Showing posts with label medicine. Show all posts
Showing posts with label medicine. Show all posts

Tuesday, December 5, 2023

Medieval Germ Theory?

It was Ignaz Semmelweis in the 1840s in Vienna who noticed a link between illness (and death) and unsanitary conditions, specifically a link between women dying during childbirth who were aided by people who also were performing autopsies. He spent years trying to implement a universal handwashing policy. He did not know what was causing the deaths, but he saw a link to something.

Figuring out the cause of disease was a goal for anyone practicing medicine from the beginning of the discipline. Long before germ theory was developed, the miasma theory was proposed by Hippocrates (c. 460 – c. 370 BC): that some form of "bad air" or even "bad water" arising from rotting matter caused diseases like the Black Death, cholera, and other infections. This was an important move away from the theory of supernatural causes of illness. (There was also the idea of an imbalance in the body's natural humors.) The miasma theory allowed infection to pass through a population because of the environment, not from personal contact.

To counter bad air, you would naturally want "good air."  medical faculty of the University of Paris, writing in 1348 to explain the causes of the Black Death, said "The present epidemic or pest comes directly from air corrupted in its substance" and recommends incense which "hampers putrefaction of the air, and removes the stench of the air and the corruption [caused by] the stench."

Earlier, however, there were counters to the miasma theory.

The Classical Era and Middle Ages did have theories of person-to-person contact. Thucydides (c.460BCE - c.400CE) believed that the plague of Athens was being spread by personal contact. Galen (129 - c.200CE) referred to "seeds of plague" in the air. Isidore of Seville also mentioned "plague-bearing seeds." Avicenna (c.980-1037) was widely studied, and he linked the miasma theory with personal contact, believing an ill person could infect others by transmitting the "bad air" through breathing. His example was tuberculosis, and he believed that disease could also be transmitted through dirt and water, anticipating Semmelweis by 800 years.

Recent posts have mentioned Bologna as an important center for medical study, so it is not surprising that it was a professor of Bologna, Tommaso del Garbo (c. 1305–1370), who in 1345 promoted Galen's "seeds of plague" idea in his works

It took Girolamo Fracastoro in 1546, however, to publish De Contagione et Contagiosis Morbis ("On Contagion and Contagious Diseases"), three volumes on different diseases and their avoidance and treatment. He believed that there were particles that could travel through the air or by direct contact.

The idea that these "seeds of disease" were living things (what we call "germs") and traveling from one person to another was not being entertained, simply because there was a long-standing theory that living matter could arise spontaneously from putrefaction, and no one believed in invisible living things floating in the air. The belief that life could spring from rotting organic matter hindered understanding of bacteria already existing in the air around us. As it turns out, there were plenty of examples of Spontaneous Generation; let's talk about those tomorrow.

Monday, December 4, 2023

Theodoric Borgognoni

Speaking of surgery recently, we need to take a look at Theodoric Borgognoni, who pioneered some practices that were ahead of their time. Born in Lucca in 1205 to a physician and teacher, Hugo Borgognoni, he was destined for a medical career. He studied medicine at the University of Bologna. He also became a Dominican, then the personal physician to Pope Innocent IV, was made Bishop of Bitonto, and eventually became Bishop of Cervia.

Although he had ecclesiastical duties, he still practiced medicine and taught. One of his students was later the "father of French surgery," Henri de Mondeville. Borgognoni wrote the Chirurgia ("Surgery") in the mid-13th century, four volumes that cover what was known about surgery at the time, with his own additions. (A copy of the work created c.1300 on vellum was auctioned at Christie's a few years ago; a sample page is illustrated above.)

In the Chirurgia, he advocates many interesting techniques. Broken bones were a serious problem, and Borgognoni explained how to re-align the bones and tie them together with gold or silver wire. He also advocated post-operative massage of the area to aid proper healing.

Much of Chirurgia is similar to a work written 15 years earlier by Bruno da Longoburgo, but since both of them were students of Hugo Borgognoni, that can be expected. Borgognoni the younger, however, has plenty of ideas not found in the other work.

He departed from standard medical beliefs about pus. For centuries, pus bonum et laudabile ("good and laudable pus") in a wound was considered a sign of proper healing. There was some sense to this, because severe infection led to necrotizing tissue, which and looked very different was much worse. Pus was a different symptom, and looked to early doctors much better than the other option. Wounds that showed pus, therefore, would be left open to suppurate to support the healing process.

