A Brief History of Medicine to the Year 1630
by Mike Zalor
Introduction and Bylaws
Interpretive
Clothing
Scottish Culture
History
Music and Dance
Military Life
Language
Bibliography, Sources
and Library Materials
In any study of the medicine of the early 17th century, 2 name must immediately stand forth; those of Galen and Paracelsus. Each had devotees of their differing methods, and the whole arena of medical debate was given over to the confrontation between the Galenists and the Paracelsians.
Galen was the elder of the two. Born in 130 AD, he traveled throughout the ancient world studying anatomy and medicine. He did not confine himself to mere book learning, but took a hands-on approach conducting autopsies on human cadavers, as well as experimenting on a variety of animals from mice to elephants.
In 161 AD, he traveled to Rome where he eventually became personal physician to the emperor. He was extraordinarily methodical and logical, distilling the knowledge of the ancient world and writing numerous books (many lost) of which nearly 140 made their way into Arabic and so to the Medieval world. His works became the basis for all medical knowledge, and were so complete that, after he died in 200, virtually no improvements were thought possible in the next 1400 years. Of particular interest to us are Galen's theories on respiration and circulation (to be dealt with below), and of the four humours.
The Humours
The fundamental theories about disease at the time that Galen wrote centered around four humours which corresponded to the four elements: blood/fire, yellow bile/air, black bile/earth, and phlegm/water. All disease was thought to be either an imbalance of these or a breakdown in the organs (which might also produce an imbalance).
The humours were thought to contain a variety of different characteristics (Summarized below), the most important of which were: hot, dry, cold, and wet. A person suffering from an excess (or plethora) of black bile, a cold-dry humour, would be best served by the used of its dietary opposite - wet, moist foods (eggs, for example) or herbs that were likewise considered wet and moist.
The humours were also known to influence personality. A man who normally tended to produce excesses of yellow bile was termed choleric, and thought of as generally intelligent, but testy. An excess of blood, however, produced the sanguine personality, cheerful, but foolish. Phlegm was thought to induce a dull heaviness in a person, while black bile produced the dark, brooding, steady melancholic personality.
Humoural Characteristics
Blood Yellow Bile Black Bile Phlegm
fire air earth water
hot / moist dry / hot dry / cold moist / cold
salty bitter sour sweet
simple acute / intelligent solid / steady dull / forgetful
digestive attractive retentive expulsive
Formed in:
liver flesh of liver spleen/liver brain
Problems caused by:
anemia jaundice cancer chills
some fevers gallstones elephantiasis epilepsy
vomiting melancholia heartburn
varicose veins heart attacks
There are other humours produced in the body for specialized purposes: sperm (male and female) for example. An undue retention of sperm in men may cause extreme fatigue and headaches. Likewise, a lack of sexual intercourse in the female may cause the uterus to move upwards against the diaphragm and induce the respiratory difficulty termed hysteria.
Paracelsus
Philipus Aureolius Theophrastus Bombastus von Hohenheim, better known as Paracelsus, was born in the Swiss village of Einsiedlem, in 1493. Like Galen, he traveled throughout the western world, gaining knowledge wherever, and from whomever he could. At the age of 22 he earned a doctorate in Ferrara, and in 1526, he was appointed city physician and professor in Basel. However, because of his unorthodox views and literally "bombastic" personality, he was chased from the city under the threat of arrest in February 1528.
He continued to wander until his death in 1541, always loudly proclaiming his views (which he stated came from "experience and my own reasoning, and not from reference to authorities") and copiously writing volumes in defense of his ideas.
Paracelsus did not create a great leap forward in medicine - his cures were not much more effective than those of Galen - but rather took a leap sideways, opening new doors and avenues of exploration to medicine's future. He was an iconoclast, not trusting mere books (the reason for his expulsion from Basel), but demanding experimental and experiential evidence to back up theory.
He was also an alchemist, and applied the principles of alchemy to medicine. He believed that all things contained not merely the four elements, but a fifth, or "quint essence" which could be distilled from the thing, and which contained the basic "virtue" of that thing. Utilizing this in medicine, he felt that by distilling the quintessence of herbs, the cures would become stronger and more powerful.
The Three Principles
Paracelsus did not totally abandon humoral theory, but undercut it by saying that the humours themselves were made up of the more fundamental alchemical principles. These principles (mercury, sulphur and salt) should not be thought of as substances themselves, but as qualities inherent in all things. A burning twig, for example, would reveal its sulfurous qualities in the fire itself, its mercurial aspect in the smoke and other vapors, and its salt in the ashes and material residue.
