What were the wars between the Houses Plantagenet and Lancaster called? The Wars of the Roses. What was set into motion by Martin Luther when he published his 95 theses? The Reformation. Easy to remember, huh? Well, it’s all thanks to names! There are so many historical events that are stuck into our minds thanks to the names that we’ve known them by, most probably from our history classes. There’s the Pax Romana, the Defenestration of Prague, or the Third Impact for example.
The mnemonic power of words is undeniable – especially its ability to invoke emotions. Just the mere mention of your 3rd grade crush can send feelings of discomfort and innocent bliss right through your body. Hell, the slightest mention of Coldplay channels a rush of hot hate all throughout my being. But with memory comes the question of accuracy. Did species of roses actually wage war against each other? Why are the 20th century’s major wars called “World Wars I and II” when there were previous world wars? Are the Napoleonic wars not world war in scope? Were not the Chola Empire’s conquest and expansion across Asia in the 10th century worldwide in ambition and effect, hence, also world war?
In the interest of science and history, there is one historical period that is rife with misunderstanding thanks to the name attached to it. I’m talking about the supposedly dim “Dark Ages”, a misnomer often used to call the Medieval period. Judging by how the name perseveres to this day, lot of people’s opinions of the Medieval period are still stuck in the shadows, devoid of light and robbed of intellectual riches. Even historians are wont to call it “Dark” because of a false progressivist bias (a wrong assessment for sure, read this for a related discussion). But it gets much worse when you add the dimension of health into the discussion. An even darker image is conjured, where scenes of death and decay dubbed the Black Death set the immediate mood.
This is unfair for two reasons.
First, the plague, or any of the past plagues for that matter weren’t unique to the Medieval age. When the Roman Empire was in its death throes, an unexpected plague swept across the ancient city, hastening its imperial collapse. Even Ancient Greece, particularly Athens, fell victim to the swoop of disease. While the Athenians were preparing for war against Sparta, a sinister dread sneaked its way inside their city and struck terror without needing to clang metal against metal. Thucidydes writes of this cataclysm in his History of the Peloponessian War:
“Never were so many cities captured and depopulated—some by Barbarians, others by Hellenes themselves fighting against one another; and several of them after their capture were repeopled by strangers. Never were exile and slaughter more frequent, whether in the war or brought about by civil strife. And traditions which had often been current before, but rarely verified by fact, were now no longer doubted. For there were earthquakes unparalleled in their extent and fury, and eclipses of the sun more numerous than are recorded to have happened in any former age; there were also in some places great droughts causing famines, and lastly the plague which did immense harm and destroyed numbers of the people.” [Emphasis mine]
Taking hints from the Greek experience, we can conclusively say that the problem of plagues cannot be simply lumped into the domain of medicine. That is to say, outbreaks of plague resonate loudly issues of social organization and historical contingency rather than the relative inadequacy and incompetence of medical response. In other words, to say that the main medical legacy of the Medieval period was its failure to counter the plague is a completely mistake. The Black Death was largely the result of global commerce opening up new networks of opportunities for trade, consequently increasing the chances of diseases to tag along and move from points A to B. Contagia that found little opportunities to life in one region of the world found favorable conditions elsewhere thanks to rapid human movement to and from various emporia.
Second, the Medieval period was an active age of scientific and cultural pursuits. These would later serve as precursors for the Renaissance and the Enlightenment. Of course, superstition and ridiculous beliefs remained rampant in the Medieval period (and continue to do so now), but the best practicing physicians at that time were plying their trade with the best possible science available to them.
So why are the dark clouds that dim our view of the Medieval period still pervasive to this day in the tongues and texts of man? I hazard that this has something to do with modernity’s sensational reading of the Enlightenment, as the romantic period when science finally broke free from the shackles of superstition. This misreading carries a rabid anti-clerical flavor, which at best, only provides a haphazard critique of the oppressive episodes of religion, and at worst, a blatant failure to acknowledge and appreciate the unique cultural and historical context from which religions emerged and survived. The corollary is a propensity to immediately equate anything religious as unscientific, which in turn makes one turn a blind eye to the actual historical roles and achievements that religion and religious institutions have played in the advancement of scholarship and the nurture and protection of scholars. While it is true that religious sects have done their fair share of intellectual persecution, it should also be put in mind that other religious institutions chose to offer scholars safety and security for growth and development.
