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A Mite of Medieval Medicine
Fancy a trip to hospital? Are you mad, might be the normal response, with MRSA on the loose and other spectres that have made going to a hospital a cause for concern. Well, years ago, one exception to that view used to be held by harassed housewives and mothers, saying the only real break they got was when they were hospitalized. They were not entirely joking! – No chores, no demands expected to be met, and relative peace. However, there is another exception, when holidaying in Scotland why not visit one of the rare seats of Medieval Medicine outside Edinburgh. ‘Soutra Aisle’, or to give it its medieval name ‘The House of the Holy Trinity at Soutra’, the building of which (pictured above) is all that remains of a grand hospital, monastery and church founded by King Malcolm IV in 1164AD.1 The ancient funding for Soutra Aisle came from immense monastic estates, augmented by benefactors thankful for their hospital treatment. It was the biggest and best endowed hospital of medieval Scotland and laudably run by Augustinian monks: to give alms to the poor, hospitality to travellers and pilgrims, to treat the aged, sick and infirm, as well as giving sanctuary to fugitives. “… You would put it down at first for a shepherd’s hut, or even powder magazine; it is all that remains of the magnificent twelfth-century mediaeval foundation of the old Scots King Malcolm, called the Maiden, for travellers and poor folk. Here was in distant days dispensed that strange mediaeval charity which fell like the rain and sunbeam of heaven on the just and unjust, and ministered to the wayfarer and the beggar according to their needs and not according to their deserts. …” 2
Unfortunately, come the 1460s, the renegade Master of Soutra hospital (Stephen Fleming3) caused a scandal, which punishment resulted in the Crown confiscating most of the estates, leaving the hospital impoverished. The misdemeanour cost Soutra its international medical standing and it became ‘Trinity College Hospital’3 Edinburgh’s gain when most of the estates and their revenue were given over for its support.4 Almost overnight, Soutra’s eminence was reduced from lofty heights to a ‘local service’. It was the crucial historical event that led to the development of Edinburgh’s status as an international centre for medical research and practice.5 The building survived into the 17th –Century because it had become the burial place of the Pringles of Soutra. In 1686 Pringle of Goodman’s Acre had built a sort of vault out of the ruins.6 &6A ‘Soutra’ Lintel inscription dated 1688 to the Pringle family (now of Torwoodlee by Galashiels) - www.undisoveredscotland.co.uk
As researchers probe further and further back into history looking for the foundations of medicine that works, it is obvious from Soutra’s archaeological excavations that anaesthetics and disinfectants are not the province of our modern world alone; medieval doctors were aware of and used a great deal more than a handful of remedial herbs. Through the discovery of human remains and the residues of herbal treatments, Soutra is giving a unique insight into mainstream medieval medical practice. For example, unearthed fragments of pottery vessels that were once used for storing medicines have revealed an analgesic salve made from opium and grease (normally animal fat was used) and treatment for parasitic and intestinal worms.7 Dressings have also been found, some with salves or human tissues attached. Scientists have also discovered a mixture of Quicklime (calcium oxide), which they believe was used as a disinfectant and a deodorant.8 Using seeds and waste, scientists are able to piece together what the herbs and medications were used for, giving an unusually graphic insight into Medieval Medicine. The uses of ergot fungus and juniper berry seeds were of particular interest in relation to their application. Dr Brain Moffat, archeo-ethno-pharmacologist and director of investigations for the Soutra Project concluded from historical texts that it is highly likely these were used to help induce birth, as this also tied in with still-born bodies of malnourished babies found nearby. This is doubly interesting, as men in holy orders were banned from assisting in any aspect of childbirth. But, neither is this as implausible as it may sound, because Hildegard of Bingen (1098-1176), whose fame is on the rise eight hundred years after her death and was an untapped source for our growing understanding of pre-modern European medicine, was at the age of fourteen entered into the double monastery of Disibodenbergy in the lower Rhineland. The idea of ‘double monasteries’, housing both men and women, resurfaced during the early years of the 11th- Century.10 So, it is even possible that the good monks did not treat the women concerned, but they may have been treated by other trained women in the hospital. In today’s world, some of the newer classes of drugs developed to help migraine sufferers’ condition include ergot derivatives e.g. Migranal nasal spray. Although it has also been mooted that ergotism (an LSD-like experience) produced by ergot, a fungus on rye seed and other grains, can also be held responsible for some ‘visionary’ experiences of the religious. However, in 1999 researchers found that: “Over the past 50 years, the use of oxytocin and ergot alkaloids preparations as prophylaxis against postpartum atonia has led to a marked reduction in maternal deaths!”11 To find Juniper berries at Soutra is also not surprising, as the plant occurs throughout most of Scotland, including the Borders area and is common in the Highlands. Two species are found in Scotland, the erect shrub Juniperus communis ssp. communis or ‘Common Juniper’ and the prostrate form, Juniperus communis