How can a modern medic help medieval patients

Question

My modern doctor has been time-slipped to a medieval city, without any equipment. She has the patronage of a powerful, rich noble, so being accused of witchcraft is not a problem. She will be embarking on a public health program, but what can she do in terms of treating people with the available materials? Are there any drugs she can make, and what sort of life-saving surgery could she perform without anesthetics, etc? Can she help with midwifery to reduce the infant mortality rate? Or should she stick to training others in basic hygiene?

((Edit: previous questions have dealt more with hygiene/publish health, for worldbuilding/story pruposes I'm more interested in how she can help individuals although I appreciate this may have less overall impact))

I have the impression this very question has been asked and answered before. — L.Dutch, Mar 09 '20 at 18:32
This question looks like it's asking about an individual's actions within a pre-existing world, rather than asking about building the world. — sphennings, Mar 09 '20 at 18:35
@sphennings this scenario (stranger in a known world) is generally acceptable, as long as this can be a common situation. — Alexander, Mar 09 '20 at 18:43
Very-close, another very-close, close, and close modern-medicine-in-ancient times questions. — user535733, Mar 09 '20 at 19:00
As a curiosity, she could do life-saving surgery of a disease unknown in the Middle Ages: appendicitis. It wasn't identified until the 16th century. — Carlos Martin, Mar 09 '20 at 20:49
In real history the Romans were getting quite close to sensible medicine. Then the plague of Justinian hit them, followed by the collapse of Rome. Their progress was subsequently lost to the dark ages. — nigel222, Mar 10 '20 at 11:42
A modern medic with boxing skills could help by knocking out medieval medics before they get to the patient. — Misha R, Mar 10 '20 at 13:57
Go watch Outlander now... It's not 100% what you were asking, but WW2 nurse getting transported back in time to the mid 1700s isn't too far off. Plus, it is a little bit more medieval, because the Scottish highlanders were still largely using swords at the time... — TitaniumTurtle, Mar 10 '20 at 18:44
All those time traveler stories forget or no know in present days we have immunity to several microorganisms we tolerate and our bodies are ok with them. Once you go to the past you turn yourself in a powerful biohazard weapon against the weak immunity system of persons live there. — Rodolfo Penteado, Mar 10 '20 at 21:30
"what can she do in terms of treating people with the available materials?" - despite "the patronage of a powerful, rich noble`", the sad fact is that the simple best thing that she can do is to try to pass as male :-( — Mawg says reinstate Monica, Mar 11 '20 at 06:14
Is the doctor male or female? A female may have considerable issues convincing people of the time that she is correct, if she isn't instantly killed for being a witch as she is performing 'rituals' (Cleaning tools, hand washing, etc.) and trying to get rid of traditions of the time. — KM.Thomas, Mar 11 '20 at 09:44
Being female is a problem only if she wants to practice medicine among those who can afford doctors. She needs to stay away from there anyway because the established physicians will see her as wholly ignorant of medical theory and dangerously incompetent. As a woman she can pass for a long time nearly invisible as a folk healer and midwife to the poor. If she she produces good results, she will get a reputation, the poor will tell the noblewomen, the noblewomen in desparation will seek her services, and there is a chance (not a guarantee) that her ideas will reach a wider audiance. — David42, Mar 11 '20 at 21:22
A modern doc can easily diagnose and cure Vitamin C deficiency induced diseases such as scurvy. — Pushpendre, Mar 12 '20 at 00:31

Skyler · Answer 1 · 2020-03-09T19:41:20.770

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Cleanliness

This one's a big one. Getting people to just wash their hands and bodies will go a long way, as the medicine of the time was often not helpful at all, if not downright harmful (leeches, for example). In the 14th and 15th century medicine really started to turn around due to the rejection of commonly accepted authorities, and people instead doing what worked. Considering that this is really all it took to turn things around, I would guess that your medic could make leaps and bounds in the health of your vassals.

Surgery

As far as this is concerned, surgeries were being performed with some success as early as 750 CE in the middle east. In Europe, as late as the 18th century, barbers were performing successful surgeries, and guess what most of the fatalities came from? Infection and bloodloss. With your medic's advanced knowledge of sterilization and sutures, they're going to have a much easier time avoiding this. Especially since those same barbers actually thought bloodletting was a proper treatment.

