For Your Enjoyment, Part 9: Premodern medicine for lifelike well-being

Well, here we are. As far as I can tell, this is the last topic I can helpfully cover about premodern life. Everything else is too varied or too complex to discuss in an article of reasonable length.

But, that leads into two new upcoming series! For Your Enchantment will revisit the topics covered in the For Your Enjoyment posts, adding magic and other fantasy elements to the mix to speculate about what might change. I’m also thinking about a For Your Enlightenment series that would look at the early modern period in the same way that we’ve examined the premodern era. Let me know what you think!

Same conditions as always: there’s an attempt to present principles that are true across most premodern societies. If my European- and Mediterranean-heavy education shows through, please feel free to let me know if there’s anything I’m not aware of. You could also make an argument that most fantasy settings are early modern instead of premodern; I’ll look at early modern in the next series (assuming people are interested). Lastly, fantasy elements like magic and monsters change things drastically. I’ll leave that for the other series, too.

We will look at medical theory, doctors, and ailments and treatment. Most of this article is dedicated to understanding the philosophies behind premodern medicine, but I do have some comments in other sections, too.

Medical Theory

• The same perspective that helped us gain empathy regarding premodern religion can shed light on premodern medicine. These people weren’t stupid. They were trying to be scientific, but they didn’t have the tools and perspective to do it well. In addition, the high price of failure discouraged innovation and encouraged people to follow tradition; if it works, why risk killing someone to try something new? Of course, “works” is very relative, and without large sample sizes and regular experimental procedures, it’s very hard to tell whether one practice performs better than another.
• Cultural norms could also make things difficult. One frequent factor is dissection taboos. Many, many societies viewed dissection as desecration of the body. Many even considered the dissection of animals to be morally wrong. This understandably made research into the nature of the body incredibly difficult. Without this information, people had to make guesses based on philosophy or religious doctrine about what was actually inside the body and how it worked. If scholars were able to dissect animals, they could try to draw parallels—the Greek physician Galen used monkeys for this. If a culture didn’t have dissection taboos—like the Egyptians—they frequently moved drastically ahead of its neighbors in medical knowledge.
• Lastly, religions could either be a help or a hindrance. Some encouraged medical research and practice, while others actively repressed the medical fields, believing that this these things were the domains of the divine.
• Now that we understand why premodern physicians believed the things they did, let’s talk about what they believed. While there’s a lot of different theories proposed models of how the body would work, almost all of them have one key philosophy in common. They believed that phenomena in nature, society, and morality all paralleled what happened within the body. Seasons, elements, personalities, types of food, and other things had corresponding organs or bodily functions. In general, illnesses were caused by imbalances or corruptions of these elements, and treatment involved restoring balance and/or purging corruption.
• Anthropologist Charles Leslie described this as saying that traditional medicine theories focused on an “all-encompassing order of things.” I call it “microcosmic medicine,” since it suggests that the body and soul are microcosms of what we see in the rest of the universe.
• Many, many theories followed this model, but we can briefly look at the two that had the most wide-reaching influence. These are the four-humors model and traditional Chinese medicine.
• Humorism suggested that there were four “humors,” or fluids, that controlled everything in the body: blood, phlegm, black bile, and yellow bile. There’s a possibility that this theory came from watching blood coagulate over time. If left in a container, blood will settle into four layers: black platelets, red blood cells, clear-ish white blood cells, and yellow serum. The humors had parallels to seasons, stages of life, classical elements, organs, and personalities.
• Like other microcosmic medicine theories, illness was often seen as due to an imbalance between the humors. This is where bloodletting and leeches came from—it was theorized that too much blood was a cause of disease, so getting rid of the excess was a form of treatment.
• While the phrase “traditional Chinese medicine” glosses over a lot of regional and temporal differences, the fundamental theory behind it is mostly the same wherever you go. The model of the body draws from the Yin-Yang model as well as the Wu Xing, or “five phases” model of elements (fire, earth, metal, water, wood). These meet to form a series of functions in the body that are named after organs, but aren’t entirely the same thing (the function “triple burner” doesn’t have any corresponding physical organ, for example).
• Energy flows through these organs/functions along paths called meridians. Again, illness is seen as an imbalance of the functions or blockages of energy (“chi”). Treatments involve restoring balance, sometimes through stimulating energy by inserting needles in specific points along meridians—acupuncture.
• Having covered all this, there’s one last thing I should mention. Among non-scholars, it often didn’t matter why treatment worked, only that it worked. The technical phrase is that folk medicine is “non-explanatory,” meaning that it doesn’t necessarily try to provide explanations. Formally trained doctors might be familiar with these theories, but local physicians might not know about them, and might prescribe treatments that go against the prevailing scientific consensus.

