Elma Brenner on medieval wellbeing: "People in the Middle Ages were absolutely focused on staying healthy"

Elma Brenner, Wellcome Collection’s medieval specialist: Yeah, we’re in a remarkable place, it’s a biomedical research charity, the Wellcome Trust, that funds all kinds of amazing and important projects. As part of that charity, there is a public venue, Wellcome Collection, which is based around a phenomenal collection of library and archive materials dating from the early centuries AD right up to the present day. And including a number of really important medieval manuscripts.

DM: OK, so what we’re going to talk about today is medieval medicine, broadly. We’re going to pick up on some of the themes that you’ve talked about in the feature that you’ve done. But before we do that, can you just define the general period and sort of geographical spread of your research? Where do you focus on?

EB: So I focus on the period, really, towards the end of the medieval period, the centuries between, roughly, really just before the Black Death in the mid-14th century up till the very end of the 15th century. And I look at Europe, particularly at France and England. But it’s really important to think about the global side of the Middle Ages and the fact that we can study all parts of the world in that period.

• 7 facts about the history of medicine
• 6 women in science history you (probably) didn’t know about

DM: OK, thank you. Now, we know of some horrible diseases that people suffered from during the period, and you’ve written about them in the feature, so plague, leprosy, dysentery, pox. We kind of have this view that medieval people were running the gauntlet of a horrible demise on a daily basis. I’m sure that’s not the case, so can you just sketch out the health landscape for us a bit, just give us a sense about the general tenor of health and medicine during the period.

EB: Yeah, as you’ve said, there were some terrifying diseases that we’re able to treat today and that in the medieval period, people didn’t have the medical means to treat them. But, at the same time, it’s clear that people had many mechanisms to stay healthy and they lived healthy and incredibly fulfilled lives. You just have to look at cultural outputs – like books of hours or sculpture in churches – to see that people had a thriving, cultural landscape; they celebrated life and they lived life to the full. At the same time, they were aware of these diseases and of the dangers and one of the key things that they did was to try to live a balanced and healthy lifestyle to ward off sickness. So, the key thing was to try to avoid becoming sick in the first place.

DM: I find that fascinating and there’s a little quote that I’m taking from the feature that you’ve written: “Medieval people also believed that environmental factors and behaviour had an impact on health in terms of the quality of the air, diet, sleep and exercise.” That feels quite modern, doesn’t it? That feels like the concerns that we have today, you know, we’re always measuring how much sleep we get and how much exercise and how much fat we’re eating. So, they had the same concerns?

EB: Absolutely, and it’s really strikingly modern to us, actually, that people were thinking about what happened to their bodies in terms of health. So, what went into their bodies and how their bodies experienced life, in terms of how much sleep they got, in terms of how much exercise they got. And really, what I find really striking is that these things make sense. So, there are also ideas that were both present in incredibly learned medical treatises by authors who wrote in Latin and Greek. But they were also held by people in small communities to whom these ideas trickled down, but also I think the common sense factor really played a big role.

It’s really strikingly modern to us, actually, that people were thinking about what happened to their bodies in terms of health

DM: We’ll come back to that. In terms of the medieval attitude to wellness, if that’s not an anachronistic term, one of the things that perhaps is a little different to now is the importance of the soul. And you make the point in your feature that perhaps the soul was more important than the body in terms of people’s understanding of their health and wellbeing. Tell me a bit about that.

EB: That is something that is different from the way we live our lives today, certainly in Western Europe, most of us. I think we can safely say that most of us live in a very secular society and when we think about Europe in the Middle Ages, it is a deeply Christian society, although there were very important Muslim and Jewish communities as well. And in terms of the Christian context, there was a very big emphasis on preparing your soul for the life to come. And thinking about purgatory, a period when your soul would kind of be in transition and doing the requisite things to make sure that your soul achieved salvation. And this linked in to bodily health because people tended to think that when you became sick, this was a sign of some kind of intervention by God and so there must be something somewhat troubling going on with your soul. And so, it kind of made sense to primarily pay attention to what was happening with your soul. And then there was an expectation that naturally your body would then recover as a consequence.

