Jewish Medicine

Jews comprise less than 0.02% of the world population, and yet 28% of Nobel prize winners in medicine have been Jewish. This expertise has a long history.

The Sefer Refuot or "Book of Remedies" is the earliest known Hebrew text on medicine. It contains information on illnesses and treatments, but also talks about how to maintain health through exercise, eating properly, and observing proper hygiene. It also suggests that astrology is connected to health, and there are different treatments depending on the month. It includes a code of conduct for doctors.

Although the only manuscripts we have are later medieval ones, they are considered to be faithful copies of a very early work for a particular reason: the book does not have any of the Arabian medical knowledge that was so prevalent in the Middle Ages. The assumption is that this book recorded Jewish knowledge, including a theory of blood vessels and circulation, that pre-dates the cross-cultural sharing that happened with the spread of Muslims after the 7th century.

There was some controversy about medicine in Jewish culture. In II Chronicles 16:12, King Asa of Judah is criticized because “in his illness he sought not God but rather physicians.” In the same book, King Hezekiah is praised for hiding a medical book in order to get his people to turn to God for aid. The 13th-century Nachmanides argued that Jews have a special relationship with God and should thrive or suffer according to His will; they should not try to subvert his will through practices like medicine. Because of this turning to natural cures, he says, their relationship with God in this area has been annulled, and now they have no choice but to turn to doctors. The practice of medicine is now considered a mitzvah, a fundamental religious obligation.

Jewish physicians often learned Latin, Greek, and Arabic; along with Hebrew, they had access to many medical texts inaccessible to their Christian counterparts. This made them exceptionally knowledgeable and effective—and sought after. I've already mentioned Jacob Mantino ben Samuel, who was so important to many high-ranking figures in Venice that they asked the Council of Ten to exempt him from wearing the degrading yellow cap that was mandated to denote Jews in public.

Jewish physicians also included women among their number, not just as midwives, which we will talk about next time.

A Jewish Physician

Article One of King Henry III's 1253 Statute of Jewry allowed Jews to stay in England so long as they served the king in some capacity. There were financial advantages to having Jews around, since they were not limited by the Biblical injunction against usury (charging high interest on loans) when lending to non-Jews. Usury created a dilemma for many: usury was not to be allowed, and yet Jewish lenders were an important source of funding for some.

Another dilemma for Christian Europeans in the Middle Ages was the idea that Jews were not to be fraternized with, and yet they were often the best physicians. One example of this was mentioned here, Jacob Mantino ben Samuel (died 1549).

Jacob's family was from Tortosa, Spain, but were forced to flee in 1492 because of the Alhambra Decree. Jacob studied medicine at Padua and Bologna, staying in Bologna to set up his practice. His translations of scientific works from Hebrew to Latin brought him to the attention of the court of Pope Clement VII. War in 1527 (between the Holy Roman Empire and Protestants) caused him to settle in Verona, where the Catholic bishop protected him. When the bishop went to Rome, however, Jacob left Verona and settled in Venice.

Jacob had many influential clients: ambassadors from France and England, papal dignitaries, and other wealthy local patrons. Despite medieval culture's antipathy toward Jews, his clients made an appeal to Venice's ruling Council of Ten. The appeal—which was granted—was to exempt Jacob from wearing the yellow that was intended to denote Jews in public. Originally this was temporary, but later was made permanent.

Jacob later went to Rome, acquiring great influence and becoming personal physician to Pope Paul III in 1534. In 1544 he returned to Venice, where once again he was exempted from wearing yellow. Accompanying the Venetian ambassador to Damascus, he died in 1549.

Why was he exempted from wearing yellow? Was it a desire on the part of his clients to not be seen associating with a Jew? Or was it for a slightly more kind-hearted reason: they understood the insult of being forced to wear yellow and wanted to spare the feelings of a man they had come to respect? Perhaps a little of both. He was not unique in the Middle Ages: Jewish doctors and Jewish medicine were regarded very highly. We'll delve into that a little more deeply tomorrow.

The Etymologies of Isidore

The Etymologiae of Saint and Bishop Isidore of Seville (c.560 - 636) is an early encyclopedia that summarizes in 20 volumes all the knowledge that he considered important. It is most remembered and mentioned for the section on etymologies, but he also wrote about (or quoted from Greek and Roman sources) the trivium (grammar, rhetoric, logic) and quadrivium (arithmetic, geometry, music, astronomy), law and medicine, the Church and various heresies, buildings and roads, materials and tools, war, foods, clothing, languages, pagan philosophers, architecture, and more. (Pope John Paul II named Isidore the patron saint of the Internet.)

