Humorism

Trying to understand biology had many false starts. You probably have some idea of "humors" and the adjectives cold, hot, wet, and dry. These four provided a nice symmetry, and as you can see in the illustration, they also fit with the foursome of elements.

Other cultures came up with different paradigms. Indian Ayurveda medicine believed in three humors (tissues, waste, and dosha, "that which can cause problems") and five elements (adding "space" to the four seen here).

These qualities were supposed to explain the functioning of the body as a balanced mixture. An unhealthy state was the result of the balance being thrown off, the excess or absence of one of the humors.

The arrangement familiar to the West likely started with Hippocrates (although there were others around his time who also expressed ideas about the four elements), who systematized the idea of different substances being balanced in humans:

The Human body contains blood, phlegm, yellow bile, and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others. [On the Nature of Man, attributed to either Hippocrates or his son-in-law, Polybus]

Galen furthered this theory, tying it to seasons and stages of life. For instance, a child corresponded to spring. Blood was hot and wet, which corresponded to spring. Yellow bile, hot and dry, corresponded to summer, corresponding with the life stage of a young man, and so on.

The humors could also influence personalities; one Greek text put it thusly:

• The people who have red blood are friendly. They joke and laugh about their bodies, and they are rose tinted, slightly red, and have pretty skin.
• The people who have yellow bile are bitter, short tempered, and daring. They appear greenish and have yellow skin.
• The people who are composed of black bile are lazy, fearful, and sickly. They have black hair and black eyes.
• Those who have phlegm are low spirited, forgetful, and have white hair. [from link]

These attributes were not predictive, like astrology. If a person's manner changed, it could be because the mix of humors in him had changed.

Humorism, or humoral theory, "explained" so much about physical health and temperament for 2000 years. The 1600s brought more exploration via surgery and the use of microscopes to better understand the function of the organs of the body and the fluids inside it. With the advent of germ theory, proposed in 1546 and expanded in the 18th century, the idea of humors fell by the wayside. 

Of course, there was much more to medical treatment in the Middle Ages than just fiddling with the balance of humors. Sometimes you had to get out the knives. Let's talk about medieval surgery tomorrow.

Leprosy

Hospitals in the Middle Ages could be designed for different clientele. Some (like the Jerusalem Hospital) were specifically for pilgrims/crusaders who needed help in the Holy Land. Some were for the poor and infirm/elderly. Then there were hospitals specifically designed for those whom you wanted to keep distant from everyone else: lepers.

The word "leprosy" comes from Greek Λέπρα, literally "a disease that makes the skin scaly" (yep, they had a word for it!). The earliest English language use is in the Ancrene Wisse, a 13th century handbook for nuns. The word "leprosy" is falling out of use since the disease is less common. It is more commonly referred to as Hansen's disease, after the Norwegian physician who identified Mycobacterium leprae in 1873. Four strains have been identified, largely confined to geographical area.

Symptoms described in literature that could be leprosy have been recorded as early as 700 BCE in Sri Lanka and by Hippocrates (who was aware of a lot) in 460 BCE.

Lepers were not welcome in town or village, and leprosaria, a hospital for lepers, were few and far between. Covering the open sores with bandages was one way of dealing with it. 

Sometimes it could be treated with blood—a physician might think the leper had too much blood, and would make an incision near a sore to drain some blood. Because some thought leprosy was the result of sin, attempts to restore the victim to pre-sinful innocence involved a bath that was "medicated" by adding  some blood from an innocent infant or pure virgin. Supposedly, the corrupt blood would leave the body, to be replaced by the innocent blood. Another method to restore purity was an alchemist's concoction that contain the "purest" of elements, gold. Pliny and others thought snake venom was a potential cure; as recent as 1913 doses of bee stings were considered as a cure by someone named Boinet.

These days Hansen's can be controlled by bactericides and by the patient developing good habits: frequent VSE (Visual Surveillance of Extremities), cleaning any scratch/wound immediately, good hygiene.

Now to "turn on a dime," let's look at that manual for nuns next.

Hysteria

from a Latin copy of Gynæcology by Soranus of Ephesus

Hysteria describes two different states: exaggerated or uncontrollable emotion or excitement, and as a psychological disorder in which psychological stress can manifest physical symptoms. The word is derived from the Greek word for uterus, ὑστέρα [hystera]. Hysteria was once assumed to be solely a female medical problem.

It seems to have started with Hippocrates (c.460-c.370 BCE), who maintained that men and women had entirely different bodies: men's humors were hot and dry by nature, women's were wet and cold. Women also had different processes, such as menstruation. Hippocrates did not pass judgment on these differences; they merely needed to be addressed by the practitioner of medicine.