Borgognoni did not believe that pus in the wound was proper: he advocated cleaning and drying the wound, then suturing it:

"For it is not necessary that bloody matter (pus) be generated in wounds -- for there can be no error greater than this, and nothing else which impedes nature so much, and prolongs the sickness."

He also (which was not a unique idea) used wine to treat a wound. Now we know, of course, that alcohol in wine would help to kill harmful bacteria. Of course, wine for treating wounds did not automatically lead to the idea that a substance in wine was "killing" something in the wound. Wine was a good thing, and its goodness had healing properties—that was the thinking. It would take centuries to develop germ theory. There were, however, small steps in that direction, and I'll explain those tomorrow.

Sunday, December 3, 2023

Medicine Men

In the middle of the 14th century, the centers of medical knowledge were the universities at Bologna, Montpellier, and Paris. One of the professors linked to Bologna who trained several future doctors was Taddeo Alderotti.

Alderotti was born in Florence but moved to Bologna where he taught several men like Gentile da Cingoli, the emperor's doctor Bartolomeo da Varignana, and the anatomist Mondino de Luzzi.

Alderotti was a highly reputed doctor in his own right, and patients came from all over Italy to see him, making him a very wealthy man.

Another student at Bologna was Henri de Mondeville. Mondeville (c.1260 - 1320) was French, and studied at Montpellier and Paris before moving to Bologna to study under the prominent surgeon Theodoric Borgognoni, who had some new ideas about treating wounds. After studying under Borgognoni, he went back to the University of Montpellier as a professor of anatomy and surgery. He became royal surgeon to King Philip IV and his son King Louis X.

Mondeville wrote the first French surgical treatise, La Chirurgie ("Surgery"). Intending to write it in five sections, he only completed two from 1306, when he started, to his death in 1320. Some of his statements were opposed to current "wisdom," and it wasn't until centuries later that it was rediscovered in 1892 and Mondeville's ideas were justified.

What was so controversial? His approach to treating wounds, which he learned from Borgognoni. I'll explain the radical ideas of Theodore Borgognoni next time.

Saturday, December 2, 2023

Mondino de Luzzi, Anatomist

Successful surgery benefits from knowledge of the body's interior, and the study of anatomy was not always easy to come by. Dissecting human bodies fell out of favor after the Classical Era. One Italian physician did extensive research in anatomy and restored the study of it. His name was Mondino de Luzzi, and he lived and worked in Bologna from c.1270 - 1326.

His father and grandfather were pharmacists, and his uncle taught medicine. Mondino himself taught medicine and surgery at the University of Bologna from 1306 to 1324. In 1316 he published an illustrated manual of details of the inside of the human body (sample to the left). The Anathomia corporis humani ("Anatomy of the human body") was the first of its kind.

He theorized a hierarchy of body parts based on what he considered most important. The abdomen was the "least noble" part of the body, and so should be dissected first. The thorax came next, and last was the head with its "higher and better organized" structures (the organs of the senses: eyes, ears, mouth). He also discussed different methods of dissection between simple versus complex structures, like muscles and arteries versus eyes. When dissecting muscles, he suggested letting the cadaver desiccate, rather than mess with a decaying cadaver. The Anathomia was a manual to explain Mondino's proper methods for dissection.

That doesn't mean he was right about everything. He claims the liver has five lobes, the stomach is round and its internal lining is where sensation happens and the external layer is where digestion takes place. He apparently never found an appendix in a cavern, even though he examined many intestines. He says the heart has three chambers, not four. Still, the text became a standard in medical knowledge for 300 years.

Mondino wasn't much interested in pathology of disease, which is just as important to medicine as understanding how the physical; body works, if not more so. Fortunately, there were others—contemporaries of Mondino's, in fact—of whom we shall speak...tomorrow.

Friday, December 1, 2023

Surgery in the Middle Ages

The Middle Ages saw illness as an imbalance in the humors of the body. Sometimes that could be treated by changing the diet. In the case of some illnesses, it might be determined that the body had too much of the "hot, wet" humor, blood, for which the treatment was to drain some of it.

