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Chapter 7
Spitting Blood: Medieval Mongol Medical Practices1
Timothy May
In 1201, during a battle along the Onon River in northern Mongolia, Chinggis
Khan suffered a neck wound, presumably from an arrow. Jelme, one of his subordinates, saved his khan by sucking the wound, thereby preventing blood
clots and possible embolism from occurring. When Chinggis Khan awoke, he
glanced around and noticed that he was surrounded by blood splatter. His
reaction is both laconic and exasperated: “What is this? Could you have spat
farther away?”2
But for the presence of one of his servitors, Temüjin (the man who became
Chinggis Khan and established the largest contiguous empire in history) would
have died from a neck wound in a battle that is even now forgotten in history
and would have been of even less consequence in world history with his death.
Although a number of studies on Mongol warfare have been written, much
less attention has been given to the medical care associated with the wounds
sustained through warfare.3 While the incident between Jelme and Chinggis
Khan demonstrates that the Mongols possessed a more sophisticated understanding of trauma medical care than one might suspect, other incidents
1 My thanks go to Scott Jacobs for funding part of the research for this article.
2 The Secret History of the Mongols, §145. Henceforth, SHM. The best translation is Igor de
Rachewiltz, trans. and ed., The Secret History of the Mongols (Leiden: Brill, 2004). For this work,
I have also consulted Frances W. Cleaves, trans. and ed., The Secret History of the Mongols
(Cambridge, MA: Harvard-Yenching Institute, 1982); Urgunge Onon, trans. and ed., The Secret
History of the Mongols: The Life and Times of Chinggis Khan (London: Routledge Curzon, 2001);
and Mongoliin Nuuts Tovchoo, ed. Sh. Gadambaa (Ulaanbaatar: Bükh erkh khamgaaladsan,
2012). Hereafter, Section numbers are given in parentheses in the text.
3 A Soup for the Qan: Chinese Dietary Medicine of the Mongol Era as Seen in Hu Szu-Hui’s Yin-Shan
Cheng-Yao: Introduction; Translation; Commentary and Chinese Text, ed. and trans. Paul D.
Buell and Eugene N. Anderson (London: Kegan Paul, 2000); F.W. Cleaves, “A Medical Practice
of the Mongols in the Thirteenth Century,” Harvard Journal of Asiatic Studies 17 (1954): 428–44;
Sophia C. Kaszuba, “Wounds in Medieval Mongol Warfare: Their Nature and Treatment in The
Secret History, with Some Notes on Mongolian Military Medicine and Hygiene,” Mongolian
Studies 19 (1996): 59–68; R.C. Rudolph, “Medical Matters in an Early Fourteenth Century
Chinese Diary,” Journal of the History of Medicine and Allied Sciences 2 (1947): 209–306. The
latter does not directly deal with military medical practices, yet still offers some useful information from the period.
© koninklijke brill nv, leiden, 2015 | doi 10.1163/9789004306455_009
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reveal that the Mongols incorporated not only native Mongolian practices but
also other medical techniques as the empire expanded.
The battle itself took place after Temüjin and his suzerain, Toghril (d. 1203),
Khan of the Kereit, fought a confederation of nomads led by Jamuqa (d. 1205–
6), who challenged Toghril’s domination of Central Mongolia in 1201. Toghril
and Temüjin defeated Jamuqa’s confederation, which promptly fell apart. As
the various components of the confederation fled the battlefield, Toghril and
Temüjin took the opportunity to finish matters. Toghril pursued Jamuqa, his
former war leader and servitor, or nökör. Temüjin chased the Tayichi’ut, another
branch of the Mongols and rivals for the leadership of the Mongols (SHM,
§142–144). A’uchu Ba’atur, the leader of the Tayichi’ut rallied his forces at
Ülengüt Turas along the Onon River, keeping the river between Temüjin’s army
and the Tayichi’ut. The river proved to be an insufficient barrier, however, and
Temüjin’s Borjigin Mongols forced a crossing. The resulting battle ranged
widely and throughout the day, ceasing only with nightfall. Under the cover of
darkness, both sides retired to their camps. Due to Temüjin’s successful efforts
to cross the river, both camps were hastily formed and near each other.
Furthermore, due to the far-flung battle and the fact that fighting ended with
only nightfall, for those left on the battlefield – the wounded, stragglers, and
even people displaced by the attack from the Tayichi’ut camp – it was not clear
which camp belonged to whom (SHM, §144).4
At some point late in the battle, Chinggis Khan received an arrow wound in
the neck. He attempted to staunch the bleeding but failed to do so. The Secret
History of the Mongols says: “He waited until sundown, then he pitched camp
just there where the two armies had encamped right next to each other” (SHM,
§145).5 Although the source indicates that he was in a weakened condition, it
still says that he made a camp there.
Regardless of the camp situation, Chinggis Khan’s wound continued to
bleed. Jelme sucked the wound, spat out the blood, and continued to watch
him. The sources indicate that they were not alone: “Still, Jelme, not trusting
other people, stayed there and looked after him” (SHM, §145). There are several
4 The pell-mell situation of the camps is further evinced in §145. After Chinggis Khan awakes
in the middle of the night, he tells Jelme he is thirsty. Jelme then sets off to find kumiss (fermented mare’s milk) for Chinggis Khan to drink. He entered the nearby camp of the enemy
and finds a bucket of fermenting cheese curds. The camp was largely deserted and the anonymous author of The Secret History notes that the people had fled, thus, allowing Jelme to
complete his mission unobserved.
5 There is some question about the veracity of this statement. If it was a formal camp, complete
with a fire, it is doubtful that either side would have ignored it although, in the post-battle
chaos, perhaps Chinggis Khan’s and Jelme’s camp blended in with everyone else.
Spitting Blood: Medieval Mongol Medical Practices
177
reasons for this. Jelme’s own background as Chinggis Khan’s nökör made him
beholden to Chinggis Khan, although a nökör (pl. nököd) could traditionally
enter the service of another liege. Because Jelme entered Chinggis Khan’s service as a household servant, given by his own father to satisfy a debt to Chinggis
Khan’s father, Yesügei, Jelme did not have a high status (SHM, § 97).6 Indeed,
Jelme came from the Uriangqai, a people who had been historically subordinate to the Borjigin Mongols for at least three generations. Because of this, it
was unlikely that he could enter the service of another member of the aristocracy or, at least, not in the same capacity that he enjoyed with Chinggis Khan.
