On Medical Milestones, the Myth of Progress, and Textbooks, Part II

My loves, it’s a week later and I am still Big Mad at J. Stuart Showalter, textbook writer and noted basic. Now, this is understandable give that my man is low-key racist with his shall we say “approach” to the medicine of the Islamic world. However, that sort of racism is just the worst and most harmful type of ignorance of the several which permeate said timeline, this textbook, and our society’s approach to medieval history. There’s a whole lot more incorrect where that came from, and that is what we are going to discuss today.

So, in order to discuss just how wrong this whole approach is, let’s first refresh our memory and have another glance at said timeline:

I just … still am not dealing well with it.

Although it pains me to ask you to look at this again, we we do we can see that there is one correct thing about it. Up there near the top, you can see where the timeline notes that from 1000 BCE through to about 1850 CA the “four humors are the dominant medical theory”. That is true in Europe and the Middle East of course. Now this is true if you are racist enough to think that only white people and what they think about medicine is “dominant”, which I think we can all agree this textbook is. Chinese people, African people, the native peoples of the Americas and Australia, they might all have something really different to say about that! But since white people decided to dominate the world I guess you can kinda say that so did our preferred thinking about medicine. So that is almost three thousand years during which humoral theory is the accepted approach to medicine.

That is centuries upon centuries of people who believed in humoral theory not because they were just too stupid to know any better, but because it was how things had always been done and it was how they thought about and were taught. As I have said over and over again, someone isn’t inherently ignorant for accepting the thing that they have been told. Anyone reading J. Stuart here’s basic ass textbook can’t be blamed for thinking this fool is right about medieval history, for example. He’s been put in front of an audience as an expert and it is not his audience’s fault if they take that in good faith. Same goes for medical theories.

We now have the benefit of the germ theory of disease, and turns out it is pretty great. I for instance, a person with a doctorate, probably wouldn’t be able to come up with the idea of germ theory on my own. I know about germ theory because I was taught it in schools after it was theorised by specialists that I believe. Because that is their job. It helps me stay healthy and I am extremely into that! Yay germ theory!

Germ theory did not, however, spring from the mind of Ignaz Semmelweis fully formed. The fact that particular things could be contagious and lead to illness was also present in most earlier medical theories. The ancient Greeks and Romans often wrote of “seeds” which could cause someone to become ill. Galen, for example, noted in his On the Different Types of Fever that it was likely fevers were caused by “certain seeds of the plague” that could float in the air.[1] These seeds could be ingested, and would case the imbalance of humors which lead to illness.

Medieval people – because they were not stupid – then expanded on this. You know who in particular? Yeah, Ibn Sina. The guy this graph ignores. Probably for totally chill not racists reasons, I’m sure. In The Canon of Medicine Book IV, Ibn Sina noted that disease can be spread from one person to another through breathing. He also noted that air and dirt can contain things which cause illness. This is what we historians refer to as miasma theory. It holds that air in and of itself can be noxious and make people sick by throwing off the humors.

Image showing the adverse effects of the plague. Note the “miasma” in the air near the hands of the standing figure. Miniature out of the Toggenburg Bible (Switzerland) of 1411. 

Now sure, all of this isn’t germ theory, but it ain’t far off. Medieval people were clearly noticing that people could become ill if exposed to other ill people, or contact with unclean things. They knew that you should probably bathe and that you should watch yourself around sick people.

You know when this comes into play? During the Bubonic Plague, aka the Black Death, AKA my OG homeboy and one true love, which this timeline has managed to note existed, unlike one of the greatest medical thinkers of all time. LOL.

In 1348 during the height of the plague, the University of Paris medical faculty, when called upon by the King of France to explain what, exactly, the fuck was causing the Black Death wrote a really complicated report on it. According to them there had been “a major conjunction of three planets in Aquarius”. This, for reasons known only to noted astrology hoes, in turn caused “deadly corruption of the air around [them]”.

As they informed the king:

… bad air is more noxious than food or drink in that it can penetrate quickly to the heart and lungs to do its damage. We believe that the present epidemic or plague has arisen from corrupt air… By which we wish it be understood that air, being pure and clear by nature, can only become putrid or corrupt by being mixed with something else…

The Report of the Paris Medical Faculty, October 1348

Is it weird to us that they think planets can make everyone get the plague? Sure, yes. But what is crucial here is that they were aware and able to articulate that something in the air in and of itself was what was making people ill. They knew that there was something moving about that caused this that was invisible.

Miasma theory helped to nudge people in the direction of the germ theory of disease because it provided a model that stated that air or dirty things could cause illness. This is a development in medical thinking which the  Association of University Programs in Health Administration and J. Stuart Showalter might have wanted to note if they weren’t so busy being racist and wrong, rather than just noting on the timeline up there that the Black Death happened and that “humoral theory persisted”. Yeah it sure did, but it was delux humoral theory with added miasma thank YOU very much.