Blood-letting was the simplest surgical procedure, but medieval surgeons were eager to accomplish more. Part of the history of surgery in Western Europe was tied to the needs of warfare. Consider John Bradmore's efforts to remove an arrow from Henry V. Another surgeon connected to royalty was John Arderne, the expert on a very particular and painful physical problem that he treated with surgery.

Monasteries and other religious organizations were more educated than the general population, and their access to books meant knowing more about medicine. There was one branch of medicine they avoided, however, even though the Egyptian and Greeks practiced it: dissection and surgery. The church was squeamish about surgery because it shed blood (and could lead to infection and death). The Fourth Lateran Council of 1215 prohibited clerics from surgery or any practice that shed blood. Dissection of corpses was also frowned on.

Lay people, however, continued to expand knowledge of anatomy. The Italian Cronica of Salimbene di Adam (1221 - c.1290) tells the story of an epidemic that was killing men and chickens. A physician of Cremona discovered through dissection that the chickens had abcesses in their hearts. The corpse of a human victim was dissected; the same abcesses were found. The physician put out a pamphlet warning people against eating chicken or eggs, assuming that they were causing the spread of the disease.

Italy was where great strides in anatomy and surgery took place. The Anatomical Theatre of Padua, begun in 1595, was the first permanent anatomical theater in the world, where students watched their teachers dissect bodies to learn human anatomy. Anatomical dissection in Italy had begun long before that, however. For that story, we have to look at Italian physician Mondino de Luzzi (c.1270 - 1326), and the Anathomia corporis humani of 1316. We'll look into him next time.

Thursday, November 30, 2023

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.

Wednesday, November 29, 2023

The Maintenance of Health

The modern Italian word for a notebook is taccuino. It comes from the medieval (and later) popularity of the Tacuinum Sanitatis. That name is a Latinized version of the Arabic Taqwīm aṣ‑Ṣiḥḥa ("Maintenance of Health"). It was written in the 11th century by Ibn Butlan of Baghdad, a physician and Christian theologian during the Abbasid Era.

The original was organized in synoptic tables: a way to present data in a simple and condensed manner, previously used for astrological tables. Ibn Butlan used them to present not just ways to treat illness and to maintain health, but also ways to prepare food and how and what to grow for health. Later manuscripts were lavishly illustrated, especially after the 14th century. (The illustration is of a facsimile edition made in 1986.)

Ibn Butlan set out the essential elements of health and well-being:

  • sufficient food and drink in moderation
  • fresh air
  • alternations of activity and rest
  • alternations of sleep and wakefulness
  • secretions and excretions of humors
  • the effects of states of mind

If one is not paying attention to these elements, illness occurs.

The Tacuinum includes lists of many vegetables, fruits, nuts, and herbs that are good for treating certain conditions. It also includes the dangers of excess consumption. As the manuscript was copied and distributed, changes were made, and not every copy includes every list. Some added remedies that were not in the original.

The word "humors" was italicized in Ibn Butlan's list because I wanted to draw attention to it. I've ignored discussing the medieval idea of humors for over a decade because I assumed people have already heard of them and I want this blog to focus on all the things that are not generally known. Of course, the details of humors are probably worth talking about. See you tomorrow.

Tuesday, November 28, 2023

Sugar!

Our teeth would no doubt be better off if this had never been discovered, but Pandora's box was opened long ago. Different species of sugarcane were being harvested in the Indian subcontinent, New Guinea, Southeast Asia, and other places long before the Common Era.

An admiral of Alexander the Great learned of sugar on a campaign in India, so it was inevitable that sugar would make it to the Mediterranean area by traders. Pliny the Elder describes it in his Natural History, but not as a food:

Sugar is made in Arabia as well, but Indian sugar is better. It is a kind of honey found in cane, white as gum, and it crunches between the teeth. It comes in lumps the size of a hazelnut. Sugar is used only for medical purposes.

Crusaders brought sugar back to Europe from the Middle East, calling it "sweet salt." It was a common sweetener during the reign of Henry II, and Edward I imported a lot. Until the 1300s, it was affordable only by the wealthiest.

Venice saw its value and set up manufacturing in Lebanon, becoming the chief sugar distributor in 15th century Europe. Sugar was introduced to the Canary Islands and Madeira, after which Europe could get it more easily (but not necessarily cheaply). In the same year that Columbus sailed westward on his maiden voyage to the New World, Madeira produced 3,000,000 pounds of sugar.