DM: And you talk a little bit in the feature about the use of religion and magic, I suppose, as cures, and you’ve got an example of sort of invoking saints to ward off demons. So, practically, what did people do to improve their soul health?

EB: They did a number of things and this ranged from very orthodox religious worship to practices that were frowned upon by the Church, although interestingly were also practiced by some religious men and women as well. So, on the orthodox side, it was about prayer, it was about repentance and it was also about charity, so supporting charitable causes and showing your devotion in that sense. And on the less orthodox side, there were magical practices, particularly the use of healing charms, which were remedies based around appeals to the saints and to key religious figures, so Christ and the Virgin Mary and adopting ritualistic behaviour in connection with that. So, reciting religious words, inscribing them, possibly, on a piece of paper or a piece of parchment, attaching that to your body, or possibly putting it into a drink so that the words kind of melted into the drink and then you would drink it. And these were seen, these were seen as magical practices and, as I’ve said, many religious authorities did not condone them – but it’s pretty clear that they were very widespread.

DM: So if you lived in a village, the local priest would have frowned upon that sort of behaviour if you were a local peasant and you drank a bit of manuscript with some words on?

EB: I have to say it would depend on the priest. We see a real range of responses to this kind of thing and it’s clear that in some instances, priests were part of this system of magical religious beliefs. In other instances, you might find a manuscript, and we have a few of these here at Wellcome Collection, where there are magical remedies that have been very vehemently crossed out by someone. So initially they’d been written down because they were considered to be valid and important. Someone else came along, possibly after the Reformation, actually, and was deeply troubled by these and felt the need to erase the completely.

DM: You mentioned the Reformation there, so does this attitude towards magic and magico-religious ceremonies change as the period progresses?

EB: It does. After the Reformation they are bound up with the whole range of responses to Catholic ritual and there is the destruction of manuscripts and other kinds of artefacts that contain this kind of material. But it’s also clear that some of these forms of behaviour persisted; indeed they clearly persist right up until the 20th century in some instances.

DM: And you also mention astrology and celestial observation. How did that figure in this part of the story?

EB: This is another really key component for medieval medicine and it’s the idea that the movements of the planets, and particularly the phases of the moon, will influence the health of your body. And it’s to do with the way that blood pools within the body and the different zodiacal signs and a kind of linkage made between different signs of the zodiac and different parts of the body. And an understanding that at those particular moments in the calendar, it might be dangerous to treat that part of the body.

• Florence Nightingale: nursing by numbers
• 10 of the most surprising numbers in history

DM: Was that a widespread practice; was everyone aware of these sort of zodiac signs and living their lives by them, in a way, or..?

EB: It’s certainly clear that it was very widespread. It was also linked to overall understandings of the cosmos and the overall calendar of the year as well. So people’s attention to the seasons and their concerns about things like harvests. At the very end of the period, we do find expressions of concern by certain physicians about these ideas. So certain physicians were becoming sceptical, particularly if astrological beliefs might cause the delay in treatment of someone who had an urgent illness. A physician, at the end of the 15th century, might look at that situation and say, “I’m not so sure this is a good idea, I think we should intervene and treat them, regardless of astrology.”

DM: Moving away from the soul and those aspects of it, if you actually did want to get some practical, medical treatment as closer to the way we understand it today, where would you actually go to get medical treatment?

EB: This would depend very much on your socio-economic situation. So someone who was very wealthy would actually try to avoid going into a hospital. Hospitals were really there to cater for the sick poor, people who didn’t have any other option. A wealthier person would seek out the services of a medical practitioner. And that might be a physician who had been to university, it could be a surgeon who had more practical training and it could be other types of very, quite specialised practitioners such as people who specialised in areas like the pulling of teeth as well.

DM: And monasteries?

