As school children we are taught the theories of Charles Darwin: evolution and survival of the fittest. Generally, throughout our educational career, we learn to accept the idea that the human being is the result of a lesser organism once subject to gradual modification over an extended time period. The essence of evolution is that the human being is more progressive than the ape, which is more progressive than the dog, which is more progressive than prokaryotic bacteria. In most cases, contemporary knowledge and scientific research will not dispute this idea. However, what if Darwin’s theory is wrong? What if evolution, progression, and the fundamental hierarchies of species did not exist? How would the world be interpreted differently? Similarly, we can think of the evolution of ideas in the same way. What if an old idea, thought to be obsolete, is proven to be just as valid or more valid than a current idea?
Thomas Kuhn, scientist and philosopher, felt that “progression is in the eyes of the beholder.” He argued that Aristotilian physics is no different from the modern ideas of quantum mechanics, and that the same principles once used to guide the construction of the pyramids in ancient Egypt are being used today in developing the newest space technology.
Kuhn writes: “One conceptual world view is replaced with another…we may have to relinquish the notion, explicit or implicit, that changes of paradigm carry scientists and those who learn from them closer and closer to the truth." However, most cannot fathom the idea that the ape is no different than the human, is no different than the dog, is no different than the prokaryotic bacteria. If we were to accept the validity of an older framework, would we be able to understand nature and human interaction in a more normalized, fundamental manner, and essentially create a new scientific paradigm? Would old ideas once lost re-emerge and help scientists answer the questions that our current paradigm fails to address? Could twelfth-century medical principles once used to treat common disorders provide information that could re-direct current research efforts? Perhaps.
In studying the history of science and ideas one must overcome the difficult tendency of qualitative reasoning. In studying the history of medicine one is faced with the daunting task of understanding the exact disease condition and, essentially, creating in one’s own mind a hypothetical patient that one can neither see nor touch, and do such without being subject to making inferences. However, it is not surprising that the disorders suffered by those of antiquity are not much different than many of the disease and infections prevalent today such as rickets, leprosy, jaundice, epilepsy, infertility and cancer, among others. The misinterpretation lies within the gap of ancient versus contemporary ideas of pathophysiology. What are the underlying causes of certain disease states? Is the cause different from our understanding due to the difference in physiological conditions and parameters such as nutrition, climate, and sanitary aspects?
Problems may also arise in the interpretation and the nature of the language expressed in the ancient texts and in translation - if questions arise, do translators assume certain truths as well? Are we seeing an accurate recount of the actual disease symptoms, or rather, a manifestation of a predetermined condition defined by contemporary thought? These questions serve as the basis for the fundamental impurities or percent error that may arise and must be acknowledged when studying ancient medical and scientific texts.
On the Origin of Medieval Medical Writings:
The eleventh and twelfth centuries produced an inoculation of medical thought and writing in southern Italy and in other parts of Europe and marked the beginning of formal medical writings in the Lombard and Norman territory of Salerno. The medical writings flourishing at the time were essentially a permutation of early Greek and Roman medical doctrine and the formalized, more philosophically-minded medical theory of the Arabic world. The most notable Arabic translations arose during 1070-1090 A.D. at the monastery of Monte Cassino. Knowledge of the works spread rapidly west of the Alps and into Salerno where they were fused with the late Latin and Greek texts, and eventually became the primary texts of the early teaching universities.
However, prior to the circumvention of Arabic influence and the formalization of healthcare by universities, medical services and the study of medicine took place primarily in monasteries. Established by the Benedictine order in 540 A.D. by Benedict of Nursia, De infirmis frattribus describes medicine as an integral, and essential part of monasticism. The mandate was further solidified by the idea of Christus medicus or Christus sanator, which is the biblical parallel between spiritual and physical healing: “Care of the sick must rank above and before all else, so that they may truly be served as Christ, for he said 'I was sick and you visited me'" (Matthew 25:36). Additionally, part of the Benedictine rule required that every monastery have buildings for healthcare services and a medical herb garden for the purpose of healing the sick and wounded.