Part of the allure of sugar was its reputed health properties. The Tacuinum sanitatis ("Maintenance of Health") of the 11th century has this advice about sugar:

Ask the grocer for refined sugar which is hard, white as salt, and brittle.  It has a cleansing effect on the body and benefits the chest, kidneys and bladder...It is good for the blood and therefore suitable for every temperament, age, season and place.

If it's that good for ill bodies, imagine what it could do for a body already healthy? There was plenty of inducement to enjoy sugar for its "healthful" effects.

You might guess that the Tacuinum sanitatis—considering its early provenance—was not a European text, and you'd be right. Let me tell you more about it tomorrow.

Thursday, November 2, 2023

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.

Wednesday, November 1, 2023

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.

Sunday, October 29, 2023

The Pearl of the Adriatic

The oldest apothecary in Europe was founded in Dubrovnik, in southern Dalmatia in Croatia. At the time, it was called Ragusa; to be fair, it was called both names for centuries, "Ragusa" being used since the 10th century (it was the center of the "Republic of Ragusa") and "Dubrovnik" showing up a century later as the town name and widely used in the 16th and 17th centuries up to now. 

It was founded in the 7th century by Romans from the south fleeing fighting between Slavs and Avars. Byzantium initially protected this part of the world, but later it would fall (like much of the Adriatic coast) under control by Venice.

One of the things Ragusa became known for was ship-building; in fact, they built their ships indoors because their methods were so innovative that spies wanted to copy them.

A very forward-thinking city, they adopted a code of laws and public services that sound very modern. A medical service was started in 1301, the apothecary mentioned above was established in a monastery in 1317 and still functions today. In 1347 they opened an almshouse (just in time for the Bubonic Plague which arrived a year later), and a quarantine hospital in 1377. Ragusa established a separate town outside the walls for those suffering from leprosy. 

Their law only allowed a doctor to be paid when the patient was healed. A female doctor was mentioned in records in 1325. A service for removing garbage from the town was first recorded in 1415. The city paved the streets, and shop-owners were required to sweep the area in front of their shop. Aqueducts and sewage systems were installed in 1436. Underground silos were built that could hold 1200 tons of grain (which they had to import). They voted to abolish slavery in 1416.

Ragusa/Dubrovnik has so much fascinating history that I want to continue this tomorrow.

Saturday, October 28, 2023

The Plague Continues

The Bubonic Plague, also called the "Black Death," first hit the European Middle Ages primarily in 1348-1351, but that wasn't the end. To be fair, it was revving up to the east long before 1348. It was responsible for deaths in the 1200s in China. In the 1340s it was killing people living around the Black Sea. In fact, we know that it existed among rodent populations high up in the Alps.

How do we know this?

The spread of the plague has been better understood in recent decades thanks to modern science and the sequencing of genomes. The bacterium Yersinia pestis has been sequenced, and modern science can detect it from bones of the long-dead. In many cases, those bones are easier to identify because the plague killed so many so fast that the corpses were thrown into mass graves quickly. In fact, the approach of the plague did prompt preparation: the mass graves in London were dug before the plague actually arrived. (The illustration shows a mass grave of plague victims in France.)

Therefore, by examining skeletons from different eras, we can track the spread and durability of the plague, which was endemic in Europe after the mid-14th century appearance. Plague returned approximately every decade or so for centuries. Whatever the cause (see the link in the first paragraph), folk realized they should try to stay away from those who were infected. This led to quarantining when news of a plague resurgence came to a community. You could either barricade yourself in your house or escape the town. In 1377, the town of Ragusa on the Adriatic initiated the first wide-spread, mandatory quarantine. In the second half of the 1400s, quarantines were common around the Mediterranean, whose warm weather and coastal ports allowed plague to thrive and spread.

Ragusa actually had a reputation for doctors. If you search for Ragusa on a map today, it will show you a city in southern Sicily, not on the coast of the Adriatic. That's because it's got a different name now: Dubrovnik. Let's talk about its medieval history tomorrow.

Thursday, October 26, 2023

A Few Medical Firsts

Gentile da Foligno was a physician who learned his art at Padua and Bologna and then became a teacher—quite a wealthy one, as it happens. At the University of Perugia in Siena he made 60 gold florins per year (1322 - 1324). He then went back to his origin at the request of the Lord of Padua, Ubertino I da Carrara.

