SCIENCE / A day in the life of a medieval hospital: On a windswept hill in Scotland, archaeologists are excavating the site of an infirmary run by monks. Their finds shed new light on medical practice in the Middle Ages, says Steve Connor

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AS THE wind whistles over Soutra, a barren hilltop 17 miles south-east of Edinburgh where the greatest medieval hospital north of York once stood, one could be forgiven for imagining the groans and cries of its long-dead inmates. Their pain and suffering is no more, yet the secrets of how the medieval monks of Soutra practised their primitive medicine are gradually being teased out of the soil. Clues are emerging from the scientific analysis of what is effectively 800-year-old medical waste.

Nothing much above ground remains of the Soutra hospital. Its attractive red sandstones were carted away over the centuries as locals re- used them elsewhere. The only building left intact is a 17th-century family burial vault, built from the same medieval stone, which has nothing to do with the much larger construction it replaced.

For Dr Brian Moffat, who for nearly 10 years has led the archaeological investigation of the site, it is what lies buried that is important. He believes the remnants of waste left behind by the medieval monks who ran the hospital will shed light on Soutra's secrets. His goal is to

discover how Augustinian monks used herbs and remedies to assist in procedures ranging from the amputation of limbs to the purging of intestinal worms.

Situated 1,100ft above sea level on a remote B-road, Soutra is just about the most inhospitable place imaginable - even in mid-summer, squalls are frequent and sudden. The first question that comes to mind is, why build a hospital here? It is, after all, the highest of the 2,000 or so monastic sites in Britain.

The most obvious explanation is that Soutra once stood on what was the main highway from England to Edinburgh, and would have been the last night stop-over (or the first, depending on the traveller's direction) on the journey. Dr Moffat believes a nearby well 'with a healing reputation' could also have played a part in the decision to build a hospital on the top of the Soutra massif.

Hospitals then were not exactly as we think of them today, he adds. 'Their purpose in the Middle Ages was to provide a range of basic hospitality. One of the specific purposes of this one, according to its charters, was to look after the sick, the aged, the infirm and the poor. It was very unusual to specify the sick. If you were on the trail of medieval medical waste, you would choose to look for it in a place like this.'

Architectural historians who have studied the intact 17th-century burial vault, called 'Soutra Aisle', have identified carved stones in the base of its walls that were evidently designed for use around the door of an earlier Augustinian church. The Augustinian monastic order was renowned for its medieval hospitals. Dr Moffat says the burial vault is a 'true red herring', and nothing whatsover to do with the buildings that had preceded it by some 500 years. He believes the Aisle stands today on the actual site of the hospital's much larger church and that nearby, where aerial surveys have identified the foundations of a quadrangle, there stood the monks' living quarters and cloisters.

Discovering that the site was once populated by monks of the Augustinian order was important, because they were the leading practitioners of herbal medicine. The brethren were known to be self-sufficient in most things, including growing their own herbs, both for the dining table and the infirmary. Dr Moffat says Augustinian monks in the Middle Ages ran more hospitals in Europe than any other monastic order.

He estimates that in the hospital's heyday (from around the middle of the 12th century to perhaps the middle of the 15th), there must have been 300 or so people permanently living on the site - monks and servants - to cope with the stream of guests wanting either to stay the night, or needing treatment. This means that thousands upon thousands of 'patients' must have passed through Soutra during its existence, leaving some medical waste behind.

One great advantage of the site, built as it is on a hill that is constantly waterlogged because of its impermeable clay base, is that many archaeological objects remain preserved. 'If you dig a ditch here,' says Dr Moffat, 'whatever you put in it will not seep away. Waste disposal here is a dreadful problem. But turning that on its head, if you dig a pit 3m deep here, whatever you put into that pit stays in that pit.'

Some historians of medical science have expressed scepticism about Dr Moffat's approach to unearthing clues from our medieval past. He himself recognises that his views and methods are often unconventional. Holding up an 'ointment jar' he found on the site six years ago, he says: 'Go to any museum of medieval artefacts and you see that the objects are cherished but separated from the type of use.' Museum curators will say this is an ointment jar on the basis of what it looks like, he adds, not what analytical chemistry shows it once contained.

'Analytical chemists and botanists can quite readily recover a range of residues and microscopic plant remains from artefacts,' says Dr Moffat, 'but this is rarely done for objects from the Middle Ages'. He says chemists and botanists have shown that this particular jar once contained a mixture of opium and animal grease. 'That's a painkilling ointment; you rub it on any painful area. That's what they say in the medieval recipes. We take it a stage further by asking whether it would work. Anaesthetists and pharmacologists say it would.'

Dr Moffat defines medical waste using three criteria. First, there must be some evidence of blood. This he finds using modern medical kits for detecting minute amounts of blood in faeces - used for the early diagnosis of colon cancer. He says the iron-containing 'haem' component of blood binds to the clay soil and forms a very stable compound that can be detected centuries later. Biochemists who have studied the test believe it to be accurate. Dr Moffat says he has used about 5,000 of the tests to determine where on the site the remains of blood can be found.

The second criterion of medical waste is the detection of lead, which would have been deposited by the draining of waste water that had flowed through lead pipes. The third is the presence of 'certain indicator drug plants that are common yet which are never used for anything other than medical purposes', he says - the main one being the opium poppy.

