In the interests of healthy characters and BELIEVABLE fantasy game worlds, it is assumed that all the healthcare practitioners in RoM act much more in the spirit of the Middle Eastern and Oriental physicians, who were appalled at and abhorred the barbaric practices of the Western physickers in the medieval era that naturally resulted from the utter rejection of scholarly works originating in the ‘heathen” East. Where the Church in the era of the game blocked all the texts written by the scholars outside of Christendom as being “heretical,” no such interference with the intimate workings and process of teaching and learning is tolerated among the practitioners of the arts of healing in the Regna Mythica.
For the purposes of the game, the craft and community of healers only employ treatments that serve some legitimate medical purpose, rather than being dominated by Church dogma that condemned the MUCH sounder practices of the Middle Eastern doctors, actually aiding the health of the patient in an empirically proven or provable manner, tried and tested over time.
The scholars and practitioners of all manner of trades keep a brisk correspondence going among their practitioners and, where a friendship is strong across international borders, trade secrets might even be shared. Among healthcare practitioners it is a matter of life and death and, as such, is expected.
The Healers in Society &
The Guilds of Healers
The healing arts were much subdivided in skills and responsibilities in the period of the game, much divided along lines of education, which also followed also divisions of social class and station – and also sex. The society of women must be maintained separate from that of the men in the period of the game. It was not meet or fit that a man, even a Physician, should see a woman unclothed. A woman residing out in the countryside might visit a man engaged in Leechcraft, but only on a general or common complaint and he would never examine her bodily. A Midwife is a woman’s first choice for care.
Socially, Barbers are rated on an equal footing with Apothecaries, but in London, the Apothecaries were also part of the large and very powerful Grocers’ guild. Often very wealthy, they were very much merchants before doctors. The Physicians, impressed with the Surgeons’ skills and knowledge, associate with them freely. Thus, they enjoy the same level of patronage, and neither had any need of the protection afforded by the institution of a guild. On the other hand, both Physicians and Surgeons maintained exclusive fellowships of the trade, to patronize a given chapel, take care of the aged and infirm of the craft, the widows and orphans left behind, and perform such charitable works as they were able, after the custom of the period.
Surgeons can generally command better pay than Barbers and the other healers due to their greater training and experience. All Surgeons are adept at all the procedures of the Barber’s craft, except that it is a matter of pride in their extensive and specialized skill that Surgeons do not cut hair, give shaves, or deal with teeth, except in extreme cases where oral surgery is required to remove bad flesh. Those employers who are their social betters don’t often make that distinction, however, and they often called upon their private surgeons to perform the functions of a barber. When those employers keep them on retainer in their households, feeding and housing them and supporting their good names and reputations, the wise surgeon quietly and dutifully complies.
Being protected because of their use to the nobility, Surgeons never have a need of a guild proper to preserve their rights, but they do gather in fraternities, social groups usually patronizing a particular local church or chapel. These fraternities are just as exclusive as the guilds, without the political clout or standing before the law of a guild.
Some of the Surgeons of the London Fellowship had university education. All could read, and many wrote practical treatises. Some were among the most distinguished doctors of their time (skills and royal patronage resulting from their service in the 100 years’ war, as noted).
As far as public trade, female Barbers or Midwives cannot practice their craft on any but other women for profit. This does not bar them from acts of charity, though propriety must be observed. It is not considered fit that any man should see a woman naked even for the cause of her health, especially if she be married, so the women must provide for their own care and the men make all the relevant medical texts available for their use. This does not mean that they will tolerate the competition in the workplace, however, when it comes to treating men or children. While their skills certainly allow them to treat men and children, if their male competitors find out they are profiting from those patients, they are likely to get hauled up before the municipal authorities, unless the goodwife practices her craft in the country, beyond the jurisdiction of any guild or municipal authority.