All in all, I think your medic would make an incredible impact on the health of the people, and possibly even change the course of history should their methods spread.

edited Mar 09 '20 at 19:41

answered Mar 09 '20 at 18:37

Skyler

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Name 1 modern disinfecting medium which was available in medieval time – L.Dutch Mar 09 '20 at 18:45
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@L.Dutch-ReinstateMonica Are you serious? Alcohol and fire. Heat your equipment and use distilled grain alcohol to disinfect the area. – Skyler Mar 09 '20 at 18:48
sutures may be a bigger issue – Andrey Mar 09 '20 at 20:32
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@Skyler They didn't have distillation in the middle ages. But fire still works. – Ryan_L Mar 09 '20 at 20:50
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@Ryan_L Actually, europe had distillation as early as the 12th century. https://en.wikipedia.org/wiki/History_of_alcoholic_drinks#Medieval_Europe – Skyler Mar 09 '20 at 21:10
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Also, simply telling folks to boil water (and then let it cool) would be an improvement, for both cleaning and drinking. – StephenS Mar 10 '20 at 02:53
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@Ryan_L Any medical student knows how to distill alcohol. – DJClayworth Mar 10 '20 at 03:37
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@DJClayworth No need to go that far, distilling is well within high school chemistry curriculum... EVERYBODY should know how to distill alcohol... – Oxy Mar 10 '20 at 08:18
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@L.Dutch-ReinstateMonica Besides alcohol and fire, honey has antibacterial properties, and has been used to dress wounds throughout much of recorded history. It was used by WW1 medics, and even today, "medical-grade honey" is used by doctors. Someone with modern medical knowledge with access to a couple of beehives and basic tools (knives, fire, alcohol) would likely be able to clean and dress a wound pretty tidily and with a much better prognosis than healers of the time. – anaximander Mar 10 '20 at 09:50
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Surgery's still not going to get anywhere near modern standards without anaesthesia. Prior to the invention of anaethesia, surgery was seldom used for anything that couldn't be done quickly, like amputation, and surgeons prided themselves on how quickly they could perform a procedure - not on their survival rates. Still, might be some anaesthetics that can be readily produced with medieval technology. – James_pic Mar 10 '20 at 10:42
@Andrey sutures? Animal guts ('catgut') will probably work, provided boiling or baking them to sterilize them doesn't destroy their stringiness. For external sutures, plant fibres ('cotton') will be fine, and definitely boil OK. – nigel222 Mar 10 '20 at 11:47
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@James_pic Opium? Not sure if mediaeval Europe had yet imported opium poppies along the silk road. But your doctor could ask merchants to procure some oriental poppyseeds. The chemistry to make heroin (stronger) is probably within reach, but failing to keep it secret might wreak more harm than good. – nigel222 Mar 10 '20 at 11:54
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I want to add cholera your medic will know that its important to not drink sewage(put the sewage away from water sources) to avoid cholera epidemics which were a pretty big issue – Nullman Mar 10 '20 at 11:55
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@James_pic just checked wikipedia to confirm what I though I knew. Belladonna (deadly nightshade) has pain relieving properties and was used for such in folk medicine. It is of course a pretty dangerous drug. Too much is deadly, and somewhat less causes unpleasant hallucinations. – nigel222 Mar 10 '20 at 12:01
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@Nullman has pointed the single biggest impact she could make: Simply convincing the people to keep sewage well-separated from drinking water will save enumerable lives. – Paul Sinclair Mar 10 '20 at 16:59
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@Oxy, indeed. Our high school teacher had us bring raisin 'mash' in gallon milk jugs for us to distill into 'grain' alcohol. He was fired a few years later for some reason... – Tracy Cramer Mar 10 '20 at 19:41
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@PaulSinclair - Plumbers save more lives than doctors. 'convincing' people isn't the way to go though; OP needs to forget about medicine and start practicing the art of logistics. Everyone who attempted to build the Panama Canal first tried draining the swamps and building barracks, but until it was serviced by railroad to do those things right, they all failed. – Mazura Mar 10 '20 at 23:48
For a particularly interesting series on the discovery of the importance of good plumbing practices, check Extra History's series on the The Broad Street Pump. – Paul Sinclair Mar 11 '20 at 01:27
Not only is cleanliness "a big one", it's almost impossible on a large scale. Heating water is expensive, and a medieval society is poor. Furthermore, without microscopes to demonstrate the existence of bacteria, antisepsis has no more obvious truth than banishment of devils. Sure, it will work statistically, but statistics are no match for existing beliefs - see the example of Semmelweiss. – WhatRoughBeast Mar 12 '20 at 20:28