Beyond practical concerns, Jelme’s loyalty and devotion to Chinggis Khan
served him well later in his career; he became one of the most esteemed commanders among the Mongols.7 Furthermore, he also understood the threat of
a wound to the neck. Any neck wound could be serious because of the proximity of major arteries and veins, not to mention the potential for damage to the
esophagus and trachea. Judging from Jelme’s treatment, it was also a fairly
common wound and, indeed, it was one of the most vulnerable areas for a
nomadic warrior.
While a popular image of the Mongols is that of unarmored warriors, the
Mongols did wear body armor into battle, although it was of lesser weight than
that of European knights, Japanese samurai, or mamlūks. More often than not,
it was lamellar armor made with overlapping segments of lacquered leather or
pieces of metal sewn together with leather thongs. Each plate was only a few
inches long and wide. It not only allowed for easy, though tedious, manufacture but also provided excellent protection against arrows by distributing the
force of the arrow’s impact through plates and thongs. Also, the overlapping
plates prevented many wounds and provided better protection against arrows,
the primary concern of the Mongols who eschewed close combat until the last
moment, although this also meant that the armpit was exposed when the
archer raised his bow.8 John of Plano Carpini, the Franciscan friar/espionage
6 Jelme was presented to Temüjin with the instructions, “Now let Jelme put on your saddle, open
your door.” Clearly, this demonstrated that Jelme was to be Temüjin’s servant, if not slave.
7 Jelme became one of the dörbön noqai or Four Hounds of Chinggis Khan, a commander of an
elite regiment. His younger and better-known brother, Sübedei, also held this title. See:
Timothy May, The Mongol Art of War (Barnsley, UK: Pen & Sword, 2007), 127. In addition to
this, because he saved Chinggis Khan’s life at Ülengüt Turas, Jelme received the “Nines,” or
received pardon from nine punishable crimes.
8 David Nicolle, Arms and Armour of the Crusading Era (London: Greenhill Books, 1999), 18;
David Nicolle, Medieval Warfare Source Book: Christian Europe and its Neighbors (London:
Arms and Armour, 1997), 136.
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agent, sent to the Mongol court by Pope Innocent IV in the 1240s, describes the
manufacture of the Mongol lamellar armor in exquisite detail:
… they make a number of thin plates of the metal, a finger’s breadth wide
and a hand’s breadth in length, piercing eight little holes in each plate; as
a foundation they put three strong narrow straps; they then place the
plates one on top of the other so that they overlap, and they tie them to
the straps by narrow thongs which they then laced through the aforementioned holes; at the top they attach a thong, so that the metal plates
hold together firmly and well. They make a strap out of these plates and
then join them together to make sections of armor as has been described
above. They make these into armour for horses as well as men and they
make them shine so brightly that one can see one’s reflection in them.9
An additional benefit of lamellar armor was that it was not only fairly simple
to create but easier to repair. Often, only one piece of metal or leather was
needed, or perhaps new thongs to fasten the armor. Failure to maintain the
armor’s condition, such as ensuring the thongs were knotted tightly, however,
meant that the pieces could loosen or weaken and allow a blade or arrow to
slip between them and cause injury.
The potential penetrability of lamellar armor may have inspired the popular
myth that the Mongols wore tightly woven silk shirts as added protection,
partly because it made it easier to withdraw an arrow from the wound when
the silk wrapped around the arrow head.10 Although a few of the Chinese
sources mention the Mongols wearing silk shirts, there is no indication in any
of the primary sources that silk was worn for protective purposes. Arrows shot
with Mongol bows were known to pierce mail easily; it is difficult to imagine a
silk shirt preventing further damage even after most of the arrow’s energy had
been dispersed by penetrating the armor. Indeed, John of Plano Carpini
recommended that European knights wear two layers of mail since one coat
9
10
John of Plano Carpini, “History of the Mongols,” trans. A Nun from Stanbrook Abbey, in
Mission to Asia, ed. Christopher Dawson (Toronto: University of Toronto Press, 1980), 34.
James Chambers, The Devil’s Horsemen: the Mongol Invasion of Europe (New York: Atheneum, 1975), 55–56; Thomas J. Craughwell, The Rise and Fall of the Second Largest Empire
in History (Beverly, MA: Fair Winds, 2010), 145; Richard A. Gabriel, Genghis Khan’s Greatest
General: Subotai the Valiant (Norman, OK: University of Oklahoma Press, 2006), 32. If it is
a book intended for a popular audience, this myth will appear. Chambers, to the best of
my knowledge, is the first to write it. I have not found any reference, primary or secondary,
prior to 1975.
Spitting Blood: Medieval Mongol Medical Practices
179
was insufficient protection.11 Most likely, the Mongols wore silk garments
because they earned them as tribute or received them as loot from the conquest of the Jin Empire. The silk shirts also must have been more comfortable
than felt shirts, and served as a barrier between the coarser felt or armor and
the skin, which could have been easily irritated.
While silk shirts may have been worn for comfort rather than as a supplement to armor, Mongols wore helmets for practical, protective purposes. The
helmet, made of iron, usually had a leather skirt, or aventail, attached to it.
While the helmet gave adequate head protection, the aventail also shielded
against glancing blows that would otherwise wound the face, neck, or shoulder.12 Furthermore, the aventail could also be fastened in the front to serve as
a mask – much needed by those at the end of a galloping Mongol column.
Although it did not serve as filter against dust, it at least mitigated some of it.
Nonetheless, the aventail did not offer complete protection to the neck, which
remained vulnerable and often exposed, as was the entire face below the forehead, necessitating the knowledge of medical care for such wounds.
His neck exposed, Chinggis Khan was wounded, but it appears that he did
not go into shock. This can be ascertained by the treatment he received, which
did not include the normal Mongol practice for treating shock; namely, killing
an ox or a similar large livestock and inserting the patient into the animal.