His etymologies were worthy of the father in My Big Fat Greek Wedding who linked every concept to a Greek word. (The evidence suggests that Isidore was not well-versed in the Greek language.) Examples are that dominus (master) begins with "D" because so does domus (house), and a dominus is the master of a domus. Also, the Latin verb "to teach" is docere, which is related to docile (compliant) because compliant people can learn easily. He finds the origin of mendicus, the Latin word for beggar, in the Latin phrase manu dicere, "to speak with the hand," because (he says) there was an ancient custom for beggars to close their mouths and hold out their hand for food. Prostitutes (fornicatrix and fornicarius) are named from fornix, "arch," because they would hang about under an arch waiting for a client.

Among his other offerings:

—A table that explains family relationships ("Who is your second cousin twice removed?") and the terms for each family member.

—The classic "T" map of the world, the mappa mundi.  (The illustration is from a 10th century copy, showing such a map.)

—How the four elements make up the body:

But flesh is composed of four elements: earth is in the fleshy parts, air in the breath, water in the blood, fire in the vital heat. The elements are mingled in us in their proper proportions, of which something is lacking when the conjunction is dissolved.

—Bodily functions:

The mouth is compared to the door of the belly which receives and passes on food to the intestines through the esophagus which is near the windpipe, and which is closed off by the epiglottis during deglutition. 

The intestines are arranged in long circular entwinings so that food can be gradually digested. The abdominal viscera are separated from the heart and lungs by the diaphragm and covered by the omentum. Food, when first passed into the small intestine, is called jantaculum. The large intestine, the “blind gut,” is identified and it is pointed out that the gastrointestinal tract is open at each end. The rectum and anus are turned away from our faces to spare us the indelicacy of witnessing their evacuation.

—Medicine:

The poppy is the sleep-bearing herb, of which Vergil says [Georgics 1. 78]: Lethaeo perfusa papavera somno, ‘Heavy sleep, pressed out of the poppy,’ since it stupefies the sleeper. Some poppies are common; others are stronger, namely those from which flows the juice called opion.

...and many other topics, as mentioned above.

His Etymologiae was studied and copied and illustrated through the Middle Ages, and many versions of the manuscript exist in various museums.

One of the other notable things about Isidore is his family. His parents died early in the life of Isidore and his siblings, but all four children became saints; three became bishops. His older brother Leander has been mentioned, but not the rest. A brief look at his family next time.

The Medieval Drugstore

The Ancient Greek ἀποθήκη (apothḗkē, "storehouse") became Latin apotheca and gave us the English word apothecary, used for both the place one would go to find pharmaceutical preparations and for the pharmacist himself who made the medicines to sell to doctors or directly to people requesting them. Apothecaries were also sources of medical advice for the common people. (Kings and wealthy folk had personal physicians.)

The apothecary was a source of many, many substances used either alone or in combination. Typical medical materials were herbs familiar to the modern seeker of comfort, such as chamomile, garlic, mint, or witch hazel. Less familiar as medicinal sources were dung, urine, animal fats, and even saliva. All these might be used in the production of materia medica, medicine.

The apothecary, as an expert in chemistry, was also a source of non-medicinal products: cosmetics, perfumes, dyes, and soaps.

Apothecary shops existed thousands of years before Chaucer, who wrote in The Canterbury Tales:

    Though in this toun is noon apothecarie,
    I shal myself to herbes techen yow,
    That shul been for youre hele and for youre prow.

    [Though in this town there is no apothecary,
    I myself shall teach you herbs
    That shall be for your health and for your pride.]

Apothecaries became more and more respected over time, and finally gained their own livery company, the Worshipful Society of Apothecaries, in 1617. That was not their first time in a guild, however: in 1617, they broke away from their original guild, the 12th century Guild of Pepperers. I'll tell you about them tomorrow.

So Many Poisons

We talked a little about the history of poison here, but now it's time to look at what Medieval Europe had at hand for killing enemies. Fortunately, there were many toxic substances available for dispatching an unwanted person: aconite, arsenic, datura, hemlock, henbane, and mandrake were a few.

Hemlock, made famous by the execution of Socrates, was no relation to the conifer. It comes from a plant in the carrot family found in Europe and North Africa. Every part—leaves, seeds, roots—is toxic when ingested. The toxicity remains up to three years after the plant is dead and dried, making it easy to import from its native land. It was less popular in the Middle Ages than in Classical Greece.

Aconite (monkshood, wolf's-bane, blue rocket, et alia) is common all over the Northern Hemisphere. It contains an alkaloid toxin called aconitine, which can "lead to diarrhea, convulsions, ventricular arrhythmia and death." A sufficient dose causes death within two to six hours.