ssp. nana. It is well known that in the 19th-century Highland juniper was sufficiently prolific for the berries to be collected and taken to the Inverness and Aberdeen markets to be exported to Dutch gin distillers. Juniper berries were used to flavour other alcoholic drinks, a Swedish health beer and a French beer-type drink made from equal amounts of Juniper berries and barley called ‘genevrette’. In the medieval period, juniper berries were also used to flavour whiskey in Scotland, the whiskey thought to have been an appealing way ‘to help the Juniper medicines go down’. Medicinal use of juniper berries was first recorded in the Egyptian papyrus 1500BC, and they were also used medicinally by the Romans. The post-medieval herbalist Nicholas Culpepper (1616-1654), English Physician and Astrologer, recommended them for a wide variety of conditions, including the treatment of flatulence for which juniper oil is still used today.12 However, a phrase used in Lothian in the Middle Ages of giving birth “under the savin tree”13 was a euphemism for juniper-induced miscarriage14 and, therefore, directly connects to the proposed use of the herb for birth-induction. Another Soutra find of a small mass of watercress lying close to a pile of teeth, with no sign of forcible extraction, has its use firmly fixed to the high vitamin C content of watercress being used to relieve scurvy; a condition that loosens teeth and can cause them to fall out. Medieval texts revealed that loose teeth can be ‘fastened or secured’ by eating watercress, which was confirmed by the World Health Organization.15 If the scurvy sufferers were smokers, modern research has proved that in chewing watercress they were also protecting their lungs from cancer.16 Watercress was important in early medicine and has a long history. When Hippocrates (born c.460BC-died c.370BC or 468BC-377BC), the father of medicine, founded the first European hospital on the Island of Kos, Greece (c.400BC), the location is thought to have been decided upon because of its proximity to natural springs in order to use only the freshest watercress to treat his patients.17 Hippocrates himself attended ‘medical school’ at the ‘Temple of Imhotep’ in Memphis, Egypt (the world’s first hospital).18 There he would have noted the power of watercress; the Egyptian Pharaohs served freshly squeezed watercress juice to their slaves morning and afternoon to increase their productivity.19 Another of the exciting finds at Soutra was an abundance of hemlock in the drains, posited to provide a pain-killer used before amputations. Also found in one of the cellars were traces of a mixture of the seeds of hemlock, black henbane (with its anaesthetic properties was administered to the ill prior to amputations20), and opium poppy, no doubt also used as a general anaesthetic for amputations. The first herbal anaesthesia was administered in prehistory; opium and hemp were two of the most important herbs used; at that time they were ingested or burned and the smoke inhaled.21 From the 10th -12th –centuries medical knowledge could have come to Soutra from far and wide. In the 10th –century there was already The Leech Of Bald (c.900AD) written by a monk, which contained herb and medical traditions combined with Greek and Roman information from the much travelled Druids of Wales. By the 11th –century (c.1000AD) there was the Canon of Medicine by the Arabian philosopher and physician Avicenna, (Ibn Sina 980-1037AD), plus 12th – century knowledge was spread from the Holy Land to Europe via the ‘warrior monks’, the Knights Templar, including herbal medicine and healing skills.22 Later, there is evidence that from the 13th –century-16th century three orders of friars were in Aberdeen; the Trinitarians, the Carmelites and the Dominicans (Black friars). A fourth group, the Franciscans (Grey friars) took up residence later in the 15th –century. A number of plant remains found in Aberdeen show medicinal use, for example opium was useful as a sedative, while hemlock was used as a painkiller to dull pain.23 Soutra had access to a lot of knowledge, and remember knowledge was freely shared in those days and not for profit, but to help heal. There was no a race going on then to work out the Human Genome, shrouded in secrecy for profitability, and as Dr Moffat remarked: “The monks’ knowledge of herbs was so great it could be used to influence medicine today.” 24 However, that’s already happening because e.g. Mites (lice) that were very much around in Medieval times and have never left us, have of late been treated with plants’ essential oils, which are a better choice for removal than organophosphates.25 However, the latest research suggests simple ‘wet combing’ (a conditioner helps) is the safest method.26 Although contemporary ‘blow-fly’ Maggot Debridement Therapy (MDT) has been used for more than 70 years to treat non-healing soft tissue wounds, its use in hospitals is not as yet widespread in the UK,27 this medieval form of medicine would have been commonplace to the Monks at Soutra. On record, maggots have been known for their healing ability since the late medieval period of the 16th-century. Leeches are also making a terrific come-back, which Soutra physician monks and surgeons would certainly have known about, as the use of leeches in medicine dates as far back as 2,500 years ago when they were used in ancient Egypt.28 Records of the theory of leeches’ blood-letting use in relation to ‘balance’ of the body’s humors were found in Hippocrates’s collection 5th-century BC! 29 To understand the attitude, dedication and beneficence of the medieval monks at Soutra, perhaps doctors and patients alike should read or re-read the original Hippocratic Oath, for it tells us just how much these devoted people did and were prepared to do for their fellowman.