Francis W. Cleaves found several examples of this procedure, demonstrating
that it was common practice among the Mongols. It appears in the Yuan Shi for
Guo Baoyu, who suffered from a chest wound from an arrow; for Li Ting, who
was struck twice from bolts shot by ballista while attacking the Song city of
Shayang in 1274; and for Muhan,13 who underwent this procedure after being
shot with three arrows while scaling a wall at the siege of Xijing in Xi Xia.14 In
all instances, an ox was found, killed, and its intestines removed. 15 The patient
11
12
13
14
15
John of Plano Carpini, “History of the Mongols,” 46.
John of Plano Carpini, “History of the Mongols,” 34.
Yuan Shi, 169.
Francis W. Cleaves, “A Medical Practice of the Mongols,” 433–441.
Cleaves, “A Medical Practice of the Mongols,” 441–442. Note that the intestines were
removed for this procedure. Although the sources only mention the intestines, it appears
that all or most of the internal organs were removed as well. As one might expect, it was
to make room for an adult male body. Furthermore, they were removed so that the intestines were not accidentally damaged and leak into the animal, contaminating the “healing chamber.” Although perforation of intestines is, unfortunately, common enough in
modern day operating rooms, the Mongols did have significant experience in removing
them from the slaughtering of animals. They also had the benefit of doing so while not
also trying to repair damage within the body. Other organs were removed as well, but they
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was then stripped and inserted into the carcass naked and left in it for an undetermined amount of time. In all three instances, the men recovered. Perhaps
most interestingly, the commanders are the ones who ordered this procedure.
For Muhan and Guo Baoyu, Chinggis Khan not only ordered it, but also performed the procedure, while in the case of Li Ting, the great general Bayan
performed it. Muhan was so grateful he devoted his life to Chinggis Khan and
placed himself in the forefront of the army. If the sources can be trusted on the
matter, and if the generals and Chinggis Khan himself performed it, this medical knowledge was probably not specialized but rather considered basic first
aid. The size of the wound and the part of the body that needed to be healed
dictated the animal’s size. For instance, in the case of a wounded hand, a sheep
would suffice. In some cases, one did not have to be inserted into the animal,
but the skin of a freshly slaughtered animal could be applied to the affected
area. Indeed, it appears that this was still a common idea in the early twentieth
century and used among Kazakhs for frostbite.16
The method of slaughtering the animal also played a key role in in this medical technique. The typical method for killing an animal involved restraining
the animal on its back, making a small incision so that a hand could be slipped
into the chest of the animal to either still the heart by squeezing it, or by ripping the aorta.17 In the former instance, minimal blood loss occurred, thus
keeping most of the blood in the vessels. If the aorta was ripped, the blood
then filled the body cavity and flowed out when the animal was eviscerated.
The preferable course was to maintain the blood for the healing process. When
the wounded person was inserted in the body, the ox blood may have also
assisted in the coagulation of the wounds.18 The pressure provided by the ox
carcass was also important in staunching the wound as well as preventing
shock by forcing blood flow. Also key to this was the position of the body as it
was placed inside the ox. While ox or water buffalo can be tremendously large
animals, it would be difficult to place a full-grown human male into one.
Supposing the average Mongol was around five and a half feet tall, they still
could not fit into the torso of an ox while fully prone. It seems likely that the
16
17
18
were not simply refuse. Pulling the cud, or masticated grass, from the stomach, the Mongols applied it as a poultice for wounds.
Cleaves, “A Medical Practice of the Mongols,” 441–44. Cleaves cites a letter from Antoine
Mostaert commenting on the Mongolian belief of the healing properties of a freshly
killed animal.
The best discussion of this practice is found in Johan Elverskog, Buddhism and Islam on
the Silk Road (Philadelphia: University of Pennsylvania Press, 2010).
Anne Hauet, M.D., telephone interview by author, 14 April 2013.
Spitting Blood: Medieval Mongol Medical Practices
181
wounded was inserted into the abdominal cavity in a fetal position, which had
the additional benefit of generating pressure with the folding of the legs.
Folding the legs also kept the blood circulating and assisted in reducing
shock. Similar techniques are used by modern militaries and Emergency
Medical Technicians (EMTs) through the use of pressure trousers, or Medical
Anti-Shock Trousers (MAST), that place pressure on the legs and keep the blood
circulating in the wounded and injured who are at risk of going into shock. 19
MAST have been used to treat gun-shot wounds, fractures, stab wounds, and
internal bleeding and ruptured livers, in addition to preventing shock and
increasing blood flow throughout the body. 20 Indeed, the application of MAST
appear most beneficial when used for “blunt or penetrating trauma to the
abdomen which results in bleeding in the abdominal and retroperitoneal
regions” in addition to stabilizing compound fractures in the femur and/or pelvis.21 Furthermore, they assist in reducing blood loss. In short, MAST are used
for the same reasons the Mongols used the oxen minus the gunshot wounds,
although this might have occurred in the fourteenth century.22 Judging from
medical studies, however, using MAST is, perhaps, not as foolproof as stuffing
an injured person into an ox or water buffalo. Admittedly, the sample pool for
the Mongols was much smaller, and the procedure was not used for every
Temür, Daritai, and Qorqudagh.
Of course, the patient could only remain in the ox for a set period of time. In
the first hour after death, the body (human or animal) temperature drops 1.5–
2.0 degrees Fahrenheit and then continues to decrease by 1.0 to 1.5 degrees per
hour for every hour until approximately twelve hours elapse. The method of
killing the ox, stilling the heart or ripping the aorta, had no effect on the rate
19
20
21
22
Fatimah Lateef and Tan Kelvin, “Military Anti-Shock Garment: Historical Relic or a Device
with Unrealized Potential?” Journal of Emergencies, Trauma, and Shock 1.2 (2008): 63–69;
P. Randall, J. Banks, and R.A. Little, “Medical (military) Anti-Shock Trousers: A Short
Review,” Archives of Emergency Medicine 1 (1984): 39–51; Caroline Bunker Rosdahl, Textbook of Basic Nursing, 9th ed. (Philadelphia: Lippincott Williamson & Wilkens, 2008), 473.
Originally this device was known as Military Anti-Shock Trousers (MAST), but they have
become increasingly ubiquitous for emergency and trauma medical care. This practice
began for the American military during the Vietnam War and then with the first civilian
use in 1973.
Randall et al., “Medical (Military) Anti-shock Trousers,” 40–42.
Lateef and Kelvin, “Military Anti-Shock Garment,” 65.
