Sickness, suffering and supplication: A conversation about health and medicine during the Middle Ages and early modern era in Europe

John Slater and Nicole Archambeau

Nine years after the first wave of plague decimated 40 to 60% of Europe’s population at the close of 1351, plague would rear its head again. 

Two centuries later, the people of the Iberian Peninsula battled epidemic level diseases like smallpox that would stretch across generations, leaving people exhausted and seeking healing from the emerging and often dueling establishments of medical professionals and religion. 

Now in the 21st-century and the third year of a global pandemic, many of us are asking ourselves the same questions that the people of the Middle Ages and early modern era wrestled with as well: How long will this last? How do I stay well? What do I do when I get sick? 

“I’m very interested in what people do when they get sick and how they try to understand being ill and how they try to fix it,” said Nicole Archambeau associate professor of history and author of the 2021 book, Souls Under Siege, which focuses on pursuits of health and healing in 14th century Provence, France. 

“I’ve been working a lot with religious documents that show the broad spectrum of the ways people understood the world anywhere from spiritual sickness to physical sickness.” 

John Slater, a literary and cultural historian in the Languages, Literatures and Cultures department, studies the interplay among medicine, science and religion in the 16th and 17th centuries in Spain and Spanish colonies. Much of Slater’s research analyzes how Iberians of the 16th and 17th century utilized literature to address rising concerns in science and medicine. 

John Slater (right)

“The period that I study, hundreds of years later, people are exhausted. People are exhausted by public health interventions, they’re tired of having their movement limited,” said Slater, professor of Spanish. “I would say that distrust of medicine is really a constant in history.”

Nearly 645 miles and 300 years separate the specializations of Middle Ages historian, Nicole Archambeau, and Early Modern Era historian, John Slater, but there are similarities in the way that people of that time and place thought about illness, pursued wellness and incorporated a variety of modalities to get better.  

We invited Slater and Archambeau to sit down and discuss how Europeans viewed health and interacted with medicine – offering insights into what has changed in our own views of health and what hasn’t changed. 

How did the people of 14th century Provence/16th century Spain view health, particularly in the face of their biggest disease crises?  

Nicole Archambeau   

[The people of France and Provence] would be looking at health differently than we do. We tend to think of one germ equals one disease. You catch a cold or you catch a certain sickness. 

They’re thinking of it more in terms of imbalance within their own lives. So they would have a fever, but it wouldn’t be something that they caught from outside themselves — it would be something in the environment that triggered an imbalance in their bodies.  

They would try to treat it as, “What’s going on in my environment? What am I eating differently? How am I sleeping differently? What’s causing me to have this imbalance in my body that’s being expressed as a fever?” 

In the 14th century, epidemic diseases like the plague push people to think differently about disease, but that’s just kind of the beginning moment and then comes the understanding of disease in different ways. 

(Nicole Archambeau on the spread of disease and interplay of war, famine and the 100 Years War)

An illustration of the Battle of Crécy on 26 August 1346 CE between the armies of Edward III of England (r. 1327-1377 CE) and Philip VI of France (r. 1328-1350 CE). Edward was victorious thanks to his troops' experience, discipline and use of the longbow. From a manuscript copy of Jean Froissart's 'Chronicles', 15th century CE. (National Library of France, Paris)
A painting of citizens of Tournai burying their dead by Pierart dou Tielt (c. 1340-1360 CE). Made c. 1353. (Royal Library of Belgium)
Miniature from a folio of the Antiquitates Flandriae, depicting the citizens of Tournai, Belgium burying those who died of plague during the Black Death. By Pierart dou Tielt (c. 1340-1360 CE). Made c. 1353. (Royal Library of Belgium)

John Slater 

If you’re looking at the 16th and 17th centuries in the Hispanic monarchy more broadly, smallpox is the big thing. It may have killed as much as 80% of the population in the Americas.

Some of the most commonly treated diseases in Spain during the 17th century would be, for example, the disease that we call syphilis today and they called pox. [Syphilis] was treated freely at municipally funded hospitals, and there were a couple of different treatment modalities that they employed. One would be the use of guaiac, which is an American plant that was brought over to Europe, and another was the use of a kind of salve made from mercury, that was rubbed all over people’s bodies.   

There was a real gamut — from knowledge at home that was real knowledge, to some widely recognized and accepted forms of healing that seem to us today to be very superstitious or even ludicrous to health care professions that look a lot like in terms of their corporate structure, a pharmacist today or an internist today or a surgeon. 

(John Slater on the various treatments and healers available to the people of Spain)

What institutions would be considered the authority on public health at the time?  

