Theory vs Practice

Opening remarks

'Theory vs Practice' is perhaps an unfortunate title. 'Theory and Practice' would be more appropriate. Historians of medicine have neglected the practice at the expense of the theory. But how can we get at the practice? How can we bring together the different kinds of evidence – texts, artefacts, palaeopathology, etc. – to begin to build up an idea of what early medieval healers did? That a copy was made of a particular text is evidence that some minimal value was placed on its content. But it is no guide to the manuscript's further use. Sometimes annotations testify to a text's employment in therapy, but this is relatively rare. Recipes may be copied from one manuscript to another long after they must have ceased to have any practical utility. An obvious example of that is the remedy for epilepsy that required the blood of a gladiator. The remedy was copied in Byzantium into the tenth century, a very long time indeed after all gladiatorial shows had ceased. Apparently direct indications of use can be highly deceptive. An author notes 'I did this'. Yet that can be a record of something that happened years, if not centuries previously. The late Anglo- Saxon medical texts attest to an interest in Mediterranean materia medica; but how regular was the supply of such Mediterranean materia in tenth-century England? Are the Mediterranean ingredients being preserved out of antiquarianism or an admiration for the exotic? Or, are the very names themselves deceptive? Anglo-Saxon plant names are from univocal. Galen certainly conflated medical advice that he had heard with his own experience, drawing no distinction between the two that is clear to us now.

Overall, any study of medical practice around the year 1000 must be seriously hampered by lack of evidence. We are in a period that is too late for substantial quantities of papyri and too early for such archives as the Cairo Geniza to help us. There is no epigraphic evidence. The historical documents we have are, as we have been seeing, very difficult to interpret. The evidence of palaeopathology is clearly important, but is restricted, both geographically and in the range of conditions about which it can tell us. We have no idea what is typical and what is exceptional. There is no tenth-century Augustine. For many areas of the world that interests us we have virtually no direct evidence at all. We have to use other kinds of source material, such as hagiography to supplement our evidence. Only by that means can we get any idea of the activity of local healers, for instance of the village doctor, who may have been a vet as well.

The use of parallels from other periods and cultures may help to focus our imaginations. Mary Dobson's achievement in her book, Contours of Death and Disease in Early Modern England (1997), was to bring out local changes in the patterns of malaria. We have to try something similar for our period. We also have to integrate palaeopathology, ethnobotany, and the like, always bearing in mind the difficulty of inferring the effectiveness of ancient treatments from modern drug use. All this might begin to tell us what it was like to be a doctor around the year 1000 and what was the impact of disease on society, on demography, on the choice of healer.

Points arising in discussion

What is to be included under the heading 'Medical Practice'? Does it span all kinds of therapeutic acts, a visit to a shrine or a healer, self-help, domestic medicine? It is tempting to say that we can think in terms of concentric circles: treatment within the family being the first stage, and only then the recourse to some outside source of healing. It is also easy to suppose that we have virtually no evidence for domestic therapy. From the Islamic world, however, there survives a relative abundance of material. We should not impose on it a modern division between health care and medicine. Any attempt to maintain well-being or restore health is to be seen as part of medical practice. In the Middle East much of the magical equipment and some of the texts that have come down were 'home made'. As for western Europe: monastic texts are in a sense domestic to the monastery, but they may also, of course, have value to outsiders. The quasi-domestic care of monks, as recorded in monastic consuetudines, may offer some analogy to genuine domestic regimes.

One of the problems with identifying traces of medical practice within texts is our frequent inability to distinguish between quotations and original record. Galen has left us an account of a man who, when bitten by a snake, cut his finger to prevent the venom from spreading through his body. This account occurs in both an Arabic text and the Syriac Book of Medicines. Yet in both cases it does so without the ascription to Galen, so that it has been mistakenly thought to be the author's account rather than a quotation from Galen.

Perhaps we should not be so obsessed with recovering the medical practice of the early Middle Ages if the evidence simply does not tell us about it!