The Greatest Benefit to Mankind. Roy Porter

‘after a grief, would ‘fumble, pluck, scratch, pick hairs, weep and then laugh, but … not speak’. Melancholy madness caused by black bile was occasionally seen as the spark of genius, originating the notion of melancholy as a disease of superior wits which achieved its most erudite treatment in Robert Burton’s Anatomy of Melancholy (1621). Plato could similarly represent madness as a transcendental divine fire with the power to inspire, a view influential in the Renaissance and the Romantic movement.

      Galen held that mania was a disease of yellow bile or the vital spirits in the heart. A cooling regimen was indicated, for mania was a ‘hot’ disease. Soranus devoted chapters to mania and melancholia, describing symptoms in detail and discussing aetiology. Among the causes of mania were ‘continual sleeplessness, excesses of venery, anger, grief, anxiety, or superstitious fear, a shock or blow, intense straining of the senses and the mind in study, business, or other ambitious pursuits’. Something which could later be interpreted as hysteria – a disorder marked by palpitations, migratory pain, breathing difficulties and the globus hystericus – might be attributed to a wandering uterus. By way of cure for many female psychological disorders, doctors recommended marriage.

      The consolidation of Greek and Roman medicine over the course of some seven hundred years laid solid foundations for learned medicine, including the naturalistic notion of disease as part of cosmic order, and the idea of the human body as regulated by a constitution, intelligible to experience and reason. It created the ideal of the union of science, philosophy and practical medicine in the learned physician, who would be the personal attendant of the patient rather than a medicine-man interceding with the gods or a functionary working for the state.

      For the next thousand years and more, medical knowledge would change little. This was partly the consequence of the break-up of the Mediterranean civilizations, but also because of the solidity of these foundations. Galen’s enduring reputation was the epitome of these beliefs: he unified theory and practice, discourse and the doctor, but his death brought that tradition to a halt.

* The life of learning could be precarious, as is clear from the fate of even the great Alexandrian library. Part was wrecked in 48 BC during riots sparked by Julius Caesar’s arrival; later Christian leaders encouraged the destruction of the Temple of Muses and other pagan idols. And, so legend has it, in AD 395 the last scholar at the museum, the female mathematician Hypatia, was hauled out of the museum by Christian fanatics and beaten to death. The Muslim conquest of the city in the seventh century resulted in the final destruction of the library.

* Pliny compiled a Natural History, completed AD 77, a compendium of all natural learning. Books 12 – 19 deal with botany and 20–27 with materia medica from botanical sources, followed by five books (28–32) on animal materia medica. His remedies proved of great influence, being quarried by Isidore of Seville and subsequent medieval encyclopaedists.

CHAPTER IV MEDICINE AND FAITH

      THE PASSAGE FROM THE GLORIOUS DAYS of Rome to the Middle Ages was often violent, especially in the West, with wave after wave of barbarian onslaughts from the East. These culminated in the sack of the Eternal City by Alaric’s Goths in AD 410, which effectively put an end to the western empire and frayed the thread of learned medicine.

      Fortified from AD 324 by its new capital, Constantinople (later Byzantium, modern Istanbul) on the Bosphorus, the eastern empire remained a bastion of imperial strength and a treasury of hellenistic learning and culture. From 364, the empire formally split, the two halves being ruled by separate emperors, and by the close of the sixth century the West had splintered further into fragmented kingdoms ruled by descendants of the invading Goths and Vandals. Its economy was feebler than that of the East, its cities declined or collapsed altogether – Londinium (London), once boasting a population of 30,000, became a ghost town – and civic institutions dwindled. In such circumstances, it was inevitable that eastern and western medicine would go separate ways.

      CHRISTIANITY

      Throughout the Mediterranean the mental climate began to shift from 313 with the Emperor Constantine’s establishment of Christianity as one of the official imperial faiths; from the early fifth century it was the sole official religion. Thereafter, by contrast with the naturalistic bent of Hippocratic and Galenic medicine, healing became more spiced with religion, for the rising Church taught there was a supernatural plan and purpose to everything (every human had a soul to be saved) and Christian doctrines, rituals and sacraments covered every stage through which believers passed from womb to tomb, and beyond.

      Religion, of course, shared common ground with medicine. Etymologically, the words ‘holiness’ and ‘healing’ stem from a single root, conveying the idea of wholeness. But early Christianity also made demarcations between the body and the soul, implying the subordination of medicine to religion, and of doctor to priest, the one attending merely to the cure of bodies, the other to the cure of souls. The boundaries between temporal and eternal were of course endlessly blurred, and physic and faith, while generally complementary and enjoying a fairly peaceful coexistence, sometimes tangled in border disputes.

      Christian outlooks on the body and sickness drew on various traditions. The faith absorbed aspects of eastern asceticism, which prized the soul or spirit above the flesh, and Jewish healing traditions were also influential. Early Judea had its distinctive healers, not least King Solomon (r. 970–931 BC), who was credited not only with wisdom but with magical and medical powers. Hebrew ideas on healing expressed in the Old Testament (compiled between the eighth and the third centuries BC), and the Talmud (between 70 BC and the second century AD), shared with Egypt and Mesopotamia a religious orientation: disease signified the wrath of God. ‘It shall come to pass’, it was recorded in Deuteronomy,

      if thou wilt not hearken unto the voice of the LORD thy God … the LORD shall make the pestilence cleave unto thee, until he have consumed thee from off the land; whither thou goest to possess it.

      The LORD shall smite thee with a consumption, and with a fever, and with an inflammation, and with an extreme burning, and with the sword, and with blasting, and with mildew; and they shall pursue thee until thou perish.

      Certain maladies were associated with the Almighty’s punishments for sin, including Zara’ath, which has usually been translated as leprosy, though this identification is medically dubious. ‘When a man shall have in the skin of his flesh a rising [a swelling], a scab, or bright spot, and it be in the skin of his flesh like the plague [the spots] of leprosy,’ states the Book of Leviticus,

      then he shall be brought unto Aaron the priest, or unto one of his sons the priests; and the priest shall look on the plague in the skin of the flesh: and when the hair in the plague is turned white, and the plague in sight be deeper than the skin of his flesh it is a plague of leprosy: and the priest shall look on him, and pronounce him unclean.

      Such polluting diseases were curable by the Lord alone, and this encouraged certain Jews to reject human medicine in favour of divine, citing the fate of King Asa (c. 914–874 BC), who ‘sought not the Lord, but his physicians’, and whose foot sores consequently worsened until he died. Jewish sacred writings have no place for the professional physician as such, nor even for priestly healers; Jahweh alone is the healer. Naaman the leper was instructed by the prophet Elisha to wash himself seven times in the River Jordan, so as to be cleansed; the only surgical operation mentioned in the Old Testament is the religious rite of circumcision.

      Suffering could be a godsend and a trial. ‘Blessed is the man whom God correcteth,’ declared Job, singled out by the Lord to undergo great suffering, ‘therefore despise not thou the chastening of the Almighty: For he makes sore, and bindeth up: he woundeth, and his hands make whole.’ For devout Jews, the pagan assumption that a healthy body was a great blessing could seem trifling.

      Nevertheless, the Hebrews did develop