Given proper distillation, these principles could be isolated, and so used as medical remedies. The humours were likewise narrowed to three choler (yellow bile), melancholy (black bile), and phlegm, and were treated by sulphur, salt and mercury, respectively. This does break with Galenic thought in that similar instead of opposite medicines were being used to treat the humour.
Macrocosm and Microcosm
Another essential element of Paracelsus' philosophy was the relationship between the heavens and man. He believed that everything which is essential in man (the microcosm, or little world) could be found reflected in the heavens (the macrocosm, or greater world). Therefore it becomes important for the physician to be also a student of astronomy. The constellations of the zodiac ruled over various parts of the body, and it was important to take them into consideration when conducting cures. The position of the moon in the zodiac regulated the proper times for various procedures -the moon in Taurus was a good time to purge, but evil for bleeding, and so on.
A corollary of this was the doctrine of signatures, which said that each thing revealed its inner virtues through some outward sign. The roots on Solomon's seal, for example, are white and segmented like knuckles, or vertebrae. This suggests that Solomon's seal is a good herb for bones. Likewise, one should be able to determine a man's character through chiromancy (palm reading), or physiognomics (the study of a man's face).
Paracelsus never had a great many adherents to his theories during his lifetime, but after his death, more and more physicians began espousing his ideas. A great debate developed between the entrenched Galenists and the Paracelsians. It was highly vitriolic, with a great deal of name calling and personal attacks by extremists on either side. But there was also something of a middle ground, which decided that there were good points made by each, and that the best idea was to simply use what worked, regardless of who developed it. There was some common ground even between Galenists and Paracelsians on the mechanics of the body: digestion, circulation, and so on. In these cases the Galenic view held until Harvey's publication of the circulation of blood in 1628.
Perhaps the most important thing about the great debate (which might still be seen today between herbalists and medical companies) is that it occurred at all. Physicians were forced to examine their beliefs, to defend them, and to come up with better solutions if necessary. This mental exploration led to the important medical advances of the later 17th century.
Treatments
Before proper treatment could be given, the competent physician must first find out as much as possible about the disease by checking certain signs. Obviously, the first step would be to know the climate and the season, including the positions of the stars, in order to determine the most likely influences on the body. The physician would also check for outward signs such as the eyes and discoloration of the tongue (a white tongue indicating an excess of phlegm). Urine, or distilled urine under Paracelsus, would be considered of extreme importance - white, cloudy urine was considered a good sign, while dark clouds in the urine was ill.
Once a basic understanding of the type of disease was formed, and what humours were affected, proper treatment could begin. Although the specifics varied from case to case, treatment would generally be broken down into three different steps. 1) Purging was generally the first step in treatment. As it was thought that diseases were most likely caused by impurities coming in through the stomach, the ideal course was to eliminate them as soon as possible. Purging could be done either upwards, or downwards, violent, or easy, and differing to suit the humour involved. If an oral purging was not workable, then a clyster (enema) could be used to the same ends. It was suggested that a patient be kept warm during and after a purge, and that a proper "corrective" be given should the purge last too long.
2) Bloodletting is perhaps the most well known treatment used during the Renaissance. It was meant to drain the excess humours in the blood in order to, with the assistance of medicines, reassert the natural balance in the system. There were several methods used in bleeding. The first was to simply open a vein and allow the blood to flow freely from the arm. Leeches could also be used (and still are today) to gently suck the blood from the body. Also in use were cupping glasses which would be heated and then placed over a small wound. As the air in the glass cooled, it would contract and form a partial vacuum in the glass, drawing the blood from an incision which would otherwise clot too quickly. Bloodletting was an art in its own, and usually a doctor would call in a bloodletter to perform the procedure. Numerous charts showed the proper places to bleed, from under the tongue to the ankles (more preferable for women than the arms, as the bleeding there was less). Blistering, scarification, or cupping glasses without a wound would also be used to draw blood away from an area of the body. For instance, hot irons might be applied to the feet to counteract a wound or bruises on the arm.
3) Medicines of the period were many and varied. Mainly they came from plants, or the distillation of plants, though lead and antimony were also frequently used as well as mercury on some external cases. Using these poisons, the cure might be more fatal than the disease.
Above all was the quintessence (not to be confused with the alchemist's fifth essence) of an herb. The plant would be distilled, so that the sulphur, mercury and salt would be separated and refined so that no impurities remained, and then recombined so that only the vital elements of the plant remained. Indeed, it would take several distillations in order for the true quintessence to be completed.
