MEDICAL EDUCATION AND PRACTICE

12 May

The processes that  led to the establishment  of medicine as a profession based upon a formal education,  standardized curriculum,  licensing, and legal regulation  were set in motion  in the Middle Ages. Of course, laws differed  from  place  to  place,  as did  enforcement  and  the  balance  of power  between  unofficial   healing  and   legally  sanctioned   medicine. Law  codes  might  specify the  nature  of  the  contract   between  patient and doctor  and the penalties and fines for particular errors.  Physicians could  be fined for public  criticism of other  doctors,  failure  to consult other  physicians  in  cases  of  serious  illness, or  for  treating  a  female patient  in the absence of proper  witnesses. The law might even require giving more  weight to the patient’s  spiritual  welfare than  his physical well being. The law could compel the doctor to advise the patient to seek confession, even though the fear inspired by this warning might be dangerous  in itself.

Despite some unwelcome constraints, the doctor achieved the bene- fits of a legally defined status.  As a consequence,  healers who practiced without a state-approved license became subject to criminal prosecution and  fines.  Professional   physicians  argued  that  standards of  practice would  be raised  by eradicating  unfit  practitioners, generally  identified as ‘‘empirics, fools, and  women.’’ However,  formal  requirements  also excluded  many  skilled  healers.  Another   unfortunate consequence  of medieval legal codes was the tendency to separate medicine from surgery and diminish the status of the surgeon.

Not  all medical  practitioners were either  highly educated  priest-

physicians or illiterate empirics. For example, the Anglo-Saxon  medical books,  known  as leechbooks,  provide  some insights  into  the concerns of practitioners and  patients  outside  the  realm  of the  ‘‘high medical culture’’ of the  learned  centers  of Europe.  Little  is known  about  the education  and  practice  of the typical  medieval  English  physician,  but both  monastic  physicians and  secular healers appeared  in illustrations and  paintings.  Early  English  leechbooks  were generally  compilations of ancient texts, unique only in that  many were written in Old English, rather  than Latin. Presumably,  most English doctors—often referred to as leeches—were literate,  at least in the vernacular.  By the fourteenth century, monastic centers of learning were producing scholars with little tolerance for the Anglo-Saxon leechbooks. Considering the fact that parchment  was a valuable  and  usable  resource,  it is rather  surprising that  any of the early English medical texts did survive.

Fortunately, the nineteenth-century revival of interest  in folklore inspired the Rev. Thomas  Oswald Cockayne (1807–1873) to rescue sur- viving Anglo-Saxon  medical texts and prepare a three-volume collection with the wonderful title Leechdoms, Wortcunning and Starcraft of Early England, Illustrating  the History  of Science in This Country Before the Norman Conquest. The leechbooks  describe surgical techniques,  herbal remedies,  rituals,  and  charms  to  prevent  a host  of diseases, including sudden  illness caused  by ‘‘flying venom’’ and  ‘‘elf-shot.’’ Descriptions of ‘‘Devil-sickness’’ and ‘‘fiend-sickness’’ presumably referred to various forms of mental illness and strange seizures. Many chronic diseases were attributed to ‘‘the worm,’’ a term applied to all manner of worms, insects, snakes, and dragons. Some rather colorful descriptions of ‘‘worms’’ were probably  inspired  by observations of the  very real  pests  that  live on human  beings  and  domesticated animals.  Bits  of  tissue  and  mucous in excretions,  vomit,  blood,  or  maggots  in putrid  wounds  could  also provide evidence of worms.

Anglo-Saxon leechbooks reflect the mingling of Greek, Roman,  Teu-

tonic,  Celtic, and  Christian  concepts  of medicine and  magic. According to such texts, healers could variously cure diseases by invoking the names of the saints, exorcism, or by transferring them to plants,  animals, earth, or running  water.  The preparation of almost  every remedy required  the

recitation  of some prayer or charm,  along with the number  magic of the pagan ‘‘nines’’ and the Christian  ‘‘threes.’’ Despite condemnation of amu- lets as magical objects, Christianized versions of these highly popular protective devices were discussed in the texts and apparently widely used.

The prescriptions in the leechbooks suggest the common disorders endured  by medieval people, such as arthritis, eye diseases, burns  and scalds, unwanted  pregnancies,  impotence,  and  infertility.  A wealth  of recipes testify to the universal presence of the louse. Iatrogenic  disorders (those  caused  by  medical  treatment) such  as  complications   resulting from venesection were not unknown.  In retrospect,  it would not be sur- prising to find infection  or tetanus  among  patients  whose venesection wounds  were dressed  with  ‘‘horses tords.’’  Remedies  and  charms  to regulate  the  menses,  prevent  miscarriage,  ensure  male  offspring,  and ease the pains of childbirth  were discussed at great length.

