Empirics, Quacks, and Alternative Medical Practices

Overview

During the Middle Ages and through the Renaissance, physicians who were educated and trained in the scientific method—with a reliance on observation and experimentation—were few in number. Most of the population relied on a combination of alternative healers for their medical care—empirics (those outside the medical mainstream), barber-surgeons, and apothecaries. These healers learned their trade mostly through an apprenticeship, and used folklore, herbs, and guesswork to cure the sick. Disease was often attributed to supernatural causes, from evil spirits to punishment by God. Superstition and religious fervor dominated the philosophy of caring for the sick. In Europe the population embraced empirical healers along with the prevailing mysticism in desperate attempts to escape the great plagues of the late Middle Ages. By 1661, as London was in the grip of another plague, new explanations for disease were sought. Interest in science was rekindled and classical texts were rediscovered, as Renaissance thinking spread from Italy throughout Europe. With the rebirth of the scientific method based on observation and experimentation, the early foundations for modern medicine were laid. Slowly, empirics and folklore medicine declined, and the science of medicine assumed prominence.

Background

Most Renaissance villages were without a resident physician or surgeon. Often the local barber would perform surgeries, along with his traditional duties of trimming villagers' hair and beards. The barber-surgeon's repertoire of procedures, often performed with the same razor with which he cut hair, included bloodletting, lancing infections, and excising lesions. The barber-surgeon also set broken bones and extracted teeth. Bloodletting was seen as the appropriate treatment for many common illnesses, and attempted to aid the victim by cleansing the blood of the excess of the "sanguine humor" in the Galenic tradition. After the barber-surgeon made a small incision and sometimes placed a cannula (small hollow tube) into a vein, the patient was encouraged to drink large quantities of fluids thought to dilute the blood and have a cleansing effect. Up to a pint of blood was removed per session. The familiar barber's pole is a symbol of the barber-surgeon's role in the practice of bloodletting. The patient gripped a staff in order to make the veins appear prominent for the procedure, and afterward the barber-surgeon secured the blood soaked bandages to the staff to dry. The familiar red-striped effect was created by the wind blowing the bandage around the staff. Barber-surgeons also used the red-striped staff to advertise to the public that, according to the position of the stars, the time was optimal for bloodletting cures.

Empirics, Quacks, and Alternative Medical Practices

Overview

Background

Until the seventeenth century surgery was a free-for-all trade that almost anyone could practice. A Papal edict during the thirteenth century forbade monks to draw blood, and therefore prohibited them from practicing medicine. Monks would often pass their knowledge of anatomy and medicine on to barbers, who often visited monasteries to help the monks maintain their smooth-shaven appearance. Thus, barbers acquired surgical knowledge, then practiced in public for others to observe. With few laws governing surgery, the result was an army of charlatans who wandered the countryside and filled the marketplaces and county fairs representing themselves as tooth-pullers, cataract-removers, and "cutters-for-the-stone," or lithotomists, who specialized in a quick surgical removal of stones of the urinary tract. The most notorious of these was the French lithotomist Jacques de Beaulieu. After an apprenticeship to a wandering Italian surgeon in 1690, Beaulieu donned monk's robes, named himself Frère Jacques (believed to be the inspiration for the familiar nursery rhyme), and was eventually expelled from France due to the number of patients who died from his lithotomy techniques.

Apothecaries and herbalists were among the lowest in the social order of the Renaissance healers. Apothecaries dispensed medicines of the day upon the order of physicians and surgeons. Many also practiced alchemy, the ancient and futile search for a method of turning ordinary substances into extraordinary ones, notably gold. Herbalists, often known as "witch women," made potions of dried herbs and plants, parts of dead animals, and sometimes excreta. The efficacy of the potions was trial and error—if a sick or injured person recovered, the herbalist recorded the herbal potion as successful and added the concoction to her medicinal collection. Occasionally, an herbalist stumbled upon a plant with legitimate curative action. In the early eighteenth century an herbalist near Shropshire, England, reported great success in curing dropsy (congestive heart failure) with a mixture of brewed foxglove. Digitalis, an important drug still used today for its action on the heart, is derived from the foxglove plant. In 1638 the Countess of Chinchon, wife of the Spanish Viceroy of Peru, was cured of malaria by an extract of the bark of the Peruvian quinaquina tree. The news of the cure spread quickly throughout Europe, and the drug was named chinchona in honor of the countess. Now known as quinine, the drug remains an effective weapon in the prevention of malaria. More often, the herbalist and even the apothecary stocked medicines that had little effect on the diseases for which they were intended. Some curatives involved elaborate and expensive hoaxes. Mumia, a powder derived from dried Egyptian mummies, was one of the most valued commodities on the apothecaries' shelves. Believed to contain powerful, mystical cures for many diseases, the demand for mumia in seventeenth-century Europe was so great that it was impossible to supply it. As a result, medical charlatans grew wealthy selling fake mumia, made from the remains of recently executed prisoners.

