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Viking Age Surgery and Medicine

Posted on 7th April 2020by Kael

It is very difficult for people in the 21st Century to fully comprehend the rudimentary state of medicine and healing of a thousand years ago. Steeped in ancient superstition, people then believed that ill-health had more to do with God (or Gods) and worship than any other factor. In an age where the existence of germs was unknown and the circulation of the blood as yet undiscovered, many so-called ‘cures’ and remedies belonged to the world of quackery, old wives’ tales and a gullible populace.

The Anglo-Saxon word for doctor was Lach, from whence derives the word leech; hence the common title of collections of remedies ‘A Booke of Leechdoms.’ That universal panacea for all ills, the humble leech, so beloved of the Middle Ages and ‘Blackadder’ alike, takes its name from this early word rather than the other way round. There are those, however, who, quite cruelly suggest that this epithet, as applied to modern private practitioners of the art, is not entirely inappropriate! Many early lachs were monks, and other learned people.

Despite the perceived wisdom of these ‘doctors’, our ancestors knew little of the workings of the human body. Indeed, in the few remaining texts dealing with Anglo-Saxon medical procedure, magical remedies and charms are used as treatments, often in conjunction with holy days and solar or luna events on the calendar – but not on one of the ‘Egyptian Days’ where a healer must not let neither man’s nor beast’s blood be diminished.

One such charm used to remove a fever is unbelievable to modern eyes and would act as a placebo at best:

“For fever: One shall take several little wafers such as are offered [at the Mass], and write these names on each wafer: Maximianus, Malchus, Iohannes, Martinianus, Dionisius, Canstantinus, Serafion. Then afterwards one shall sing the charm which is named hereafter, first in the left ear, then in the right ear, then over the top of the man’s head; and then let a virgin go up to him and hang it on his neck, and let this be done thus for three days. He will soon be better.“

Here came stalking in an (inspiden) creature,
Had his (haman) in his hand,
Said that you were his steed.
I Lay for thee his (teage) on the neck.
They began to move from the land.
As soon as they came for the land.
Then his limbs began to cool.
then came stalking in the animal’s sister.
Then she made an end and swore oaths
That never this should do harm to the sick one
Nor to the one who might get this charm
Or who knew how to sing this charm. Amen, so be it.
Lacnunga

Despite these superstitions, there were still practical procedures to deal with ailments. Much of our understanding of Anglo-Saxon medicine comes from only a few texts, and extrapolations from the earlier Roman period. While there is the odd bit of evidence of surgery performed on a broken bone, there has been no archaeological discoveries of tools, or salves, or medicine. However, we can build a picture of a number of procedures and cures from the combined texts of the Venerable Bede, Bald’s Leechbook, the Lacnunga, latin texts translated into Old English and others such as the Roman Celsus. The Viking Sagas also occasionally describe cures and techniques for healing. It is likely that many remedies were simply passed down through the generations; but as we know from the game of ‘Chinese Whispers’ this is hardly going to lead to the consistent application of medicine!

Astronomical pages from Bede, Harley MS 3091 from the British Library.

Cures

Some Anglo-Saxon remedies could work, even if their effectiveness is questionable when put up against modern medicine, or the severity of the ailment.

A compound of leek and garlic (antibiotics) mixed with wine in a brass or copper container released cytotoxic properties – literally salt in the wounds. It would be painful, but useful against infection. Bald’s Leechbook describes this for a remedy against a stye on the eyelid.

Honey was also used as an antiseptic – it’s high sugar content draws out water from bacteria cells, dehydrating and killing them. While the Viking Age Lachs’ would not know this, the effects could be seen as a wound heals rather than festers, turns septic or gangrenous.

The use of the herb marrubium vulgare, or horehound, as a treatment for a cough is still used today in lozenges – the Roman, Celsus and the author of Bald’s Leechbook certainly knew that it worked:

“For a cough: boil a good deal of horehound in water, sweeten and give the man a cupful to drink.”
Bald’s Leechbook, Volume III

While they didn’t know the roots of families of plants (sometimes using a plant because its name sounds like it should work on a body part, or against an affliction), experimentation and results were at least noteworthy. It is clear that an awful lot of trial and error led to workable cures.