There is an ancient taboo attached to Trades that shed blood. Butchers, executioners, Barbers and Surgeons weren’t just craftsmen, but were men of crafts considered to be “tainted” by blood. For the purposes of the game, there will be no moratorium on the cutting up of cadavers, however, so knowledge of anatomy will be rival that achieved during the Renaissance.
The overwhelming majority of healthcare practitioners will be Barbers, especially in the shire towns. Their majority rules the craft. The tests required by the Barber’s guild in London became general throughout the realm after the advent of the Plague, however, with the proliferation of quacks and charlatans preying on the misery of the people. The testing reduced the number of practitioners and restored the trade to profitability.
For the purposes of the game, it is likely that no such general calamity need be necessary for the tests to have been made general for the weal and good health of the subjects of every realm in the Demesne of the Light.
Since the Surgeons are a craft and not a product of university training governed by the Church, for the purposes of the game, there is no moratorium on the dissection of cadavers assumed by the interference of the Church in the Surgeons’ craft, so the level of knowledge and skill available in RoM game worlds are actually more on a par with the achievements of the Renaissance, much more safe and effective.
We are also proposing that what was true in London be made true in general for game purposes. The Surgeons’ skill and knowledge of anatomy was a far cry greater than the general run of Barbers. Outside the city, however, it was all too often true that the Barber and Surgeon were on equal footing.
Historically, the Barber-surgeons eventually rivaled the true Surgeons in skill due to a lack of wars in which to learn their craft, and so were united with their rivals by an act of Parliament in 1540.
Printing brought proliferation of succinct, common language how-to books to the hands of the general public, simplified translations and the “mysteries” revealed to be complete hokum.
The GM must decide how much technology and of what sorts he is allowing in his perpetually medieval gameworld. If only for the capabilities of magick to fulfill the same role, books of all sorts should be much more readily available, though if produced by magick the price would not be any lower than for a hand-scribed copy. The prices of books would remain elevated. Only the mechanical press was able to put easy multiple copies in the hands of the people quickly and with minimal cost.
The Sunday work issue was a perennial one for the Barber Trade, as their services always in demand. In 1445, Barbers along with blacksmiths were finally required by statute to offer their services EVERY day, with no provision for Sabbath observation.
Due to the obvious need and the lack of interference in most worldly matters by the Church of the Light in the gameworlds of RoM (in contrast to the historic medieval church), the dispensation from observance of the Sabbath for the care of the sick and injured on Sundays could be general and long established in the era in which the GM’s game takes place.
Historically, when the king traveled, especially on campaign, Surgeons and Barbers figure most prominently for healthcare services, although there are always a Physician and/or Apothecary or two, also.
The Plantagenets had military Surgeons that went with them on campaign, but they never brought them to court. Henry III instituted the post of Chief Surgeon in the royal party 1233-54. This, when the norm was to travel with a Physician and an Apothecary, as mentioned.
The great esteem in which the Surgeons were held in medieval England stemmed largely from their extensive experience with tending the wounded during the 100 years’ war across the Channel with France. Battle provides all the bodies needed to truly learn the craft. By 1350, English Surgeons were the best in all of Europe.
Henry VIII kept mostly Italians as Surgeons trained in universities practicing a new surgery resulting from more accurate appraisals of anatomy and physiology, and integrated with physic. These were the best to be found in the Renaissance.
Many Barbers could be found in the Goldsmith’s guild doing dental work in gold and silver. This avenue will be open to the Barber character if he is also equipped with the Gold-Smith Trade. The Surgeons had the same association with the Gold-Smiths. In the 1380’s, the Bradmores were famous as makers of surgical instruments, hence also Smiths. Surgeon-Smiths often held positions in the royal mint, and were usually members of the Goldsmith’s guild.
The Barbers were prominent in Bristol politics, taking a major part in the Corpus Christi plays, as opposed to London where they merely held the watch at Newgate.