The excavation team has identified medical waste in 15 separate trenches on the site, which covers an area of some three-quarters of a square mile. The most important so far identified lies adjacent to where the orginal church once stood. Excavations have revealed what appears at first sight to be a four-walled building divided into several rooms, complete with an old stone bread oven in the middle. In fact, Dr Moffat believes the bread oven is contemporary with the 17th-century Aisle and has nothing to do with the earlier hospital. The four-sided building was in fact made from the north wall of the church and the south wall of the monastic living quarters. Originally, nothing stood in the gap between the church and the monk's living quarters, except a storm drain to take away rainwater.

Excavations have shown an abundant amount of what appears to be medical waste in this area, Dr Moffat says. Blood, lead and medicinal herbs have all been found. It seems odd that the monks should have created what must have been a noxious waste dump so close to their living quarters and church. Dr Moffat believes the waste could have been the result of exceptional circumstances - such as occupation by an invading or retreating army (the ancient road was also an invasion route).

It is known, for instance, that Edward II with his retinue of 600-800 men and army of perhaps 45,000 soldiers stayed at Soutra on his way to defeat at Bannockburn in 1314. Dr Moffat surmises that the monks' living quarters may have been requisitioned - perhaps many times over the centuries - to tend to injured soldiers. Bleeding and amputations would have taken place, resulting in blood and waste spilling into the storm drain.

Dr Moffat's excavations have found evidence of attempts to sterilise what must have been a foul- smelling pit. It must also have been highly dangerous, as he has been able to recover anthrax and tetanus spores. Lumps of quicklime - a disinfectant - have been found at regular intervals and depths, suggesting it was deliberately mixed in. Spreading a caustic chemical on a pit of human blood and waste must in itself have been a dangerous job. 'I'm half expecting to come across what's left of the man who did it,' says Moffat.

BEFORE THE OP: HENBANE, HEMLOCK AND OPIUM

A total of some 230 plant species with some medicinal application have been found at the Soutra site. Included in these are exotic herbs and spices imported from abroad, such as pepper, ginger, nutmeg, cloves, frankincense and myrrh. Pollen analysis shows that opium poppy, flax and hemp - cannabis - were all cultivated on the site.

One of the most exciting finds from analysing Soutra's medical waste is a clump of 574 seeds which Dr Moffat believes represented a single herbal preparation. It is, he says, 'a precise and complete recipe recovered intact and a direct window on pharmaceutical and medical practice in the Middle Ages'. The seeds came from three species of poisonous herb: black henbane, opium poppy, and hemlock - which killed Socrates - in the ratio by volume of three parts, to one part, to one part respectively. The seed cache found at Soutra has been dated to between 1300 and 1320, during Scotland's Wars of Independence.

Dr Moffat says he knows of only six medieval written recipes where all three herbs were used together. All were general anaesthetics administered in advance of major surgery. One medieval manuscript suggests that the potion could result in the patient being rendered unconscious for between 72 and 96 hours, a staggering length of time to be under anaesthesia even by modern standards, and presumably dangerous enough for many to have died in the process.

The severity of the anaesthesia suggests it was primarily used in the Middle Ages for amputations. Dr Moffat cites a medieval recipe suggesting that a potion of the herbal mixture, taken in a draught of ale or wine, would bring on a deep sleep: 'And thanne men may safly kerven (safely carve) him'.

Another find, dated to the same period in the early 14th century, has revealed the presence of the deadly ergot fungus, and berries of the juniper bush. The black ergots are the resting stage of a parasitic fungus that attacks cereal crops. It is now known that ergot contains alkaloids including ergometrine, which causes catastrophic contraction of the uterus.

Juniper was a commonly used herb in the Middle Ages and it was customary to grow the bush at the centre of a monastic herb garden to represent the Tree of Life. Dr Moffat suggests that there are also references to juniper being used as a 'uterine stimulant'.

This raises the intriguing possibility that the combination of ergot and juniper might have served the role of either helping in childbirth or bringing on an abortion. Augustinian monks were strictly forbidden to practise midwifery. Could it nevertheless have been carried out in the grounds of the hospital, either illegally by monks or by female midwives? A recent discovery of fragments of bones from a foetus suggests one or the other.

A less dramatic example of a medieval herbal preparation was found in an old drain that ran under a cobbled path between the monks' living quarters and the church. Dr Moffat has found evidence here of the herb tormentil and the eggs of parasitic worms that must have plagued the guts of medieval travellers. In fact he has found the same association at several points around the Soutra site. 'Tormentil has been found in drains with, and only with, the eggs of parasitic worms,' he says.

It is also known that tormentil contains tannin, chinovic acid, and glycosides that can alleviate diarrhoea and internal bleeding. Medieval recipes cite tormentil as being effective at 'slaying' worms and checking 'fluxes'. The fact that it has been found at several points around Soutra suggests that the monks were administering it in food as a primitive form of community medicine, says Dr Moffat.

Open Days at Soutra: 2-5 September at 2pm. Site open to visitors in August. Soutra Aisle grid ref: NT453584, on the B6368 road 1km off the A68.

(Photographs omitted)

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