Besides teaching, he produced several medical treatises. One was a massive and widely copied commentary covering the Canon of Medicine by Avicenna. The Nuremberg Chronicle of 1493 referred to him as Subtilissimus rimator verborum Avicenne, "that most subtle investigator of Avicenna's teachings"; the illustration above shows Gentile learning "at the feet of Avicenna."

He is said to have performed the first medical dissection in centuries. Even the Romans, for all their search for knowledge, did not approve of cutting open the deceased. Examining the insides of the human body was necessary for starting to learn how organs work; for example, how liquids flow through the body.

Foligno wrote a commentary on urine and suggested that the blood passes through "porous tubules" (per poros euritides) in the kidneys, which strain it and pass the urine to the bladder. He was also the first to suggest that a fast pulse rate led to higher urine output (as a faster metabolism would). He also believed there was a correlation between the heart and the color of urine. A Journal of Nephrology article says he may have been the first cardionephrologist in history.

He also wrote a popular treatise on the Black Death, and recommended theriac for its treatment. Unfortunately, theriac preparation was complex and time-consuming, so there may not have been enough of it to go around. Not that it would have helped: presumably Foligno would have had access to some; however, he died of the plague at its start, on 18 June 1348.

To cure the plague, you would probably want to know what caused it, and that was a puzzle. Tomorrow I'll tell you of the Paris Consilium, who believed they had the answer.

Wednesday, October 25, 2023

The Poison that Cures

It started with King Mithridates IV of Pontus (132 - 63 BCE), who was afraid of being poisoned. He wanted to know all about poisons, so he not only tested them on criminals so he would understand their symptoms (and antidotes), but also he ingested the poisons himself in order to build tolerance. His personal physician developed for him a universal antidote which he named mithridatum, composed of 40 ingredients, including opium, myrrh, saffron, ginger, and cinnamon.

Mithridates' method of self-inoculation worked so well that, when he was captured by Pompey, he tried to poison himself, but the poison had no effect. His writings about developing the cure-all was found by Pompey's people and translated into Latin. Nero's physician added more ingredients, most notably mashed and roasted viper's flesh.

The search for a panacea, a universal cure, has a long history. Mithridatum is one example. The Greek physician Galen (mentioned many times in this blog) wrote an entire book on the making of his cure-all; he called it Galene after himself, but it also became known as theriac (from the Greek word for a wild beast); it contained viper's flesh, opium, honey, wine, cinnamon, and more than 70 other ingredients. It needed to ferment for six years and then be applied orally or topically; it kept its potency for 40 years.

In the 7th century a theriac made by the inhabitants of Anatolia was given to the emperor of the Tang Dynasty. The Tang apothecary declared its usefulness against a hundred illnesses. The Middle East called it Tiryaq. Medieval English apothecaries called it "Venice Treacle" because it came from the Mediterranean, and was distributed by the Worshipful Company of Grocers. "Treacle"? Yes. Produced from cane sugar, the thick and sweet syrup was considered "good for what ails you"; the word is actually linked to theriac. In modern medicine, the word "treacle" is defined as

A medicinal compound once in wide use as an antidote to poisons. Treacle was a kind of salve. It was reputed to be a remedy against venomous bites in particular and against poisons in general. It also came to be considered a "cure" for cancer. [source]

In Henry Grosmont's 1354 treatise,  Le Livre de Seyntz Medicines or "The Book of Holy Medicines," he mentions theriac: "the treacle is made of poison so that it can destroy other poisons."

You may ask: if they believed it was so effective, wouldn't they try to make vast amounts to keep on hand? Would they try it as a cure for the Bubonic Plague? Well, one man thought that was a good idea, but ... well, we can talk about him next time.

Tuesday, October 24, 2023

Grosmont's Observations

The 1st Duke of Lancaster, Henry Grosmont, the wealthiest and most popular peer of the realm, wrote a book about his sins and the way to heal or atone for them using the metaphor of sin as sickness. This book, Le Livre de Seyntz Medicines or "The Book of Holy Medicines" also includes many autobiographical notes, as well as comments and observations that give us insight into the beliefs and culture of mid-14th century England.