score 33 · Answer 2 · answered Mar 09 '20 at 18:46

There are actually several areas where she can help.

Germ Theory. She can educate them about the Germ Theory, and how important it is to disinfect stuff. This is a huge life-saver in many areas, the biggest being wound care, midwifery, and surgery.
Getting Rid of the Theory of Humors. One theory of medicine that was particularly popular back in the day was the Humor Theory. According to the Humor Theory, the body's health was controlled by four "humors." When people got sick, they blamed it on an excess of blood, which they "alleved" by extensive bloodletting. Your nurse could dissuade them of this opinion via a few anatomy lessons.
Wound Care/Triage. Back in the medieval times, wound care generally consisted of a loose bandage, occasionally with an herb lavage. While this sometimes was enough, a lot of people died from infections, and a broken bone generally meant permanent crippling due to it not setting right. At the very least, your nurse could improve this area by introducing the ideas of stitching, antibiotics (honey/bread mold), and splinting.

Just stopping bloodletting would improve the survival rate for some illnesses. — Patricia Shanahan, Mar 09 '20 at 19:53
It may be surprisingly difficult to get these ideas accepted. Our own history shows this. In the 1840's it was twice demonstrated that if doctors in maternity wards washed their hands, maternal deaths from childbed fever fell from 16% to 18% to 2% to 3%. Still doctors resisted and openly mocked this idea for decades. And this was but one chapter in the fight for the acceptance of germ theory, a fight which continues today. I suggest or time-traveler doctor avoid contact and conflict with the local medical profession as much as possible until she has won over the common people. — David42, Mar 11 '20 at 20:25
@David42 I agree; however the OP asked for the maximum impact, and this is it. I personally think that she should stay out of the way, but that's irrelevant to the question. — In Hoc Signo, Mar 11 '20 at 22:59

score 25 · Answer 3 · answered Mar 09 '20 at 19:08

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The modern doctor's background in chemistry, biology, physics, statistics, methods of scientific inquiry, and the germ theory and pharmacology they are based upon are much more valuable than the patients she can cure alone.

She's a one-person University that just advanced many fields by 500 years. A society would gain the greatest benefit by her spending the rest of her life teaching the future instructors of all those fields, and coaching them in the scientific techniques to preserve and continue when she dies of old age in her lecture hall.

answered Mar 09 '20 at 19:08

user535733

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Founding a university, even a small one, is a major undertaking. Toward the end of the medieval period there are medical faculties which she could in theory join, but without recognized qualifications she should have to first attend as a student. The only woman I can find who did this is Virdimura in the 14th century. It probably helped that her husband was a doctor. If getting to attend medical school is tough, her chances of becoming a instructor are surely far worse. Maybe she could make this work by marrying an up-and-coming doctor who was open to her ideas and would go on to teach them. – David42 Mar 11 '20 at 21:02
@David42 Nobody said she should found a University. That was a simile; a useful comparison. The OP said she had a rich and powerful patron, and implied that she has freedom of action, so marrying to achieve that freedom of action seems unnecessary given the conditions in the question. This answer merely points out that clinical care improvements is at the lower bound of what she can bring to that society, and makes a few suggestions toward the upper bound. – user535733 Mar 11 '20 at 22:55
I understood you meant a more informal setting, but wanted to cover all bases. She must choose between medical and social reform. A patron, no matter how powerful, cannot alter people's perceptions by fiat. She will have to choose an existing female role: maiden, prostitute, wife, or widow. Married women will not listen to a maiden since they are employed whereas she has been unable to get a job. Nor can a maiden move about freely or hang out with men without being seen as a prostitute. Finally, if she wants to teach men, she needs to recruit a man to be, at least officially, the teacher. – David42 Mar 12 '20 at 15:00
@David42 you seem to be suggesting much more than an adjustment to this answer. You seem to be challenging at least one premise of the answer (freedom of action). Got that. Further discussion on that point is futile argument. Consider adding your own answer with the premises you consider valid. – user535733 Mar 12 '20 at 15:45
I am attracted to this answer because it represents the direct route and is the way we would all like to see the story end. I wish I could see a way to make it work with her a beloved figure at the end receiving the credit for a medical revolution. I'll consider writing my own answer. – David42 Mar 12 '20 at 16:31