Hippocratic
Oath -- Classical Version30 COMMENT: For those with little interest in history, medieval or modern medicine, from Soutra’s summit on a clear day can be seen breath-taking views of 60 peaks – the Pentlands, Ochils, Sidlaws, Lomonds and the magnificent span of the Firth of Forth. On a sunny windless day, it’s a wonderful place for a picnic. For a family or party of mixed interests, on a sunny windless day leave Edinburgh City behind, go for a drive and don’t forget to take your ‘vitals’ - there’s something at Soutra for everyone.
References: 1. ‘Soutra Aisle’ Undiscovered Scotland - http://www.undiscoveredscotland.co.uk/pathhead/soutraaisle/ ‘Soutra Aisle’ gazetteer for Scotland – http://www.geo.ed.ac.uk/scotgaz/features/featurefirst8386.html 2. ‘Rosslyn Battle site’ 700th Anniversary, 23rd February 2003 - http://www.gems.scot.info/dayplans/historical.htm 3. Ibid. - Trinity College Hospital (now beneath Waverley Train station) Edinburgh, Scotland. 4. ‘Soutra Aisle’ gazetteer for Scotland – http://www.geo.ed.ac.uk/scotgaz/features/featurefirst8386.html 5. Ibid. 6. ‘Edinburgh and the Lothians’ Chapter XXV – On Lammer Law. http://www.electricscotland.com/history/edinburgh/chap25.htm 6A. Pringle Clan Name Change: “PRINGLE: The earliest form of the name was Hoppringle, or Hopringill, and such remained the norm until the mid-16th when Pringle became more popular. However, it should be noted, the chiefly house retained the old form until its demise in the 18th century. The name was derived from lands near Stow in Roxburghshire where it is first noted when Robert de Hoppryngil witnessed a charter granted in the reign of Alexander III (r.1249-86) to the Hospital of Soltre(Soutra).” http://www.electricscotland.com/webclans/ntor/pringle2.htm Elsewhere Robert de Hoppryngill’s witness is said to be “to a charter of Edward de Alba Fonte (Quhytwell) granting lands to the House of Soltre (Soutra), along with the Archdeacon of the Lothians, Sir William de St. Clair and the Sheriff of Edynburgh. Although undated, the document is known to date from the period of 1265-1275 (the reign of Henry III in England).” http://archiver.rootsweb.com/th/read/PRINGLE/1999-11/0941778625 7. ‘The Medical World of Medieval Monks’ by Jane Elliott, BBC News Online, 6th August 2005. 8. Ibid 9. Ibid 10. ‘Hildegard of Bingen and the Greening of Medieval Medicine’ – Bulletin of the History of Medicine – Vol. 73, No. 3, Fall 1999, pp. 381-403. The Johns Hopkins University Press. http://muse.jhu.edu/cgi-in/access.cgi?uri=/journals/bulletin_of_the_history_of_medicine/v073/73.3sweet.html&session=41601061 . Also for Hildegard’s herbal remedies: ‘Hildegard of Bingen’s Medicine’ by Dr. Wighard Strehlow, Gottfried Hertzka, pub. Bear & Company (1987), ISBN: 0939680440 11. ‘A Risk-Benefit Assessment of Oxytocics in Obstetric Practice’ Wrinkler M, Rath W. Drug Safety Vol. 20, No.4, 1999, pp. 323-345(23). Prophylaxis: A measure (action) taken for the prevention of a disease. Postpartum: ‘after childbirth’ Atonia: Atony: Lack of normal muscle tone, especially of a contractile organ. 12. Trees for Life: Restoring the Caledonian Forest – Mythology and Folklore of the Juniper. http://www.treesforlife.org.uk/forest/mythfolk/juniper.html 13. “under the savin tree” ‘savin’ is an older name for Juniper. 14. Trees for Life: Restoring the Caledonian Forest – Mythology and Folklore of the Juniper. http://www.treesforlife.org.uk/forest/mythfolk/juniper.html 15. ‘The Medical World of Medieval Monks’ by Jane Elliott, BBC News Online, 6th August 2005. 