The Greek physician Alexander of Tralles (sixth century) was best known for his Libri duodecim [Twelve Books on Medicine], popular in Latin, Greek and Arabic. After travelling in Greece, Italy, Spain and Gaul, he settled in Rome. He was the first European to champion the eastern laxative, rhubarb, later so prized, but was also keen on more exotic remedies, for example live beetles. Henbane, he taught, was effective only if held between the left thumb and index finger while the moon was in Pisces or Aquarius; and he advised epileptics to ‘take a nail of a wrecked ship, make it into a bracelet and set therein the bone of a stag’s heart taken from its body whilst alive; put it on the left arm; you will be astonished at the result.’ Over the next centuries, the rational medicine of antiquity went through a long process of being diluted, or rather spiced up, with more magic ingredients and more exotic recipes.
Slightly later, Paul of Aegina (fl. 640) studied and practised medicine in Alexandria. A Galenist, he wrote on gynaecology and poisons, but his only extant work is his medical encyclopaedia, Epitome medicae libri septem [Seven Books of Medicine]. It opens with pregnancy, the diseases of childhood and of old age, and then passes to diet and regimen. Illness is dealt with in Book II. Maladies affecting specific parts are next treated from top to toe. For mental illness he recommends gentle treatments, including music, but also alludes to satanic possession. Book IV is concerned with skin diseases, beginning with scabies and ‘elephantiasis’ (presumably a form of filariasis) and progressing to herpes, oedemas, cancers and ulcers. Discussion of conditions caused by noxious body humours is followed in Book V by a survey of external agents, principally poisons, with a brief appendix on impostors. Book VI deals with surgery, including an account of tracheotomy, and a final long book is taken up with drugs, including the use of colchicum for gout. As a practical introduction, his Epitome was esteemed by Islamic physicians.
Such writers as Oribasius and Paul of Aegina saw it as their job to stitch extracts from earlier writers into a compendium of teachings and remedies. Their encyclopaedias spread Galen’s influence far and wide; they also reveal emergent tensions between theory and practice. Galen’s insistence on the need for a doctor to understand philosophy was interpreted as a call for logic and book-learning. This encouraged a drift towards treating medicine in terms of set texts. Though Galen had laid down no canon, by AD 500 in Alexandria there was not only a syllabus of Hippocratic texts (those which Galen had followed) but an embryonic Galenic canon, which became known as the sixteen books, taught with commentaries and studied in a set order, beginning with On Sects and the Art of Medicine. Alexandrian scholars also summarized the sixteen books for ease of memory, thus imparting to Galenism a more dogmatic air. Just as Christ’s teachings were theologized by the Church, classical medicine was being given its own orthodoxy. Medicine was becoming a matter of great texts.
While a scholarly tradition maintained itself in the eastern Roman empire, promoting a somewhat stilted Galenism, learned medicine was languishing in the West, where erudite doctors almost disappeared. Schools dwindled and Latin became confined to the Church. Cassiodorus (c. 540–c. 583) advised his monks at Vivarium in southern Italy to tend the sick and trust in God, while recommending a few practical medical texts: ‘read above all the translations of the Herbarium of Dioscorides, which describes with surprising exactness the herbs of the field,’ together with some Latin Hippocrates, Galen’s Method of Healing, Caelius Aurelianus’ On Medicine, and a handful of others. But that amounted to a sparse diet, and such texts were largely practical. The Lorch Book of Medicine, written about 795 in a Benedictine abbey in Germany, similarly contains brief introductory texts on anatomy, the humours and prognostics, and ends with recipes and dietary advice. The range of learned medicine was shrinking.
Knowledge was also transmitted in the West through encyclopaedias like the Etymologiae of Isidore, archbishop of Seville (c. 560–636), a medieval bestseller. Writing amid the turmoil in Spain – Goths ruled the country while Arian heretics (those who denied that Jesus was divine in the same way as God the Father) were bickering with the pope – the young Isidore felt called upon to shore up classical culture. His Etymologiae (the name reflects his passionate interest in the origins of words) takes in theology as well as history, grammar, mathematics, law and virtually all other learning. The fourth book concerns medicine, drawing on late-classical compendia, including the works of Caelius Aurelianus.
Isidore served up a beginner’s guide to Greek science, philosophy and medicine. The physical world was explained in terms of the four qualities (hot, cold, wet, dry), and the four elements (earth, air, fire, and water). The body operated on a similar plan, ruled by the four humours (blood, choler, phlegm, melancholy). Disease in the microcosm was caused by humoral imbalance, and treatment had to restore that equilibrium allopathically by diet, regimen or drugs. The medical sections of his encyclopaedia abstracted learned medicine, but his very title highlighted the new focus of study: words not bodies. Semantics was the key to a cosmos created by the Divine Logos, an orientation symptomatic of the cloistering of learning in the Latin West during those times of which little evidence survives: the ‘Dark Ages’.
The Venerable Bede (c. 672–735) was the English Isidore, a man aware of the need to meld healing and holiness. Although their North-umberland lay on the outer rim of the civilized world, Bede and his monks possessed many medical writings. Indeed, England was unique in producing a medical literature in a non-Latin tongue, Anglo-Saxon. Knowledge of plant remedies was extensive, and the English healer (laece or leech) used chants and charms, predicated on the belief that certain diseases and bad luck were caused by darts shot by elves, while others involved a ‘great worm’, a term applied to snakes, insects, and dragons. Bald and Cild’s do-it-yourself Leechbook (AD 900) mirrors medical tracts common elsewhere in western Europe, simplifying Latin recipes by removing the more exotic ingredients and interweaving local remedies. Disease could be cured by prayers or by invoking saints’ names, by exorcism, or by transferring it to animals, plants or the soil. Christian amulets were prescribed, together with number magic (the Anglo-Saxons favoured nines). For paralysis, ‘scarify the neck after the setting of the sun and silently pour the blood into running water. After that, spit three times, then say: “Have thou this unheal and depart with it”.’
Anglo-Saxon medicine conveys the spirit of early medieval Europe. A basis of classical therapeutics endured, explained by a sprinkling of Greek theory. The emphasis, however, had shifted to practicalities: recipes, meteorological and astrological advice, tips for uroscopy and bleeding, all indicative of an unstable society where books and learning had grown precious. The torch of medicine had meanwhile moved from Galen’s Rome to the east.
ISLAM
The eastern Mediterranean experienced turmoil of its own. Prolonged warfare between the Byzantine (Roman) and Persian empires caused chaos; within Byzantium, ethnic tensions between Greeks, Semites, Persians, Armenians and Slavs were exacerbated by vitriolic doctrinal splits amongst Christian sects. The heroic military efforts of Justinian (r. 524–65) to recover the western Roman Empire and his ruinous building ambitions caused further upheaval. The appearance of bubonic plague in 541 heralded two hundred years of devastating outbreaks. The Greek heritage grew less assured. Learned medicine continued in large cities, especially Alexandria, but most doctors were increasingly working in isolation, and religion assumed a dominant role in everyday life. The scene was set for Islam.
Muhammad (570–632) was a member of the tribe of Quraysh who ruled Mecca. He began life as a poor orphan but rose to become a wealthy merchant. When he was about forty, he received a call, and the Qur’an (Koran) was revealed to him in visions. He gradually assumed the mantle of the last of the prophets in a long line beginning with Adam and Noah. In 622 an assassination plot against the Muslims in Mecca led him to flee to Medina where he commanded a growing following.