EB: Yes, absolutely. So monasteries were very important sites for medical knowledge and learning but also for medical practice. In terms of the knowledge side, because monasteries were sites for the creation and production of manuscripts and for education, real expertise developed among monks and nuns. And then they also, because of their community setting, because these were quite self-sufficient communities with a monastic infirmary, monks and nuns would become specialised in how to actually treat the sick and would have particular skills, like bloodletting. And this would permeate through into lay society, so into the parts of society outside the monastery. We know of a number of monasteries which offered services to people to come there and receive a particular kind of treatment.

DM: OK, and so you talked about the socio-economic aspect to it. I imagine if you’re a high-ranking individual who’s ill, you would call upon the services of someone and they would come to you and you would presumably pay them. But if you were less exalted, you were just an every-day person, how would you access these medical resources? Who was the gatekeeper? Presumably you would have to pay, or would you not have to pay?

EB: It’s likely that you would have to pay. There was a whole spectrum of medical practitioners, so you would be able to get hold of the services of someone that you could afford to pay. In certain instances, in a small, localised, community, quite often it would really revolve around the parish priest, potentially, who might, himself, have medical knowledge, who would have a network of contacts who would be able to come in. And it also might revolve around people in that community who had a number of areas of expertise. So you can think of, for example, the butchers trade. So a butcher might also have certain skills in barbary, in treating human bodies and performing certain things upon them, as well as obviously being able to engage with animal bodies as well. So it really depends upon the particular local setting. But the other important thing to mention is that in that kind of network of practitioners, women play an incredibly important role as well as men.

DM: Do you want to talk a little bit more about that? What was the role of women in this process?

EB: The most obvious role, which we know quite a bit about, was as midwives, so providing the expertise around childbirth and pregnancy. And that is the kind of knowledge that was learnt on the job. It wasn’t necessarily book learning at all, but that it was absolutely about expertise and it was absolutely about having a prominent place in the local community. Women also practised other kinds of medicine. So they were clearly involved in the process of bloodletting and also related practices like cupping, which was another way of kind of expelling corrupt matter from the body through the skin.

• 6 women in science history you (probably) didn’t know about
• 5 "bloody brilliant" 20th-century women

DM: You’d better explain what cupping means…

EB: Yeah, so cupping is something quite specific which is about applying a glass vessel and heat to the surface of the body and trying to draw out corrupt matter. And what’s really interesting is that there are manuscript illustrations of women engaged in this practice, so it does seem to be something that women did as well as men.

Cupping is applying a glass vessel and heat to the surface of the body and trying to draw out corrupt matter

DM: OK, and did that give a certain sort of level of agency and potency to women in local communities that they would otherwise not have had perhaps?

EB: I think so. I think it’s an interesting one because clearly women would have been paid for these services and that’s an important type of agency that they would have. I think it’s also really interesting to think about it in the broader context of women’s economic role and the fact that women did practice crafts and they did engage in certain professions beyond the realm of medicine. And that their situation is not always visible from the records or from manuscript illustrations but that they were definitely there, engaging in the economic landscape.

DM: Now I imagine that you would only seek the services of any of these people if you were feeling particularly poorly. Is there any similar example to, you know, if I woke up in the morning with a headache, I would take a paracetamol, I would take some self-care. I imagine that your average person would look to self-care first, was that a thing that they could do at all?

EB: Yeah, I think people absolutely were focussed on staying healthy and if they had an ailment that they felt they could treat themselves, then they would have done that. They would also have drawn upon their family and community network and, in particular, they would have been able to get hold of remedies that they could treat themselves with. Particularly from apothecaries who were the pharmacists of the day, but also from household production of medicines. And late-medieval manuscripts tells us quite a bit about how medicines were produced and a sense of ingredients and processes that could be done in the kitchen. And so it would make sense to try to do that yourself rather than to pay someone else to do that for you.

• 7 bizarre cases in the history of medicine
• Medieval medicine: killer or cure?

DM: And how effective were most of these remedies? Because we have this sense that, you know, medieval medicine is basically just a bunch of quack cures of things which have no scientific basis and would do more harm than good. Did these things work?