Guild regulations in Bristol were much more concerned with medical practice, more like the guild in London – including dentistry, bone setting, sale of medicines, and the usual cupping and leeching. The Barbers had their social substructure of fraternities and charities, like any other guild, as well.
Most guilds are administration-oriented, all about preserving the status quo and the monopoly held by the masters. The London guild was somewhat more concerned with training and regulation, historically, but also with innovation, unlike most other guilds elsewhere. In the same vein, the guild book of the Barber-Surgeons of York served as a sort of Communal reference for the craft, in addition to containing most of the records of the guild. Over time it became not just one book, but an entire library. New blank pages were always available for recording new members as well as new knowledge and techniques, “mysteries” of the craft. This practice is assumed to be the general practice among the craft guilds of the worlds of RoM. The guild chapter in each town will keep its own records and its members will constantly seek to improve the extent of its library.
This practice tends to sharpen the competition between the guild chapters in different towns, making them unlikely to share knowledge but use it instead as leverage for politicking between chapters, to increase reputation and prestige as a means of attracting new members, business, and patronage. This also gives the guild-member PC’s a great way to benefit their guild and make a name among their peers. It is also a great hinge-pin for a number of different sorts of adventures in which guild-member PC’s might get involved, dragging their comrades along.
1370, The Barber’s Hall in London noted as having a library. 1376, books appear in Barbers’ wills bequeathed to other Barbers or to their guild library.
1400, public lectures on surgery and anatomy were held by the guild.
Though in the great minority among healthcare practitioners in the period of the game, “a sophisticated kind of physic was taught and practiced” at the nunneries”. This was a charitable service provided for travelers and the indigent in need.
Everyone, it seems, wanted in on the trade in surgery, it seems, if they had the slightest chance at encroaching on the Trade. In 1430, wax-makers petitioned to practice surgery, too, by virtue of the fact that they “like Barbers, used wax for embalming” – so Barbers were doing embalming as well. The Barbers had the wax-makers tested before the Mayor according to the guild rules, the wax-makers failed and their request was quashed.
In 1258, the long robes denoting the rank of Barber-Surgeon were instituted. Apprenticeships were made mandatory at 7 years in duration, up to 10 years if the master deemed fit, and the limit set on the number of apprentices a Barber could take on at 4 or 5.
The concentration of those providing healthcare services varied greatly, but their numbers always seem to be spread very thin. Norwich, had a population of c. 10,000 in 1300 when they had somewhere between 12 and 20 masters. That is roughly a 650 : 1 ratio of citizens to Barbers. They enjoyed a much greater pattern of continuity of the Trade in the family line there, also, with almost 1/10th followed by either sons or daughters. The ratio of patients to Barbers in Coventry was much better at c. 200 : 1. They had 20-30 active Barbers in a town of roughly 6,500.
John Harrow was a surgeon in royal service; made Chief of Surgeons twice during the French campaigns; was a member of the Fishmonger’s Company (as such, a Merchant also); financier; was made a judge in malpractice cases and a Searcher for the Port of London (worth £10/yr in income); he accumulated extensive properties.
Thomas Morstede, Esq. was court Surgeon, made a Searcher for the Port of London for 25 years (worth £10/yr in income); was twice made the Chief of Surgeons during the French campaigns; a war hero; a teacher and famous author (a fair book of Surgery, used as a standard text thru the 15th century). He was the driving force behind the foundation of a college of medicine. He had £154 in land and £200 in debts receivable at his death.
Margery Cobbe of Devon used her Leechcraft in the service of Elizabeth, wife of Edward IV, for which she received a pension of £10 a year – the same amount given to royal physicians.
John Crophill of Essex was a well-educated but self-made man, primarily a bailiff on the manor of Wix Priory for 30 years, an ale-conner, and “doctor”, he was literate so the various texts on medicine were available to him, and saw patients on more than 12 vills scattered across southern Suffolkshire and northern Essexshire. He practiced Leechcraft for more than 20 regular patients, including local gentleman and their wives, with fees ranging from 12d. to 2s. His position as bailiff allowed him to buy some medicaments at wholesale rates. All told, a comfortable living.