Datura (jimsonweed, thornapples, devil's trumpets, moonflower) is extremely poisonous but was used by many North American tribes for its psychoactive properties. It is found all over the world (the illustration is the Western Hemisphere's datura inoxia), and Indian Thuggee practitioners used it routinely on victims in their sacrifices to the Hindu goddess Kali.

Henbane was used as an anesthetic, especially when combined with mandrake, deadly nightshade, and datura. Pliny said its use was similar to taking wine and therefore "offensive to the understanding."

Mandrake has long been used for magical rituals because of the branching root that vaguely resembles a human body, and because of the hallucinogenic alkaloids. Many in the 21st century likely heard of it for the first time because of the Harry Potter books and films.

Of course, these substances were available from any apothecary, or were cultivated and prepared by an individual without raising suspicion, because in small doses they were medicinal. Hemlock was used as a sedative and for swollen joints. Aconite in very small doses was thought to improve circulation. Dioscorides recommended henbane as a sedative.

I have deliberately skipped over arsenic, because it has such a long and glorious history that I felt it deserved its own entry, so please join me tomorrow for that.

Pre-Medieval Poison

The use of poison—a toxic substance deliberately introduced to a living creature for the sake of incapacitating or killing it—is found as early as 4500 BCE. How do we know? Grooves in ancient weapons, such as arrows, have been found to contain evidence of toxic substances like tubocurarine, an alkaloid found in the bark of a South American climbing vine. It paralyzed the muscles of a mammal, but did not prohibit eating the flesh safely. Pliny claimed there were over 7000 different poisons.

King Mithridates of Anatolia (114 - 63 BCE) was so paranoid about being poisoned that he worked hard to discover cures. He would test cures (after applying poisons) to criminals. He also attempted to immunize himself by taking minuscule amounts of poison himself daily. He eventually created a "cure-all," a mixture of dozens of substances, which he named Mithridatium. His notes on plants and cures were taken to Rome after Mithridates' kingdom was defeated by Pompey the Great. 

The Roman Empire brought poisoning "into the mainstream," using it to eliminate enemies and political rivals, even right at the dinner table. Several emperors were eliminated by poison, if we believe Roman historians. A praegustator or "pre-eater" (food taster) was a slave used to try out one's food for safety. If you could bribe a food taster, however, you could get rid of your victim easily. Of course the food taster in many cases ate the food when it was ready for eating, immediately prior to the diner tucking in, so there was no warning. If the diner and the food taster died with the same symptoms, however, the survivors knew it was poison, and could react accordingly (either seeking revenge or enjoying their nefarious plan).

The European Middle Ages likewise embraced poison to solve political problems:

Henri of Flanders (d. 1216), the second Latin emperor of Constantinople, and Blanche II of Navarre (d. 1464) were both supposedly poisoned by members of their own families. This was also the case for Robert IV of Artois, count of Eu, and his wife Joanna of Durazzo, who paid a visit to Joanna’s sister Margherita, Queen of Naples, in 1387. Neither of them would leave the royal residence of Castel dell’Ovo alive, ...

Dmitriy Yurievich Shemyaka, twice Grand Prince of Moscow, however, irritated the Muscovites ... In 1453, the city’s inhabitants bribed the prince’s cook to poison his roast chicken dinner. Other poisonings of high-ranking individuals remain unsolved: the Irish peer James Butler, earl of Ormond and a cousin of Anne Boleyn, died in London in 1546 as the apparent victim of poisoning along with seventeen other members of his household. [link]

Medieval apothecaries provided many different substances and the knowledge of their uses. What did they supply? Tomorrow we will look at several of the known poisons available at the time.

"The Hands of the King...

...are the hands of a healer." This line from The Lord of the Rings sounds fantastical, but as a first-rate historian and medievalist, J.R.R.Tolkien knew well the idea that the laying on of hands by a king (or queen: that's Mary I of England in the illustration) could heal illness. This was supposedly possible because of their "divine right" as anointed kings.

The King's Touch, or Royal Touch, was the practice of laying on of hands by English and French monarchs that was believed to cure diseases, particularly the King's Evil, scrofula. Hippocrates thought scrofula was a disproportionate accumulation of phlegm.

Scrofula, a disease of the lymph nodes, is now called mycobacterial cervical lymphadenitis, and is associated with tuberculosis. It usually manifests as a painless swelling in the lymph nodes of the neck caused by infection. It almost disappeared in the second half of the 20th century, but the appearance of HIV/AIDS has caused a small resurgence.