Lateef and Kelvin, “Military Anti-Shock Garment,” 65–66; Randall et al., “Medical (Military) Anti-Shock Trousers,” 46–48.
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of temperature loss because blood does not serve as an insulator.23 Also, after
some time, the ox would have begun putrefying, thus risking infection for the
patient. While the Mongols may not have understood the exact reasons for less
than favorable results by keeping the patient in the carcass for a long duration,
they did apparently determine the right time length for the process to be beneficial to the wounded individual.
While the Mongols understood that the pressure and warmth of the interior
of the animal had curative attributes (preventing shock), they also concluded
that blood carried healing properties and could serve as a cure for other ailments. Indeed, the taboo nature of blood may have also played a role in this
concept.24 The insertion of the foot or leg into a body cavity was considered a
method of curing gout. The best known example of which comes from the sixteenth century when Altan Khan, the ruler of the Tümed Mongols, suffered
from gout which his medical professionals treated by having him place or soak
his foot in the chest of a horse or slave.25
Yet, pre-sixteenth century examples of this exist as well. Francis W. Cleaves
notes one in the History of the Nation of Archers.26 Here, however, an animal is
not used but a boy with red hair. In 1251, a Mongol commander named Xul
(Khul) contracted gout, which may have been a fairly common ailment due to
the Mongols diet of alcohol and meat, leading to build-up of uric acid, particularly if the meat contained purines.27 As a treatment, a Jewish doctor prescribed
that Xul soak his foot in the belly of a red-haired boy. The Mongols then raided
the Armenian villages for red-haired boys. After thirty sessions (each one needing a freshly killed boy), Xul still was not healed, thus, he ordered that the
physician be disemboweled.28 Not long afterwards, Xul died as well. While
there is no evidence of gout killing him, his case appears to have been severe
and must have lasted almost a month (assuming one child a day). He most
23
24
25
26
27
28
Prof. Joseph Morgan, University of North Georgia, telephone interview by author, 15 April
2013.
Kaszuba, “Wounds in Medieval Mongol Warfare,” 64.
Cleaves, “A Medical Practice of the Mongols,” 431. According to conversion narratives, this
failed to cure him, but a Buddhist monk happened to be present and cured him, after
which Altan Khan renounced shamanism and converted to Buddhism.
Cleaves, “A Medical Practice of the Mongols,” 429.
WebMD, “Gout – Cause” <http://arthritis.webmd.com/tc/gout-cause> (accessed 12 April
2013).
Robert F. Blake and Richard N. Frye, trans., “History of the Nation of Archers,” Harvard
Journal of Asiatic Studies 12 (1949): 329–331.
Spitting Blood: Medieval Mongol Medical Practices
183
likely died from a heart attack since many of the same factors that lead to gout
also factor in heart disease.29
So, Chinggis Khan did not go into shock, but the question remains, why did
Jelme “spit blood”? Most scholars have suggested that Jelme’s procedure was
meant to suck out any poison.30 It is not clear if poisoned arrows were used – it
is possible, but there is no mention of it in The Secret History of the Mongols.31
Nonetheless, it was not unusual for the nomads of the Mongolian plateau to
use poisoned arrows. Still, Jelme admits that he also swallowed the blood,
which, if poisoned, carried great personal risk for himself as well as Chinggis
Khan (SHM, §145). If Jelme perished while operating on Chinggis Khan, the
Mongol leader could have died on the table, so to speak. Hence, it is doubtful
that the wound was poisoned or that Jelme was concerned about poison.
Rather, he sucked the wound because it was a learned practice from the
nomads’ centuries of experience with wounds. The continued sucking of the
coagulated blood potentially removed poison and perhaps any debris, but it
also prevented an embolism from reaching the brain and causing a stroke.32
Just as a surgeon in a modern operating room requires suction to prevent air
bubbles from forming in the blood stream, Jelme’s action served the same purpose. Sophia Kaszuba concludes that, “Although the medieval Mongols could
not have known the theory behind the practice of sucking wounds, it was an
established treatment with them, probably based on sound observation of
more frequent recovery when wounds were occluded in this way.”33
After Jelme cleaned the wound, it was most likely cauterized, a procedure
suggested in accounts of similar wounds, like that of Chinggis Khan’s son,
Ögödei. In a later battle, Ögödei suffered a neck wound while fighting the
Kereit at Qalaqaljit Sands in 1203 after Toghril became worried about Temüjin’s
success. Another nökör, Boroqul, followed the same procedure with Ögödei by
sucking the wound and spitting blood (SHM, §173, 214).34 Boroqul stayed the
29
30
31
32
33
34
Anne Hauet, M.D., telephone interview by author, 14 April 2013.
SHM, 528–529. Rachewiltz summarizes the literature on this matter.
Paul Ratchnevsky, Genghis Khan: His Life and Legacy, trans. Thomas Nivison Haining
(Cambridge, MA: Blackwell, 1992), 63. Ratchnevsky simply mentions: “The nomads were
in the habit of using poisoned arrows… .” There is no further discussion of the use of
arrows or evidence that they did. I have not found any other evidence that the Mongols or
other nomads in the Mongolian steppes used poisoned arrows.
Anne Hauet, M.D., e-mail correspondence with author, 9 and 10 April 2013.
Kaszuba, “Wounds in Medieval Mongol Warfare,” 64.
The battle occurred because Toghril attempted to assassinate Chinggis Khan with a ruse.
Chinggis Khan had requested Toghril’s daughter, ­­­­­­­­­­­­­­Ch’aur Beki, as a bride for his son, Jochi.
To many Kereit, this was an affront and a sign that Chinggis Khan was placing himself as
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night with Ögödei, which is why they did not appear at the rendez-vous point
after the battle. Despite Boroqul’s efforts, the wound did not cease bleeding.
