an open wound straight down into the jaw.

Infections from dental work could spread into the bone, into the neck, down toward the chest, and these could and did kill. A bad tooth left alone could send poison into the blood and end you. A bad tooth pulled badly could do exactly the same. No clean way out of that room. You either kept the agony or you risked the wound. And both roads sometimes led to the same fever bed.

One small strange wrinkle in all this. Tooth decay was actually more common among the wealthy than the poor because the rich could afford sugar and sugar rots teeth. The poor, eating coarse bread and little sweetness, had fewer cavities, though they wore their teeth down to stumps, using them as tools and grinding grit from stonemilled flour.

And for those who could pay, there were even false teeth carved from cowbone or ivory, or in the grimmer cases, taken from the mouths of the dead and fitted into the living. You could, if you had the means, walk around with a dead stranger’s teeth in your jaw. The market found a way. Alzarawi, the great surgeon of Cordoba, whose work we’ll come back to in a bigger way shortly, actually wrote carefully about dentistry, illustrated dental instruments, warned against careless extraction, described scraping the hard deposits off, even discussed wiring loose teeth in place.

The knowledge to do better existed in the texts. It just rarely reached the screaming man at the fair with a toothdraws hook in his mouth and a crowd watching. Back in the realm of the mouth for a final detail, the people who lost teeth, whether to rot or to the pelican, faced a life reshaped around the gaps.

Chewing changed. The diet narrowed towards softer food. The face itself altered as the jaw lost the teeth that had shaped it. And for those with the means, the replacements were makeshift and uncomfortable. Carved bone or ivory or the repurposed teeth of others, lashed in place with wire or thread, fitting badly, prone to slipping.

A full set of working teeth was something a person could lose piece by piece over a lifetime. Each loss marked by a session in the chair with the hook until the mouth was a landscape of gaps and stumps and sore receding gums. And all of it endured without relief. Because the one thing the age could reliably offer a suffering tooth was its removal, and removal was its own ordeal.

So people carried their dental misery quietly for as long as they could stand it, which was often a very long time. Before anyone reached for the pelican, there were gentler attempts that almost never worked, but that people clung to because the alternative was so frightening. Charms and prayers were everywhere.

Written words to be worn against the jaw, appeals to particular saints, St. Appalonia chief among them. A woman who according to her legend had her teeth shattered and pulled out during her martyrdom and so became the saint you prayed to when your own teeth were killing you. People in agony recited her name and wore little written prayers and hoped.

People packed picuses against the gum, mixtures of herbs and oils and resins. Clove being one of the few that actually had any effect because clove oil genuinely does numb dental pain a little. One of the rare folk remedies that wasn’t pure hope. People tried rinses and pastes and cauterizing the gum with a hot wire or a drop of acid to try to kill the pain at its source, its own small horror, pressing something burning against an already screaming nerve.

The mouths themselves were often wrecked in ways that went well beyond a single bad tooth. Gum disease was rampant. The gums receded and bleeding and abscessing. Teeth loosening in their sockets and shifting and falling. The grit in stone ground flour wore the chewing surfaces down to the dentine and sometimes to the pulp, exposing the nerve through sheer grinding erosion, so that even people without cavities could be in steady, low pain just from eating bread their whole lives.

Abscesses formed at the roots and built pressure with nowhere to drain. And when one finally burst, it released a flood of pus and a stench and a temporary blessed drop in the pressure and the pain until it built up again. Some people lived for years with a chronic draining sinus from a dead tooth, a small hole in the cheek, or the gum that wept infection constantly.

And the deaths were real, even if we can’t count them precisely. An infection that started in a tooth could climb. It could spread up toward the eye and the brain or down through the floor of the mouth into the neck and the throat, swelling the tissues until they closed off the airway or into the bloodstream as a general sepsis.

Ludvig Zangginina, a massive swelling of the floor of the mouth that can choke a person, has its roots in exactly this kind of untreated dental infection. So the man putting off the tooth drawer out of terror, choosing the daily agony over the hook, was not making an irrational choice exactly. But he was also gambling because the tooth left to rot could quietly send the infection somewhere that killed him in his sleep.

Either road had a cliff at the end of it. You just couldn’t see which one was yours. It’s worth dwelling for a second on what the extraction itself actually did to a body mechanically because the pelican was such a blunt instrument. A tooth is anchored in the jaw by a web of fibers and set into living bone and it does not want to come out.

So the force required was substantial and it was applied through a lever with the gum or the next tooth as the fulcrum which meant the pressure landed not just on the bad tooth but on everything around it. Crowns sheared off leaving the roots behind to fester. The jawbone itself, the thin bone of the socket, cracked and splintered.

Neighboring teeth, perfectly healthy, were dragged loose or snapped by a slip of the claw. The gum tore, and all of it happened inside a mouth on a fully conscious person whose head had to be held still while a man hauled and twisted at the inside of their face. The screaming that the fairground musicians were brought along to cover was not theatrical.

It was the sound of bone breaking and nerves being torn with nothing whatsoever to take the edge off. Let me move from iron in the mouth to iron in the fire because we’ve reached carterization. And this is where medieval medicine becomes genuinely useful and genuinely monstrous at the same time, often in the same minute.

The principle is brutally simple. Heat a piece of metal until it glows. Press it against living flesh and several things happen at once. The heat seals torn blood vessels and stops bleeding that might otherwise kill. It burns away tissue the surgeon once gone: a growth, a rotten edge, an ulcer. And though no one understood this part, the searing heat sterilized the wound surface, killed the contamination sitting on it, which means cauterization is one of the rare medieval treatments that accidentally got the infection problem right. A red-hot iron is a clean iron. Nobody knew why that mattered, but it did. And it saved lives. A wound that would have bled a man white could be shut in a few seconds with a hot blade laid across it. Those few seconds, though, were about as bad as anything a human body can be asked to endure while staying conscious.

The smell came first, and it’s the detail that survivors and witnesses kept returning to in their accounts. The smell of your own flesh cooking which fills the room and soaks into the hair and the clothes and stays there for days. The pain was total. There’s no part of the mind that can step back from a brand held against living skin and cauterization was not reserved for emergencies for the bleeding stump or the sliced artery.

It was a generalurpose tool applied to a staggering range of conditions on the theory that fire could draw out illness the same way bleeding could draw it off. The medieval and Islamic medical texts describe quarterizing for headache by burning points on the scalp. For epilepsy, for melancholy and madness, again by burning the head, for diseases of the chest and the gut, by burning the skin over the suffering organ.

For hemorrhoids, for fistulas, for sciatica, for joint pain.”