Master William was a “sergeant surgeon” in royal service and a cleric in minor orders. He received £10 a year, equal in honor to a royal physician. At his demise, he owned a house and 13 shops in London, and had an additional 50s. a year in income.
In 1251, Master William took on an assistant named Henry of Saxeby. Henry and his son, Nicholas, were gentlemen by birth. That same year, a Thomas of Weseham saved the life of the king.
In 1252, Thomas was invited to court and made the trip there.
In 1254, Thomas started serving with Master William and Henry.
In 1255, Master William died and Henry of Saxeby was made “sergeant surgeon”.
In the midst of the persecutions leading up to the expulsion of the Jews in 1290, Thomas Weseham used his position at court to buy up Jewish properties in Norwich, London, and Oxford at well below market value. He eventually received a number of annuities for his service, was knighted, and made both a royal Moneyer and a Forester.
It took 2 years after saving the king’s life for Thomas to be granted a position at court with Master William and Henry. It was common for such rewards to take a while to be decided on and then put in place. The GM should take note of this. The pace of life in an agrarian world in one based on the turning of seasons, not of minutes or “what have you done for me lately”.
William Hamon was prior of the Benedictine cell of Catges (Oxfordshire) and served as a royal surgeon from 1341-67, for which he was awarded a base salary of £30 a year.
Peter of Newcastle was surgeon to three kings, Edward I, II, and III.
In 1298, Peter’s own “personal valet” was also a surgeon, named John Marshal (very likely it was his apprentice, or a Journeyman he picked up to mentor). Peter was a merchant running a number of ships out of London, dealing regularly with the pepperer’s guild; he was commissioned to supply the royal court with medicines, in favor over the traditional appointment of a royal Apothecary. With his dealings with the pepperer’s guild, it is possible that Peter was actually an Apothecary and indeed a member of the pepperer’s guild, but he is not noted as such.
Despite the “taint” of blood, Philip of Beauvais, a “sergeant” Surgeon in 1304, became a wealthy courtier.
Roger Heyton served Edward III in the 1330’s and 1340’s, with an undersurgeon named Jordan of Canterbury. After the Battle of Crécy, Roger was considered indispensible and given a manor in Wales worth 50£ a year, and an annuity of £20, as well. Like Philip of Beauvais, he became a wealthy courtier.
This should give the player and GM alike some idea of what sorts of opportunities can be found for advancement in the healer-Trades.
The State of Medicine
in a Medieval Fantasy World
Historically, medieval medicine in Europe was a mixture of existing ideas from antiquity, spiritual influences such as the “shamanistic complex” and a “social consensus.” In this era, there was no tradition of scientific medicine, and even first-hand observations were always interpreted hand-in-hand with spiritual influences.
The underlying principle of medieval medicine was the theory of humours. This was derived from the ancient medical works, and dominated all western medicine up until the 19th century. The theory stated that within every individual there were four humours, or principal fluids – black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by “blood-letting”, using leeches (the origins of the term “Leechcraft” for country healers).
The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.
Astrology and Astronomy are also closely allied with the healers’ trades. The signs of the zodiac are associated with certain humours through the elements by which they are divided, thus dovetailing with these beliefs perfectly. Even now, some still use words “choleric”, “sanguine”, “phlegmatic” and “melancholy” to describe personalities.
The use of herbs dovetailed naturally with this system as well, the success of herbal remedies being ascribed to their action upon the humours within the body according to the subject’s nature and health complaint. The use of herbs also drew upon the medieval doctrine of signatures which for the purposes of the game states that the Light has provided some form of alleviation for every ill, and that these things, be they animal, vegetable or mineral, carry a certain mark or “signature” upon them that provides an indication of their usefulness.