Regarding the medical metaphors: we don't know that Grosmont himself had a large library, but his writing suggests a well-read man who could draw on other sources for his knowledge and ideas. Also, he would have had access to Leicester Abbey's library near his home, which at the time held at least 80 books on medicine. He also—as many nobles would— had a personal physician from Bologna from whom he would have learned much. (Bologna was known for training physicians, such as Jacob Mantino and Guy de Chauliac.)

His own physician probably gave him the information mentioned here that theriac is a good poison for driving out other poisons; however, if the patient is too far gone because of poison, theriac will only make things worse. He also offers the cure for delirium by slicing open a live young rooster and placing the cockerel on the patient's head.

During Grosmont's lifetime, Pope Urban V (whose personal physician was Guy de Chauliac) founded the medical University of Montpelier. One of its features was the collection of the bodies of executed criminals for dissection and research. Grosmont wishes his own soul could be opened up in this way to examine and understand his sin.

Some less medical or religious comments are about things like salmon. They understood that salmon are born in freshwater streams then head out to the ocean only to return to their streams to spawn. He expresses that a salmon born in a stream is not truly a salmon because it has not gone through its life cycle of stream-ocean-stream. He also tells us that goat's milk is ideally drunk in Spring, because the goat has only dined on new fresh plants at that time. Grosmont also offers a recipe for chicken soup, and how to know if a pomegranate is fresh.

In 1360, Grosmont was chief negotiator of the Treaty of Brétigny, ending a phase of the Hundred Years War. When he returned to England from the continent late in that year, he fell ill. Although only about 50 years old, he died on 23 March 1361. There was a resurgence of the Bubonic Plague that year, but it was not being noted until May, so we cannot attribute his death to it. He also wrote up a will 10 days before his death, so whatever prompted him to do so took longer to kill him than the Plague would. He was buried in the Church of the Annunciation of Our Lady of the Newarke ("New Work") in Leicester, which Grosmont had founded in 1354.

I am thinking that paragraph three above mentions something that would be unfamiliar to most readers. Tomorrow I'll explain theriac. See you then.

Thursday, October 5, 2023

The Royal Physician

Where there are royals and people of means, they will endeavor to have the best health care. A physician who had a good track record was well worth his fees (and worth giving special dispensations to; consider the example in the 5th paragraph of this post).

Although I would never want to live in the time before modern medicine, I have to admit there were some clever men and women who certainly made a difference in people's lives. One such was John Bradmore, court surgeon to King Henry IV of England. He was from a family of surgeons: his brother Nicholas was a surgeon, and his daughter Agnes married a surgeon named John Longe.

A lot of surgeons in the Middle Ages had side hobbies as metalworkers, no doubt because it was convenient to be able to visualize and manufacture your own instruments. John was a metalworker (and also called a "gamester," suggesting he made jewelry, or used gems for their supposed curative properties (see the use of amethyst here). Facility with metals could arouse suspicion, however.

The Battle of Shrewsbury in 1403 between forces led by King Henry's son Henry (who would become Henry V) and Henry "Hotspur" Percy resulted in an arrow embedded in the prince's left cheek. Higher and it might have taken out an eye and gone into his brain. Lower and it might have hit his throat and he could have bled to death. He survived the blow, but the arrow was going to require careful handling.

Normal procedure for an arrow in the flesh was to push it through and treat the wound; this could not be done without driving it through Henry's skull. The surgeons on hand tried to pull it back out, but either the shaft broke or it came free from the point; either way, the arrowhead was still there at the bottom of a deep wound.

John Bradmore would have been the ideal choice for the procedure. There was one problem: Bradmore was in jail. He was suspected of counterfeiting coins, a serious offense against the Crown. This was no time for standing on principle, however. Bradmore was sent for with haste.

Bradmore wrote one of the first treatises on surgery, called Philomena, and in it he describes his steps to help young Henry. He used the pith from an elder branch wrapped in honey-soaked linen to probe the wound to assess its depth. He then used increasingly larger probes to expand the wound. He designed an instrument (the illustration is one re-creation of it based on his description) that he could insert, twisting a screw to open the tongs and grip the arrowhead. He was able to wiggle the arrowhead back and forth and exact it. He then filled the wound with white wine, laying over it a poultice of bread, flour, barley, and honey. He stayed with the prince, changing the dressing as needed, until Henry recovered.

Bradmore died nine years later, in 1412, but lived on a handsome pension from the King in that time. He deserved it; surviving a wound like that was nearly impossible: septicemia or tetanus would have killed anyone without the extreme care that Bradmore provided. Henry went on to become King Henry V, win the Battle of Agincourt, etc.