Nonetheless, Boroqul assessed the situation and determined that Ögödei had
to be moved, even if he could not ride a horse. Thus, they both rode Boroqul’s
horse, Ögödei in the front and Boroqul clutching him from behind, continuing
to perform suction on Ögödei’s wound. It is only after they returned to camp
that Ögödei’s wound was cauterized (SHM, §173). Although it is not mentioned,
it is likely that Jelme cauterized Chinggis Khan’s wound, including the blood
vessels and skin, in the same way. Unless the jugular vein or the carotid artery
was cut (in which case both Ögödei and Chinggis Khan would have died), there
are sufficient smaller blood vessels that allowed for cauterization without
adversely affecting blood circulation in the neck.35
Staunching the flow of blood was crucial, but there were also other concerns. Although, not recorded in The Secret History, the Persian historian
Rashid al-Din, who mined much of his data from senior Mongol officials in the
Ilkhanid court as well as other documents, recorded that, as a youth, Chinggis
Khan was wounded in a skirmish with the Tayichi’ut. This time, he was saved
by another nökör, Borghochi. Instead of sucking the wound to remove the clotted blood, Borghochi heated a stone and poured water over it. He then held
Chinggis Khan’s mouth open so the steam entered and loosened the clots.36
While it is not certain that this event took place, what is important is the
description of the treatment, which provides an alternate method and appears
to be most concerned with preventing the patient from choking on blood.
Furthermore, if the event took place, it further illustrates that the neck was
extremely vulnerable to wounds.
While neck and other battlefield wounds occurred, the Mongols also dealt
with repetitive stress injuries that affected battlefield performance. Warfare
and the training involved for the military classes takes a toll on the human
35
36
Toghril’s equal. They responded by promising Ch’aur to Jochi, hoping that he would come
to them. By tradition, the wedding party would come unarmed, thus making them easy
targets. Fortunately for the Mongols, Chinggis Khan was warned of Toghril’s perfidy. Even
so, the Mongols suffered a set-back (in which Ögödei received his wound), but rallied and
defeated the Kereit a few days later.
Anne Hauet, MD, telephone interview by author, 14 April 2013.
Rashid al-Din, Jami’at al-Tawarikh, ed. B. Karimi (Teheran: Iqbal, 1983), 169; Rashiduddin
Fazullah, Jami’u’t-Tawarikh: Compendium of Chronicles, trans. Wheeler M. Thackston
(London: I.B. Tauris, 2012), 64. Borghochi is the Bo’orchi in SHM. Henceforth RD/Karimi
and RD/Thackston respectively.
Spitting Blood: Medieval Mongol Medical Practices
185
body in any era.37 Injuries result not only from violence but also through the
constant and prolonged use of repetitive motions of muscle groups, tendons,
ligaments, and even bones. The Mongols primarily fought as horse-archers, so
most injuries undoubtedly came from repetitive stress injuries related to
archery and associated with riding. The Mongol composite bow was an impressive weapon, possessing an average pull of 130 pounds, or 59 kilograms. With it,
the Mongol could shoot arrows over 300 meters; some instances of almost 500
meters have been recorded, 38 although most warfare took place at a much
closer range and harassing attacks occurred at the outer limits of the bow’s
range. Drawing such a bow required a great deal of upper body strength. In
order to achieve this, Mongols began their archery training as small children
using smaller and less powerful bows. Much as a body builder gradually
increases the weight he lifts, the Mongols gradually increased the pull of the
bow as they trained.39 After reaching adulthood, the Mongol warrior was
capable of wielding the war bow. Constant use of the bow in warfare, training,
and hunting ensured that the warrior maintained his conditioning. Despite
a warrior’s best efforts, however, some deterioration in ability and injury
occurred through the years.
The Secret History of the Mongols, in the sections prior to the birth of
Chinggis Khan, mentions an archery-related injury. In an effort to secure peace,
the Mongol leader Ambakhai Khaghan arranged a marriage between the Tatars
and his daughter. When he accompanied her to the wedding, the Tatars violated tradition and took Ambakhai captive. The Tatars then turned him over to
the Jin Empire in northern China (1125–1234) where he was later executed at
37
38
39
See, in this volume: M.R. Geldof, “And describe the shapes of the dead”: Making Sense of
the Archaeology of Armed Violence,” 57–80; Rachel E. Kellett, “…Vnnd schüß im vnder
dem schwert den ort lang ein zů der brust”: The Placement and Consequences of Swordblows in Sigmund Ringeck’s Fifteenth-Century Fencing Manual,” 128–49; Michael Living­
ston, “‘The Depth of Six Inches’: Prince Hal’s Head-Wound at the Battle of Shrewsbury,”
215–30; Iain A. MacInnes, “Heads, Shoulders, Knees and Toes: Injury and Death in AngloScottish Combat, c. 1296-c. 1403,” 102–27; William Sayers, “The Laconic Scar in Early Irish
Literature,” 473–95; Patricia Skinner, “Visible Prowess? Reading Men’s Head and Face
Wounds in Early Medieval Europe to 1000 CE,” 81–101; and Robert C. Woosnam-Savage and
Kelly DeVries, “Battle Trauma in Medieval Warfare: Wounds, Weapons and Armor,” 27–56.
Hok-Lan Chan, “Siting by Bowshot: A Mongolian Custom and Its Sociopolitical and Cultural Implications,” Asia Major 4.2 (1991): 53–78, at 61. It should be noted that normal
range of Mongols bows came with a pull of 100 to 160 lb. pull, with the latter being rare, yet
still recorded.
J.D. Lathem and W.F. Paterson, Saracen Archery: An English Version and Exposition of a
Mameluke Work on Archery (London: New Holland Publishing, 1970), xxv.
186
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the orders of the Jin Emperor, Hailing Wang (r. 1150–1161). Ambakhai successfully relayed a message to a person sympathetic to him, telling the Mongols of
the Tatars’ treachery and demanding that the Mongols avenge him:
“Until the nails of your five fingers
Are ground down
Until your ten fingers are worn away
Strive to revenge me!” (SHM, §53)
Albeit melodramatic, his plea illustrates a reality. Over the lifetime of a steppe
nomad, injuries to the hands could occur, including where the fingernails are
torn out or damaged beyond natural repair, often from drawing the Mongol
bow. In some instances, even the fingers could atrophy or suffer lacerations,
leading to amputation at the first joint.
Another common injury experienced by Mongols resulted from horse riding, or, more precisely, falling from the horse. Even though the nomads began
riding as children, even the most proficient rider was susceptible to injury. The
most notable example also comes from the Secret History of the Mongols. In
1226, Chinggis Khan returned to Xi Xia (modern Gansu and Ningxia Provinces
of the People’s Republic of China) to quell a rebellion. In the winter of 1227
(January or February), while hunting wild asses near Arbuqa, a sudden rush of
the animals startled Chinggis Khan’s horse, Josotu Boro, causing it to rear and
throw him (SHM, §265).40 The injuries to the Mongol leader were sufficient for
him to camp at Cho’orqat instead of pressing the campaign. Here, his generals
and sons attempted to persuade him to rest and not continue his attack.