Where did the Royal Touch start? A 16th-century physician thought it began with Clovis I (reigned 481 - 511) after he accepted Christianity. Many other origins are offered. King Philip I of France (1052 - 1108) was perhaps the first time a king's touch was requested to heal a stubborn disease, so the French say. King Henry I of England (1068 - 1135) was appealed to for the same reason, although some scholars believe Edward the Confessor (reigned until 1066) was the first. The French denied this, and claimed that it started with Henry in England only because he was imitating Philip. What we can say is that records under Edward I show the practice of a penny given to sufferers afterward was established by 1276, two years after Edward's arrival back in England as king. Some say this means it was probably introduced by Edward's father, the pious Henry III, who was also a huge fan of Edward the Confessor and might have patterned his behavior after that monarch and therefore—but let's just stop there because there's too much speculation to reconcile all the conflicting theories. The record of tokens handed out suggests that Edward "touched" about a thousand people a year.

Scrofula became known as the "King's Evil" because an appeal to the king was considered the best recourse. John Gaddesden (1280 - 1361) recommends it as treatment for scrofula and other skin diseases. Eventually, a special gold-plated coin would be given by the king to the sufferer to be worn around the neck to ward off the disease. The truth is, the disease rarely was associated with death, and often went into remission on its own, supporting the notion that the king's touch cured the patient.

The Royal Touch persisted into the Renaissance, even though there was plenty of evidence that it did not inevitably lead to a cure. The formula in France added the line Le roi te touche, Dieu te guérisse ("The King touches you, may God heal you"), taking the burden of healing off the king's shoulders (or hands) and placing the possible healing on God. Louis XIV of France touched 1600 people on Easter 1680. Voltaire wrote that a mistress of Louis XIV died of scrofula despite "being very well touched by the king." Louis XV stopped the practice by not calling sufferers to be touched at Easter 1739. Louis XVI touched 2400 at his coronation in 1775, and Charles X touched 121 at his coronation in 1825, but there are no records of the Royal Touch being used after that date.

But where does the word scrofula come from? That's a slightly trickier question that will lead us into sympathetic magic and the Doctrine of Signatures. That's for another day.

Of Hospitals and Treatments

Much of the medieval "medical" care happened in the home—herbal remedies and such—but hospitals did exist, run by religious groups such as the Order of the Hospital of St. John. This Order founded and managed the Jerusalem Hospital to support crusaders and pilgrims to the Holy Land. In the case of this Order, they were so committed to care that, in the words of an anonymous cleric who visited the Jerusalem Hospital:

It has happened on a number of occasions that when the space … proves insufficient for the multitude of the suffering, the dormitory of the brethren is taken over by the sick and the brethren themselves sleep on the floor.

Their charity did not know boundaries. Jerusalem had thousands of Muslims and Jews living there who were also in need of care. Therefore,

the sick are gathered together in this House out of every nation, every social condition, and both sexes, so that by the mercy of the Lord the number of lords increase in proportion to the multitude of languages. Indeed, knowing well that the Lord invites all to salvation and wishes none to perish [Ezek.18:32], men of pagan religion find mercy within this holy House if they flock thither, and even Jews.

Of course daily "treatment" would have included Christian instruction and daily prayer as well as food and medicine and ointments. Since sickness was often considered the result of sin, this made sense at the time.

The hospital and the care offered even tempted wealthy citizens to act poor so they could get treatment. 

There was only one type of person was outright refused entry to the Jerusalem (and other) Hospital.

Next? Lepers.

Ergot Poisoning

When the relics of St. Geneviève were paraded through there streets of Paris in 1129 during an outbreak of St. Anthony's fire, they seemed to work. The truth is, however, that St. Anthony's fire could abate as suddenly as it arrived, so coincidence might have figured in the miraculous cure. But what was (is) St. Anthony's Fire? Modern researchers put their money on ergotism, or ergot poisoning.

Ergot is a fungus— Claviceps purpurea—that grows on certain grains, especially rye. The early symptoms may not cause too much alarm: fatigue, nausea, diarrhea. Later, it can lead to convulsions. It becomes St. Anthony's Fire when the fungus causes the blood vessels in the outer extremities to constrict. The arms and legs do not get blood and oxygen and therefore develop gangrene. At that stage, amputation (or a miracle) is the only recourse. While the limbs were dying, the sensation of burning was intense, hence the reference to "fire." So why "St. Anthony"?

The Order of Hospitallers of St. Anthony founded hospitals to treat the disease. There was plenty of work to do. St. Anthony's Fire was a problem waiting to happen as soon as stored grain started getting moldy.

Ergot was known at some point: the black growth on the rye was studied. In 1582, a German doctor used small doses to produce contractions in pregnant women. In the 20th century, ergotamine was developed to help with migraines and cluster headaches.

Tomorrow I'll talk a little more about medieval hospitals and cures.