EB: I think in many, many instances they did. And it’s really interesting to look at the ingredients of the remedies and to think about what we know today about the ability to treat illnesses. So one particular ingredient that comes up a lot is honey, which is definitely there to sweeten unpleasant-tasting medicines but we also know today that it has wound-healing properties and antiseptic properties. And so I think, you know, that’s just a small example of something that was an ingredient that we know today has an effective mechanism. And so I think we can say that a lot of the remedies did work. Certainly not all of them and certainly it’s really interesting to think about remedies that have incredibly convoluted or exotic ingredients. Theriac is a good example of that, which was a very kind of, a kind of cure-all medicine of the later Middle Ages that anyone who could, wanted to get hold of, particularly against plague. And it’s not clear that that would have worked. But it would have, we can also think about the placebo effect as well, which obviously is impossible to measure, but it’s something we can also think about today with some of the remedies that we take on a day-to-day basis like paracetamol. You know, that you take it, you’re reassured that you’ve done something and you start to feel better.

• Listen | Simon Bowman of the Royal College of Physicians discusses how the work of doctors has changed since the time of Henry VIII

DM: Do we know what theriac was? What went into that?

EB: It was a whole mixture of ingredients, some of which came from the East, so from outside Europe. It included things like snake’s venom to counteract poison, so a sort of like-for-like counteraction.

DM: Are there any remedies or treatments that people took, that we are aware of, that we can say would definitely have been harmful?

EB: There definitely are. Some remedies, for example, involve lead, which we know is not a good thing. For the treatment of the pox, which is roughly equivalent to modern-day syphilis, in the early decades of the 16th century, mercury was an ingredient which we again, know is not a good thing. Overall, however, the overriding impression you get if you’re leafing through the pages of a late-Medieval recipe compendium with lots of medical recipes is that these are plant-based remedies with a number of plants that we might use today in cooking, that we also know are actually ingredients for modern-day pharmaceuticals, that we don’t think would have harmed the body. So the overriding impression is that these wouldn’t have harmed people. You do get interesting, occasional law suits, actually, from the later Middle Ages, against apothecaries or physicians, sort of claiming that the remedy was harmful. So there is some evidence for that kind of thing, but not much.

DM: And generally speaking, do you think, did medieval people believe in the treatments that they took or were advised to take? Did they believe that they had efficacy?

EB: That’s a really interesting question. So, on the one hand, yes, because we see these remedies being copied numerous times and in the early decades of printing, from the end of the 15th century, we get printed compendia that were clearly selling very well and there were lots of different versions of them and they were kind of popular, kind of, self-help books. On the other hand, within those collections, you get multiple different remedies for the same ailment. So you might have something like excessive bleeding, which is a quite common thing that understandably was very alarming and you needed a remedy. You might have seven different remedies to try to counteract that, which suggests an awareness that it might not work. Which is an important difference, I think, from modern-day medicine when we tend to have complete faith in pharmaceuticals and we go and buy something over the counter and we’re confident that that will work, we’re not shopping around for a different version of aspirin, for instance. A different attitude in the Middle Ages where you might try several different things, you’re quite open-minded, you’re ready to see failure.

So that’s definitely one for the surgeon and the surgeon will take a look at it and provide you with some kind of dressing that might be infused with various plant extracts. And also with extracts such as silver, which we know does have antiseptic properties.

DM: We ought to take a moment to just stop and think about some of the more unusual treatments that we’re aware of, which you do flag up some of them in your feature. So just give us a taste of some of the things which we would consider very unorthodox nowadays.