score 14 · Answer 4 · answered Mar 09 '20 at 22:07

Forceps delivery.

Your medic will be familiar with obstetric forceps.

The success of this dynasty of obstetricians with the Royal family and high nobles was related in part to the use of this "secret" instrument allowing delivery of a live child in difficult cases. In fact, the instrument was kept secret for 150 years by the Chamberlen family, although there is evidence for its presence as far back as 1634... The forceps were used most notably in difficult childbirths. The forceps could avoid some infant deaths when previous approaches (involving hooks and other instruments) extracted them in parts. In the interest of secrecy, the forceps were carried into the birthing room in a lined box and would only be used once everyone was out of the room and the mother blindfolded.

Public health is fine if you want to save a bunch of poor people who will not know they have been saved. If you want to impress a rich man, show up after 48 hours of labor and extract his heir alive and well while leaving his wife alive and well.

Would the use of forceps be something a GP would know? It seems like something a specialist would learn. — nick012000, Mar 10 '20 at 10:44
@nick012000 - GPs deliver babies. Forceps are standard tools now. — Willk, Mar 10 '20 at 14:06
Somewhat off topic, but deeply curious - what sort of deep psychopathy would lead to someone keeping this innovation a secret? — Iron Gremlin, Mar 10 '20 at 19:55
@IronGremlin - I think it was just financial gain. I agree it seems evil - letting babies die so your family can maintain a corner on the difficult delivery business, — Willk, Mar 10 '20 at 23:33

score 10 · Answer 5 · answered Mar 09 '20 at 18:35

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Even with no equipment a modern doctor would be superb and outstanding. Merely keeping adequate hygiene of his materials (knifes, I assume), administering alcohol on wounds and overall being capable of diagnosticate correctly different illness is enough to be considered the best medic in the century. As for anesthetics, my best educated guess would be opium based destilations, relatively available back then.

answered Mar 09 '20 at 18:35

maxisalamone

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modern hygiene cannot be kept with no modern means 2) modern doctors are much dependent on modern diagnostics means

L.Dutch

Mar 09 '20 at 18:44

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You can do a lot with distilled alcohol, which has been possible to make for quite some time. – Matthew Mar 09 '20 at 18:54

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@L.Dutch-ReinstateMonica: They had soap in the Middle Ages (at least in Europe they did). And they had public baths and they tried to keep as clean as possible. – AlexP Mar 09 '20 at 20:21

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@L.Dutch-ReinstateMonica You can keep surgical tools clean for long enough to complete your surgery. Put them in boiling water for a few minutes just before you start cutting. You don't really need to keep the tools clean indefinitely. – Ryan_L Mar 09 '20 at 20:53

@Ryan_L Even today, the surgical tools aren't clean for long. After their protective packaging is opened, it's skill to keep them not touching dirty things, and under ideal conditions, they become contaminated by the patient. – Edwin Buck Mar 11 '20 at 06:46

Alexander · Answer 6 · 2020-04-21T00:02:50.373

There are great many things that modern doctor can help with in medieval times. They can be categorized into several groups:

Surgery

Even without anesthetics, knowledge of germs and antiseptics can revolutionize surgery. If this doctor is a surgeon, a whole range of operations (like appendectomy) can have a much higher rate of success. Strong spirits and sterile gauze alone can make a revolution.

