As I’ve noted several times, I generally try to ignore whatever is currently passing for ‘governance’ in America at the moment, cuz I just ain’t got the patience, or ability to do all that emotional labour. However, they will keep on doing things that call back to the medieval period, so we’re gonna have to talk about it.
So currently in America, which is defo a first world country and for sure very prosperous and a good place to live, there is some debate about whether or not sick people should be driven into bankruptcy, given the audacity of their instance on being ill. (Have they tried not getting ill? IDK.)
Some Americans, who are for sure good Christians and well into Jesus, need you to know that no one should be obligated to help sick people pay for medical care. To whit:
This idea – that health care is something that requires a) payment, and b) is an individual, not a community, concern is what we’re going to talk about today.
Now, as you may be aware, European medicine was underpinned by the idea of humorism, which was central to Hippocratic medicine. Hippocratic medicine itself was developed from the tradition of Greek natural philosophy. Hippocrates, obviously, gave his name to the discipline, but the Hippocratic Corpus – a series of sixty some essays on medicine – was developed by several authors and compiled around 250 BCE. Galen then came along sometime around 129 AD and updated the ideas slightly, and notably had some influence on theories of anatomy and pharmacology, but was still a stan for humor theory.
As the theory went – the body held four humors: blood, yellow bile, black bile, and phlegm. These humors, in turn corresponded to the four seasons, the four elements, four temperaments, and four stages of the life cycle like so…
More or less, the idea was that if your humours were balanced you would remain healthy. If something got out of whack, you got sick. To get better you needed to get those humors back into balance. A lot of this idea was based on observation. If you were so sick to your stomach you were vomiting bile it sure did look like you had too much and your body was trying to rid itself of it. Bad cold? Same thing with phlegm.
Medieval medicine took this classical basis and ran with it. Classical medical texts were copied and edited in monasteries and monks also wrote their own works on herbal medicine and botany based off their own observations. As groups of devout Christian men with access to medical knowledge, monks considered it to be their religious obligation to provide medical care for members of their communities.
As a result, most monasteries ended up having a sort of informal hospital. Because they were actual fucking Christians.
There were a lot of other groups practicing medicine in the medieval period however. Barber surgeons, famously, did a lot of medical work that involved cutting people. Basically if you were able to keep a razor sharp enough to shave someone, odds were it was sharp enough to do minor surgery. Homeboys would do stuff like blood letting, dentistry, looking after soldiers during and after battle, and also keeping your cut fresh AF.
Barbers were medical professionals and for sure got paid. However, the medical services they provided were generally in reach of your average (read: peasant) medieval person.
There was also something for the ladiez to do medically – that is look after other ladiez. (Did you know that half of all people in the medieval period were actually women? No for real. I’m serious.) Midwifery was some real shit, and basically one of very few professional options for individual women at the time. (Fuck yeah the other option was sex work – shout out to my girls.)
Midwives were typically apprenticed at a young age in order to learn the trade, and had to have a reference from their parish priest as to their good character in order to do so. They then learned all about assisting the labour process. Labour was an exclusively female medical event – with men being excluded from the birth chamber. Midwives were certainly professionals, but the great majority of people (again, peasants) could still afford their services.
There were also straight up apothecaries who were sort of like modern day chemists/pharmacists who made drugs and medicines. By the thirteenth century they had their own guilds, and they often worked alongside other medical practitioners in order to establish what drugs should be made or
There were, of course, also dedicated physicians in the medieval period. There were several schools that taught medicine, including the much-celebrated Salerno, and later Montpellier, which is still in operation.
These institutions trained doctors including the famous Rogerius who wrote a killer book called The Practice of Surgery (Practica Chirurgiae) round about 1180, and also came up with the term ‘lupus’ and Giles de Corbeil who wrote a series of influential medical poems on the urinary tract and pulsology. The university system was making some pretty good advances in medicine, if slowly. People started doing more work with human dissection and learned more about anatomy. (Fun fact – high medieval Europe did not totally ban human dissection, but Pagan Rome did. Bring that up when people say the medieval period was backwards.)