EB: Well, the most obvious one is bloodletting because that was something that was the kind of knee-jerk reaction, both to an illness but also actually to a concern to stay healthy. So on the one hand, if you became sick, the physician would say there is an imbalance of the humours inside your body. So these were four different fluids that were understood to exist and circulate in your body and they needed to be in balance for you to be healthy and any sign of sickness meant that they were, they’d gone out of sync, possibly they had become kind of corrupted, so you needed to get that humour out. And so you would bleed someone, possibly quite a large quantity of blood. On the other sort of side of things, if you were someone who had the means to kind of follow a regime to stay healthy, you would regularly have yourself bled in order to just keep the humours balanced. And we know that this certainly happened in monasteries as part of the monastic life. I think this is quite alarming to us, we can’t see any benefit to your health to remove a quantity of blood. We do know, however, that donating blood is not that dangerous, that you can go along and donate blood and you can step up and go home, as long as you drink some fluid, you know, you’ll be OK. It’s just it doesn’t quite fit with our understanding of what’s good for you.

• 6 weird inventions in history
• Pig-chickens, beavers’ tails and turtle soup: 8 weird foods through history

DM: Yeah, OK, I gave blood last week and I’m still alive, so, yeah. What did they do with the blood that they let? I often wonder that, did they find any uses for it?

EB: They, usually it was disposed of. So some medical ingredients of the magical kind, actually, might include a quantity of human blood, possibly. An interesting variant of this is the blood taken from the little finger of a child sometimes comes up as something that you would put into your magical remedy. Apart from that, I think it is disposed of. However, other human fluids, particularly urine, did have a range of functions. So urine had a range of industrial functions including in the production of parchment, which is quite interesting.

DM: Talking about some of these more unpleasant diseases, the bigger killers that we mentioned earlier, the plague, leprosy, dysentery, those sorts of things. I have a sense certainly that if you got such a disease then your chance of survival would be pretty low. You kind of think that, you know, you’re basically a goner. You had an example in the feature of someone who survived the Bubonic plague. How widespread was survival from these more unpleasant diseases?

EB: So it depended. The mortality rates are pretty shocking, particularly for the Black Death, so the very first plague outbreak that hit Europe in 1347 and lasted for about three years. And that is, in some localities, it’s pretty clear that about two thirds of the population perished, which is terrifying. At the same time, about a third did survive and there would be a range of reasons for this, to do with your resilience, I think, your kind of ability to ward off the infection. Also about preventive measures that you took. The most basic preventive measure was to flee, so just to get out of a place of infection or to get away from a heavily-populated area and go into the countryside. And that’s a remedy that persists right up until the 17th century that, certainly with the Great Plague of London in the 1660s, people are getting out of the city of London. So people did survive and there’s a range of reasons for that. Other types of epidemic, such as the English Sweating Sickness which, kind of, there were two or three of these outbreaks from the 1480s onwards. These are less devastating, they strangely sometimes seem to affect particular groups of people, the Sweating Sickness seems to have been linked to young men, we’re not sure why that is still. So, on the one hand, if it does affect you, that’s terrifying, on the other hand, you may survive it. And communities clearly did continue, there’s been fantastic work looking at the social and economic aftermath of the Black Death. The disruption is vast but there is continuity none the less.

DM: And we’re talking today when there’s the coronavirus in China, and across the world, seems to be spreading with alarming results. One of the responses to that is quarantine. I wonder is there any such thing as the concept of quarantine in the medieval period that we’re aware of?

EB: It really comes a little bit later, certainly than the Black Death. But by the beginning of the early modern period, so the 16th century, this is something that is happening. And it is, particularly in Italy, so in major Italian cities like Venice and Florence, there is a process of quarantine. But earlier on, I think really it’s about a kind of response on the ground that isn’t able to incorporate that kind of practice. I think there is an awareness that it spreads very rapidly among heavily-populated areas and that it would make sense to kind of separate the infected. One thing that does happen is about sort of separating, on a local level, kind of enclosing people in their houses does happen. And there is also interesting evidence about getting rid of material objects that might be contaminated. So particularly cloth that is kind of burnt or taken away to a remote place and washed many times, this kind of thing. But not quarantine as we would understand it today.

DM: Who would have orchestrated those sorts of measures though? Because there’s no public health body that would have said: “Right, we need to burn all this cloth or we need to get people to move away.” Would that just have been on individual agency or would there have been anyone sort of actively suggesting community response?