Hygiene

This can help doctor's patients directly, but even more so if followed by others.

General knowledge of diseases

In addition to hygiene, just knowing about the origin and progression of diseases can make a very strong effect on medieval healthcare. Making proper quarantine in case of plague or advising a proper diet in case of diabetes can save many lives.

Gypsum cast

Before 1800s, treatment of fractures was rather crude, resulting in many poorly mended limbs. With the application of gypsum plaster, the process had become much more dependable.

Pharmaceuticals, chemicals and vaccines

If this doctor has strong chemical background, a whole lot of new possibilities will emerge.

Iodine. Solution of iodine in alcohol is a simple and powerful antiseptic;
Ether and chloroform. First anesthetics that should be well within the range of medieval chemistry;
Aspirin. A more advanced chemical that, given enough resources, medieval alchemist should be able to synthesize.
Microscope. Not very difficult to make, with the help of a lens crafter.
Vaccines. Many vaccines (like smallpox) are not that difficult to make. The benefit will be enormous, but it would still require years of work.
Antibiotics. This is well outside the range of a medieval alchemist, but, if this doctor is able to set up a state of the art lab and has years to conduct research - why not to try?

Willow bark tea is a natural form of aspirin and was used as a pain reliever, to treat fevers, and reducible inflammation. . The foxglove plant contain digoxin which is a medicine for treating congestive heart failure. A local herbalist would probably have better knowledge about medicinal plants than a modern doctor. — James Cook, Mar 09 '20 at 19:55
@Alexander "advising a proper diet in case of diabetes" Without a means of producing insulin, I'm pretty sure that diabetes would be 100% fatal regardless of diet - at best you'd just prolong the time before their inevitable death. — nick012000, Mar 10 '20 at 10:42
@nick012000 1) There are 2 types of diabetes; 2) "Prolonging" is not as bad as it sounds. — Alexander, Mar 10 '20 at 16:54
@nick012000 The knowledge of the causes of diabetes is a great start even. And a primitive insulin can be obtained from pigs with even medieval technology, I think. RDNA insulin is a lot harder to get, though. But even today, the only thing doctors do for type 1 diabetes is "prolong", hopefully for many years though. — Garrett Motzner, Mar 12 '20 at 21:01

score 6 · Answer 7 · answered Mar 10 '20 at 16:13

As mentioned by several other answers, germ theory and hand-washing is a low-hanging fruit that could yield major improvements in health across whole populations. Boiling drinking water is a good start but hand-washing may feel a bit tricky to implement since in most developed countries we are habituated to washing with soaps etc which in the medieval period are likely to be unavailable, in short supply, or too expensive.

In this context, perhaps the best alternative to soap is wood ash.

As a strong alkali, wood ash can be applied to the hands and washed off with running water to kill bacteria, germs etc.

At least one study comparing Bangladeshi households based on their primary hand-washing method (soap + water vs water only vs ash + water) found that the soap and ash had similar health outcomes with regards to diarrhea (water only and no washing predictably had the worst outcomes). There are many more studies on ash based hand-washing and lots of NGO's and health organizations focus on spreading the method in developing countries.

Its worth noting though that the main downside to handwashing with ash is that if you leave it on your skin mixed with water for too long it will begin to burn your skin.

Leaving soap on your skin without rinsing it off isn't great for your skin either ☺. — Matthew, Mar 10 '20 at 16:31

score 5 · Answer 8 · answered Mar 09 '20 at 20:39

The doctor could probably have her biggest effect through two very low tech public health campaigns:

(Already mentioned in another answer) Stop bloodletting as a treatment. Encourage rest and fluids instead as standard treatment for undiagnosed illness.
Encourage keeping healthy, well-groomed, indoor cats. Cats can carry fleas and the plague, but regular grooming, by any combination of the cat and its humans, will reduce that effect. Keeping it indoors will also reduce flea exposure. The presence of cats will tend to keep rats away.

score 4 · Answer 9 · answered Mar 10 '20 at 11:23

Depending on how well your medic remembers their college chemistry, they may be able to whip up a few substances that would assist greatly with medical practice.