Physicians
According to Paracelsus, a good physician "should not be a run-away monk" and "must not have a red beard," as well as having more obvious qualities such as "he should know the bones of the body," and have "greater regard for his honor than money. " Further, Paracelsus said, "Medicine rests upon four pillars -philosophy, astronomy, alchemy and ethics. The first pillar is the philosophic knowledge of earth and water; the second, astronomy, supplies its full understanding of that which is of fiery and airy nature; the third is an adequate explanation of the properties of all four elements - that is to say, of the whole cosmos - and an introduction into the art of their transformations; and finally, the fourth shows the physician those virtues which must stay with him up until his death, and it should support and complete the three other qualities. "
The old school of medicine, however, did not take quickly to Paracelsian theories, and it was the old school which controlled the universities that produced accredited doctors. It therefore took quite some time for new theories to be introduced, and if a student had a predisposition toward new ideas, it was wise to wait until received his degree before espousing them. William Harvey, for instance, had developed his theories on circulation of the blood by 1616, but although a member of the Royal College of Physicians, did not publish his work for another 12 years.
A medical doctorate in France required a four year degree once the Master of Arts degree had been obtained. Examinations were done orally before a panel of nine examiners, and would last 6 hours. The primary part of the examination was for the student to study and defend a thesis such as "Whether the cure of Tobius by a fishes gall was natural?", or "Is woman more lascivious than man?" Such questions would perhaps test the students' knowledge of rhetoric, rather than of medicine.
Still, the way to becoming a physician was a long and arduous course. So much so, that within the population of Paris in 1657 (600,000 people) there were only 110 accredited doctors. Such a monopoly meant the service of the physician was at a premium, and could only be afforded by the rich. The poor would have to get along with the spurious remedies of the local quacks, alchemists, and medical pitchmen, whose knowledge of medicine would be minute compared to their salesmanship.
It should be remembered that alchemists were thought to hold the secret of the Universal Medicine, or panacea, which could cure all diseases and restore youth to the aged. Such cures were not to be deemed as magical, or supernatural, but rather as an extension of natural means. If God gave us diseases, God would necessarily have given us the mean to eliminate them. Therefore, a huckster selling a miraculous cure would have been thought to have dabbled in secret sciences rather than witchcraft, or worse. As a last resort, a person could turn to the old-fashioned family recipes which, if not particularly in vogue or efficacious, would at least run less of a risk of out-right killing you.
Although bloodletting was a primary cure, a fully trained doctor would not conduct the bleeding himself. Rather, he would have a surgeon-barber, or a barber-surgeon do the work. The surgeon-barber was the higher classed of the two, having attended a university to learn the art. The barber-surgeon, on the other hand would have learned his way up, like other craftsmen, through 13 years of apprenticeship, starting with the traditional shaving and dressing of wounds, to being a near partner in the shop of his master. There was also a third and lowest class of bloodletter, that of the inciseur, who would travel from village to village working not only on human patients, but if necessity demanded, farm animals as well. He had no formal training, but worked from practical experience in a trade that may have been handed down from father to son. On the basic level, he may have been far safer than the surgeon-barber, who had much book-learning but little hands-on experience.
In short, there was no lack of medical help available, though the quality depended greatly on a person's ability to pay. And though lofty ideals may have been expressed, a physician's work was more often motivated by greed. In this profession, perhaps more than any other, one should be guided by the creed caveat emptor, let the buyer beware.
Conclusion
Although Paracelsus began to question the ancient traditions, it was not until Dr. William Harvey published his treatise on the circulation of blood in 1628 that any significant medical breakthrough occurred. His detailed and scientific analysis of the blood stream changed the course of physiology forever. Although his theories would not be totally accepted for quite some time (they were still disputed by a few over a hundred years later), they shifted the focus from experimental chemistry, to anatomy and the study of the physical processes of the body. If the blood supply in the body remained constant, and the blood circulated between the arteries and the veins, then the entire Galenic concepts of the functions of the body must be suspect. Our interpretive characters may not know it yet, but they are at the dawn of a whole new era of health and medicine.
But the final question, and one of most importance to us, is how do we, as a military camp, attempt to include this medical knowledge into our portrayal of 17th century life. Obviously, a majority of the camp would not be privy to any information on the subject, but if they had some problem, they might approach the camp physician or surgeon and begin a discussion on that matter. Galen and Paracelsus might not be know to the ordinary soldier, or even officer, but certainly there may be some disagreement among the men as to whether a "chemical", or "herbal" approach to the treatment of ailments is preferred. Perhaps some recruit, on his way to the camp, might have purchased some form of universal medicine from some huckster.
Likewise, there might be some discussion as to whether you would prefer to be bled by leeches or a cupping glass (a cupping glass did not always require the drawing of blood), and you could even ask audience member which they would prefer. The officers might be more aware of medical practices and could get into a discussion about the differing philosophies. Once the door has been opened, and the interest of the public has been piqued, then you may step beyond your character in order to answer questions or call in the help of an "expert" to answer further queries.
