The Black Death

The main flaw in the monumental labour of Hippocrates was that he had insufficient data from which to draw valid conclusions. He deduced, for instance, that spells of warm, moist weather were, in themselves, conducive to ill health; a thesis reasonable enough where malarial regions were concerned but irrelevant if not positively misleading when applied to England. His great achievement was to have provided a blue-print for research on which subsequent generations should have worked. The tragedy is that the vast compilation of case histories, on which a serious study of epidemiology could alone have been based, was not made by his successors. After the death of Hippocrates in 377BC, medical science slumbered for five hundred years; it awoke only to find itself rigidified by the misplaced formalizing genius of Galen of Pergamos.

Galen was one of the outstanding intellects of his age and a great experimental physiologist. But, when it came to epidemiology, rather than work from the Hippocratic base and accumulate fresh data from which empirically to establish new and constructive theses, he instead elected to devise an inflexible theoretical pattern which left no room for further research or original thought. He lived through a major epidemic of bubonic plague but the phenomenon was in no way reflected in his work. To attempt to summarize Galen’s complicated and, within his own terms of reference, logically faultless theorizing would be to reduce it to a parody. Suffice it to say that he believed ill health to depend on the interaction of temperament, the constitution of the atmosphere and certain other factors such as excessive or ill-judged eating and drinking. Temperament and constitution in their turn depended on the blending of the elementary qualities and any failure to achieve perfect balance led to one of a number of possible discords. The permutations on these factors were developed into an intricate mathematical pattern: a computer into which the details of any case could be fed and a logically satisfactory explanation provided.

Unfortunately, though the logic might be impeccable, its relevance to anything so mundane as the prevention or cure of plague was sadly tenuous. What was worse, the medieval physician believed that Galen had said the last word on epidemics and that any further research was unnecessary if not positively disrespectful to the teachings of the master. And yet the teachings of the master themselves were in doubt since the original texts had been largely lost and doctors in the West for several centuries worked almost exclusively from inadequate Latin versions of Arabic translations of Hippocrates and Galen. The result was an Arabic-Latin literature, in Dr Singer’s description,

…generally characterized by the qualities most often associated with the words ‘medieval’ and ‘scholastic’. It is extremely verbose and almost wholly devoid of the literary graces. An immense amount of attention is paid to the mere arrangement of the material, which often occupies its author more than the ideas that are to be conveyed. Great stress is laid on argument, especially in the form of syllogism, while observation of nature is entirely in the background…. Lip-service is often paid to Hippocrates, but his spirit is absent from these windy discussions.^{122}

Nurtured on such material it is hardly surprising that medical science did not flourish in the Middle Ages. ‘The Dark Ages for Medicine,’ wrote Dr Singer, ‘began at the death of Bede in 753’.^{123} They did not end until long after the Black Death had run its course. But the failings of the fourteenth-century doctors should not be exaggerated nor their limitations presented as grotesque extravagances. Ill-informed and unimaginative they might have been but there was, on the whole, surprisingly little of the:

Watres rubifiying, and boles galle,
Arsenyk, sal armonyak, and brymstoon,
And herbes koude I telle eek many oon,
As egremoyne, valerian, and lunarie.[1]

which were the stock-in-trade of Chaucer’s alchemist.