Disinfectant

Reasonably pure alcohol shouldn't be that hard to produce; a still can be made entirely of metal, which is useful because medieval glassworking probably isn't up to making the sort of tubes you see in chemistry labs). Once a local blacksmith has been instructed, they should be able to fashion a workable still and start producing grain alcohol. The technology did exist in medieval times, so depending where they are in the world, someone nearby may be able to assist with this. Strong alcohol can be used as a disinfectant; depending on how much it's diluted, it can be used to clean wounds, surfaces, and surgical tools. The still itself can be sterilised using fire or a hot oven (a bread oven should do it), and later using the alcohol, so it should be relatively uncontaminated.

They can also use the same process to produce distilled water, which would be free of germs and contaminants, and would stay that way if stored in glass bottles that have been sterilised with steam and/or alcohol. This can be used to dilute the alcohol; pure ethanol is too harsh to use on wounds directly. adding a touch of salt (which you'd want to leave in an oven for a while to kill germs) would produce medical saline, which is useful for flushing dirt out of wounds. (It can also be used to treat dehydration, or in case of blood loss, but you'll have to figure out a method of administering it intravenously using medieval technology, which I'll leave up to you.)

Anesthetics

One of the earliest anasthetics was ether (diethyl ether, to be precise). You can produce this using ethanol (which we just acquired) and a strong acid. This is surprisingly accessible; there are references to "vitriol" as far back as the ancient Greeks. Sulphuric acid is referred to in European writings from the 12th century, and nitric acid is recorded in the 9th century in the Middle East. It's probably a good idea to find some aluminium oxide as a catalyst; corundum is a little hard to come by in medieval Europe, but not impossible. Just be careful when using it as it's super flammable and your only sources of light all involve naked flames. Maybe your medic should invent the Davy lamp, just to be safe.

If ether is too hard to produce, there are seaweeds that naturally produce chloroform, apparently.

Antibiotics

The simplest antibiotic your medic could produce is honey. Regular honey has all sorts of stuff in it, but will work as a rudimentary antibiotic. Using knowledge of germ theory and the ability to produce disinfectants, your medic could probably set up a clean-ish environment in which to produce a more effective version.

Most medics also likely know the history of penicillin, and could therefore experiment with mould from breads and cheeses. It shouldn't be hard to assemble a few small bowls filled with literally anything that bacteria or mould will grow on in order to determine which of your mould species are likely penicillium species by observing how they inhibit or kill off the other varieties. Penicillin can be extracted from the mould using citric acid, so your medic will need to find some lemons, but that shouldn't be too difficult.

score 3 · Answer 10 · answered Mar 10 '20 at 09:06

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I will look at this question from different perspective

She has the patronage of a powerful, rich noble, so being accused of witchcraft is not a problem.

Unless that noble is a Pope, I find that hard to believe. You seem to heavily dismiss the power of Church in questions of medicine and bodies. Even the most powerful of nobles would have to deal with religious pressure in who he associates with. Especially if that someone started playing with human bodies.

The best way to demonstrate her knowledge would be public dissections. But those would be extremely difficult to get past the Christian Church.

The best should could do is to have small group of people, loyal to the rich noble, to change their habits in cleanliness. But I wouldn't expect any greater change in medicinal consensus of the time.

answered Mar 10 '20 at 09:06

Euphoric

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Being accused of witchcraft for knowing science is unlikely to happen anyway. The Catholic Church's official position at the time was always that witchcraft basically didn't exist - the Spanish Inquisition, for instance, was formed to hunt down Jews pretending to be Christians. She might be accused of Heresy if she was a Protestant, though. – nick012000 Mar 10 '20 at 10:37
@nick012000 forgetting of course the (at least) thousands of women (and men) put to death for accusations of witchcraft. The Malleus Maleficarum was a real thing. – TylerH Mar 11 '20 at 16:14
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@TylerH And the Catholic Church regarded it as heresy. Witch-hunting was explicitly forbidden by the church, and it was mostly an Early Modern/Renaissance phenomenon rather than a Medieval one. The Spanish Inquisition, for instance, was formed to hunt down Jews and heretical Christians rather than witches. Additionally, the Medieval church was very much a place of scholarly learning; many early scientists were Catholic monks. – nick012000 Mar 11 '20 at 23:31
@Euphoric According to this article dissections were actually fairly common: https://news.harvard.edu/gazette/story/2011/04/debunking-a-myth/ The article suggests the dissection ban is one of those 19th century myths about the Catholic Church and science. – David42 Mar 09 '21 at 17:34