Chinggis Khan disagreed, urging his army to lay siege to the Tangut capital
despite being wracked by fever.41 Chinggis Khan continued to campaign from
his bed, even summering at Chasatu Mountain. He ultimately died as a result
of the fall from his horse, but he encouraged his army to destroy the enemy.
Even on his deathbed, Chinggis Khan remained the strategist. When the Tangut
ruler, Iluqu Burkhan, paid homage to Chinggis Khan as he laid siege to Uraqai,
the Mongol ruler did not admit Iluqu Burkhan into his presence, forcing the
Tangut to perform obeisance outside his yurt in an act of revulsion before having him executed (SHM, §267). In this manner, Chinggis Khan continued to
hide his injury while using it as a political stratagem. Furthermore, he ordered
40
41
Rachewiltz discusses the possible location of Arbuqa but concludes that no one is certain.
See: SHM, at 966–967.
The Tangut were the ruling element of Xi Xia. Xi Xia itself was comprised of Han Chinese,
Turkic and Mongolian nomads, along with the Tangut, who were of Tibetan origins.
Spitting Blood: Medieval Mongol Medical Practices
187
his generals and sons to not relent in their attacks saying, “While I take my
meals you must talk about the killing and destruction of the Tang’ut and say,
‘Maimed and tamed, they are no more’” (SHM, §268).
It is impossible to know the exact nature of Chinggis Khan’s injuries,
although scholars have speculated. To be sure, injuries from falling from a
horse can be severe and range from a few bruises, to broken bones and internal
damage to the organs, and even death. While normally excellent horsemen,
even the most experienced nomad was subject to accidents as in the case of
Chinggis Khan or the modern herder, Bat-Ochir Oldov, who, in January 2012,
suffered severe injuries when his horse slipped on a snowy slope while attempting to round up stray horses. Although Bat-Ochir clung to his horse as it slid
down the hill, he ultimately fell with his foot stuck in the stirrup, was dragged
and kicked in the head once. He suffered a broken hip and broken right leg in
addition to contusions. Ultimately, his feet were amputated due to frostbite
after spending six days in -36 C weather during the Mongolian winter.42
Though sustained while tending his herds, Bat-Ochir’s injuries are identical
to injuries Mongol warriors could suffer on the battlefield. In addition to
trauma from the battle, mounted warriors had additional risks. Simply toppling out of the saddle could lead to contusions and broken bones. Once on the
ground, the risk of being trampled was omnipresent, not to mention being
more vulnerable to attack.43 Of course, falling from the saddle entailed other
risks, such as being dragged, as in the case of Bat-Ochir. Another possibility
was that the shift of the rider’s body could also bring the horse down with
them. While the steppe horses tended to be smaller than sedentary grain-fed
horses, 900 pounds can still crush a human.
As illustrated by Chinggis Khan’s accident, the Mongols (as with any horsebased army), of course, carried additional risks of injury. The Mongols not only
had to be concerned about injury to themselves but to their horses. The smaller
steppe horses still provided a large target for archers, some of whom used narrow armor-piercing arrows44 that could puncture armor and drive deep into
the body, killing when they penetrated organs. Exsanguination was unlikely
because the shaft was larger than the point, thus limiting blood flow.45 Other
42
43
44
45
Mongolia Today, “Six Winter Days Alone with Death”: <http://www.mongoliatoday.com/?
p=401> (accessed 15 June 2014).
Cf. Stephen Atkinson, “‘They … toke their shyldys before them and drew oute their
swerdys …’: Inflicting and Healing Wounds in Malory’s Morte Darthur,” in this volume,
519–43, at 529.
John of Plano Carpini, “History of the Mongols,” 46.
This has been demonstrated in simulations. See: Deadliest Warrior, “Genghis Khan vs.
Hannibal,” August 10, 2011(Los Angeles, CA: 44 Blue Productions, 2011).
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May
arrows included more traditional double-bladed, and sometimes triple-bladed
or tri-lobed, heads. Yet of equal interest are the flat and rounded, yet sharpened
arrowheads.46 These appear to have been primarily intended to wound by slicing and cutting, rather than penetrating the enemy – perhaps severing
bowstrings or blood vessels. Larger arrowheads were also used and appear to
have been intended, not for use against people as anti-personnel weapons, but
rather against horses.47 While the Mongols did use barding on some horses,
particularly those of the heavy cavalry and officers, the vast majority of Mongol
horses were unarmored to avoid diminishing their mobility. In addition, the
armor worn by the Mongols may have also assisted in mitigating the severity of
wounds sustained by falling from a horse, but it certainly did not provide complete protection from falls.
A startled or wounded horse could rear or fall, possibly throwing its rider,
leading to broken bones and internal injuries. The Mongol horse, however, was
less likely to rear suddenly. Unlike many societies, the Mongols’ war horses
were not truly war horses but simply horses used in war and trained to be docile.48 The Song emissary Zhao Hong noted,
When their horses are only one or two years old they ride them harshly in
the steppe and train them. They then maintain them for three years and
after that mount and ride them again. Thus they train them early and for
that reason they do not kick or bite. Thousands and hundreds form herds
but they are silent and are without neighing or calling. When they dismount they do not rein them in and tether them, but they do not stray.
Their temperament is very good.49
Treating the injuries sustained from riding horses as well as similar injuries
caused by concussive force required (and still requires) different techniques
than injuries sustained from arrows and sabres. The Mongols were expert
bonesetters. Even modern nomads learn the basics because the loneliness of
the steppe requires a modicum of basic medical knowledge. However, internal
injuries, particularly in the medieval era, were more confounding. While bro46
47
48
49
Yu. C. Khudyakov, Vooruzhenie Tsentral’no-Aziatikikh Kochyevnikov v Epokhu Rannyego I
Razvitogo Spegnyeveko’ya (Novosibirsk: Academy of Sciences, 1991), 118–119. Cf. Livingston, “‘The Depth of Six Inches,’” for a discussion of European arrow wounds.