John Slater 

In the case of Spain during the 16th and 17th centuries, there is a medical tribunal. So, there’s first a physician who runs essentially a kind of forensic tribunal. They would be the ultimate authority as to asking if a healthcare practice is acceptable or not.  

There was a government oversight body that was responsible for making sure that physicians were actually being educated, and beyond that sort of kingdom or monarchy-wide tribunal, there would also be municipalities that would have inspectors. They would inspect medical schools frequently, and there would be examinations, and the nature of those examinations would be known to the public, and if university professors were qualified. 

John Slater

There was a robust apparatus of control and quality control for the making of medicines: are the ingredients fresh, or are the ingredients what they are supposed to be; is the strength of the ingredients what’s being advertised. 

Municipalities are publishing lists of the medicines that are approved for use. It’s not like the FDA in the sense that there’s not a similar really rigorous testing regime, but it is like the FDA in the sense that they say, “Here’s what is legitimately allowed to be sold.” Not that you couldn’t find other things, but if you wanted to sell it in an apothecary shop and not just hock it on the street, then you had to follow the rules. 

Especially before 1492, there were three religious groups living in Spain, and those would be Christians, Jews and Muslims. In 1492, Jews are forced to leave Spain in an event called the Expulsion of the Jews that happened in other countries in Europe. This is one of a succession of expulsions, but this one was especially catastrophic, not only because many Jewish people were intellectuals, but also because they were many of them were physicians. 

(John Slater on the removal of Jews and Muslims in Spain)

Was that authority trusted by the public? What was the response to those authorities providing that oversight?

John Slater 

I would say that distrust of medicine is really a constant in history. It’s especially the case in the 17th century because cauterization is such a common treatment for imbalance of the humors.

Medieval woodcut showing the four humors

Traditional physicians and traditional academic medicine in the 16th and 17th centuries believed that the body was composed of four humors and that imbalances in the humors made sickness. People who had sort of an alchemical tendency believed that the body would function, could function perfectly if impurities were removed from it, like blockages and and things that were just keeping the body from functioning the way that it was supposed to. 

If you take a hot iron and you press it against someone’s arm, that wound will weep and people will say, “Look at all the bad stuff that’s coming out of you. You really needed this.” But people really didn’t like the pain of being cauterized. They really hated it.  

People would be angry about the pain that they underwent, and they would be angry that it didn’t work, and they would be angry that they had to keep scraping together whatever money they had to pay for these treatments.  

Part of this exhaustion is reflected in the fact that people who are either poor and don’t have access to a physician or who are frustrated with the health care that they’ve been getting, that dissatisfaction creates a void. During the 17th century in Spain, the church attempts to step into that world. 

Plate for the ‘Atlas Anatomico’ (unpublished)
Crisóstomo Alejandrino José Martínez y Sorli Spanish
Plate ca. 1680–94; printed 1740

We are familiar with the production of medicinal drinks like Chartreuse, which is a distilled drink with herbs. Well, Benedictines were distilling all over the place and Carthusian churches were distilling all over the place. And they’re giving these medicines to poor people. Then other folks are interested in buying those medicines. The church starts to realize that that they can have a larger role in the medical system. And so there starts to be more opposition and more conflict between the church and the medical establishment during the 17th century. It’s a real institutional reorientation about the way that these secular and religious institutions are going to interact with one another. 

For the most part in Spain, they distilled things like wine, and what you do when you distill something is you just take the most volatile part of the of the wine, which is the alcohol, and if you keep distilling it and keep distilling it, it eventually becomes clear.  

People were really interested in the idea that you were getting down to the quintessence of the grape, because all of a sudden you were left with something that was clear that you could light on fire, and that you could put fruit into it, and it wouldn’t rot.  

It had all these qualities that made people think that distilled beverages were kind of related to spirituality, and so they were called spirits. It’s the spirit of the grape, what’s left when all the worldly stuff is stripped away. 

(John Slater on the distilling of spirits and purifying of the body)

Nicole Archambeau 

In the 14th century it [the medical authority] would have been very local, it would’ve been very much the town governments that would have been overseeing their own public health systems.  

John Slater (left) and Nicole Archambeau (right).

If we’re thinking about public health from a modern perspective, we’re thinking about sanitation and a kind of oversight of medical care to a certain extent, sanitation was certainly a concern of all these local communities.

We do have some evidence of civic positions, so a city would pay a physician just to stay in that region and treat people on a sliding scale. This individual and this civic position might have some influence.  

We see a lot of these physicians writing plague treaties for the whole town when they know the plague is coming.  

They can see it on the horizon as it hits the cities nearby. The civic physician of the town wrote the plague treaties that would be translated into a language and read aloud to the local community, “Here’s how to take care of yourself and things not to eat. Here are some ways to take care of what we would now call ‘mental health.”

