About Preventing Children

Folk in Classical and Medieval times developed many methods for avoiding getting pregnant, but sometimes the inevitable happened. The Bible's statement to "be fruitful and multiply" made the Church's stance on aborting a pregnancy clear, but the rest of the culture did not always see it that way.

Avicenna (c.980 - 1037) offered this reasoning:

At times it may be necessary to induce abortion; that is, when the pregnant woman is young and small and it is feared that childbirth would cause her death, or when she suffers from a disease of the uterus or when a fleshy growth in the uterus makes it very difficult for the fetus to emerge. Also when the fetus dies in the womb of the woman. Know that when labour continues for four days it means that the fetus is already dead.

Methods of abortion could be dangerous to the women as well. Hippocrates had refused to use abortifacients because of the danger they posed to the mother. The early Church stated that women who abort a child should be exiled from the church. A synod in 314 modified that to 10 years of exile. The Church Father Basil the Great later softened that, saying it should be less if the woman shows repentance.

In another case, a woman was sentenced to death for aborting her child precisely because she did it with malicious intent to prevent her husband (whom she had come to hate) from having an heir. Roman law allowed that, if a woman were to do the same thing for the same reason but it post-divorce, then she should only be exiled.

The Church Father St. John Chrysostom criticized abortions, but gave the example of a sex worker who needed to abort a pregnancy or else she would lose her livelihood. He goes so far as to blame her male client, who was responsible for getting her pregnant, as the real murderer.

A 9th century Byzantine author of a biography of a Greek Patriarch Ignatios tells the story of a woman with a breech birth who is in intense pain. The doctors prepare for an embryotomy (removing the baby by cutting it into parts and removing them). The 6th-century Bishop Paul of Mérida, who trained as a doctor in his youth, doesn't scruple to perform an embryotomy to save a woman's life.

That late-term abortions can find their way into accounts of religious lives and can be justified by Christian saints suggests a very different attitude toward the health and safety of the mother than is sometimes taken these days.

Embrotomies would have been difficult for the surgeon and the patient. Let's talk next about some of the other surgical practices that were employed in the Middle Ages. 

Aëtius of Amida and Acne

Galen was one of the primary sources of medical expertise in Antiquity and the Early Middle Ages, often to the neglect of other authors. The works of the 6th century Aëtius of Amida have more recently undergone closer scrutiny and revealed his originality and importance in his field.

He was born in Amida in Mesopotamia (what is now the city of Diyarbakir in Turkey), but at some point moved to Constantinople. His writings refer to Petrus—the personal physician to Theodoric of the Ostrogoths—as a contemporary, which would indicate that Aëtius was writing at the end of the 5th century or early in the 6th.

As a Byzantine Greek in the 5th-to-6th centuries, he was likely a Christian.  His closeness to the emperor(s) of Constantinople can be discerned by the title sometimes attached to his name in records: κόμης ὀψικίου ("komés opsikiou"), the "chief officer" who is part of the emperor's retinue. He might have been given official duties outside of his medical profession, since he traveled to copper mines on Cyprus, and at Jericho and the Dead Sea.

His great work was Sixteen Books on Medicine, which later editors thought to organize into four tetralogies. He does quote the Greco-Roman Galen and Oribasius (personal physician to the Roman Emperor Julian), but adds much original information. Some of his work directly applied to pregnancy—or rather, avoiding such. He is known to have developed a concoction for causing a pregnancy to abort; the ingredients are not known. He also developed a contraception medicine consisting of aloe, pepper, saffron, and the seeds of the wallflower (a member of the cabbage family).

He described a condition of the skin, a particular kind of blemish that arises when one is in the "acme" of his or her life, during puberty. Due to a typographical error, however, when he described it as part of the acme (ἀκμή) of life, the word was written as ἀκνή, accidentally substituting the "n" sound in place of the "m" sound. The word "acne" never having been seen before, it was assumed that this was his name for the blemishing, and the scourge of adolescent complexions through the ages got its name.

About his contemporary, Petrus; or rather, about Petrus' chief patient: I've referred to Theodoric more than a few times, but haven't yet dug into the details of the man who was king of one thing or another from 471 to 526—a pretty substantial length of time. It's time we looked into his life in a little more detail, which we shall do tomorrow.

Saint Blaise

The man who would become known to Western Europe as Saint Blaise was Bishop Vlasi of Sebastea in Armenia. His life was written about 400 years after his death, in the Acts of Saint Blaise:

Blaise, who had studied philosophy in his youth, was a doctor in Sebaste in Armenia, the city of his birth, who exercised his art with miraculous ability, good-will, and piety. When the bishop of the city died, he was chosen to succeed him, with the acclamation of all the people. His holiness was manifest through many miracles: from all around, people came to him to find cures for their spirit and their body; even wild animals came in herds to receive his blessing. In 316, Agricola, the governor of Cappadocia and of Lesser Armenia, having arrived in Sebastia at the order of the emperor Licinius to kill the Christians, arrested the bishop. As he was being led to jail, a mother set her only son, choking to death of a fish-bone, at his feet, and the child was cured straight away. Regardless, the governor, unable to make Blaise renounce his faith, beat him with a stick, ripped his flesh with iron combs, and beheaded him.

This incident forever joined the saint's name to throat ailments, but he is also the patron saint for infants, animals, builders, stonecutters, carvers, drapers, wool workers, wool industry, veterinarians, physicians, healing, the general sick, choking, and Ear Nose and Throat illnesses.

As well as a plethora of causes for which one might appeal to Blaise, there were numerous locations that claimed his patronage: several towns in Italy, in Sicily, Sebastea, and Dubrovnik, whose Republic of Ragusa even has his likeness on their flag! Dubrovnik and others have parades and festivities on 3 February for the saint's feast day.

Blaise was very popular in the Middle Ages, with many churches and locations named for him. A shrine near where he was martyred was commented on both by Marco Polo and William Rubruck.

Outside of works on saints' lives, he was mentioned by Aëtius of Amida, a medical writer, for his healing abilities. Aëtius is interesting for many reasons, one of which is the typographical error in one of his works that named a near-universal medical issue. But that's a story for tomorrow.

The Invention of Acne...

A copy of his work [source]

...was a typographical error.

The word "acne" does not come from a classical language root; that is, not in the way we usually derive our modern medical terms. It was described by a Greek physician and then mis-transcribed in a later volume of his work.

Aetius of Amida was a contemporary of Theodoric the Great (454 - 526; mentioned here in connection with Grammar). He was known for the breadth of his learning; his writings show a great knowledge of those who came before him as well as personal skill. He came out of Mesopotamia and learned medicine at Alexandria, known for its medical school.

His famous work was Sixteen Books on Medicine, in which he compiles knowledge from Galen and others of whom we would otherwise have little information: the surgeons Rufus of Ephesus and Leonidas, and the obstetricians and gynecologists Soranus of Ephesus and Philumenus. He is not completely derivative, however. He includes original treatments for eyes, ears, nose and throat, as well as goiter and rabies and others. He also addresses surgical procedures such as for a fistula or tonsilitis.

Although a Christian, he was not immune to the cures that came from non-Christian sources. He relates spells and charms popular in Egypt at the time. Also, in explaining how to help a person suffering from a bone stuck in the throat, he makes the earliest reference to St. Blaise.

As for the condition in which the skin is covered with small eruptions or peaks, he used the Greek word ἀκμή ["acme"; point]. Unfortunately, a scribal error in a later copy turned this into ἀκνή ["acne"]. The popularity of his text made this the common name for the affliction, and so it remains.