John of Plano Carpini, “History of the Mongols,” 35.
May, The Mongol Art of War, 56.
Zhao Hong, Meng-Da Bei-Lu: Polnoe Opisanie Mongolo-Tatar, Russian trans. Nikolai Ts.
Munkyev (Moscow: Academy of Sciences, 1975), 68–69. This English translation by the
author.
Spitting Blood: Medieval Mongol Medical Practices
189
ken ribs could be bound, organs perforated by them or ruptured by a mace or
hoof blow had no treatment, so they had to come up with other practices.
In addition to their own traditional methods, the Mongols adopted many
other forms of medical knowledge. The Mongols favored Islamic medicine in
all of its forms, including medicine that entered the Mongol world in distinctly
non-Islamic forms, such as that found in the Chinese medical text Huihui yaofang (HHYF) or Muslim Medicinal Recipes, which consisted of lists of methods
and recipes for a wide variety of conditions. As Paul D. Buell explains,
The text describes procedures for such things as setting broken bones,
including cranial features with surgical indications, treating wounds and
cauterization. It also contains theoretical discussions, many of them oriented to dietary therapy. Nearly all the Arabic script entrees explain the
original names and terms appearing in Chinese transcription, often in
grammatically Persian phrases. Sometimes a brief commentary is added.
The majority of the simples and recipes and a good deal of the text go
back to Greek medical tradition. Greek forms are also at the root of many
Arabic forms, although these are not distinguished in the examples given.
Others stem from the ancient Near East. Also present specifically are a
number of simples an recipes labeled as Indian, although much Indian
medicine had already been assimilated to Arabic by the time that the
HHYF was written.50
Though influenced by Ibn Sina’s Qanūn fī al-tibb, it not a direct translation and
includes many synthesized treatments combining “Muslim” (meaning Islamic
and Galenic medicine) with Chinese medicine. Some cures clearly came from
the Mongols themselves, such as using powdered cheese on a wound to
prevent bleeding and assist in healing.51 It is difficult to pinpoint when the
Mongols began to use these treatments, though they did use them.
Although China and Persia are the usual suspects for cultural exchange and
borrowing by the Mongols, Islamic or “Muslim” medicine did not always come
directly from Muslim or Middle Eastern sources. Tibet played a surprising role
in influencing medical practices in the Mongol empire. In addition to introducing Buddhist influences, Tibet also served as an intermediary for Indian
50
51
Paul D. Buell, “Tibetans, Mongols and the Fusion of Eurasian Cultures,” in Islam and Tibet
– Interactions Along the Musk Routes, ed. Anna Akasoy, Charles Burnett, and Ronit YoeliTlalim (Burlington, VT: Ashgate, 2010), 201–202.
Paul D. Buell and Eugene N. Andersen, Huihui Yaofang: Translation and Interpretation
(forthcoming).
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medicine as well as non-Indian medical knowledge, such as techniques that
fell into the category of “Muslim” medicine or that which came from the Levant
and whose true origins may have been Greek.52 “Muslim” medicine also
included texts in Arabic, Persian, Nestorian Syriac, as well as Turkic.53 During
the period of the Mongol World Empire, “Muslim” medicine became more
widespread and was practiced throughout the Mongol Empire, even gaining
popularity in China, particularly in the Mongol court of the Yuan.54
The practitioners of “Muslim” medicine included many Uyghurs, who submitted to the Mongols in 1209. The Uyghurs were in the perfect location to
receive the various influences that comprised “Muslim” medicine. Located in
Central Asia, they sat astride trade routes connecting them with the Islamic
World as well as Chinese influences. Missionaries from the Church of the East
(Nestorians) had been active in the region for centuries as well. The Uyghurs
had contact with Tibet via Buddhism. As Buell suggests, the Tibetans’ own role
in synthesizing medical knowledge should not be ignored.55 Although the
Mongols benefitted from the enormous store of medical knowledge in their
empire, that knowledge was not confined to the Mongol military or the court.
Indeed, it disseminated throughout the empire: thus Islamic medical techniques from Syria could find their way to Korea.56
The Mongols not only valued Islamic medicine but used Chinese medicine
early on, and it continued to have influence throughout the existence of the
empire. Chinese medical texts offered many remedies for internal injuries.
While there is some question about how effective they were, the fact that medical texts from the Yuan court exist suggests that they were found at least
somewhat useful. Chinggis Khan’s death due to internal injury explains why
the Mongols sought more effective ways of treating these kinds of wounds,
including acupuncture, moxibustion, herbal, and dietary medicine.57 One
text, Yin-Shan Cheng-yao (YSCY) or The Proper and Essential Things for the
52
53
54
55
56
57
Buell, “Tibetans, Mongols,” 191–92.
For a discussion of Muslim medical knowledge and practice on the Iberian Peninsula, see:
Carmel Ferragud, “Wounds, Amputations, and Expert Procedures in the City of Valencia
in the Early-Fifteenth Century,” 233–51, in this volume.
Buell, “Tibetans, Mongols,” 192.
Buell, “Tibetans, Mongols,” 192.
Michael J. Seth, A Concise History of Korea: From the Neolithic Period through the Nineteenth Century (Lanham, MD: Rowman & Littlefield, 2006), 110.
Buell and Andersen, Soup for the Qan, 139. Moxibustion consisted of the “burning of an
artemsia extract on or near the skin largely at the same meridian points used in acupuncture.” Here I have stayed with the Wade Giles transliterations for the benefit of those who
may consult the text and are not versed in the pinyin spellings.
Spitting Blood: Medieval Mongol Medical Practices
191
Emperor’s Food and Drink was written by Hu Szu-hui, the imperial physician in
the early 1300s who also specialized in dietary medicine.58 Thus, while the
Mongols may have viewed food as a meal, their physician used meals as a form
of treatment and as preventative medicine. Furthermore, as Hu Szu-hui may
have served in the keshig or imperial bodyguard, he may have been familiar
with not only treating wounds but also the long-term recovery.59
Although very little of the YSCY has anything directly dealing with battlefield wounds, some of the recipes may have aided recovery from those wounds.