The above (wrong) criticisms of the past have a cathartic quality that cannot be denied. They make us think that we are obviously better than our predecessors by virtue of our technological and intellectual advance. But this approach and reading of history fails any sobriety test. It is an intoxicating position to take, as it allows one to forget everything else while encouraging false feelings. Sure, drink it up. Just don’t expect to be taken seriously.
Thus, a quick trip to the apothecary is necessary so we can acquire the appropriate remedy for this malaise.
This essay is an attempt to cure or, if not, lessen the symptoms of this modern myopia. It is the first of a series of essays that seek to trace and define the medical legacy of the Medieval period and its roots. The discussion will center around the idea and activity of healing, the medical response as seen appropriate towards specific maladies and diseases in ancient times. Thus, while it may broach the larger topic of health, it cannot fully account for it. That is an altogether different topic that deserves its own space and concentration. For now, wounds caused by wrong readings require immediate attention. We have no time to waste. It is time for healing.
Ancient peoples have had to make do with crude tools in order to make the most of their environments. As such, injuries from the creation and use of such tools would’ve been frequent. Standard safety precautions were most likely not in vogue at that time. From the making and handling of sharp hunting and flaying tools, a lot of our ancestors must have had the unfortunate experience of cutting themselves in the process. Not to mention that these tools would’ve also been used for warfare. So it’s likely that wounds and infections were a top concern for proto-physicians at that time. It is no wonder that when mankind finally had the knack for recording things, they immediately went on to write how they dealt with the healing of wounds.
In Ancient Sumeria, we find this instruction for making a wound remedy: “Pound together fur-turpentine, pine-turpentine, tamarisk, daisy, flour of inninnu strain; mix in milk and beer in a small copper pan; spread on skin; bind on him, and he shall recover.” It is interesting to note that beer is one of its ingredients. Perhaps the Ancient Sumerians knew of beer’s antiseptic properties, and may even have used it as a stand-alone disinfectant for cuts and wounds. Or maybe it served as anesthetic when the pain became unbeerable.
Led by the iconic Hammurabi, the Ancient Babylonians replaced the Ancient Sumerians and became the dominant force in Mesopotamia around 1792 BC, where they found themselves in the middle of a buzzing terrain teeming with commercial activity and a rich intellectual tradition. But the Babylonians were not just passive recipients of old knowledge, they were also active participants in the development of the Mesopotamian intellect. We have records from Old Babylon of patients being sent to medical practitioners for treatment. In one inscription, a certain Eidiman-šun, who might have had connections with Babylonian higher-ups, was sent to the care of a medical practitioner with an urgent request that he should be healed as quickly as possible.
The Medical practitioners of Ancient Mesopotamia were grouped into two: those that dealt with the physical aspects of disease and injuries were called the asu; and those that dealt with the spiritual dimension of health were called the ashipu. This was a necessary division since their destinies were still up to the whims of the gods, and that there was only so much that man can do to keep their temporal vessels healthy. However, what at first glace may seem untenable is actually an integrated system that didn’t pit one against the other, but it encouraged a synergy between the two to provide the best healthcare possible to their patients. The gods needed healthy people to worship them; the people needed the gods to make them healthy. It was a bond of mutual benefit. Or in modern speak, a healthy relationship.
Moving westwards, we find ourselves in Ancient Egypt where the marvelous but mysterious pyramids stand erect. Of course, when one thinks of pyramids one is also reminded of its residents. What image comes to mind when one is asked to think of Egyptian mummies? Cadavers wrapped in strips of cloth, like the bandaged bandits in Scooby Doo. This mummy wrapping technique might have evolved from their wound treating practices, as the Ancient Egyptians were the first to record the use of bandages in covering wound and infection sites. They also recognized the antibacterial and healing properties of honey in the treatment of wounds. Lint and grease were also used to hasten the healing process.