score 3 · Answer 11 · answered Mar 12 '20 at 19:05

I really like this question since it presents unique challenges. The question of whether it would be physically possible to practice enough of modern medicine in a medieval setting to be useful has been well addressed in a number of answers. I want to talk about the social difficulties which are far more formidable.

The question proposes that she "embark on a public health program" and refers to training others. This implies far more than visiting the sick and working as a midwife. She must somehow establish herself as an authority on medicine able to persuade others to implement her ideas. Obtaining supplies and avoiding an accusation of witchcraft are the least of her problems.

First of all, the unswerving support of a powerful noble is not something that can be conjured out of thin air. I suppose you could have her save his heir, but how does she, a woman, a total stranger, without known medical qualifications, get near the heir in the first place?

If she overcomes this difficulty and performs the miracle cure, she will have earned the eternal gratitude of the nobleman and his wife, but she will have alienated all the attending physicians she pushed aside. These will, with considerable justification, consider her a dangerous charlatan. They may have medical degrees, whereas she (as far as they know), has none. They known modern medical terminology and theory, whereas she does not. This is not the best way to start influencing medical practice. The nobleman could protect her physically, but he is not a former of medical opinion either. I would strongly suggest she attach herself to the nobleman's household in some other way and enter medicine in a less threatening manner.

This means she must either get hired as a servant or become a companion to either his wife or daughters. I suppose she could use forged letters of introduction or something like that. Other options are limited. If she could somehow marry him she could start practicing medicine among his tenants. There aren't really any other options. If he were to sponsor her without a good explanation, then she either would be or would be perceived as his mistress. That does not sound like a route to to power and influence.

Having attached herself to the females of the noble's household, she needs to work on her medical credibility. As I said above, visiting the sick and the poor the the best way to do this. The established (male) medical profession is unlikely to see this as a threat. In fact, they are likely to see such dirty work as beneath their dignity.

If all goes well, her visits will be appreciated and other women may join her. If she is really good, she might be able to jump start the nursing profession as Florence Nightingale did in the 19th century. It might be acceptable for her to organize women in this manner in the name of Christian good works. She will have to be very careful how she does this in order to remain within the bounds of socially acceptable behavior for respectable females. She must not be perceived as immodest or unchaste. If she is perceived as having never been married (and hence a virgin), she must never go anywhere unless she is accompanied by a respectable female such as the nobleman's wife or daughters. If she passes herself off as a widow, she will have somewhat more freedom.

Establishing a reputation for practicing competent medicine will not be a walk in the park. Many of her ideas will be novel, almost impossible to explain convincingly, and may require people to forgo medical treatments (such as bloodletting) which they have been told are life-saving. She will have to be creative in how she explains things. She will not be able to dispel mistaken notions about the cause of disease, only supply new ones to keep alongside them. When she starts her campaign for better sanitation, she should quote from the Mosaic law in the Bible.

This is already an very ambitious plan. But barring unlikely developments, it would almost certainly be underappreciated and die out shortly after her death. The deliberate avoidance of confrontation with the established (and male) medical community would deprive her efforts of lasting influence.

If you need the unlikely developments for your story, I suggest you have her meet a broad-minded medical student whom she can convince of the value of her approach and subsequently marry. She then feeds him enough medical knowledge to make him a star professor and spreads her ideas through him. She has to marry him for the simple reason that this is the only way she can spend the necessary time with him while remaining a respectable (and hence influential) member of society.

This means that her husband the professor will receive almost all the credit for her accomplishments. The students and other faculty members will almost certainly have some idea what is going on, but the fact that it is a male standing in the front of the lecture hall while she "assists" him will allow everyone to save face.

