World Without End by Ken Follett

In World Without End, the sequel to The Pillars of the Earth, Ken Follett immerses the reader in the England of the fourteenth century and the Black Death, the plague that killed off something like half of England as well as decimating the population of Europe.

At this time, medicine was mainly in the hands of the Church, and doctors lived and worked in the priories, having studied ancient texts on medicine in the universities. This medicine was anything but practical, usually relying little on observation and experience.

Local surgeons and “wise women” were practical in their approach, but were barely tolerated by the official doctors. Surgeons often had battle experience and their ability to tend to wounds and perform surgeries had been learned the hard way, not from a book, but from saving lives of soldiers as they fell. “Wise women” used knowledge of herbs and home remedies passed down to them by other “wise women” or learned from their own experience.

Some of the remedies prescribed (without examination) by monk-doctors in the book included eating lark’s livers and applying dung poultices to wounds to “draw out the pus” so evil humors would be expelled. The local surgeon recommended instead to wash the wound with warm wine, stitch it closed and bandage it. Sounds rational, right?  The treatment chosen in the story was that of the monk-doctor, and the result was that the patient developed gangrene and his arm had to be amputated.

One of the notable passages about the practice of a wise woman was one in which a young woman who had just given birth was hemorrhaging. She was given up on by the priory doctor. The wise woman who was attending the birth massaged her abdomen, and the bleeding stopped. (This is a common practice of mid-wives and obstetricians today, to cause the production of the hormone oxytocin, which helps contract the uterus and slow bleeding.)

One of the book’s home remedies which must include the warning to not try this at home was the use of the essence of poppy as a love potion!

Interesting herb references include the use of honey for wounds and in drinks, wine infusions of herbs, and herbs used for culinary purposes.

During the plague years, sick people often came to the priories for treatment. Since the priories were also used as guest houses for visitors to the town, infection spread easily.  At this time, no one was sure how disease spread from person to person. One idea, from Arabia, was that it spread by a sick person looking at a well person. Italians adopted the use of the face mask, so obviously there were some that felt it could spread by way of the breath.  In the book, an innovative prioress wants to build a separate quarters to isolate the sick and thus prevent the spread of the disease.

Sanitation (washing of hands) was another measure imported from the Italians and mostly disregarded by the monk-doctors. But during the plague, these protective measures were more tolerated, partially from desperation and partially because so many died that those who were left coped as best they could, without the “benefit” of the approval of the local doctor-monk, if indeed one could still be found!

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