The Book of Pee

One of the medical texts composed by Isaac Israeli ben Solomon was translated from Arabic to Latin and called De Urinis ("Concerning Urine"). One manuscript copy (Ms. 690) in the University of Utrecht Library shows signs of frequent use, and yet has survived for 800 years with its original binding, showing extreme care being taken by any of its owners.

De Urinis was not one of the books translated at Toledo; the Latin version that was used in the Middle Ages was translated by Constantine the African, a Benedictine monk and physician who spent the first part of his life in Ifriqiya, then brought Isaac's work and others from Tunisia to his retirement at the Benedictine Abbey of Monte Casino. Unfortunately, Constantine often did not include in his translation the name of the original author, leading many to think that he himself wrote the medical texts. It took other references to these works to be able to affix the proper author's name. (The illustration here shows a dog's head added to the margin by a bored copyist.)

There are ten sections to De Urinis, as follows:

1. The science of uroscopy, placing it in context of the four temperaments*, particularly in relation to the blood;
2. The importance of nocturnal urine;
3. Types of urine in relation to pathology;
4. Urine as humor-discharging fluid;
5. Types of urine by colour;
6. The state of the body judging by its colour;
7. Types of urine based on clarity and viscosity;
8. Sediment in relation to pathology;
9. Types of urine in coherence with sediment;
10. Different types of urine and sediments and their meaning.

According to the Utrecht summary of the manuscript:

This text influenced islamic medicine to a great extent (where uroscopy was of great importance) and contributed to the rise of uroscopy as one of the most important branches of medicine in the Middle Ages (Prioreschi 2001). Ms. 690 is a remarkably early witness of this.

If you would like to see the manuscript in digital form, click here.

This is the second post in a row that mentions Ifriqiya, which sounds like "Africa" and should be addressed. I shall do so next.

*Referring to the four humors whose proportions determined a human being's temperament and health: yellow bile, black bile, phlegm, and blood.

Isaac Israeli ben Solomon

Some of the works translated at Toledo by our old friend Gerard of Cremona were the Book of Definitions and the Book of Elements into Latin from Arabic. Written by Isaac Israeli ben Solomon (alias Isaac Israeli the Elder, alias Isaac Judaeus), sometimes known as Isaac the Jew, they and his other works became standard works in medicine at Salerno.

Isaac Israeli ben Solomon was born in Egypt around 832CE. Growing up in Cairo, he became known as a skilled oculist (illustration is from an Arabic manuscript on oculism, showing the parts of the eye). About 904CE he was made court physician to Emir Ziyadat Allah III of Ifriqya (and I really should talk about him and there in the near future). A few years later he traveled to Kairouan, Tunisia and studied under a famous Arab physician, then became the doctor to 'Ubaid Allah al-Mahdi, who founded the Fatimid dynasty. al-Mahdi found Israel charming and witty.

In Kairouan he started writing his treatises, which were considered "more valuable than gems," and giving popular lectures on medicine and other topics in science. All his treatises were written in Arabic. Besides the ones mentioned above, they also include The Book on Fevers, a work on food and remedies called Universal Diet, and more. He also wrote books on philosophy, metaphysics, logic, a commentary on Genesis, and a treatise on the difference between the spirit and the soul. The Latin translations of many of these were quoted by Albertus Magnus, Aquinas, Roger Bacon, Nicholas of Cusa, and others.

Next I want to delve into one of his works specifically. I don't think I've ever indulged in what they call "dad jokes," but let me just say "urine for a treat."

De Gradibus

De Gradibus (Latin: Concerning degrees) was written by the Father of Arab Philosophy, Al-Kindi (801-873CE). In it, he applies mathematics to medicine, demonstrating a method he invented to determine the proper strength of a drug for a patient. Also, he discusses the degrees of the phases of the moon and how they help a physician to determine the most crucial days of a patient's illness.

When it was translated into Latin, the complex mathematical reasoning made it difficult for Western Europeans to grasp. Roger Bacon appreciated his approach, and endorsed it thusly:

The degree can only be determined by the method taught by Al-Kindi’s De gradibus, one extremely difficult and almost entirely unknown among Latin physicians of these days, as everyone is aware. Whoever wants to become perfect in this philosopher’s art must know the fundamentals of mathematics, because the species of greater and lesser inequality, the species of ratios, and the very difficult rules of fractions are all used by this author.

Plinio Prioreschi, a 20th century expert on the history of medicine, credits Al-Kindi with the earliest attempt to quantify medicine.