Surgical Procedure

Just as today, the Viking Age doctors could perform operations on wounded men and women. The tools are broadly the same as today, but larger and less precise: scalpels, knives, tweezers, pincers, saws. It’s unlikely that a surgeon’s tools would belong to a specialised kit. It’s more likely that should a limb need to be amputated, the surgeon would call on the carpenter for his saw; or a seamstress for her needles and silk thread to suture a cut. Other tools might include irons to cauterise a wound, the preferred method of closing a wound, and probably the most devastating to the patient – although he might not have to worry about infection from a dirty needle!

The irons are placed into a fire until red hot, the wound is held closed with pincers and the hot iron is placed upon the wound, searing the flesh shut. Without anaesthetic, the pain would be unbearable. The patient may have been given strong alcoholic drinks, or small amounts of the poisonous hemlock or belladonna – both methods dangerous during surgery as they thin the blood. Simply knocking him unconscious wouldn’t be without risk either with one wrong move inadvertently ending his life. The screams emanating from the lach’s ‘surgery’ must have sounded absolutely horrendous. Perhaps the patient was given something to clench between his teeth, but more often than not, mercifully, he probably passed out.

Even with the risks, these surgeries must have had a degree of success. A simple procedure, like draining an abscess is described by Bede:

…the physician Cynifrid, who was present at both her death and exhumation. Cynifrid used to relate that during her last illness she had a large tumour under the jaw. “I was asked,” he said, “to open the tumour and drain away the poisonous matter in it. I did this, and for two days she seemed somewhat easier…
Ecclesiastical History of the English People

There are also much more dangerous procedures. A stomach wound, perhaps from battle, comes up in many texts.

If someone’s bowels be out […] put the bowel back into the man, sew it together with silk
Bald’s Leechbook

Celsus also describes the treatment of a stomach wound where the intestines have fallen out, and a similar procedure seems to have been used on Thormod after the Battle of Stiklestad, described in Heimskringla, a saga about the Kings of Norway.

Sometimes the abdomen is penetrated by a stab of some sort, and it follows that intestines roll out. When this happens we must first examine whether they are uninjured, and then whether their proper colour persists. If the smaller intestine has been penetrated, no good can be done, as I have already said. The larger intestine can be sutured, not with any certain assurance, but because a doubtful hope is preferable to certain despair; for occasionally it heals up. Then if either intestine is livid or pallid or black, in which case there is necessarily no sensation, all medical aid is vain. But if intestines have still their proper colour, aid should be given with all speed, for they undergo change from moment to moment when exposed to the external air, to which they are unaccustomed. The patient is to be laid on his back with his hips raised; and if the wound is too narrow for the intestines to be easily replaced, it is to be cut until sufficiently wide. If the intestines have already become too dry, they are to be bathed with water to which a small quantity of oil has been added. Next the assistant should gently separate the margins of the wound by means of his hands, or even by two hooks inserted into the inner membrane: the surgeon always returns first the intestines which have prolapsed the later, in such a way as to preserve the order of the several coils. When all have been returned, the patient is to be shaken gently: so that of their own accord the various coils are brought into their proper places and settle there. This done, the omentum too must be examined, and any part that is black is to be cut away with shears; what is sound is returned gently into place in front of the intestines. Now stitching of the surface skin only or of the inner membrane only is not enough, but both must be stitched…

..The signs when the small intestine and the stomach have been wounded are the same; for food and drink come out through the wound;
Celsus, De Medicina

In Heimskringla the wound is diagnosed by ingesting a soup with a strong odour:

The girl said, “Let me see thy wound, and I will bind it.” Thereupon Thormod sat down, cast off his clothes, and the girl saw his wounds, and examined that which was in his side, and felt that a piece of iron was in it, but could not find where the iron had gone in. In a stone pot she had stirred together leeks and other herbs, and boiled them, and gave the wounded men of it to eat, by which she discovered if the wounds had penetrated into the belly; for if the wound had gone so deep, it would smell of leek.
Heimskringla

The probing, diagnosis, surgical procedure are what you would expect in today’s hospitals; a learned doctor with years of evidence using the best tools he or she has at their disposal. As a patient, you’d probably just hope the ‘magic’ would work.