Regardless, it is an impressive amalgamation of the various influences that
formed the fabric of the Mongol Empire – a Chinese medical text that lists a
variety of foods using ingredients from throughout the empire that also
includes Arab, Persian, Chinese, Turkic, and Mongolian dishes. As Buell and
Eugene N. Andersen note, “There also appears to have been a conscious effort
to use traditional Mongolian foods with their medicinal values in mind, judging from the uses to which these foods are put today, and from a few suggestions
in the sources indicating that present conceptions of medicinal value of foods
may have a high antiquity among the Mongols.”60 Furthermore, herbal medicine is incorporated into in the recipes that also focus on balancing the qi.61
Returning to the application of medicine in the treatment of wounds, the
YSCY clearly incorporates ideas of sympathetic magic, perhaps originating
from the Mongols’ own practice of shamanism. The recipes are sympathetic in
that eating a wolf’s leg provides benefits to the patient’s leg; eating ox lungs
help cures the lungs.62 The implications for treating and, perhaps, rehabilitating wounded limbs are obvious. Even internal injuries, hypothetically, could be
cured by devouring internal organs, such as sheep liver, for the same injured
organ. An example is Chinese quince soup that cures “pain of loin and knee,
and evil foot [qi] insensitivity.”63 The major ingredient, despite the name, is a
sheep’s leg. Another remedy for evil foot qi was Bear Soup, which uses two bear
legs.64
In the YSCY, there are also recipes for targeted cures designed to directly heal
the wound or affliction. Turtle soup was a given to patients with a “wounded
center,” meaning the torso. Although the name was turtle soup, the Mongolian
58
59
60
61
62
63
64
Buell and Andersen, Soup for the Qan, 4.
Buell and Andersen, Soup for the Qan, 22.
Buell and Andersen, Soup for the Qan, 91–92.
Buell and Andersen, Soup for the Qan, 134, 140–142.
Buell and Andersen, Soup for the Qan, 134, 140–142.
Yin-shan cheng-yao, in A Soup for the Qan (see note 2), 279. Henceforth YSCY.
YSCY, 294.
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May
version used mutton.65 Considering that the recipes were for the Mongol court,
it is not surprising that the major component was mutton with various spices.
Another recipe, which is clearly Mongolian, miqan-u könlesün involves a
sheep’s rear leg and treats seven kinds of wounds, as does Chinese Matrimony
Vine Fruit, Sheep’s Kidney Congee, and Chinese Yam T’o.66 Unfortunately, the
seven wounds appear to concern pathological agents, such as illnesses, and not
actual battle injuries. Other recipes are prescribed for injuries to the bones and
to the organs such as Sprouting Chinese Foxglove Chicken, Sheep Entrail Gruel,
and Sheep’s Spine Gruel.67 A white sheep’s head is needed for Sheep’s Head
Hash, one of several cures for debility of hand and foot.68 There are also recipes
for “bleeding that will not stop” such as Wild Pig Meat Broth and Otter Liver
Gruel.69 Consuming the meat of a red rooster also stops bleeding.70 Elephant
tusk was used to remove objects from wounds. A piece was shaved off the tusk,
ground into powder, and then mixed with water. Ostensibly, this would make
the object come out, but how is uncertain; nor is it clear if the mixture was a
thick paste or watery.71
Naturally, there are a number of recipes for easing various pains as well as
treating poison. In addition to remedies, the YSCY also contains warnings
against certain foods. In the case of wound treatment, the most significant is
that pork should not be eaten, or eaten moderately, as it was believed to weaken
joints and bones. Furthermore, “It is even worse for those suffering from
wounds caused by metal weapons.”72 Considering that the fourteenth-century
Mongol court in China was Buddhist, it is unlikely that this prohibition had
anything to do with Islam, but as stated earlier, medical practices from the
Islamic world did influence medical practices in the Mongol Empire on a wide
scale, so it cannot be ruled out.
Another prescription for headaches may have also been applied to ailments
resulting from battle. Although blows to the head were common in warfare,
specific recipes for concussions treating concussions are non-existent.
However, one possible recommendation was to wrap the tanned skin of a
wolf’s throat around the head which would cure a headache.73
65
66
67
68
69
70
71
72
73
YSCY, 291.
YSCY, 318, 416, 418.
YSCY, 413–415.
YSCY, 431. Other cures are listed on 429 and 430. Many of these recipes also appear to deal
with symptoms related to a stroke.
YSCY, 431–432.
YSCY, 552.
YSCY, 536.
YSCY, 541.
YSCY, 545–546.
Spitting Blood: Medieval Mongol Medical Practices
193
Hu Szu-hui’s attendance at court is evidence of an ongoing concern by the
Mongols for their general health. In the instance of Xul in Armenia, the appearance of the Jewish doctor may simply be an issue of religious rivalry, but the
reference to the Jewish doctor also indicates that the Mongols quickly adopted
medical practitioners from throughout their empire. The Ilkhan Öljeitu’s
(r.1304–1316) court contained a contingent of Jewish doctors.74 Ögödei (r.
1229–1240), the second khan, also had a court physician.75 Chinggis Khan, of
course, had the aged Daoist sage traverse from China to Mongolia to Afghanistan
to make a house call in an effort to secure his own immortality. The sage replied
that he could not prolong life, but he could counsel him on protecting his life.
Oddly enough, one piece of wisdom was to stop hunting, which was given after
Chinggis Khan’s horse stumbled and threw the Khan while hunting boars.76
While Chinggis Khan avoided internal injury as well as harm from the boar
itself, his later disregard for the sage’s advice led to internal injuries and his
death.
Although Chinggis Khan ignored some crucial medical advice, it is clear
that the Mongols adopted new medical techniques as they expanded and even
promoted the spread of medical knowledge throughout their empire.
Nonetheless, their own medical knowledge base was by no means limited.
Mongolian practices and methods were still used even as Chinese and Islamic
medical practices were incorporated, and despite the “superior” knowledge of
the civilized world they conquered, it appears that when all else failed, nothing
helped the wounded as much as basic first aid, such as sucking wounds or placing a person in an ox.
74
75
76
Denise Aigle, Le Fārs sous la domination Mongole: Politique et Fiscalité (Paris: Association
Pour L’avancement des Études Iraniennes, 2006), 88.
RD/Karimi, 638; RD/Thackston, 234.
Li Chih-Ch’ang, The Travels of an Alchemist, trans. Arthur Waley (Westport, CT: Greenwood Press, 1976), 118.