The Egyptian Kahun papyri, which dates back to 2000 BC, contains a series of instructions for the care and treatment of pregnant women. In one passage, if a pregnant woman is bedridden and unable to move, it is recommended that she be asked to “drink 2 hin of beverage and have her spew it up at once”.
These were just some of the ancient medical techniques that got passed down from one generation to the next, and from one civilization to another. From these few passages and examples, we see a growing sophistication: from the simple treatment of wounds to discussions for the treatment of various ailments. So early on in mankind’s intellectual history, the issue of healing was already a growing concern among the learned. The culmination of this intellectual movement found its greatest expression in Ancient Greece, where what we now call the “western medical tradition” was slowly coming into form.
Millenia have passed, but still, traces of Ancient Greek influence abound. We don’t need to look far for examples. Forlorn lovers have invoked the name of the Greek deity Cupid to save them from the hellish flames of heartbreak. Pacifists are best advised to stay away from having any nemesis, much like how the Ancient Greeks avoided the ire of the Goddess of Retribution, Nemesis. Seeing that the Greek gods are alive and well today, the Greek influence on modern life can never be denied. It is no wonder that the very symbol of modern medicine can also be traced back to Ancient Greek iconography.
The Greek god of Health was named Asclepius. Story has it that his father, the god Apollo, had him apprenticed under the tutelage of the centaur Chiron, who was sort of a master mentor for many prominent Greek heroes in their youth. His impressive résumé lists the likes of Achiless, Ajax, Jason, and Perseus, as some of names that he has tutored. The Greek lyric poet Pindar tells us in the Nemean Odes that Asclepius’ training focused on the “gentle-handed laws of remedies”. Asclepius’ education was going extremely well, so well in fact that news of his medical talents soon spread far and wide. For some reason it reached the ears of King Minos, the ruler of Crete, who had Asclepius summoned for the treatment of his son Prince Glaucus. But what seemed like an invitation to demonstrate the medical arts turned out to be an exhibition in madness. When Asclepius was shown the body of Prince Glaucus, he found out that the prince was already dead. Only a divine miracle would bring the prince back to life, and Asclepius’ training hadn’t prepared him for such a task. However, King Minos would have none of it, and he was so angry and frustrated at the false promise brought by Asclepius’ fame that he had him locked in a dungeon. Somber and morose in his chamber, he felt a rising rage build up in his soul. Suddenly, a snake entered his cell and slowly slithered its way around his walking staff. Obviously annoyed at the turn of events, and having no other outlet to express his fury, Asclepius grabbed his staff, smashed it repeatedly against the walls, thereby killing the coiled snake. This didn’t make him feel good in any sensible way, and he deeply regretted this outrageous act. Not long after, a second snake made its way inside his chamber. But this one had something in its mouth. In between its lips was a piece of herb. The second snake slithered to the dead snake’s body and rubbed the herb on it. To Asclepius’ surprise, the snake that he had just senselessly murdered came back to life! Elated at this discovery, he called on the guard to tell King Minos that he had just found a way to resurrect the prince. He did not disappoint, for after applying the herb, the dead prince regained consciousness and was made mortal again. This was the start of Asclepius’ lifelong association with snakes.
(In Ancient Greece, snakes were highly revered and respected as they were seen as symbols of restoration and health because of their constant shedding.)
If you find yourself in a situation where you’re required to go to the nearest hospital, try to see the hospital’s logo. Chances are, it will have the symbol of a snake coiled around a staff. Well, this is in reference to Asclepius’ correspondence with the injured snake, and the symbol is called the Rod of Asclepius. Not only has it become a symbol for hospitals, but it has also come to represent the greater issue of health, as seen in the World Health Organization’s logo, where the rod takes a prominent part.