16. ‘Chemoprevention of cancer by isothiocyanates, modifiers of carcinogen metabolism.’ Hecht SS. Uv. Of Minnesota Cancer Centre, Minneapolis, USA. J Nutr. 1999 Mar;129(3):768S-774S. And, ‘Effects of watercress consumption on metabolism of a tobacco-specific lung carcinogen in smokers.’ Hecht SS, et al. American Health Foundation, Valhalla, New York, USA. Cancer Epidemiol Biomarkers Prev. 1995 Dec; 4(8):877-84. 17. Water Cress: Herb of the Ages Part 1. Natural History Notes. http://www.visitoronline.com/hayward/natural.html 18. ‘Imhotep – The World’s First Multigenius’ by David Elliott - http://www.theblacklist.net/Feature/DE-Imhotep.htm 19. ‘Watercress’ http://www.watercress.co.uk/did/ 20. Black Henbane: The fresh or dried leaves, flowering tops, and seed of commercial henbane are used for their alkaloids – atropine, hyoscine and hyoscyamine. These alkaloids are administered chiefly in tranquillizers and sedatives in cases of nervous infections, asthma, or whooping cough, and in tablet form for sea sickness. LeStrange, R. 1977. A History of Herbal Plants. Angus and Robertson, London - http://www.wssa.net/photo&info/weedstoday_info/henbane.htm 21. Anaesthesia: Wikipdiea encyclopaedia. 22. ‘A Brief History of the Knights Templar’: “ The Grand Master Hugh de Payen and his principal co-founder of the order, Andre de Montbard, travelled to England to see the King and, having obtained safe-conduct from him, went directly north across the border to Scotland, where the two knights stayed at Roslin with the St Clairs, who were Hugh's relatives by marriage. The lord of Roslin made an immediate grant of land to the new order which became their headquarters in Scotland. The oldest Templar site in Scotland, once known as Ballontrodoch, is now called Temple after the order.” http://www.ordotempli.org/history_of_the_knights_templar.htm 23. ‘The Environment of Medieval Aberdeen Project’ - http://www.aberdeencity.gov.uk/acc/yourcity/medievalabdn/exhibition/prayer/default.asp 24. ‘The Medical World of Medieval Monks’ by Jane Elliott, BBC News Online, 6th August 2005. 25. ‘Complex view on poisoning with nerve agents and organophosphates’ Bajgar J. Uv. of Defence, Faculty of Military Health Sciences, Dept. of Toxicology, Hradec Kralove, Czech Republic. Acta Medica (Hradec Kralove). 2005;48(1):3-21. And, ‘Management of acute childhood poisonings caused by selected insecticides and herbicides.’ Mortensen ML. Pediatr Cin North Am. 1986 Apr;33(2):421-45. “…Recent reports from poison control centers indicate that organophosphates have been associated with most of the serious childhood poisonings. …” 26. ‘Wet combing best to rid head lice’ BBC News Online 4th August 2005: Fine combing of wet hair is far more effective than pharmacy-bought chemical lotions for eliminating head lice, say researchers – The London School of Hygiene and Tropical Medicine pub. The British Medical Journal. 27. ‘Maggot therapy for foot and leg wounds.’ Sherman RA, Dept. of Medicine, Uv. of California, Irvine, California, USA. Int J Low Extem Wounds. 2002 Jun; (2):135-42. 28. Maggots and Leeches make a comeback’ Asiha El-Awady – Science in Africa http://www.scienceinafrica.co.za/2003/july/leech.htm 29. Ibid. 30.
Original ‘Hippocratic
Oath’ Translations from the Greek by Ludwig Edelstein: ‘The Hippocratic Oath: Text, Translation, and Interpretation by Ludwig
Edelstein. Baltimore: Johns Hopkins Press, 1943.
http://www.pbs.org/wgbh/nova/doctors/oath_classical.html
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