Before Henry went on to fight battles and get wounded, he had other pursuits. I want to talk about his youth a little more, and his time at college. See you tomorrow.

Friday, August 25, 2023

Magical Metal

Yesterday mentioned the gold and silver cramp rings used in the Middle Ages in England to avoid cramps and epilepsy. (The sample here—alas!—is a later iron version.) Gold and silver were precious not only for their rarity and beauty; it was the reason for their beauty that made them magical.

Gold and silver do not oxidize like iron and copper. This "metallic immortality" surely helped to enhance the idea that they were special in a magical way. In fact, gold was considered medicine by many early authorities.

An 11th century lecturer at Salerno, Constantinus Africanus, claimed:

Gold is more temperate than the other metals. It has the property of relieving a defective stomach and comforts the fearful and those who suffer from a heart complaint. Galen confirms that it is effective against melancholy and baldness.

 Obviously gold needed to be ingested for it to work. To do so required very small pieces, and the Arab physician Abulcasis explained the method for preparing gold for consumption:

Take a piece of good and pure gold; and have a plate with pure sweet water in front of you; and have a rough clean cloth of flax, one end of which you keep in your hand. The other end should stay soaking in water on the bottom of the plate. Then rub gold with the cloth, always moistening the cloth with water, and fine filings descend to the bottom of the container. Do so as long as much of that gold as you want to have been shaved. Then leave for an hour; and mix water speedily and wash three times and dry up and preserve it.

Gold-based preparations were called aurum potabile ("drinkable gold"), written about by Michael ScotRoger Bacon and others. Making it drinkable was no small trick, but it could be made into a liquid by combining hydrochloric acid and nitric acid. This mixture was one of the only ways to dissolve gold, and inspired alchemists to believe that an actual, pure aurum potabile was possible. Paracelsus (1493 - 1541), who was adamant that one could improve upon Nature, and his contemporary Johan Isaäc Hollandus were certain that pure liquid gold could be achieved and would have unbelievable curative properties.

The consumption of gold over time, however, far from enhancing health produced "auric fever": fever, profuse sweating, excess urination, gastrointestinal problems, and kidney damage. Evidence of death by gold has been found.

In 2013, The Geological Society published a collection of essays called A History of Geology and Medicine. One article, "Pharmaceutical use of gold from antiquity to the seventeenth century," points out that there is at least one modern medicine that includes gold: Myocrisin, an injectable used for rheumatoid arthritis.

Back to the subject of liquid gold: who figured out that hydrochloric and nitric could dissolve gold? That was a 9th century writer who produced the oldest known classification system of chemical substances. His name was Jabir ibn Hayyan, and you'll learn more about him next time.

Thursday, August 24, 2023

Epilepsy in the Middle Ages

Anglo-Saxon England called it "devil-sickness" and felt that lupins were an effective treatment, and they might have been right. What did the rest of the world think of epilepsy?

Stone slabs dated to 1067 - 1046BCE in Babylon describe "falling sickness" caused by demons and ghosts. A 600BCE Persian text on health, the Avesta, mentions Zoroaster's advice to use sacrifices to prevent convulsions. Chinese health systems in 770BCE described acupuncture as a treatment.

It was the Greeks who coined the term "epilepsy" ("to seize" or "to attack") because they thought it was an attack from a god or demon. A Hippocratic collection of manuscripts called "The Sacred Disease" actually hit the target:

I am about to discuss the disease called “sacred”. It is not, in my opinion, any more divine or more sacred than any other diseases, but has a natural cause … Its origin, like that of other diseases, lies in heredity … the fact is that the cause of this affection … is the brain …

The cause he identified was an excess of phlegm in the blood. Plato agreed, but Aristotle believed it was vapors from certain foods that went into the brain during sleep. (The idea that epilepsy was a disorder of the brain would not be explored medically until the 1700s CE.)

Seizures in Medieval Europe were usually attributed to demonic possession, requiring exorcism and religious rituals. They drew this conclusion logically from Jesus curing a boy from seizures in Mark 9:14-16. It was also thought in England that the king had healing powers, even over epilepsy. Part of this cure was the handing out of rings.