The medical schools were drivers of medical thought and research and the people who trained in them often ended up working for the elite. You had to go to school for years to be licensed, and it wasn’t cheap, so you charged.
That’s where the trouble started.
After the Black Death showed up, people were not too enthused about medical practitioners. If they knew so much, why couldn’t they stop the plague?
People began cracking down on non-licensed medical practitioners. If these people were actually skilled in terms of medicine then for real, why TF was everyone dying on the regular? Soon laws began to propagate stating that only licensed, i.e. university educated physicians could practice medicine. This fucked shit up.
Suddenly a lot of people who had been offering health care services couldn’t. The barber who pulled out your rotten teeth? Not licensed. Apothecaries who knew everything about how to create drugs? Part of a guild that learned through apprenticeship, not university. The monks who had killer medical libraries, actual running hospitals, and gardens full of medicinal herbs at their disposal? Only educated in the cloister.
It was even worse for women who could not go to university. In the medieval period all students had to take holy orders in order to join university, meaning that they were clergy members, if only for their time in school. Women couldn’t do that. That meant that there was no legal way for midwives to practice, despite the fact that only women were supposed to be involved in the birth of children.
So the ranks of people who could legally provide medical care suddenly dropped. Meanwhile, the only people who could legally provide it needed to see that cash money in order to provide medical care because they made a huge investment of time and money to get where they were.
In some instances, where you lived also determined whether or not you could get medical care. A trained physician would want to stay where the greatest number of potential (wealthy) clients lived. They, therefore, tended to stay in cities, or revolve around courts where their educational investments paid off. No one was going out to the country side to see to the peasants, you feel me? Moreover, the peasants couldn’t drag themselves off to a monastery for help when they got sick anymore, because monks weren’t supposed to be practicing medicine. There just wasn’t anywhere to go for help. By the early modern period, then, the poor had been stripped of a lot of the options they could exercise before.
All of this helped to create the system that America is experiencing today. Healthcare became a luxury – something that the rich elite had recourse to, and which everyone else had to do without. It is also a hugely modern ‘system’. No one is compelled by their religion to take care of the sick, despite the fact that America loves to call itself a Christian country. We compel bright young people who want to make money to go to med school, because there is a huge financial incentive. Being a medical doctor gets you paid. We do not tell them they have a responsibility to treat the sick when they are trained.
This health care system also routinely marginalises people who provide medical care but are not physicians, in particular those who are providing medical care in one of the traditionally ‘feminine’ roles. Nurses and midwives have much much more patient contact than doctors do, but are paid nowhere near as much. Hell, in America you might be paying out the nose for medical care and only ever see a nurse practitioner anyway, such are the vagaries of for-profit healthcare. So the nurse-practitioner ain’t getting paid, but you are still paying, and somehow all of this is fine and good.
None of this is to say that medical practitioners shouldn’t be paid for their services. It’s a hard job. You have to learn a lot. In the UK we really treat our junior doctors terribly and they deserve so much more. In the medieval period people still managed to treat people at all levels of society and still make a good living. The people who could afford to give away free health care in the medieval period (monks) had really comfortable life styles. The lower-level practitioners like barbers and midwives made their living on volume. There were options for patients and practitioners to enhance their quality of life.
Overall, then, while medicine has moved on from the medieval period and is much more effective – the healthcare options that many people in America have are actually much worsein comparison to what was available seven hundred years ago.
Perhaps even more distressing for enthusiasts of using ‘medieval’ to mean bad (which you should never do), is that America is a less caring society than Europe in the year 1300. Medieval Europeans were subject to strict class systems, many were unfree, and most lived lives of grinding poverty and work. Most people weren’t allowed to move down the road if they wanted to – but they were still considered deserving of health care.
Tell me one more time who the barbarians are.
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For more on medieval medicine, see:
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On Medical Milestones, the Myth of Progress, and Textbooks, Part II
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