Medicines for all infirmities

Posted on 17th March 2020by Hrafn

When we look back at Anglo-Saxon and Viking medicine in the early medieval period, we often think of it as inept at best, lethal at worst. We see a reliance on magic and religion over science and are glad we were born when we were. However, the reality is a little more complex and interesting than it first appears.

While the Anglo-Saxons believed that afflictions were just that, afflictions from God, they were the first people north of the Alps to create medical texts in their own language. This suggests that they took medicine seriously. Similarly, the Icelandic Sagas tell us of astute healers who employed fairly effective methods of healing.

To understand the medicine and society at the time we must look at the way people lived. If you were at the top of the social hierarchy the chances were, you would be well fed and have the possibility of a balanced diet. However, if you were at the other end of the scale in the winter months you would rarely have enough food and be unlikely to ever see a balanced diet. For most of society, malnutrition coupled with living in cold, dank hovels did not make for the best start to a healthy world.

Into this world strode the lǣċe, (pronounced leech or larch), which was the common term for a healer of any kind in Old English, in Old Norse it was læknir. Both words come from a similar Proto-Germanic origin and arguably derive from either the term to bleed or a term for an enchanter. Either of these origins would fit given the nature of the work they did.

Healers in Saxon England ranged from local healers often known as cunning women/men who had knowledge passed down through the ages in a verbal tradition, to monks who were specifically trained. Interspersed between the two, were secular, educated physicians of varying abilities who earnt their livelihood through their medical skills.

A lot of the book learned healing and monastic training came from old Latin and Greek texts. Some of these texts were translated such as the Herbarium, passing Mediterranean medicine into the Saxon tradition. This meant that bleeding, the four humours and Roman treatments were still being practiced in Saxon England to one degree or another.

One of the best sets of medical texts of the time were Bald’s Leechbooks. It still has elements of faith, superstition and magic but goes about critically looking at the body and its working, literally from head to foot. It often gives sound advice such as pregnant women should avoid salty foods, alcoholic drinks and vigorous exercise.

The Lacnunga by comparison is an erratically written collection of ‘knowledge’, often haphazardly put down. This may have not been the best for the patient but gives us an excellent look at beliefs that common people had that even Bald stayed away from. The best example of this is:

57. Against when a man cannot sleep: take henbane’s seed and gardens mint juice; stir together and smear the head with it; better will come to him.
158. When a man first tells you that your cattle are lost, say then, before you say anything else “Bethlehem was that city called in which Christ was born”

Here we can see that in the Saxon mind a purely herbal remedy held the same weight as a purely magical cure. Many cures, especially for things that were incurable at the time, were a mixture of both. This blending often meant that any success gained by the herbs, poultices and broths would also be giving credit to the more magical elements such as incantations, Luna phases and holy relics.

Vikings by comparison had none of these written traditions, to draw from or contribute to. Our evidence comes from the sagas written generations after the events described and archaeological remains. Undoubtedly healing went on, and at the very beginning of the Viking period this was at a local level.

The use of runes and charms are often cited in the sagas and the belief in their power was just as strong as the Saxon belief in Christian religion. In Egil’s saga chapter 73 for example a young woman was first harmed by the improper use of runes and then healed by the correct use of runes.

Given the violent, dangerous world they lived in the Saxons and the Vikings often became proficient in first aid and surgery. The tools of their trade were in many ways not dissimilar to our own, if a little cruder. Many would come from everyday life such as a needle or sharp knife. Others would be closer to workmen’s tools such as a saw, mallet or given some of Bald’s descriptions, a sledgehammer.

Germs and infections undoubtedly killed a large percentage of patients. Surprisingly, many people survived these procedures. There is evidence that people even survived trepanning from skulls that have subsequently healed. More interestingly, some of the science they employed seemed far in advance of their age. Bald recommends an early variant of biodegrading stitches, while in Heimskringla we see a clever diagnostic technique.