Aristotle (384-322 BCE), however, had other ideas. He postulated that processes like menstruation could be harmful to men, who should avoid women during that time. He also felt men's bodies were perfect and women's were flawed. Women were irrational and unbalanced—literally "unbalanced," because he believed that the uterus "wandered" in the body.

By the time medieval medicine came along, the authority of Aristotle made it clear: over-emotional women were suffering from being unbalanced because of their womb. Hysteria could be treated by removing the source of the unbalance, and the hysterectomy was "born." (Sorry.) Unfortunately, as summarized in this abstract:

The procedure was performed by Soranus of Ephesus 120 years after the birth of Christ, and the many reports of its use in the middle ages were nearly always for the extirpation of an inverted uterus and the patients rarely survived. [source]

The procedure wasn't considered remotely safe until antiseptic techniques began in the 19th century. Even so, it wasn't until the 20th century that diagnoses of hysteria declined, possibly because the general public came to understand that "hysteria" was too easily used as a label for anxiety.

Avicenna

In 1527, when the healer and alchemist Paracelsus wanted to display his contempt for tradition, he burned a book in the town square in Basle, where he had been appointed to the university by the town council. That book, allegedly, was The Canon of Medicine by Avicenna. Paracelsus had gone too far in rejecting what was still considered a fundamental work in western medicine. He was ejected from his post at the University, and from the town itself. Avicenna was too respected, even 500 years after he wrote his books.

Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā, called by the West Avicenna (c.980-1037), was mentioned here in the context of medicine. About 40 of the 240 surviving texts that he wrote (of a total of about 450!) deal with medicine. The encyclopedic Book of Healing and the Canon became standard textbooks for centuries.

The Canon assembled the best known medical knowledge to date, including Galen (129-c.200 CE) and Hippocrates (c.460-c.370 BCE) and adding a great deal of information that seems new to Avicenna. For instance:

The 'Qanun' is an immense encyclopedia of medicine. It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy; contagious nature of phthisis*; distribution of diseases by water and soil; careful description of skin troubles; of sexual diseases and perversions; of nervous ailments. [George Sarton, Introduction to the History of Science]

Another reason why Paracelsus would want to burn Avicenna: Paracelsus was advertising his reputation as an alchemist, and believed that with salt, sulphur and mercury you should be able to produce anything. Avicenna, however, was completely opposed to the idea of alchemy, rejecting the notion that man could improve on Nature.

One could still work with Nature, however. Besides dealing with disease and injury (such as explaining how to judge how much healthy tissue could be removed during an amputation or the removal of cancerous tumors), Avicenna promoted restoring health, not just treating disease. He believed in the importance of physical exercise, of a good diet, and of a healthful environment.

Among other innovations, he lays the groundwork for modern ophthalmology, even suggesting that the optic nerves cross over each other. He laid out careful ground rules for the preparation, administration, and testing of drugs.

It has been called "one of the most significant intellectual phenomena of all times."** The Canon of Medicine is an essential part of any curriculum that studies the history of medicine.

*tuberculosis
**Swiss tuberculosis expert, Arnold Klebs

The Edict of Salerno

Salerno, located on the lower "shin" of Italy's southwest coast, has been occupied continuously since pre-historic times, frequently changing hands due to the many wars in the peninsula. Despite the changing political landscape, however, at least one feature of Salerno rose to a prominence that it held for several centuries, through several political shifts.

We don't know precisely when the Schola Medica Salernitana (Medical School of Salerno) was founded, but at some point, the dispensary of a 9th century monastery became a focal point for medical study and earned the title of the first medical school in history. Because of the fame of the school, Salerno became known as the "Town of Hippocrates."

The School today.

One of its unique qualities for the time was that it not only was well-versed in the Greco-Roman traditions of Hippocrates, Galen, Dioscorides and others. Its proximity to North Africa and Sicily gave it access to Arabic learning (Sicily was under Arab control from 956 until 1072). In fact, it was the arrival in 1077 of the Tunisian Muslim merchant-turned-monk Constantinus Africanus that started a Golden Age at the school. He compiled the Liber Pantegni (Book of All Arts).  It was (as is typical for the time) largely a collection of the work of others, but it drew together Greek and Arabic medical knowledge in what is called the earliest surviving Western medical treatise [source].

Salerno produced other medical texts as well. A 12th century pair named Johannes and Matthaeus Plantearius wrote the Liber de Simplici Medicina (Book of Simple Medicine). Several books on gynecology and cosmetics were created by the most famous woman doctor of the time.

Salerno thrived, even after Holy Roman Emperor Frederick II declared the Edict of Salerno. The Modern Age would approve of the Edict: it created a legal separation between physicians and apothecaries. Physicians could no longer prescribe medicines that they themselves prepared and sold. The Edict also fixed prices to prevent overcharging the sick. Over time, this Edict was copied throughout Europe, and we have reason to be glad that similar regulations exist today.