Some physicians asked that the church not ring the church bells when people died because the constant ringing would really overwhelm people emotionally and this was thought to cause people to get sick. So, the people at the time were seeing what we call mental health and emotional distress as illnesses.

What were the healthcare options available for those populations at this time in Spain and France? 

John Slater 

There was a real gamut, from knowledge at home to some widely recognized and accepted forms of healing that seem to us today to be very superstitious or even ludicrous.  

Everything from lots of home remedies and lots of wise women and folks who knew about herbs and knew what kinds of herbs might make you cough, or make you vomit, or make you go to the bathroom – that kind of knowledge was widely distributed.  

There would be charismatic healers and they might have a cleft palate and speak in your face, and by so doing their saliva might sort of baptize you.  

There were health professions, so the apothecaries who sold medicine and made medicine and were fully professionalized, and they had a college of apothecaries that would represent them.  

There were healthcare professions that look a lot like in terms of their corporate structure, a pharmacist today or an internist today or a surgeon.

Nicole Archambeau  

Some of the healthcare options that I’ve encountered via written testimony about miracles include the range of care that they accessed before they went to a saint. This might include neighbors, local people with knowledge of the illness or town physicians.

Often someone says, “Well, I felt like I was sick, and I talked to a woman in my neighborhood to see if she knew anything about this, and she said, ‘I’ve heard about this Saint, and you should pray to this Saint.’” 

It’s really a spectrum and there isn’t necessarily a strong sense that there’s a big separation between medicine and religion. We have this wonderful example of a physician, who diagnosed his daughter with breast cancer. 

He can’t do anything about it, but he decides to take her to a saint and treats her with a relic. So again, we’re seeing kind of this mixture of family, educated medicine, religion.  

What was the role of religion and religious figures?

Nicole Archambeau 

Countess Delphine de Puimichel was seen in her community as very holy, and people would try to interact with her as if she were [holy]. They would try to access God’s mercy for healing through her. She did not want to [heal others] because she thought people suffered from illnesses in order to purify their souls — this was her view of what life should be.

Nicole Archambeau

People would try to circumvent that and try to receive a miracle from her by grabbing her and putting her hand on their wounds or waiting in a space where they knew she would walk by and grab her clothing or touch her.  

John Slater 

There is a role that suffering plays in purification, and this is a very old idea; you can find it in the Bible. The suffering that happens to you now will be rewarded in the afterlife, that the meek will inherit the earth, and it’s sort of the essence of the Beatitudes, from the Sermon on the Mount. 

People thought that they were being particularly tried, and they frequently thought, especially in the 17th century in Spain, that they are the instruments of God’s providence, and they assume that any obstacle to universal monarchy is a kind of work of Satan.  

… there are a lot of folks who will say that this is part of a trial, that we are being tested and that this test is ultimately a little bit like in the case of your saint (Saint Delphine) thinking that people need to go through this, that this is either foretold in Revelation or this is just what must happen. 

What can we today learn or glean from people then that might be instructive or useful in our own experiences of illness and pursuits of health and wellness?  

John Slater

John Slater 

People are exhausted by public health interventions, they’re tired of having their movement limited, they are tired of there being no answers. They are tired of the advice they’re getting about what to eat, what not to eat.  

We can anticipate some of the reactions we’re going to see [in our own time]. It can make us more patient with people who are exhausted and tired of living their lives in times of epidemic disease. It can also help us discipline our own behavior: “Yes, I don’t like this. I wish things were different. But this is the way that people have felt about this for a really long time. It’s not just me, and my feeling has a history that is very old. I’m not alone.” 

(John Slater on what we can learn from histories of health in Europe)

Nicole Archambeau

Nicole Archambeau 

I’m thinking of how I’ve talked to my students, and my students were really struck by how concerned people were with their emotions and that emotional health was taken seriously. That this was something that you had to do — to try to control how you were feeling and that it was valid medicine to try to be in a pleasant room, to try to be around pleasant smells, to have a good conversation and to try to change your internal emotional distress. 

(Nicole Archambeau on what we can learn from histories of health in Europe)

Learn more about Nicole Archambeau’s research into health and wellness in her 2021 book, Souls Under Siege available online and in CSU’s Morgan Library as well as her articles, “Penance and plague: How the Black Death changed one of Christianity’s most important rituals,” and “Surviving an invasion during a pandemic in the 14th century. 

To learn more about John Slater’s work, read “Balancing our bodies: how people in early modern Spain approached health and medicine, and his collection of essays in “Medical Cultures of the Early Modern Spanish Empire,” soon to be available in CSU’s Morgan Library.