EB: This is where public health becomes a thing, and you can definitely see it, and it actually precedes the Black Death, interestingly. From the very early 1300s, town authorities are doing things. We’re not thinking necessarily of national responses and I think in the Middle Ages, we don’t have national measures in the way that we do today. And certainly, some parts of Europe were not united countries at all: Italy and Germany. But on a more localised level, civic authorities, or in the Italian case, communal authorities, which was kind of a whole region, were doing things. And they were particularly trying to enact measures to remove anything that was kind of filthy or foul-smelling from the city, that they associated with contagious illness. And with the spread of illness through, kind of, infected air.

• Forgotten science: 7 of the strangest scientific theories in history
• Nazi super-cows and defamed Gods: 7 strange and forgotten moments in history

DM: Modern medicine, we’re able to cope with lots of difficulties and illnesses and I assume that in the medieval period, there were things that would have struck people down that today we’re able to survive. I’m thinking of infection specifically. How important was infection as a risk to people in the medieval period?

EB: So that’s actually one of the core terrifying risks really that, again, today, I guess we have antibiotics so we’re confident that we can treat infections. At the same time, interestingly, some of the work of the Wellcome Trust is looking at resistance to antibiotics, something that is, you know, increasingly something that we’re concerned about today. But in the Middle Ages, people definitely understood what an infection was and the word fever is used. And it’s to do with heat, it’s to do with, if it is, you know, a wound that is kind of foul-smelling and hot, an awareness that that is something that’s infected. However, they did not have the knowledge that we have today about how infections are spread and how, again, the treatments to get rid of them. And so an infection could be deadly. The mortality of women following childbirth was usually to do with an infection that kind of took hold after childbirth, sadly.

DM: I’m a fan of Twitter and, on Twitter, I follow a feed called the Medieval Deathbot, along with 87,000 other people, so it’s a popular thing.

EB: Great. I need to follow that.

DM: But it’s a curious thing which basically summarises the ways in which medieval people died as recorded in coroners’ rolls. So there’s lots of violent deaths and things like that but quite a few are from sicknesses of various sorts. So clearly, you know, there’s 87,000 people who have an interest in this, what is it, do you think, that makes us interested in medieval medicine and illness? Why do we have a fascination with this topic? It’s a bit gory?

EB: I think it’s about our own vulnerabilities, actually, and I think an awareness that… I think the coronavirus is an example of this. We’ve got huge anxiety about that right now. I think an awareness that, yes, we’ve got an amazing kind of infrastructure of modern medicine that can help us with so many things. But, in essence, we’re all vulnerable and there are things that we, that medicine can’t help us with. And a sense that people in the past, who had so many more challenges, did a great job in surviving. So I think there’s a positive story there for us, actually, in medieval medicine. But also, I think, there is a fascination with the gory and the terrifying and things that are shocking as well and there’s a kind of drama to it that I think we all take an interest in.

DM: OK, now I'm going to try some quick-fire questions. If I’m an average Joe or Jolene in Medieval England, maybe living in a town, not got much money but I’ve got some symptoms, I’m going to ask you what I might do. So let’s see if this works.

EB: OK.

DM: I’ve got a headache because I’ve drunk too much beer the night before. What might I do then?

EB: I think you know what that is, I think there would be knowledge about alcohol drinking and I think there would be received wisdom, from you or your family, about resting and drinking fluid. I think you wouldn’t seek any type of medical treatment.

DM: I’ve broken my leg when I fell off my horse.

EB: You would find a surgeon. So that might be someone who had been university educated, it might be someone who was much more practice based. You’d find a surgeon and you would ask them what to do. And they might do something, actually. They would probably try to do something to reset the bone and they would kind of heavily bandage it. They might operate, that would be deeply risky. I think the key thing about that is that there was very, very widespread awareness that that kind of operation was hugely risky, an awareness of infections. And that it might be better not to do anything of that kind. And so, you might then have an issue about your leg and your mobility in the aftermath.

DM: I’ve eaten something that doesn’t agree with me and I’m nauseous and having trouble at both ends, what might I do then?