This last part is particularly shocking to us moderns. I suppose she can take comfort in the fact that the ideas are not her own anyway. Any form of this plan will require an unbelievable cultural adjustment in which she must learn to go along with and pay lip service to ideas which she finds totally alien and even repellent. But here is no other way. Her mission requires unbelievable self-sacrifice and this will be a big part of it.

score 2 · Answer 12 · answered Mar 11 '20 at 22:49

Your medic probably has hands-on skills that aren't available otherwise. For instance, even leaving out the improvements she could make in surgical equipment, if she is a surgeon she can make cuts more precise and in the right place than local practicioners could. Even if she's not trained in surgery, her knowledge of anatomy will be far ahead of any local's.

Other similar hands-on skills would include setting bones, delivering babies, and making a diagnosis in the first place.

These hands-on skills may be of more interest for story purposes than are the mostly theoretical skills discussed in other answers.

Exactly -- it's hands-on person-to-person stuff i'm looking for — David Hambling, Mar 12 '20 at 15:54

score 2 · Answer 13 · answered Mar 11 '20 at 23:05

A person trained for basic first aid is more highly trained that the "doctors" of medieval age. Just knowing what causes infection and how to do basic cleaning of wounds is far more advanced. More people died from disease and infection than actual combat. This was true all the way up to and somewhat including World War 1.

score 2 · Answer 14 · answered Mar 11 '20 at 23:06

I've looked into this as well, after watching TV shows on 19th century doctors (Bramwell and Dr. Quinn Medicine Woman).

One interesting thing is that penicillin can "simply" be grown on bread/fruit and harvested for use. The problem is that the mold that creates penicillin also creates some other items that are toxic/cause allergic reactions. However with careful breeding you can probably create a strain of mold that creates less toxins. About 10% of people are allergic to penicillin but that's not bad odds when facing certain death from a bacterial infection. Penicillin as a routine antibiotic wasn't a thing until after 1946.

Also blood typing/cross-matching is fairly trivial and would improve the odds (I haven't actually calculated them) against transfusion poisoning. You just mix blood cells of the donor with plasma of the recipient, if there is clotting in the plasma its a bad match.

I've also looked into more sophisticated antibiotics and they are simply chemical recipes. The problem there is that you would need several factories to create the volumes of chemicals necessary to combine to get the antibiotics.

As pointed out by others, germ-theory is important and having non-porous surfaces in the operating theater would be critical to reduce staph infections. Inventing acrylic floor/wall coverings would be easier to clean with mechanical force (preventing bacteria to become resistant to chemical antibiotics) and therefore reduce both simple infections and super-bugs.

Joel Coehoorn · Answer 15 · 2020-03-13T02:32:25.620

You start wearing a clerical collar or habit. Then you take some soap, and you pray over it, where people can see you do this. Really.

In the medieval world, nearly everyone believed in God, but the belief was more as a belief in the mystic than a real faith in a living God presiding over an ordered universe.

Now you tell them this is special sacred soap that will help keep them from getting sick. The people for whom you do this will believe you, and actually use the soap, in way they would not have done if you just tried to teach them normally about cleanliness.

And in the medieval world, promoting cleanliness is likely to have a much stronger impact than anything else you could do.

medieval people knew about soap, many just did not see cleanliness as desirable and/or affordable. — John, Apr 21 '20 at 00:23

score 2 · Answer 16 · answered Mar 12 '20 at 23:47

She should focus on one thing, and that should be eliminating smallpox. (*Note, answer depends exactly when the doctor arrived, as it arrived and ravaged europe in the middle ages)

It was responsible for the deaths of roughly 10% of the population in the middle ages to the 18th century, and has a very simple vaccine to produce.

It's also simple to prove that a cure works, as she only needs to innoculate the children of her wealthy patron and his vassals. When the inevitable smallpox outbreak hits, everyone else will lose children, and wealthy patron won't. She can then use this success to expand.

All she needs for a vaccine is a cow with cowpox. Once she's given it to one person, she can use the infected person to spread the cowpox to others.