On the Dominant Scientific Paradigm of Medieval Europe:
Monastic medicine, the predominant form of healthcare during the sixth through twelfth centuries, was based on Hippocratic and Galenic theory placed against the backdrop of medieval theology. The medical handbooks contained both secular and religious portions, intertwining ideas of the creation, the cycle of human life, human sexuality, disease, the fall of man, and, ultimately, salvation. Ideas of physiology and pathology originated from pre-Socratic philosophy (5th century B.C.) and surrounded the inherent and integrative nature of the universe. All things were associated with the four elements-- fire, air, water and earth. These elements again reappear in the Corpus Hippocratium-- a compilation of medical monographs spanning over three hundred years, which present a physiological theory incorporating the four bodily fluids or humors-- yellow bile , blood, phlegm, and black bile-- with the four earthly elements. Health and disease were explained in terms of these humors. For instance, Crasis was a proportional mix of bodily humors, and Eucrasia referred to a perfect balance. By contrast, Dyscrasia was the wrong mixture of humors, which provided an explanation for systemic disorders that displayed more localized symptoms. Abundantia is the excess of one or more humors. Curruptio is the deterioration of humors, and coagulation is the curdling of humors. Humoral readjustment was achieved via changes in diet, medication, and elimination of matter through processes such as bloodletting, a very common practice during the middle ages.
Greek humoral theories underwent extensive development in Rome from 129 to 199A.D., where they were further modified into the Galelic tenets. Galenic doctrine further integrates the primal qualities of warm, cold, dry and moist. These qualities, along with the four elements and humors were combined to yield nine possible outcomes that could be used to diagnose a particular patient and to provide subsequent treatment. For instance, blood corresponds to the element air and is equipped with warmth and moisture. Black bile, corresponding to earth, has qualities of dryness and warmth. Variations in any of these combinations was a sign of disease. Furthermore, Galenic theory explains the origin of humors: the breakdown of food by a series of digestive processes, which yielded the “digestiones” that were circulated in the blood.
The pathology of a particular disease was attributed to a partial imbalance or domination by one of the four humors: choleric (yellow bile), sanguine (blood), phlegmatic (phlegm), and melancholic (black bile). For instance, a sanguine individual has the most humoral balance and is in most cases healthy, while a melancholic person may have a certain mental or physiological disorder associated with a particular humoral imbalance predominated by an excess of black bile. The abundance of phlegm or black bile was responsible for the progression of chronic disease, while an excess of yellow bile or blood was associated with acute disease. Bloodletting was used to remove the excess of a certain humor in the case of humoral imbalance and was frequently the treatment of choice, even in healthy individuals in order to prevent any type of future imbalance. Hippocratic in nature, treatments were prescribed on the basis of the primal qualities-- cure “opposites with opposites.” For instance, fever was attributed the primal qualities of warm and dry, so a possible treatment would have qualities such as cold and moist. Many practitioners utilized the principle of curing “like with like.” Healers would administer the use of a plant similar in color and consistency as the disease state. For example, in the case of jaundice, one would use a yellow flower as treatment.
Hildegard von Bingen:
By the eleventh century, women were given the role of healthcare provider and medical practitioner. Among the great healers in twelfth-century monastic medicine is Hildegard of Bingen, an ecclesiastical authority known for her visionary capabilities and ideas on natural philosophy as well as for her prolific poetry and musical compositions. She is the presumed author of the original medical text Liber Simplicis Medicinae, which contains Cause et Cure (Causes and Cures), a section devoted to the understanding of humoral physiology, disease, and treatment. The concepts discussed in Cause et Cure incorporate the dominant scientific paradigm constructed by Hippocratic and Galenic tenets of humoral physiology and pathology, as well as medieval theological principles.
Born in 1098 in Bermersheim near Alzey, her visionary capabilities were recognized at an early age as she once predicted the markings of an unborn calf inside a pregnant cow. Near age seven she was given to Jutta von Sponheim, a recluse, who resided in a hermitage adjoining the Benedictine Abbey of Disibodenberg, where Hildegard received the majority of her education. Years later, Hildegard had gained much influence among the sisters of the abbey and was elected abbess. She remained reluctant in displaying her prophecies until she fell deathly ill in 1141 A.D. She saw this as a sign that God wanted her to share her visions with her followers. During the next ten years, Hildegard recorded her testimony and many of her visions in Scivias, her most notable work. News of her prophetic gift spread throughout Europe, and Hildegard earned the recognition of political and ecclesiastical figures such as Fredrick I, Bernard of Clairvaux and Pope Eugene III. After acquiring permission to establish her own monastic community near Bingen and Rhineland in 1158, she acquired exposure to the great intellectual and political climate of Mainz, a city near Rhineland. As she was responsible for the governance of her newly established monastic community, she led a series of preaching journeys. She openly criticized the Roman Catholic orthodoxy, pronouncing moral purification and renunciation of wealth, yet steering clear of the heretical bounds occupied by the Cathars, a radical religious group of the medieval period.
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