EB: You would seek some remedies to help you with that. So there could well be some knowledge that your parish priest holds, actually, and your parish priest may have a book of remedies and might be able to look something up for you. You might go to an apothecary, a pharmacist, to make up that remedy for you. And then you would follow the instructions, hope for the best. If you worsened and if you were very poor, you might have to go into a hospital and receive care there.

DM: What about if I’ve just got toothache?

EB: So you would, there would be someone fairly locally who was expert in matters concerning teeth. And this would be someone who was, it might be a surgeon, it might actually be someone who really was, that was their thing, they were specialised. Quite often those people were itinerant, they travelled around offering their services. You’d get their advice, they might extract it.

Right, but you might have to hang around for a bit before someone turned up who could help you out?

EB: Yeah, although depending on your contacts, your economic ability, you might be able to get hold of someone as well, I think.

DM: Would there have been any sort of effective pain relief that someone might have been able to take in the intervening period?

EB: Yes, alcohol was used. Alcohol was, yeah, really interestingly in the kind of 14^th, 15^th centuries, knowledge increased about distilling alcohol to make it purer and that was used as an anaesthetic. And opiates also existed and some of the remedies that we know about were clearly opiates and were clearly used for those purposes, among other uses.

DM: Two more. I’ve got a cut on my arm that just won’t heal and is going a green colour and smelling badly.

EB: So that’s definitely one for the surgeon. And the surgeon will take a look at it and provide you with some kind of dressing that might be infused with various plant extracts. And also with extracts such as silver, which we know does have antiseptic properties. However, there would be no way of totally, sort of, providing a sterile cleansing of your wound. There was also not the knowledge that that was necessary and so you might actually be quite worried about that.

DM: OK, finally, I’ve got a sudden pain in my chest and I can’t breathe. So in modern parlance, I'm probably having a heart attack. Would I be able to do anything about that or is that going to see me off?

EB: Not very much, basically. You would seek medical help and there would be, I think there would be knowledge about instances of this kind of thing happening, there would be knowledge about getting someone to rest or to, you know, lie down. I mean, if it went on for a while, they might even perform bloodletting but there would not be a surgical intervention of any kind.

DM: Thanks. Thanks, Elma, that’s good, putting you on the spot there and asking you some difficult questions. OK, so finally, just to finish, you alluded to that in a previous answer, do you think there is anything we can learn from medieval approaches to health and wellbeing? You talked about sort of the more holistic understanding of living a healthy lifestyle, is that something we should be taking note of?

EB: Yeah, I think, definitely. I think about prevention really. And obviously, this is something that we’re aware of in terms of, you know, the dietary causes of diabetes, the dangers of smoking. But really that you can help yourself a lot and also that your body will have ups and downs and your life will have ups and downs. And you may not, I think it’s interesting, I think there’s also a connection with ideas about happiness and wellbeing and that I think these are things that we prioritise hugely and I think they were definitely factors in the Middle Ages. But there was also a real emphasis in the Middle Ages on survival and on doing what you could to keep yourself a float. And that that resulted in resilience and in many instances in people leading long lives, actually.

DM: We didn’t talk about this at all, and perhaps we should have, but the modern concern of mental health and mental wellbeing is obviously key to us. Was that a concept then, in the medieval period?

EB: It was, definitely. And one of the factors that you were supposed to kind of take care of yourself, for your health, was your emotional state. So to pay attention to what was happening to your emotions and to kind of care for yourself, if there was something difficult going on. I think this is also where religion plays a role and this idea about taking care of your soul and about seeking help for that if needed, about the kind of support network that could help you. But there was an awareness of this and it was also undoubtedly seen as an illness, if you had mental issues going on, that was categorised as an illness.

Listen to the full podcast episode with Elma Brenner here

Dr Elma Brenner is Wellcome Collection’s medieval specialist.

To watch Elma's lecture on disease and medicine in the Middle Ages, recorded as part of our free virtual Medieval Life and Death History Festival, which ran in May 2020, click here