The girl said, “Let me see thy wound, and I will bind it.” Thereupon Thormod sat down, cast off his clothes, and the girl saw his wounds, and examined that which was in his side, and felt that a piece of iron was in it, but could not find where the iron had gone in. In a stone pot she had stirred together leeks and other herbs, and boiled them, and gave the wounded men of it to eat, by which she discovered if the wounds had penetrated into the belly; for if the wound had gone so deep, it would smell of leek.

Many cures worked and are still supported by science today. Horehound was a treatment for coughs and is still used in lozenges. Honey was used as an antiseptic, and we know that its high sugar content draws out the water from bacteria, dehydrating and killing them. At one end of the scale there was often science behind the medicine, so genuine healing took place, even if the science wasn’t known to the practitioner. Just as often we have magical and (some) herbal cures that offer nothing more than hope and a placebo effect. At the other end, there were a number of lethal treatments which became more dangerous than the ailment they were trying to treat. All of these treatments combine into a lucky dip, that few in the modern age would be brave enough to try.

See more posts about Anglo-Saxon and Viking medicine throughout our blog!

Medicine Religion

Anglo-Saxon Medicine: speech therapy and hair care

Posted on 12th March 2020by Hrafn

Most of what we know about Anglo-Saxon medicine comes from the medical texts written late into the Viking period. We can see how they translated, mistranslated, and adapted earlier Latin and Greek texts each time showing more and more of their process. There is also, of course, a veritable army of dead bodies that we can tell all kinds of things from. But sometimes it is nice to have a look at those early days and see what was going on through anecdotes and stories of saintly behaviour.

Enter Bede and his Ecclesiastical History of The English People. While he did not write a manual on keeping the sick alive, he did write some interesting things on how others did. More specifically he wrote about that group of people that could read and often practiced medicine, miracles and something in between.

The case I am thinking of today was concerning Bishop John of Beverly, who we meet in book five chapter two (conveniently called John of Beverleyâ€™s cures). Here John summons a dumb youth who has a scabby head to come to him to be cured. Given a few hundred years of language evolution I am talking about a youth with no speech rather than a not very clever one. While the youthâ€™s intellect was never commented upon, I suspect he was actually quite clever given what happened to him.

John proceeds to put the sign of the cross on his tongue and gets him to start making letters and short words such as â€˜yea.â€™ John is a patient if unrelenting sort of man and spends every waking minute of the next day teaching the boy to speak. By the end of the unremitting encounter the youth is no longer dumb and can communicate through words. John then sends him off to the physician to cure his scalp.

When Bede recounts this he is full of religious wonder, but when we break it down, Bishop John is doing some really interesting and purely medicinal things. I think from the description we have stumbled into the land of genuine Anglo-Saxon medicine, not otherworldly miracles.

John starts off icebreaking, giving confidence and probably giving a physical investigation into the limitations of the tongue. Doctors wear white and look very business-like today, it is part useful, part mental. John was doing the same thing, he had God on his side, while conveniently assessing the youthâ€™s tongue. He knew of the youth, almost certainly knew he could understand, if not speak, so gave him a physical inspection.

He then goes through a day of speech therapy starting with the basics and working up. It sounds like there was lesson, practice, progress, next, rinse and repeat. After making progress he sends him to a physician to have his scalp healed and so he moves onto the next treatment. The unnamed physician is successful, and the youth goes off all healed and no doubt waiting to be struck down by some other form of horrible disease of the time.

If John had simply made the sign of the cross and the youth broke into song, a Saxon musical if you like, I would have been more than a little sceptical. But what I like about this is that there is work which is identifiable, the results are not instantaneous and when he can do no more, he sends the youth to a different specialist. This looks like medicine; this looks like therapy.

Was he totally mute before? Maybe, maybe not. Was there anything else going on? Quite possibly. But in the confines of the text this looks a good example of good healthcare when we know that health and well-being were in short supply.

Check out our other articles on Anglo-Saxon Medicine!

Tag: surgery

Viking Age Surgery and Medicine

Cures

Surgical Procedure

Further Reading

Medicines for all infirmities

Anglo-Saxon Medicine: speech therapy and hair care