Patient, heal thyself

Early medieval medicine was decidedly a mixed bag. On the one hand a decent practitioner could mend a broken bone, bind a nasty wound, and give you the best attention possible in the event of fever. There would be a decent chance your healer could rely on a book of herbal remedies from the ancient Greeks. Not too bad.

On the other hand, your healer was strictly bound by the medical theories of those same ancients, theories which began and ended with the infamous “humors” of the body. The herbal remedies had been copied many times over, usually by scribes who had never seen the plants being referenced. And indeed, those plants grew in the eastern Mediterranean, not northern Europe. Other medical ‘texts’ are filled with references to things like how to tell if a person is going to die via holding a tick from a black dog in the healer’s left hand.^1.Peregrine Horden, What’s Wrong With Early Medieval Medicine?, Social History of Medicine, v.24, n.1, pp.5 – 25. Be sure not to miss the discussion of “vulture medicine.”

Isidore of Seville wrote an encyclopedia early in the 7th century, and he included an entire section on medicine. His text was one of the foundations of early medieval medicine, and I looked at what he had to say about disease in my last post. He also said much of a theoretical, if not entirely practical nature, about the actual art of healing. He begins with a summary that could hardly be bettered today, thirteen centuries later.

Medicine is the art that protects or restores the body’s health; its subject matter concerns illnesses and wounds. To medicine belong not only things practiced by the skill of those properly called physicians, but also matters of food and drink, clothing and shelter. Ultimately, it consists of every defense and fortification by means of which our body is preserved in the face of external blows and accidents.^2.Isidore, Etymologies, bk.IV, p.109.

Isidore next lays the foundation for medical practitioners by outlining the humoral theory. The humoral theory derived from the material theory of the universe, that all things were made from four elements, earth, air, water, and fire. “And as there are four elements, so there are four humors that maintain our bodies.” The correspondence went further than that, and each humor “resembled” a particular element: blood with air, bile with fire, black bile with earth, and phlegm with water. Blood and bile were thought to cause acute illnesses, while black bile and phlegm were responsible for chronic maladies.

There are three elements of medicine, according to Isidore: regimen, or “the cardinal observance of a regulated way of life”; pharmaceutics, or “treatment by medication”; and surgery, or “incision by iron tools.” He recommends that the remedies be tried in order of intrusiveness. This advice is well aligned with Hippocrates himself, who said, “To do nothing is also a good remedy.”^3.Of course, he also said, “A physician without a knowledge of Astrology has no right to call himself a physician.” http://www.brainyquote.com/quotes/authors/h/hippocrates.html#rsog5TkRiHqYoUKk.99 The pharmaceutics was covered by Discorides, who wrote his De Materia Medica in the first century CE. It is this volume, and others, which did not always make for a successful translation, either linguistically or herbologically, to northern Europe.

The relative importance of organic cures rather than surgery is well illustrated by Isidore’s list of medical instruments. He describes several varieties of mortars (for grinding), a “cupping glass,” used to draw out ill humors from a wound, and a lancet, for making incisions. That’s it.

While Isidore may have been a rationalist, other sources point out the deeply folkloric nature of early medicine. Across the channel the Anglo-Saxons found medical rationale in a different direction.

Folk beliefs about the origins of diseases are suggested by the names of ailments. For example, a man or a horse may suffer “elfshot.” Other causes of ailments include flying poisons, elf adle (fever) and water-elf adle, elf trick, dwarfs, demons, temptation by a fiend, devil sickness, mares that ride men at night, and a variety of “worms.”^4.Lindahl, Medieval Folklore, p.265.

There was no formal medical course of study to be followed. Anyone, including “laymen, clerks, and Jews” could practice medicine, if you trained yourself up for it. The St. Gall monastery plan includes references to medical uses, which indicates that “bathing, bleeding, and the use of simples were connected in the prevention of sickness.”^5.Riche, Daily Life, pp.168-70.

Medical theory permeated learned culture. Early in the 7th century St. Benedict laid down his rule for monastic living, which includes many specific instructions for the abbot. In Chapter 28 Benedict describes the proper course for those brothers who have been ‘corrected’ multiple times, but have refused to fall into line. Note the correspondence to regimen, pharmaceutics, and then surgery. “[L]et the Abbot do what a wise physician would do. Having used applications, the ointments of exhortation, the medicines of the Holy Scriptures, finally the cautery of excommunication…. But if he is not healed even in this way, then let the Abbot use the knife of amputation… lest one diseased sheep contaminate the whole flock.”^6.Geary, Readings in Medieval History, Saint Benedict, p.173.

Leave it to a monk to instruct us as to the correct medical methodology.