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.