Bibliography
Culpepper, Nicholas, Culpeppers Complete Herbal & English Physician Enlarged. Facsimile copy of 1814 edition, originally from works of the mid-1600s. Meyerbooks, Glenwood, IL, 1990.
Debus, Allen G. The Chemical Philosophy, NY, 1977.
Encyclopedia Britannica, 14th Ed. , 1949
Hutin, Serge. History of Alchemy. NY, 1962.
Lewis, W. H. The Splendid Century. NY 1957.
Palmer, Thomas. Admirable Secrets in Physik and Chyrurgery (1696). Edited by Thomas Forbes, 1984.
Paracelsus. Paracelsus, Selected Writings 2nd Ed. Edited, Jolande Jacobi, 1958.
Siegel, Rudolph E. Galen's System of Physiology and Medicine, 1968.
Appendix
Excerpts from several medical texts of the time.
(1630's) Culpeppers Herbal: Garlic. The offensiveness of the breath of him than hath eaten garlick, will lead you by the nose to the knowledge hereof, and (instead of a description) direct you to the place where it grows in gardens, which kinds are best, and most physical. [Government and virtues] Mars owns this herb. . . It provokes urine and women's courses, helps the biting of mad dogs, and other venemous creatures; kills worms in children, cuts and avoids tough phlegm, purges the head, helps the lethargy, is a good preservative against, and a remedy for any plague, sore or foul ulcers; takes away spots and blemishes in the skin, eases pains in the ears, ripens and breaks imposthumes and other swellings. . . Many authors quote many diseases this is good for; but conceal its vices. Its heat is very vehement, and all vehement hot things send up but ill-favoured vapours to the brain. In choleric men it will add fuel to the fire; in men oppressed by melancholy, it will attenuate the humour, and send up strong fancies, and as many strange visions to the head; therefore let it be taken inwardly with great moderation; outwardly you may make more bold with it.
From the English Physician, translated and annotated by Culpepper: Aqua Caponis, or Capon Water. Take a capon the guts being pulled out, cut in pieces, the fat being taken away, boiled in a sufficient quantity of spring-water in a close vessel, take of this broth three pounds. Borage and violet-water, of each a pound and a half; white wine one pound, red rose leaves two drams and a half, the flowers of borage, violets and bugloss, of each one dram, pieces of bread, hot out of the oven, half a pound, cinnamon bruised, half and ounce, distill it in a glass according to art. The simples are most of them appropriated to the heart, and in truth the composition greatly nourished and strengthens such as are in consumption and restores lost strength, either by fevers or other sickness: It is a sovereign remedy for hectic fevers, and Marasmos, which is nothing else but a consumption coming from them. Let such as are subject to these diseases, hold it for a jewel. (This remedy seems little more than chicken soup -Mike).
From Culpepper's Last Legacies (Section on Teeth). 25. A Caution. If you will keep your teeth from rotting, or aching, wash your mouth continually every morning with the juice of lemons, and afterwards rub your teeth with sage-leaf or else with a little nutmeg in powder; also wash your mouth a little fair water after meats; for the only way to keep teeth sound and free from pain, is to keep them clean. 26. To keep teeth white. Dip a little piece of cloth in vinegar of quinces, and rub your gums with it, for it is of a gallant binding quality, and not only makes the teeth white, but also strengthens the gums, fastens the teeth, and also causes sweet breath. 28. For tooth-ache. Take the inner rind of an Elder-tree, and put thereto a little pepper, and make it into balls, and hold them between the teeth that ache.
From Admirable Secrets in Physik and Chyrurgery: An excellent purging medicine one of the safest and best I ever had the knowledge of; it works only downwards by the stoole. It is called by the name of the purging ale. It may be given to either young or ould, to women that are not with child and when nature doth not work upon them. It purgeth wind and watry humours and other humours our of all parts that can be & ought to be purged out of the body without any weakening of the body or away good colour of the face &c.
Rx. Sennam 3oz; Polypody of the oak, 6oz; bay berries huld, 2oz; ash Keyes bruised, 4oz; Sassafras week, 2oz; rhubarb of Turk, 2oz. Let these be severally bruised into powder, saving the Senna which must be put in whole. Let all these ingredients be putt into a canvas bag and hang it in three gallons of ale in a barrel that is strong of the second spall as brewers term it. . . Drink thereof every morning a half pint, and every evening 3 parts of a half pint. Ache in any part. Rx. Pigeons dung, 4oz; strong ale, sheep suet, chamomile. Stew them together. Make a poultice and apply it on a cloth all night. Now if the body be strong, vomits, purges, letting blood, sweating, the use of Cupping glasses are useful.