For example, the seeds of skullcap (used as a headache remedy) can appear to look like miniature skulls; and the white spotted leaves of Lungwort (used for tuberculosis) bear a similarity to the lungs of a diseased patient. A large number of such resemblances should exist in the context of the gameworld (GM’s discretion).
Most monasteries developed herb gardens for use in the production of herbal cures, and these remained a part of folk medicine, as well as being used by some professional physicians. Books of herbal remedies were produced, one of the most famous being the Welsh, Red Book of Hergest, dating from around 1400.
Due to the plethora of additional information available to the denizens of the RoM gameworlds in regards to the body structures due to the availability of cadavers to dissect with no Church-declared moratorium to forbid it, and the availability of magick to read the state and needs of the body, and herbals with magick to read the plants for their true virtues so that the curative properties are guaranteed to be true, along with a much more practical and empirical approach, medicine and the qualities of cures available in the gameworld will easily be as effective as modern medicine – perhaps even moreso, if fact, due to the additional information from Spirit and magick which the healers are not so foolish as to ignore.
Galen of Pergamum, also a Greek, was the most important physician of this period and is second only to Hippocrates in the medical history of antiquity. In view of his undisputed authority over medicine in the Middle Ages, his principal doctrines require some elaboration. Galen described the four classic symptoms of inflammation (redness, pain, heat, and swelling) and added much to the knowledge of infectious disease and pharmacology.
Starting in the areas least affected by the disruption of the fall of the Roman Empire, a unified theory of medicine develop, based largely on the writings of the Greek physicians on physiology, hygiene, dietetics, pathology, and pharmacology. From his dissections, he described the heart valves and determined the purpose of the bladder and kidneys. Galen’s most important work, however, was in the field of the form and function of muscles and the function of the areas of the spinal cord, credited with the discovery of how the spinal cord controls the contraction of various muscles.
The Italian physician Girolamo Fracastoro, 1478 – 1553, was the first to propose that epidemic diseases might be caused by objects outside the body that could be transmitted by direct or indirect contact. This is already well understood by those of a medieval gameworld where there is magick to discover such influences in the body and trace them back to their sources by the principle of (spiritual ) contagion and the Law of Resonance.
Much later, in 1628, William Harvey explained the circulation of blood through the body in veins and arteries. It was previously thought that blood was the product of food and was absorbed by muscle tissue.
In the gameworld this mistake could never be made; they understand the need for food to supply energy and nutrients to make blood, and the importance of certain iron-bearing plants like spinach in the diet to aid that process, and also the fact that blood DOES carry the pneuma, or life spirit, as the famous Greek healer Galen stated, but further, that it circulates through the body bringing life, nutrients, energy to all body systems and aiding in repairing damage and building a healthy body, as well as the removal of metabolic waste and toxins from the body.
Contrary to popular belief, bathing and sanitation were NOT lost in Europe with the collapse of the Roman Empire. Bathing did not fall out of fashion in Europe until shortly after the Renaissance, when it was replaced by the heavy use of sweat-bathing and perfumes. This was due to the fact that it was thought in Europe that water could carry disease into the body through the skin. Considering the effects of run-off from fields where animals grazed and relieved themselves into the local water systems. and the fact that the diseases from the waste of those animals could enter the body through any scratch or other innocent perforation of the skin, they were not all that wrong.
Medieval Church authorities believed that public bathing created an environment open to immorality and disease, but the value of cleanliness to general health and the peoples’ insistence on maintaining such personal standards will far outweigh any opposition the Church might mount, especially with the medical community coming down on the side of cleanliness and public health.
The French army doctor Ambroise Paré, born in 1510, revived the ancient Greek method of tying off blood vessels. After amputation the common procedure was to cauterize the open end of the amputated appendage to stop the hemorrhaging. This was done by heating oil, water, or metal and touching it to the wound to seal off the blood vessels. Pare also believed in dressing wounds with clean bandages and ointments, including one he made himself composed of eggs, oil of roses, and turpentine. He was the first to design artificial hands and limbs for patients who had had amputations. On one of the artificial hands, the two pairs of fingers could be moved for simple grabbing and releasing tasks, and the hand looked perfectly natural underneath a glove.