Al-Kindi was heavily influenced by noted Greek physician Galen (129-216CE). The stereotype of a Muslim rejecting any non-Muslim source of knowledge is tossed out by Al-Kindi's approach to knowledge. He wrote:

We must not hesitate to recognize the truth and to accept it no matter what is its origin, no matter if it comes to us from the ancients or from foreign people. My purpose is first to write down all that the ancients have left us on a given topic and then, using the Arabic tongue and taking into account the customs of our time and our capacities, to complete what they have not fully expressed.

How did Arabic works come to be available to European scholars. Was it haphazard, or was there a deliberate move to share knowledge. Tomorrow we will learn about Gerard of Cremona, and for a double treat, we will also talk about Gerard of Cremona. (Not a typo.)

Al-Kindi

Abu Yūsuf Yaʻqūb ibn ʼIsḥāq aṣ-Ṣabbāḥ al-Kindī (801-873CE) is called the Father of Arab philosophy. Born in Kufa and educated in Baghdad, he was instrumental in the translation of many Greek scholarly texts into Arabic. (Remember that a lot of classical scholarly knowledge came to Western Europe via Arabic translations.) He is also credited with introducing Indian numerals (what we mistakenly think of as Arabic numerals) into the Arab and western world.

He was a polymath who contributed to many fields, although he did not always find the scientific truth.

In astronomy he followed Ptolemy's geocentric theory of the solar system, and he was certain the planets followed circular orbits in obedience to God.

He was a chemist who debunked the idea of alchemy turning base metals into gold or silver. He was the first to distill pure ethanol, with which he created several perfumes. He also created cosmetics and pharmaceuticals, and wrote a book on the chemistry of perfume.

A recently discovered book of his in Istanbul, entitled (in English) A Manuscript on Deciphering Cryptographic Messages shows that he was a pioneer in cryptography with the first known explanation of how to decipher encrypted messages by analyzing the frequency of letters.

He wrote on pollution, environmentalism, and meteorology, and explained tides as a result of heating and cooling.

He published 15 treatise on music theory—five of which have survived—including the first known written use of the term "music" (musiqia); he urged the use of music in therapy.

In optics, he explained that both the eye and the object seen must be linked by a transparent medium (air) filled with light. He criticizes Anthemius of Trailes for reporting that sunlight could be focused in war to cause opposing warships to burst into flame. Anthemius did not witness it himself. Al-Kindi performed experiments to be certain this would actually work.

His theory that time, space, motion, and bodies were not absolutes but relative to other objects and the observer puts him closer to Einstein than to Galileo and Newton.

Although his belief that philosophy could support theology was contested by many Arabic scholars who followed him, his writings laid the groundwork much of Arabic philosophy to come.

He also applied mathematics to pharmacology, which I'll talk about tomorrow.

Elf Shot

Speaking of ailments caused by elves and other supernatural beings, "elf shot" was a concern in the Middle Ages, caused by invisible arrows shot by invisible elves causing sudden shooting pains. I am old enough to have experienced sudden sharp pains in limbs or my side, and I always assume it is simply the ravages of aging, or one of Hamlet's "thousand natural ills that flesh is heir to."

The Middle Ages understood enough about cause and effect to want to ascribe these pains to an external cause, and capricious and malicious elves was the best option. The Old English word aelfsogoða was used to describe internal pain from jaundice, and meant hiccups, also thought to be caused by elves.

The notion of "shot" was supported by archeological evidence; that is, folk in the Middle Ages occasionally found flint arrowheads left over from their neolithic ancestors. These were "evidence" of elf arrows. Dolled up and turned into amulets (see photo), they were worn as charms against witchcraft.

The cure was the concoction described in yesterday's post: feverfew, red nettles, way bread (European plantain); their vaguely spear-shaped leaves would make them suitable to counter an arrow wound.

Concerns about elf shot persisted. A report in 1884 from Orkney attributes the death of a cow from "her heart was riddled with fairy shot."

Going back a couple days...I mentioned St. Æthelwold's time spent at Glastonbury Abbey. It's a fascinating place, and will be the next topic.

Rabies

Rabies, from the Latin rabies which means "madness," has been noticed for a long time. The Codex of Eshnunna (c.1930BCE), found on two cuneiform tablets and pre-dating the Code of Hammurabi, declares the owner of a dog who shows signs of rabies is to be fined if the dog bites someone. Aristotle in 300 BCE described rabies as a disease that can be transmitted from a dog to the dog's victim. Excess salivation was a sign that a dog owner should take care to prevent the dog from biting someone. Rabies was known to Avicenna, who explained its symptoms, method of transmission, and treatment.

Treatment almost always failed until the modern era. There were reported cases of people surviving before modern methods of treatment, but not until Louis Pasteur and Émile Roux developed their vaccine in 1885 was there an effective way to prevent the spread.

