CHAPTER II
EARLY MEDIEVAL MEDICINE

There are two distinct periods in the history of Medieval Medicine. The first concerns the early centuries, from the sixth to the ninth, and is occupied mainly with the contributions to medicine made by those who were still in touch with the old Greek writers; while the second represents the early Renaissance, when the knowledge of the Greek writers was gradually filtering back again, sometimes through the uncertain channel of the Arabic. Both periods contain contributions to medicine that are well worthy of consideration, and nearly always the writings that have been preserved for us demonstrate the fact that men were thinking for themselves as well as studying the Greek writers, and were making observations and garnering significant personal experience. The later Middle Ages particularly present material in this regard of far greater interest than was presumed to exist until comparatively recent historical studies were completed.

The real history of medicine in the Middle Ages—that is, of scientific medicine—is eclipsed by the story of popular medicine. So much has been said of the medical superstitions, many of which were rather striking, that comparatively little space has been left for the serious medical science and practice of the time, which contain many extremely interesting details. It is true that after the Crusades mummy was a favourite pharmacon, sometimes even in the hands of regular physicians; and Usnea, the moss from the skulls of the bodies of criminals that had been hanged and exposed in chains, was declared by many to be a sovereign remedy for many different ills; but it must not be forgotten that both of these substances continued to be used long after the medieval period, mummy even down to the middle of the eighteenth century, and Usnea almost as late. Indeed, it is probable that the seventeenth and eighteenth centuries present many more absurdities in therapeutics than do the later centuries of the Middle Ages. In this, as in so many other regards, the modern use of the adjective medieval has been symbolic of ignorance of the time rather than representative of realities in history.

Popular medicine is always ridiculous, though its dicta are often accepted by supposedly educated people. This has always been true, however, and was never more true than in our own time, when the vagaries of medical faddism are so strikingly illustrated, and immense sums of money spent every year in the advertising of proprietary remedies, whose virtues are often sadly exaggerated, and whose tendency to work harm rather than good is thoroughly appreciated by all who know anything about medicine. The therapeutics of supposedly scientific medicine are often dubious enough. A distinguished French professor of physiology quoted, not long since, with approval, that characteristic French expression: “The therapeutics of any generation are always absurd to the second succeeding generation.” When we look back on the abuse of calomel and venesection a century ago, and of the coal-tar derivatives a generation ago, and the overweening confidence in serums and vaccines almost in our own day, it is easy to understand that this law is still true. We can only hope that our generation will not be judged seven centuries from now by the remedies that were accepted for a time, and then proved to be either utterly ineffectual or even perhaps harmful to the patients to whom they were given.

When we turn our attention away from this popular pseudo-history of Medieval Medicine, which has unfortunately led so many even well-informed persons into entirely wrong notions with regard to medical progress during an important period, we find much that is of enduring interest. The first documents that we have in the genuine history of Medieval Medicine, after the references to the organizations of Christian hospitals at Rome and Asia Minor in the fourth and fifth centuries (see chapter Medieval Hospitals), are to be found in the directions provided in the rules of the religious orders for the care of the ailing. St. Benedict (480-543), the founder of the monks of the West, was particularly insistent on the thorough performance of this duty. The rule he wrote to guide his religious is famous in history as a great constitution of democracy, and none of its provisions are more significant than those which relate to the care of the health of members of the community.

One of the rules of St. Benedict required the Abbot to provide in the monastery an infirmary for the ailing, and to organize particular care of them as a special Christian duty. The wording of the rule in this regard is very emphatic. “The care of the sick is to be placed above and before every other duty, as if, indeed, Christ were being directly served in waiting on them. It must be the peculiar care of the Abbot that they suffer from no negligence. The Infirmarian must be thoroughly reliable, known for his piety and diligence and solicitude for his charge.” The last words of the rule are characteristic of Benedict’s appreciation of cleanliness as a religious duty, though doubtless also the curative effect of water was in mind. “Let baths be provided for the sick as often as they need them.” As to what the religious infirmarians knew of medicine, at least as regards the sources of their knowledge and the authors they were supposed to have read, we have more definite information from the next historical document, that concerning medical matters in the religious foundation of Cassiodorus.