Skeptics  might  argue  that  the  remedies  in the  leechbooks  acted

only through  the power of suggestion, but the leech confidently ascribed great virtues to herbal remedies. Medicinal  herbs included lupine, hen- bane,  belladonna, and  mandrake. Birthwort  was said to cure external cancers, nasturtium juice cured baldness, wolf’s comb was used for liver ailments,  and swallowwort  provided  a remedy for hemorrhoids if nine paternosters were recited while the plant  was harvested.  Patients  were well advised  to  follow  instructions   carefully,  or  the  results  could  be disastrous.  For  example,  a son  would  be born  if both  man  and  wife drank  a charm prepared  from a hare’s uterus, but if only the wife drank this preparation, she would give birth  to a hermaphrodite.

Scholars  and  pharmacologists  who  have  re-examined  medieval

medicine have concluded  that  some medical practices and recipes were probably  practical  and effective. For  example, lupine, one of the most frequently  prescribed  herbs  in the  leechbooks,  was recommended  for lung disease, seizures, insanity,  as an antidote  for venom,  and for dis- eases caused by elves, ‘‘night-goers,’’ and the devil. Modern  researchers suggest that,  because manganese deficiency has been linked to recurrent seizures, lupine seeds (which are high in manganese)  might be effective in the treatment of epilepsy. Henbane, belladonna, mandrake, and other plants  in the Datura  genus are known  to contain  potent  alkaloids  such as scopolamine  and hyoscyamine.  Depending  on preparation and dos- age, extracts of such plants could, therefore, have powerful neurological effects when used as drugs, poisons,  and hallucinogens.

Given the importance of domestic animals to the medieval economy,

the use of many of the same remedies for man and beast is not surprising, but the religious aspects of medieval veterinary medicine are another  mat- ter.  Whatever  beneficial  psychological  effects  holy  water  and  prayers, might have on humans,  it is difficult to imagine that  religious rites would greatly  impress  sheep,  pigs,  and  bees.  The  use  of  pagan  and  magical rituals  to  protect  domestic  animals  was  as  much  condemned  as  their

use in treating  humans,  with much the same results. Some of the ‘‘cures’’ must  have tormented the animals  more  than  the disease. For  example, one ritual for horses required  cutting crosses on their forehead  and limbs with a knife whose haft  had  been made  from  the horn  of an ox. After pricking  a hole in the horse’s left ear and  inscribing  a Latin  charm  on the haft of the knife, the healer declared the beast cured.

English medicine from a somewhat  later  period  is represented  by

the work of John  of Gaddesden (1280–1361), physician  to Edward  II. Primarily  remembered  as the author of The Rose of England, the Prac- tice of Medicine from the Head to the Feet, John  might have been the model for Chaucer’s Doctor  of Physic. According to Chaucer,  the Rosa Anglica was invariably  a part  of the  typical  physician’s  library.  John immodestly claimed that  his treatise was so well organized and detailed that  surgeons and physicians would need no other  book.  Remedies are suggested  for  both  rich  and  poor  patients.  For  example,  physicians should prescribe expensive diuretic remedies for wealthy patients suffer- ing from chronic dropsy, but poor patients should be told to drink their own urine every morning.

One of the most famous recommendations in the Rosa Anglica was

the ‘‘red therapy’’ for smallpox, which involved surrounding a victim of smallpox with red things to expedite healing and prevent the formation of scars.  In  addition  to  some sound  medical  advice  and  acute  obser- vations  on disease, John  discussed traditional charms  and rituals,  such as wearing the head  of a cuckoo  around the neck to prevent  epileptic seizures. This approach was especially useful in treating  young children who  would  not  take  medicines.  A  brief  section  on  surgery  includes methods  of draining  fluid from a patient  with dropsy,  reduction  of dis- locations, and the treatment of wounds. Some passages advise the physi- cian to take  a particular interest  in the treatment of the diseases that would bring him the greatest  rewards.

Texts known  by the Latin  term regimen sanitatis,  which served as

practical  guides to health  and  its preservation, were originally  written for  wealthy  individuals  in  order  to  teach  them  the  fundamentals  of the  concepts  used  by physicians  to  justify their  therapeutic practices. These health  handbooks explicated  the Galenic  threefold  organization of medicine into  the following: the naturals  (such as the humors  and so forth); the contranaturals (diseases and symptoms); the non-naturals (things  that  affect  the  body).  Guided  by the  physician,  an  individual would  adopt  an  appropriate regimen,  that  is, an  elaborate  plan,  for managing  the six non-naturals (air and environment, motion  and rest, food and drink, sleep and waking, evacuation  and repletion,  and affec- tions of the soul). When physicians wrote guides for a wider audience, they placed more emphasis  on drugs and other  simple ways of preser- ving health and preventing  disease.

Random Posts

Comments are closed.