But the Middle Ages had a solution: St. Hubert's Key.

St. Hubert, or Hubertus, was the patron saint of hunters and hunting, and therefore of hunting dogs, and therefore of rabid dogs. St. Hubert's Key was an example of a sacramental, which is the church's word for an amulet or talisman. Whereas an amulet or talisman were supposed to have magical properties, a sacramental's effectiveness depended on the faith of the user.

St. Hubert's Key was a piece of iron: either a nail or a cross or cone. They were given out by the monks of the Benedictine abbey where Hubert's remains were, as tokens to go to folk who could not make the pilgrimage to the abbey. These items were hung on the wall of your house for protection against disease.

How did this cure rabies? The piece of iron would be heated and placed on the site of the bite by a priest. The practice is recorded in the 1870s in the Ardennes region (where Hubert was active while alive) of branding a dog with St. Hubert’s Key to guard him from rabies.

Doctors in Dreams

I mentioned that Cosimo de' Medici was named for Saint Cosmas, as in Cosmas and Damian. They were two Arabian physicians of the 3rd century CE, possibly twin brothers.

They were known for treating people and not charging for their services—which seems very unlike doctors, but let that go. Because they were Christians, they were martyred in Syria in 287 CE.

...and that's all we have on their lives. Afterward, however, the legends grew. As saint physicians, the healing power of their relics was considered prodigious. Not long after their martyrdom, churches were springing up dedicated to them. Numerous pilgrims came for healing, and through the Middle Ages pilgrims would sleep in their churches, hoping for a healing dream.

Healing dreams were common in classical and medieval times: the belief that a spirit would appear in your dreams and diagnose or cure you. The picture here is a 1495 painting by the Master of Los Balbases. It represents the story of a man with a w withered leg sleeping at a shrine dedicated to the saints. When he woke up the next morning, he had a healthy leg, but it was from a black man. Assuming it had been transplanted from the corpse of a black man recently deceased and buried in the church graveyard, they exhumed the man's body and found that, indeed, his leg was missing.

Their feast day is 27 September.

Midwives

When Guy de Chauliac mentioned midwives in his great work on surgery, it was only a mention: he declined to express details because the field was dominated by women; men were not even allowed into the room when a woman was giving birth. In fact, "One Henne Vanden Damme, for having hid behind a staircase to eavesdrop upon his wife, she being in labour of childbirth, which thing doth not befit a man, for the said eavesdropping was fined 15 livres." [source]

Later in the Middle Ages, there was regulation of midwifery, but midwives, unlike doctors, were not associated with any formal training. In fact, some of the early manuals produced on midwifery—by the rare individuals in the profession who were literate—do not even demonstrate current medical knowledge. Midwives never formed into guilds, as other professions did with regularity. So far as we know, the qualifications for becoming a midwife were gained from on-the-job experience. Even Trotula, the famous female doctor and professor of medicine, discussed many female conditions but not the subject of childbirth.

According to Joseph and Frances Gies:

During labor the midwife rubs her patient's belly with ointment to ease her travail and bring it to a quicker conclusion. She encourages the patient with comforting words. If the labor is difficult, sympathetic magic is invoked. The patient's hair is loosened and all the pins removed. Servants open all the doors, drawers, and cupboards in the house and untie all the knots.
...
When the baby is born, the midwife ties the umbilical cord and cuts it at four fingers' length. She washes the baby and rubs him all over with salt, then gently cleanses his palate and gums with honey, to give him an appetite. [Life in a Medieval City, pp.60-1]

Some historians have noted that the regulation of midwifery started generally around the same time as persecutions for witchcraft. This is, of course, not true in all countries, but it would be difficult to miss the similarity between two different practices of trying to place controls on a segment of society that was in a position of potential harm, either through neglect (on the part of midwives) or design (on the part of witches).

Ginger

The European Middle Ages did not like bland food, and used spices extensively—often in combinations we would find odd or downright unappealing (although cinnamon-flavored pork tartlets are surprisingly very tasty). Among the many spices cultivated and grown in Europe was ginger.

Ginger has a long history of use for medicinal and culinary purposes. References to it indicate that it was used thousands of years ago in Southeast Asia, spreading elsewhere as trade routes were established. Ancient Rome procured it from trade with India and valued it greatly. By the Middle Ages, Arab cultures were spreading westward and carrying ginger rhizomes with them to plant and sell.