These rings were called "cramp rings" because they were a preventive against cramp and epilepsy. Legend has it that the first cramp ring came from Jerusalem and was given by a pilgrim to Edward the Confessor. It was supposed to have miraculous healing powers. After Edward's death, it was given to the abbot of Westminster, who used it to try to cure people. It became known as St. Edward's Ring. Eventually this led to a Good Friday practice of the heirs of Edward blessing a number of gold or silver rings that would be handed out to prevent epilepsy. This ritual survived until the reign of Queen Mary I (1553 - 1558).

Cramp rings were not the only magical metals or magical charms in the Middle Ages. Tomorrow we'll have a brief exploration of more.

Sunday, June 25, 2023

Female Physicians

We talked here about how women and Jewish women could be physicians in the Middle Ages, but it would be a mistake to think that there was no opposition to this phenomenon, especially after a change in 1220.

Consider that, technically, anyone could practice medicine. No one would object to a mother caring for a family member, or a nun feeding a leper (as in the illustration). More formal, professional medical practice in France, however, required a degree from the University of Paris. This prevented many, women especially, from helping their fellow human beings. There were consequences for treating the sick if you were not "official."

Consider the case of Jacqueline Felice de Almania, a woman from Florence who was living in Paris. Her reputation was excellent: she was known for finding cures for patients who had been treated elsewhere without relief. She did not charge fees unless the patient was cured. 

In 1322, she was brought to trial by the University of Paris. The accusation was treating patients without any "real" knowledge of medicine; that is, she did not have a degree. Seven former patients were brought as witnesses; all testified that she had helped them where male doctors had failed. Her actions involved analyzing urine by sight, taking the pulse of patients, examining their limbs, etc. She was found guilty of practicing without a license, fined 60 pounds, and threatened with excommunication if she ever treated patients again.

The year 1322 was popular for cracking down on unlicensed medical practitioners. In that same year, records show women named Clarice of Rouen (banned for treating men), Jeanne the Convert (likely originally a Jew) of Saint-Médicis, Marguerite of Ypres, and "Jewess Belota" all were banned from practicing medicine.

The University of Paris in 1325 appealed to Pope John XXII to speak out strongly on this issue. He wrote to Bishop Stephen of Paris to forbid women practicing without medical knowledge or acting as midwives, because what they were doing was akin to witchcraft. A bit of a stretch to go from medicine to witchcraft just because the person was female, but then, John was determined to stamp out witchcraft...and a lot of other things, which I'll talk more about tomorrow.

(By the way, women earning medical degrees at the University of Paris was suppressed until the 19th century!)

Saturday, June 24, 2023

Jewish Female Physicians

Female doctors were not unknown in medieval Europe. I've written before of Trotula, for instance, and of course there were midwives. The practice of midwifery was naturally dominated by women; in some cases  men were not even allowed in the room during childbirth. Even if they were, they did not necessarily involve themselves directly in the process. One medieval Jewish medical text, in the section on childbirth, has the physician direct the midwife to "massage the orifice of her womb" with herbs rather than do it himself.

But Jewish women were not just midwives. Many of them learned and practices medicine thanks to their families. Jews were not allowed to attend Christian universities, so they could not earn medical degrees in the normal way. Anyone could, however, "test out" by passing an exam and earning a license to practice medicine. Jews—female as well as male—did this by learning from mentors and family members who were physicians.

Two examples were Hava from Provençal, mentioned in the 1320s for her medical ability, and Virdimura, who earned her medical license in 1376 in Sicily. In both cases, we know that their husbands were physicians (in Hava's case so were her sons), and so medicine was clearly the "family business." Mayrona, from Provençal, appears in 40+ documents starting in 1342 as a holder of a licentia curandi et practicandi, a "license to practice medicine."

Jews were more likely to be familiar with Greek and Arabic, as well as Latin and Hebrew, and therefore had access to more medical texts than their Western European counterparts who knew Latin but did not have as many opportunities to learn other languages, and also may not have had the motivation to read texts written by non-Christians. Female Jewish doctors were accepted in Paris, Florence, and Naples as well as Sicily. They were also respected enough to become teachers of medicine as well: Sara of St. Giles was a Jewish doctor who in 14th-century France took on a Christian pupil.

I cannot in truth say that female doctors were accepted everywhere, and tomorrow I'll share some of the less-tolerant stories of this topic. See you then.