Cassiodorus (468-560), who had been the prime minister of the Ostrogoth Emperors, when he resigned his dignities and established his monastery at Scillace in Calabria, was influenced deeply by St. Benedict, and was visited by the saint not long after the foundation.

His rule was founded on that of the Benedictines. Like that, it insisted especially on the care of the sick, and the necessity for the deep study of medicine on the part of those who cared for them. Cassiodorus laid down the law in this regard as follows: “I insist, brothers, that those who treat the health of the body of the brethren who have come into the sacred places from the world should fulfil their duties with exemplary piety. Let them be sad with others’ suffering, sorrowful over others’ dangers, sympathetic to the grief of those whom they have to care for, and always ready zealously to help others’ misfortunes. Let them serve with sincere study to help those who are ailing as becomes their knowledge of medicine, and let them look for their reward from Him who can compensate temporal work by eternal wages. Learn, therefore, the nature of herbs, and study diligently the way to combine their various species for human health; but do not place your entire hope on herbs, nor seek to restore health only by human counsels. Since medicine has been created by God, and since it is He who gives back health and restores life, turn to Him. Remember, do all that you do in word or deed in the name of the Lord Jesus, giving thanks to God the Father through Him. And if you are not capable of reading Greek, read above all the translations of the Herbarium of Dioscorides, which describes with surprising exactness the herbs of the field. After this, read translations of Hippocrates and Galen, especially the Therapeutics, and Aurelius Celsus’ ‘De Medicina,’ and Hippocrates’ ‘De Herbis et Curis,’ and divers other books written on the art of medicine, which by God’s help I have been able to provide for you in my library.”

The monasteries are thus seen to have been in touch with Greek medicine from the earliest medieval time. The other important historical documents relating to Medieval Medicine which we possess concern the work of the men born and brought up in Asia Minor, for whom the Greeks were so close as to be living influences. Aëtius, Alexander of Tralles, and Paul of Ægina have each written a series of important chapters on medical subjects, full of interest because the writers knew their Greek classic medicine, and were themselves making important observations. Aëtius, for instance, had a good idea of diphtheria. He speaks of it in connection with other throat manifestations under the heading of “crusty and pestilent ulcers of the tonsils.” He divides the anginas generally into four kinds. The first consists of inflammation of the fauces with the classic symptoms; the second presents no inflammation of the mouth nor of the fauces, but is complicated by a sense of suffocation—apparently our neurotic croup. The third consists of external and internal inflammation of the mouth and throat, extending towards the chin. The fourth is an affection rather of the neck, due to an inflammation of the vertebræ—retropharyngeal abscess—which may be followed by luxation, and is complicated by great difficulty of respiration. All of these have as a common symptom difficulty of swallowing. This is greater in one variety than in another at different times. In certain affections he remarks that even “drinks when taken are returned through the nose.”

Aëtius declares quite positively that all the tumours of the neck region, with the exception of scirrhus, are easily cured, yielding either to surgery or to remedies. The exception is noteworthy. He evidently saw a good many of the functional disturbances and the enlargements of the thyroid gland, which are often so variable in character as apparently to be quite amenable to treatment, and which have actually been “cured” in the history of medicine by all sorts of things from the touch of the hangman’s rope to the wrapping of the shed skin of the snake around the neck. A few cervical tumours were beyond resource. Aëtius suggests the connection between hypertrophy of the clitoris and certain exaggerated manifestations of the sexual instinct, as well as the development of vicious sexual habits.

It requires only a little study of this early medieval author to understand why Cornelius, at the time of the Renaissance, was ready to declare: “Believe me, that whoever is deeply desirous of studying things medical, if he would have the whole of Galen abbreviated and the whole of Orbiasius extended, and the whole of Paulus (of Ægina) amplified; if he would have all the special remedies of the old physicians, as well in pharmacy as in surgery, boiled down to a summa for all affections, he will find it in Aëtius.”