Temples in honor of Asclepius, called asclepieion, soon surfaced here and there in the ancient world. Not only were his temples venues for worship, but they were also places for healing and treatment. Make no mistake though, these weren’t the forerunners of today’s hospitals. We would have to wait for Medieval Islam (part V of this series) to acquaint ourselves with the very first instances of what soon became modern hospitals.
Attendants of the asclepieion were called the therapeutae (it is from therapeutae where the modern words therapy and therapists come from). Medical treatment in these temples included rituals that invoked the intercession of gods. Divinity and medicine was still understandably intertwined, like in Ancient Mesopotamia. Interestingly, it is because of this marriage that a secular offspring was soon born. With this birth, an intellectual shift was about to take place. Something of a revolution was brewing. If we take cultural historian Jacques Barzun’s criterion for revolutions as something that gives “culture a new face”, then indeed, something radical was about to happen. It was a movement that showed signs of science slowly making its way into the medical arts.
It was all thanks to a therapeutae named Hippocrates.
Not much is known about Hippocrates’ life, and all we have of him are the many texts that comprise the Hippocratic Corpus. But the sheer abundance of texts associated to Hippocrates lead historians to believe that a lot of the Hippocratic Corpus were written by his followers and were simply attributed to him. Thus, we can never be sure who wrote what. But what we can be certain of, is that it was through Hippocrates that we see the first emergence of a professional cadre of scientific medical practitioners. In fact, our modern health professionals have to take an oath before they could practice their craft, and that oath is what we now know as the Hippocratic Oath. If we take a short moment to recite its opening lines, we will be reminded of an old character that we just recently talked about:
“I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract.”
With Hippocrates came a drastic change in the way healthcare was administered. We see for the first time in the written record a special consideration for the continuous reciprocal relationship between man and environment and how it affects one’s general health. Because for Hippocrates and his followers, healing meant to understand the patient’s environment and history:
“Whoever wishes to pursue properly the science of medicine must proceed thus. First he ought to consider what effects each season of the year can produce; for the seasons are not at all alike, but differ widely both in themselves and at their changes. The next point is the hot winds and the cold, especially those that are universal, but also those that are peculiar to each particular region. He must also consider the properties of the waters; for as these differ in taste and in weight, so the property of each is far different from that of any other. Therefore, on arrival at a town with which he is unfamiliar, a physician should examine its position with respect to the winds and to the risings of the sun. For a northern, a southern, an eastern, and a western aspect has each its own individual property. He must consider with the greatest care both these things and how the natives are off for water, whether they use marshy, soft waters, or such as are hard and come from rocky heights, or brackish and harsh. The soil too, whether bare and dry or wooded and watered, hollow and hot or high and cold. The mode of life also of the inhabitants that is pleasing to them, whether they are heavy drinkers, taking lunch, and inactive, or athletic, industrious, eating much and drinking little.”
-Hippocrates, Collected Works I
The extension of the domain of health outside the body, and further stretched to envelope the outside environment, represented an important intellectual shift in medicine, as it allowed Hippocrates to incorporate the idea of the four temperaments into his grand system. The four temperaments is an ancient idea that can be traced back to Ancient Egypt, but found organization in the Greek philosopher Empedocles’ system, where he designated them as earth, fire, water, and air. Hippocrates used this idea to create a program of healing based on the idea of balance. He turned the four temperaments into the four humors: earth became black bile, water turned to phlegm, air liquefied into blood, and fire transformed into yellow bile. With these at hand, Hippocrates was ready to formalize his theory of health into the idea which we now call The Four Humors.
But as names go, we have to be careful and wary of what they actually represent. For our concern, we need to investigate and question Hippocrates’ sense of humor. What was so humorous about black bile?
Let me leave you with that unsettling question. In a way, it might set you off unbalanced. Which is the perfect set-up for the the second installment of this series, where the idea of the four humors will be tackled in depth, and an understanding of what balance meant, both for the practice of healing and the maintenance of good health will be sought.
Until then, stay healthy!
(The complete bibliography for this series will be provided in the last essay.)