After divine punishment, the secondary causes of illness studied at the University give diverse theories, which contribute to making mediaeval medicine so surprising to us.
Hippocrates is considered to be the father of therapeutic science, relayed by Galien. This Greco-Roman heritage enunciates a pathology which reposes on the theory of humours and temperaments, and which will remain frozen in time for ten centuries.
Humours are liquids found in the human body: hot and wet, blood secreted by the heart; cold and wet, bile or phlegm secreted by the brain; hot and dry, bile secreted by the liver; cold and dry, atrabile or melancholy secreted by the spleen. If one humour is stronger than the others, the patient is of sanguine, phlegmatic, bilious or melancholic temperament. Illness is caused by the breakdown of one of these humours. The doctor must therefore re-establish their harmony. He will apply the galenic principle of contraria contrariis, the medications having to counterbalance one of the four deficient qualities.
This contrary principle is used by the Arab scholar Avicenne, who has become another oracle of the University, since oriental medicine has started to spread throughout the West. His schema establishes correspondences among the four elements of the universe, the four humours of the body, the four seasons, the four characters of each body, the four conditions of man. For example, melancholy corresponds with atrabile, old age, earth and Autumn; pleasure, with blood, all that is male, fire and Spring.
This philosophy, inspired by Plato and Aristotle, proposes a metaphysic which is acceptable for Christians. The University is not particularly interested in knowing if its application works therapeutically. It is more interested in scholarly debate and theories than in action. So, what does the future doctor actually learn during his studies? He learns to comment and endlessly “discuss” Avicenne’s Canon, and the texts of the authors of Antiquity. He learns to exercise himself in oratory jousts and citations. Medical actions disgust him. They are a vulgar “artisanal” accessory to the knowledge which he accumulates during his five years at the Faculty of Medicine, where he obtains his Master’s Degree. He delegates them to the surgeon or the barber.
How does he behave in the presence of a patient? He hardly examines him. A few palpations, accompanied by the observation of his face, the taking of his pulse, and multiple questions asked of his entourage, are sufficient for him to make up his mind. But it is above all with the help of the examination of corporal excretions – blood, excrements and urine – that he renders his verdict. The image of the doctor absorbed in his observation of a urinal – the transparent vase in which the patient’s morning urine is collected – becomes a caricature in the Middle Ages.
The colour of the urine can be white, orangey, golden, safran, red, wine-coloured, green or blue, and the odour determines, by its degree of stink, the patient’s state of morbidity. After shaking the bottle, it is further possible to study the quality of the froth, the subtlety or the coarseness of the sediment. Taken to the extreme, this diagnostic does not even necessitate the presence of the patient. More and more doctors, particularly in Paris, practise at a distance, then send their prescriptions.
A very original manuscript dating from the end of the XIVth Century, and written by a German master doctor, conserves the record of consultations by personalities from the Faculty of Medicine in Paris, such as Guillaume Boucher and Pierre d’Auxonne. “Boucher says, looking at the urine, that it is fairly white, that the patient suffers from a stomach weakness, digests badly, and that it is a man. But then those who brought the urine start to laugh, saying that it is a woman. Boucher had ordered what follows only for a man and, when he was told that the patient was a woman, he no longer wanted to prescribe anything and was very upset.”
After the urine examination, the doctor takes the pulse, which can be equal or unequal. Equal, it is vehement or languid; unequal, it is reciprocal, intermittent or failing. According to the types of illnesses, it is small, hard, tense, long, convulsive, rare, languid, late, undulating, wormy, tingling, trembling, wavy, big or soft.
Blood can be black or watery, yellow, bluey-green, hard or coagulated, more or less resistant to the knife when it has thickened… Again, official medicine is happy to enter all the observable varieties in Nature, into an arbitrary classification which, in the absence of other methods of inspection, and notably of internal medicine, can only lead to a fantastic and subjective interpretation.