Medieval Monday – When Medicine was “Humorous”

In his book The Emperor of All Maladies: A Biography of Cancer, Dr. Siddhartha Mukherjee traces the history of cancer as it has been seen in the past and continues on through the innovations in cancer treatment in the 20th century and on to the exciting research going on now and the possible future of cancer treatment.  It’s a really cool book.  But one of the things that struck me was his statement that cancer has always existed and has been identified since ancient times, but that other diseases generally killed people before cancer could take hold.

Mukherjee spends some time talking about cancer in the Middle Ages in his book.  The observations he makes about how Medieval doctors viewed what we would later call cancer are not only fascinating, they are surprisingly advanced.

Medical knowledge in the Middle Ages, as you might imagine, was light years behind what we know now.  This was before germ theory, before an understanding of contagion, and well before almost all effective surgery and anything but naturopathic medicines.

The concept of the Four Humors was originally devised by none other than Hippocrates, the father of Western medicine.  In around the 4th century BC he proposed the theory that the human body was comprised of four cardinal fluids, or humors: blood, black bile, yellow bile, and phlegm.  Sickness, in Hippocrates’ view, was caused by an imbalance of the humors.

Several hundred years later, in around 199AD, the Roman physician Claudius Galen advanced the theory by stating that all illnesses could be classified in relation to these four humors.  All of the humors were created inside of the body, rather than inhaled or ingested, but the foods that a person ate or the stage of life that someone was in could affect the balance of the humors.  To regulate the body and relieve illness it was sometimes necessary to purge the excess of one humor or another.

Galen and Hippocrates

This is where the long-held idea of bleeding in cases of fever came from.  Blood was the hot and moist humor, so if someone was too hot and moist they had too much blood.  Break out the leeches!

The ideas of Hippocrates and Galen shifted east after the fall of the Roman Empire.  In the Islamic world they were merged with similar medical theories coming out of India.  The idea of the humors continued and was used for centuries while medical knowledge in the west floundered.

The problem in the west after the fall of the Roman Empire was the same as any other problem of the Early Middle Ages.  Civilization became rural and isolated and knowledge was controlled by the Church, which had its own agenda.  Early Medieval medicine was a strange conglomeration of folklore and herbalism and Christian mysticism.  Medieval people were just as likely to consult with the local wise woman or blacksmith for herbal remedies and spells or charms as they were to pray for healing or go on a pilgrimage to a distant holy sight.

I have no idea, but it made me laugh. A lot.

Because in this time before germ theory, when the most scientific explanation offered for disease was an imbalance of humors, people were as likely as not to believe that an illness was caused by God’s wrath or some sin on the part of the afflicted.

But it’s not as if Medieval scholars weren’t trying to figure things out.

Medical knowledge and inquiry began to change in the 12th century, the High Middle Ages.  This was the same era that the great universities of Europe were established and began to flourish.  And you guessed it, one popular course of study was medicine.  Although medical advances were just as likely to be discovered and practiced at monasteries, which were some of the first hospitals of the Middle Ages.

Many Medieval medical advances were not so much new discoveries as deeper observation and understanding of long-held herbal remedies.  One increasingly popular theory was that God had created an herbal cure for every disease that existed.  He also “marked” herbs throughout the natural world with their use.  For example, skullcap, an herb used to cure headaches, looked like tiny skulls.  Medieval physicians might not have been aware of the exact properties of the herbs they cultivated or the chemistry of how they worked, but they built an extensive knowledge of what herbs cured which diseases.

Surgery also “advanced”, if you can call it that, to the point where simple operations could be performed with a fair success rate.  Although with the knowledge of infection and the importance of sterilization still hundreds of years off surgery had its own problems to overcome.

So what about cancer?  Mukherjee hints in his book that Medieval physicians discovered a few things about cancer that it would take modern doctors a while to catch on to.  What is that all about?

It all goes back to the humors.

When I first learned about the four humors there was one thing that baffled me.  Blood I get.  Phlegm is a pretty easy concept to understand as well.  Yellow bile makes sense when you consider things like urine and liver fluids.  But black bile?  What the heck was that?

There were only two conditions caused by black bile: cancer and depression.

I’m going to start a whole new paragraph because I believe that’s super important.  Cancer and depression.  Black bile.  The Medieval belief was that black bile was systemic.  It wasn’t located in just one place.  Unless there was something wrong and it built up in a particular area.  Those log-jam build-ups of black bile were also known as tumors.

One thing Galen knew that Medieval physicians agreed with was that if you had an imbalance of black bile, if you had cancer, it was inadvisable to attempt to lance or surgically remove the tumor.  The observation was that even if life wasn’t long, patients still lived longer if you did nothing than if you treated the disease.  This was the precursor to the modern discovery that often a tumor suppresses latent cancer elsewhere in the body.  Yes, medical research within the last few decades has discovered that if you remove a tumor, quite often the cancer metastasizes throughout the body, killing someone faster.  Score one for Medieval medicine!

But what I find even more fascinating is that modern research is confirming more and more that there is a link between depression and stress and cancer.  It is well-documented that patients with a more positive outlook live longer than those who give up.  Coincidence or did they know about that in the Middle Ages?  It goes beyond that.  Stress causes cancer.  More and more studies show a link.  And while that probably has a lot more to do with the physiological presentation of stress in the body, lowering the immune system and interfering with all sorts of other things, the fact that folks a thousand years ago had made the connection is pretty cool to this Medieval Apologist.

Oh, one other thing?  Years ago I worked for an herbalist for quite some time.  I have never been one for taking allopathic medicines.  I’ve always been hypersensitive to them.  I can’t take a Tylenol without being knocked flat.  Three baby aspirins are enough to get rid of my headaches.  So I have found that herbal medicines work really, really well for me.  I’ve taken several different things over the years with very good results.  I think that’s because I have a “clean” system … a Medieval system?  It’s enough to convince me that medicine back in the day was far more effective than modern hubris assumes it was.


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