Impact

With little understanding of the nature of disease, and little to offer their patients in the way of a cure, physicians as well as other healers often embraced the occult for an explanation of illness. This philosophy impeded the rediscovery of the scientific approach to medicine by hundreds of years. Especially in the fifteenth and sixteenth centuries, the belief of superstitions and demons as the cause of disease was widespread. Demons were said to invade persons of weak stature or character and thereby cause disease. Sore throats and pneumonia were believed to be caused by demons traveling with winds from a northern direction. Many persons covered their faces or stayed indoors to avoid north winds. Epilepsy and insanity were believed to be the result of particularly fierce demons taking residence in the unfortunate victim. Priests and other clergy encouraged the belief in demons as the cause of disease, as prayer and exorcism allowed them an active role in caring for the sick.

The officially sanctioned persecution of individuals for witchcraft began during the Renaissance period. Although many of those presumed to be witches were probably suffering from delusional mental illnesses, some empirical healers were also accused. Occasionally, healers were put to death if their potions or methods did not affect a cure. Others accused of witchcraft were first sent to an exorcist. If the demon did not depart, the demented person was blamed. He was then subjected to starvation, whippings, and imprisonment in a dungeon in an attempt to rid himself of the demon. If these tortures did not induce the demon to leave the body, the demented person was burned at the stake. Mental illness was not considered a reason for humane treatment via scientific means for over another hundred years, when French physician Philippe Pinel (1745-1826) wrote a treatise characterizing insanity as an illness, and its victims worthy of humane intervention.

Many healers earned their living by catering to the prevailing superstitions of the time, becoming traveling peddlers, selling amulets and other wares intended to ward off demons and disease. The modern custom of wearing lockets in the shape of a heart around the neck is a vestige of a belief that the heart possesses spiritual powers. Often garlic or herbs were worn in the locket to ward off disease. In Scotland, these amulets were known as witch brooches and were used to protect children from witchcraft. Christians wore prominent crosses to display their faith and to ward off demons. England's Queen Elizabeth wore an engraved gold ring suspended from her neck to dispel "bad airs" about her. Healers sold vast quantities of garlic and onions, both said to have medicinal value and powers against evil spirits. One of the most dramatic superstitions involved the ground powder from a unicorn's horn, believed to cure any poisoning and bring good fortune. When English surgeon Ambroise Paré (1510-1590) suggested that many apothecaries and quacks were growing rich substituting domestic animal horns for the imaginary unicorn, he was denounced by the dean of the Paris Medical College. Amid such superstition, sanctioned by religious and many academic leaders, scientific progress in medicine crept through the latter Middle Ages and first half of the Renaissance.

Beginning in about 1550, several factors diminished the ranks of empirics, barber-surgeons, herbalists, and quacks across Europe. The renewed interest in the classics brought about by Renaissance thinking reintroduced the Hippocratic method of careful observation of patients and their symptoms. Physician and philosopher René Descartes (1596-1650) demystified the human body with his mechanical conception of human physiology. When opposition to human dissection evaporated, Andreas Vesalius (1514-1565) saw first-hand the structure of the human body, and pioneered the study of modern anatomy and physiology. Anatomical observations were accurately illustrated by artists such as Leonardo da Vinci (1452-1519). Also, the invention of the printing press made possible the dissemination of medical literature and sharing of information across Europe. Several universities were built during the period that served to train learned physicians in the classical tradition and scientific method. Laws and regulations regarding practice were strengthened. By the eighteenth century those who practiced superstition and folklore remained, but were superceded by those physicians trained in the sciences at the dawn of modern medicine.

BRENDA WILMOTH LERNER