All of these advances in medicine, which took hundreds of years to accumulate after the High Middle Ages, could easily have already accumulated towards the basic store of medical knowledge in what is essentially a perpetually medieval world.
While all these advances in medicine are basically physical and structural in nature and concern, it should NOT be assumed that the effects of spiritual influences will have been ignored. Galen also excelled in diagnosis and prognosis. The importance of Galen’s work cannot be overestimated, for through his writings knowledge of Greek medicine was subsequently transmitted to the Western world by the Arabs.
Illness is widely acknowledged in the worlds of RoM to stem from a spiritual imbalance, the root of the word disease being “dis-ease”, perhaps some extreme burden of stress or emotion. On rare occasions in the game world illness can even result from impiety or failure of faith commonly addressed by the practice of penance and pilgrimage as a means of curing illness, when the nature of the illness allows. Many monastic orders, particularly the Benedictine monks, considered the care of the sick as their chief work of mercy (opus Dei).
On the other hand, those that are caused by airborne objects could well be shepherded by evil spirits to oppress the people and afflict them, or such spirits may from time to time make sure that those illness-causing objects that are passed from one to another by a vector like a handshake, or the handle of a tool or a door, window shutter or cupboard remains viable to affect as many people as the spirit can contrive. A preponderance of Vice on one’s soul can make one susceptible to the depredations of such evil spirits.
During the High Middle Ages and through the Renaissance, trade routes were the perfect means of transportation for disease. Eight hundred years after the Byzantine plague of Justinian, the bubonic plague returned to Europe. Starting in Asia, the Plague, also called the “Black Death”, reached the Mediterranean and western Europe in 1348, killing 25 million Europeans in six years. This was roughly 1/3rd of the total population, and in the worst-affected urban areas up to 2/3rd’s. Of course, the preceding 6 years of famine specifically in England didn’t help matters there at all when the Plague arrived.
Before the Mongols left the city of Kaffa they besieged in the Crimea, the dead or dying bodies of the plague-infected soldiers were loaded onto catapults and launched over city’s walls to spread the infection to those inside. This incident was among the earliest known examples of biological warfare and is credited as being the source of the spread of the Black Death into Europe.
While such virulent disease would be devastating even in the game world, with the knowledge of healing gathered and maintained with the aid of magick over the centuries, it is likely that it would not hit as hard as it did historically in those areas where the Herbals and Physicians were sufficiently represented. In addition, with magick to fall back on to supply The greatest danger would be in running out of the herbal cures and those needed to relieve the symptoms in the most densely populated areas, due to the high rate of infection.
Anglo-Saxon translations of classical works like Dioscorides Herbal survive from the 10th Century, showing the persistence of elements of classical medical knowledge. Compendiums like Bald’s Leechbook (circa 900), include citations from a variety of classical works alongside local folk remedies.
The revival of methodical medical instruction from standard texts in the west can be traced to the church-run Schola Medica Salertnitana in southern Italy in the 11th century. At Salerno, medical texts from Byzantium and the Arab world were readily available, translated from the Greek and Arabic at the nearby monastic centre of Monte Cassino. The Salernitan masters gradually established a canon of writings, known as the ars medicinæ or “art of medicine”, or articella, “little art”, which became the basis of European medical education for several centuries.
From the founding of the universities of Paris (c. 1150), Bologna (c. 1158), Oxford (c. 1167), Montpelier (c. 1181) and Padua (c. 1222), the initial work of Salerno was extended across Europe, and by the 13th century medical leadership had passed to these newer institutions. To qualify as a Doctor of Medicine took 10 years including original Liberal Arts training, and so the numbers of such fully qualified physicians remained comparatively small.