Doctors

• Different cultures assigned the role of “doctor” to different members of society. Physicians could be religious practitioners, they could be graduates of medical universities, they could be local leaders with no other qualifications, or they could be something else entirely.
• Some societies would blend medical professions in unusual ways. Many areas in Middle Ages Europe would have their barbers perform surgery. Surgery was considered a lesser art to the rest of medicine, so cutting hair was usually enough preparation to amputating limbs. (There clearly was some training, but I’m exaggerating because I personally find this concept so bizarre.)
• Generally, there were two models of education for physicians: apprenticeships or universities. As civilizations developed, they tended to move towards standard education, certifications, etc. One Islamic government required all aspiring doctors to successfully cure three members of an opposing religious group before they were clear to practice on their own.
• Despite all this, in most cultures, most people would go to local, untrained physicians before resorting to trained professionals. This naturally led to a lot of inconsistency between diagnoses and treatments.

Ailments and Treatment

• As a society becomes more advanced, the illnesses that people deal with changes. The epidemiological transition model suggests that more developed societies experience more chronic illness (like heart disease), while less developed ones experience more infectious illnesses (like tuberculosis) and child mortality. This essentially describes the perspective shift that we need in order to imagine what premodern societies experienced. More diseases, more sick children, and fewer far-reaching and man-made difficulties like smoking and obesity.
• A few illness areas that are often underrepresented are dental, ocular, and digestive issues. Large portions of the premodern medical texts I’ve looked at dealt with these issues, suggesting that they were a source of a lot of the burden that physicians experienced.
• One key fact was that both diagnosis (determining exactly what was wrong with the patient) and prognosis (predicting what the patient will experience in the future) were both innovations that had to be thought up. Physicians might try to learn what the patient was experiencing in order to prescribe effective treatments, but classifying illnesses into recognizable patterns was unusual. Predicting what was going to happen was also usually considered next to impossible.
• Tools to diagnose illnesses or suggest treatments could be very interesting. A surprising number of cultures diagnosed based on the patient’s pulse. Other common tools include tongue examination, smelling the breath, or other things that would be extremely unusual for us. People would also look at the person’s general physical appearance to get a sense for general predilections, though these won’t make sense to us—you’re thin and have a large Adam’s apple, so you’re prone to breathing difficulties.
• Herbs and herbal concoctions were almost always at the forefront of medical treatment. In Europe, practitioners would often keep “physic gardens” of medicinal herbs at their homes. (These are actually the precursors to modern botanical gardens.) Middle Ages Europe had a religious theory called the “doctrine of signatures.” This doctrine stated that God had provided a cure for every illness, and the observant could tell what each plant was made for by looking for physical “signatures.” Skullcap flowers looked like skulls, so they were prescribed for headaches; lungwort looked like lungs, so it was prescribed for respiratory infections. Many premodern cultures had similar philosophies, though usually not so explicitly stated.
• Often, another dimension of microcosmic medicine was morality. People who were sinful were imagined to upset balances within their body, leading to sickness. According to folklore, an ailing Mongolian warlord was advised to give amnesty to everyone in his domain; when he did this, he recovered. Similar treatments could be suggested in other cultures.
• In a related vein, disease could also be related to spiritual issues. This could be essentially the same as the moral illnesses described above, or they could deal with problems in the spiritual realm. A classic example is exorcism, since the influence of malign spirits was a common thread in many religions. Here again, we can see the intersection of religion and medical science.

And there we go! Let me know if you have any other requests for the premodern era, if there’s any feedback on this article, or if there’s something you’d like to see in the upcoming series, feel free to post a comment!