Now lest you want to say that we shouldn’t care that much about miasma theory because it was wrong anyway, well fine, but in that case we get to ignore this whole ass timeline because it is so wrong. Hell, it isn’t even correct about the time that the bubonic plague happened. The Black Death very famously kicked off in 1347, not 1250. It then stuck the fuck around with notable outbreaks occurring during the seventeenth century, which is where we get the cool plague doctor bird masks.

“Dr Beak in Rome”, or , “Der Doctor Schnabel von Rom” a seventeenth-century engraving by Paul Fürst.

Yes! That is right! The bird masks are modern and invented probably by Charles de Lorme! They are not medieval but are still extremely cool! You will note that they were used because the idea was that if miasma was what caused plague it could maybe be countered by sweet smells. So, in theory, early modern doctors would strap this puppy on, stuff it with sweet smelling herbs or oranges, or oils and go to work on plague victims. TBH we don’t have a whole lot of evidence for their wide-spread use, but whatever. I like them and they show us a way in which miasma theory may have influenced medical hygiene theory at the very least, so I am keeping them.

Funnily enough, what we refer to as the third pandemic of bubonic plague took place from the mid-nineteenth century into the twentieth. You know, the same part of this chart that heralds the beginning of “modern medicine”. Because the third pandemic was first noted in China it directly led to the United States introducing the Chinese Exclusion Act, because American never met a problem that it didn’t try to solve with racism. Man how enlightened. Wow! Nothing like those stupid early medieval people am I right?

So if that range of dates has nothing to do with when the Black Death first occurred or stopped occurring, why use it at all? Well you could make the argument that Showalter here was just trying to say that this is a block of time during which humoral theory continued to exist and did so at the same time as the Black Death. But humoral theory and the Black Death both coincide together right up until 1850, with the plague continuing past that. Remember? That line up at the top that shows humoral theory existing for about three thousand years? Yeah, that’s still in play. If that is what you wanted to show, shouldn’t it be a line from 1347 into the 1850’s?

Fourteenth-century version of the meeting of the Paris Medical Faculty to discuss the cause of the Black Death. You know, when they advanced medical theory only to get ignored by some ignorant dude in the twenty-first century.

As far as I can see this is Showalter, with the sign off of the AUPHA, going out of his damn way to say that medieval people are particularly stupid. What the 1250-1475 time frame does is single late medieval people out for the twin sins of having the plague and believing what every medical authority believed and would continue to believe for another four fucking centuries. It is a specific argument for the medieval medical mind as ignorant in opposition to a “modern” rational mind.

This timeline makes a point of ignoring not just a millennium of medical thinking and advancement, but also the fact that the same thinking held true into our own time period. This timeline needs you to know that all of us, just by virtue of being born at the right time, are way smarter than our medieval counterparts. In order to do this it will ignore medical advancements and give incorrect information. How admirable.

Now, I don’t know who in the medieval period hurt Mr. Showalter or the AUPHA but that does not make it OK for them to promote incorrect information just to make themselves feel better about it. Medieval people might have accepted miasma and humoral theory but that was because no one had come along and corrected that incorrect theory yet. What excuse does The Law of Healthcare Administration, eighth edition, have for perpetuating incorrect information that even a cursory glance at any medical history introduction could debunk? [2]

As I will never tire of saying, we are not smarter than medieval people were. We have the benefit of their hard-won knowledge which allows us to go further. We are standing on the shoulders of giants, a metaphor which, incidentally comes from twelfth-century philosopher Bernard of Chartres who wasn’t too good to admit that he had learned from those who came before him. Knowledge is cumulative, and we wouldn’t be where we were without that which came before us. So, if you want to act like you are better than our fore-bearers than it might behove you to have actually done your homework.

I’m looking at you AUPHA.


[1] Vivian Nutton, “The seeds of disease: an explanation of contagion and infection from the Greeks to the Renaissance,” Medical History27 (1), 6.

[2]  J. Stuart Showalter, The Law of Healthcare Administration, 8th Edition, (Chicago: Health Administration Press, 2017).


For more on medieval medicine, see:
On Medical Milestones, Being Racist, and Textbooks, Part I
On medieval healthcare and American barbarism

For more on Islam in the medieval period, see:
Islam was the party religion, or, why it is lazy and essentialist to say that Islam oppresses women

For more on myths about the medieval period, see:
I assure you, medieval people bathed.
On colonialism, imperialism, and ignoring medieval history
That’s not what chivalry is, but OK
“I wasn’t taught medieval history so it is not important” is not a real argument, but ok
There’s no such thing as the ‘Dark Ages’, but OK

Author: Dr Eleanor Janega

Medieval historian, lush, Kendrick Lamar enthusiast.

2 thoughts on “On Medical Milestones, the Myth of Progress, and Textbooks, Part II”

  1. Excellent as expected.
    That said, I think you overemphasize the effect of the bubonic plague on the Chinese Exclusion Act, which was passed under President “May All Curse His Name!” Arthur in 1882, while the plague started in 1900 and the racism of white “America” had all but finished its work.

    Like

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