The name "ginger" [Zingiber officinale] is from the Old English gingifer, the adaptation of the Medieval Latin gingiber, from Classical Latin zinger, the Romans name for the spicy root they used in cooking and healing. (No, this is not the source of the modern term "a zinger," although relating a "zinger" to spiciness is tempting.) One author's history of ginger called it "the Alka-Seltzer of the Roman world." Ginger ale is still considered good for an upset stomach. The University of Salerno, famed for teaching medicine, claimed that a recipe for a happy old age was to "eat ginger, and you will love and be loved as in your youth."

From the 11th century, ginger became more popular as a flavoring agent, used in all sorts of medieval dishes. It became so popular that its import (it would not grow in the cold wet climates of the north, although it can be grown in well-warmed greenhouses, such as the Royal Botanic Gardens at Kew) made the value (in 14th century England) of a pound of ginger equivalent to an entire sheep (1 shilling and 7 pence, if you must know).

There is a legend that Queen Elizabeth I created gingerbread men cookies as gifts for the men of her court. That is unverified, but gingerbread definitely was known to the Anglo-Saxons. A recipe for medieval gingerbread can be found here.

The Death(s) of King Harthacnut

Harthacanute's death at the wedding feast
[Cambridge University Library, Ee.3.59, fo. 7r]

He was the son of King Cnut, and his royal name was Cnut II (of England) or Cnut III (of Denmark), but he is more usually known to us as Harthacnut. His parentage ascent to the throne has been mentioned before, but today we are going to talk about the cause of his death...or the causes of his death.

Harthacnut died on 8 June 1042, when he was only 24 years old. He was attending a wedding for one of his former stallers, Tovi the Proud. (A staller was a Norse official, a constable or standard-bearer.) Tovi was getting married for the second time, to Gytha, daughter of the powerful Osgod Clapa.

Anyway, he was drinking a toast to the bride when, as the Anglo-Saxon Chronicle put it:

A.D. 1042.  This year died King Hardacnute at Lambeth, as he stood drinking: he fell suddenly to the earth with a tremendous struggle; but those who were nigh at hand took him up; and he spoke not a word afterwards, but expired on the sixth day before the ides of June.  He was king over all England two years wanting ten nights; and he is buried in the old minster at Winchester with King Knute his father.  And his mother for his soul gave to the new minster the head of St. Valentine the Martyr: and ere he was buried all people chose Edward for king in London.  And they received him as their king, as was natural; and he reigned as long as God granted him. [Translator: James Henry Ingram]

The typical interpretation given to this by historians is that he died from a stroke due to an excess of alcohol.

Others think it was more likely a heart attack.

There is another theory, one which draws on a circumstance from long before the wedding feast.

Harthacnut, though young, was the center of a lot of political machinations. A history written at the order of his mother, Emma, says that in 1041 he sent to Normandy for his brother Edward so that they could rule together. One version of the Anglo-Saxon Chronicle says Edward was actually sworn in. Edward had no heir—not even a wife—and his naming as a king seems strange, considering Harthacnut was so young.

Did Harthacnut have a known illness? One that was making him clearly unsuitable to be king? Is that why Edward was summoned and sworn in? One historian* hypothesizes something like tuberculosis that was causing him to deteriorate in a way clear to those around him, suggesting that they secure an heir to the throne without relying on him to survive long enough to produce one himself.

*Howard, Ian, Harold II: a Throne-Worthy King. Essay included in King Harold II and the Bayeux Tapestry (2005). Boydell Press, ISBN 1843831244.

Ivar the Boneless

Ivar the Boneless, played by
Vaclovas Kiselevicius in the TV show
"The Dark Ages"

The post on Vikings in Ireland mentioned Ivar the Boneless, which was just begging for more detail on this fellow.

He was born Ivar Ragnarsson, the son of Ragnar Lodbrok and Aslaug Sigurdsdottir. Viking sagas considered him a ferocious warrior.

He was a leader (with his brother Halfdan) of the so-called "Great Heathen Army" that the Anglo-Saxon Chronicle says invaded East Anglia in 865 and then a year later marched northward and took York from the Northumbrians. A few years later, he left England, either to rule Dublin or to go back to take up rule in parts of Denmark and Sweden.

Curiously, this fearsome warrior, who was said to be so large that he towered over everyone else, had the nickname "the Boneless." It might have been some snake metaphor suggesting "slipperiness of character." His brother had the nickname "Snake in the eye" which might suggest that you could not trust him. We are not sure of that. But Viking sagas describe him with:

Only cartilage was where bone should have been , but otherwise he grew tall and handsome and in wisdom he was the best of their children. [link]

It is possible, since he was such a great fighter, that the epithet "the boneless" (in Norse: hinn beinlausi) referred to an extraordinary flexibility, which would have contributed to his fighting prowess. Suggestions that it refers to sexual impotence cannot, of course, be substantiated, although there is no evidence that he fathered any children, or even took a wife.