Hi all, Dr. Josh here again – this time to talk briefly about medicine through history (currently I'm in the ICU working 80 hours per week, so free time goes to sleeping, eating, showering, and a little blogging for the Wenches--‘brief’ is the operative word!). But when Susan Sarah (aka Mom) asked if I wanted to visit the blog, I thought it would be fun to take a look at some earlier European medical traditions, particularly the approach of the common people in households and villages in Europe and especially Britain.
After the Renaissance, most of medicine gradually became dominated by the forerunners of modern medicine, with their midnight dissections and surgical advances. But the four humours -- those long-established ancient and medieval theories of the sanguine, phlegmatic, choleric and melancholic types, based on imbalances in blood, yellow and black bile, phlegm, etc. -- persisted well into the 1800s. The germ theory of disease faced quite the uphill battle even into the early 20th century, although the possibility of infection was suspected by early Arabic physicians who insisted on cleanliness as part of treatment.
To me, medieval medicine seems wilder and more fascinating than the medicine of Paracelsus’s day, and that may be simply because I have been educated in the medical system that is steeped in the latter. And it's a good place to start a general look at the historical medicine practiced in British households. Medieval medical therapies aren’t well known or well understood now, though. For the most part, it seems to have been a hodgepodge of tradition (folk practices with some actual physiologic basis, i.e., they often worked), superstition (folk practices that didn’t usually work), and practices sponsored and administered by the Church (those didn’t usually work either). Rituals of various kinds were generally involved, with or without a physiologic basis to the treatment. The rituals became more religion-based as the Church gained a foothold, although folk-based superstition, charms, chants, etc. always persisted, though forced, to some extent, to become secret practices.
Three basic groups of healers were available to medieval people: lay physicians, both medics and surgeons, many of whom were university trained, academic physicians whose studies relied on ancient medical knowledge as well as philosophy, astrology and theology; folk healers whose training depended upon shared knowledge handed down through generations; and monks (and nuns) who might be trained in either, or both, traditions. Folk practices were gradually subsumed into academic medicine practiced by monks, with some added religious fanfare along the way. This resulted in some particularly bizarre treatments. For example, a therapy from the Lacnunga, a collection of Anglo-Saxon medical texts, involved stirring butter made from the milk of a cow of a single color with a stick that had four prongs, each of which contained the name of an evangelist. Religious blessings, folk superstition, accumulated knowledge and common sense (sometimes) were blended in early medicine.
Monasteries and convents had infirmaries or hospitals, where the ill and dying were taken for treatment. Bloodletting was common, leeches were applied, and examining the urine was typically done by academically trained practitioners, with some success. Much of medicine in those days -- both academic and folk-traditional -- was dependent on herbs, flowers and plants for treatment. Other common remedies involved wine, alcohol spirits, charcoal, oils, etc. There were salves, potions, poultices, unguents, plasters, tinctures, infusions prepared from various sources according to recipes both physiological and just plain illogical. There were charms and incantations, prayers -- and other practices reliant on sheer luck. Remedies and treatments might spring from common sense, their usage proven over the ages through trial and error and knowledge passed down from one healer to another. Other remedies evolved through superstitious belief systems; those ranged from truly bizarre to inherently practical.
For example, in medieval Britain it was widely believed that a certain prayer invoking a particular angel was the best cure for diarrhea, if the written text was hung about the neck on a string. For fever, one must write saints’ names along the arms of the afflicted – and the practical advice of the rest of that cure was to simply rest, drink fluids and wait out the fever.
As the Church took hold, traditional folk healers, those who combined herbal therapies with superstitious pagan rituals, were reviled and persecuted, although many still visited them in secret. Folk traditions remained so persistent that many of them survive to this day. Where I went to medical school (Penn State), I met some patients who attended the Central Pennsylvanian ‘Pow-Wow’. Despite the name, this practice is a medical system wholly derived from German folk healers who emigrated to North America in the 18th and 19th centuries. The traditions of herbal remedies and superstition hark back centuries.
A number of texts dealt with the medicinal properties of herbs. In the British Isles, these went back farther than the year 1000, around which time some Latin works were translated into Old English. There were earlier texts in use as well, some based on Greek and Arabic originals. Medieval practitioners of an academic bent (and those who could read and afford books) might consult the Lacnunga, along with Bald's Leechbook, and much later, Culpeper's indispensable Complete Herbal. These and many other texts, from herbal guides to anatomical studies, often held good quality information, give or take the odd superstition. It has been suggested that two-thirds of the plants listed, with their properities and uses described, would indeed act as a useful remedy in some way, shape or form based on our current scientific understanding of the compounds involved. Many of the herbs listed were used in ritualistic treatment, such as those used to make amulets that ward off evil. Lavender, for example, was said to be protective against intruders, so its physiologic effect as a calmative would make sense—one would relax, knowing lavender was on the job.
It's unclear what knowledge and what material treatments the average person had available to them. Personally, I suspect that this is a reflection of both the low level of literacy at the time among the common folk practicing various methods of treatment (no first-hand records from any but well-educated monks and nobles). Presumably what the average person kept in their medicine chests drew upon the same traditions as the folk healer. These treatments would not have been welcomed by the prevailing authorities (the Church, and local clergy in particular), who asserted that all healing ultimately came from God. Anything outside the Church's circle of acceptance was highly suspect, and could be seen as heretical, even verging on witchcraft. However, many of these traditions survive today in the forms of home remedies. We are all familiar with such treatments as honey for cough (with its soothing texture and mild natural antibiotic properties), mint for indigestion. Also, modern medicines derived from traditional herbal remedies such as aspirin (from willow) and digoxin (from foxglove). Many medicines and herbal treatments have in common their chemical properties and certain effects on diseases, conditions and symptoms.
While medical practitioners no longer recommend applying egg whites to the forehead to cure insomnia, axle grease for hemorrhoids or a cow dung poultice for eczema, the benefits of some tried and tested herbal remedies can be acknowledged -- minus the incantations, jumping on one leg while reciting the Lord's prayer, burying a black rooster (thought to be a cure for epilepsy), and the like. The history of medicine is long, varied, complex and pretty fascinating. While folk and herbal remedies are not my areas of specialization, thanks to Word Wenches, I’m enjoying the chance to look further into the matter of materia medica.
Dr. Josh
