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On Sale Jan 6, 2004

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Bantam Dell
A Division of Random House, Inc.
ISBN 0-385-33601-2
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On Sale in the UK
Nov 2003

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ISBN: 0091799414

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Asha: Sohn von Malta
ISBN: 3795118263
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The Medicine of Ironfire

"Plague derives from man’s iniquity and is the means by which the Lord punishes idolatry and the profanation of His gospel. The principal antidote against the plague is conversion...."

Though it was the age of reason, such ideas were far from extinct.  Medical schools still taught the Canon of Medicine by Avicenna, a Persian doctor who had been dead for four hundred years, and the works of Galen, a Greek physician whose views had been the standard for more than a thousand. Human health was believed to require an equilibrium between the four main bodily fluids, or humors -- blood, yellow bile, black bile, and phlegm. Each humor was built up from the four elements and displayed two of the four primary qualities: hot, cold, wet, and dry.

Doctors were reluctant to trust their own direct observations whenever they conflicted with ancient wisdom.  Out of religious concern for the sanctity of the human body, dissections were still chiefly restricted to animals, and strict laws prohibited the practice. Dogs and pigs provided most of the raw material for study. By the mid 16th century, medical faculties were reluctantly beginning to adopt the study of corpses, mostly those of executed criminals. There were never enough, and bright medical students, undeterred by fear of punishment, often took matters into their own hands. By night those who could not afford the services of grave-robbers wielded a shovel themselves, digging up fresh corpses for clandestine study.


Most physicians rarely deigned to touch a patient, save for taking a pulse or checking a fever, relying instead upon the examination of excreta in order to render a diagnosis and prescribe treatment. Samples were probed for consistency, odor, and shade. Urine was swirled, sniffed, and held up to the light.  An accomplished physician could identify more than a score of different colors and densities, and describe the significance of each.  There were five shades of yellow, four of red, and five of green (from pistachio to rainbow to verdigris to emerald to leek).  There were two shades near black; one translucent; and another the white of milk or parchment, each shade carrying a specific implication.  There were infinite subtleties.  Urine might smell fetid, sweet, or putrid, and display variations due to sex, age, and mental state.  The liquid  might be oleaginous, or ruddy, or resemble raw meat washings.  It might remind one of poor wine or chick-pea water.  It might be thick or thin, turbid or clear, musty or semen-like.  Even the sediment could be broken into ten distinct types, from flaky to fleshy to mucoid.  To the seasoned eye and nose, such nuances might indicate dispersion of vitality, the presence of an atrabilious humour, deficient digestive power, or—when white or slightly reddish—even herald the advent of dropsy.

Humors and Vapors

Doctors consulted not only medical texts but also books on astrology and numbers--and, of course, the Bible.  Hippocrates’ Epidemics was essential in interpreting the length of time between significant stages of disease, which could help predict the outcome. A physician would carefully calculate where in the “medical month” (precisely twenty-six days and twenty-two hours) a patient’s symptoms and subsequent fevers or other crises had occurred.  Every effort would be dedicated to striking the proper balance between the all-important humors—hot and dry, cold and moist—that kept the body well, or, when out of balance, made it ill.

After making a diagnosis, the doctor would prescribe medication, diet, or surgery.  Patients were cautioned not to eat fruit after salad, the mixture of which could overload one’s humours with deadly results. Strenuous sex must be avoided, for it might induce seizures. Apothecaries prepared purgatives for syphilis, emetics for poison, and tinctures of lead and mercury to cure the vapors, those exhalations of the liver and stomach that produced hysteria and depression. 


Anesthesia was primitive and most often not used at all. A surgeon's ability was measured by the time he took to operate. A patient's hands and feet were bound to the table while amputations or other procedures were performed. Various methods were tried. The hammer stroke involved encasing the patient’s head in a leather helmet that guided the surgeon as he delivered a solid blow to the skull with a wooden hammer, rendering the patient either unconscious or dead. Narcotic sponges were soaked in mandrake and belladonna and pressed over the mouth of the patient, who sucked the solution and either fell into a deep sleep or died.  Shock and sepsis killed most of those who survived the blade.


Dried ground boar penis could cure pleurisy, while pigeon dung was helpful for eye irritations. Grease was applied to burns, and verbena was prescribed for the bite of a rabid dog.

Blood-letting was the most common treatment for alleviating symptoms of disease and for releasing malignant humors.  One palette of blood—precisely three ounces—was let for pleurisy, and was drawn from the elbow of the arm opposite the affected side. Two to four palettes were drawn from the chest to cure peripneumonia.  The basilic vein was bled for difficulties of the liver or spleen, while the temporal vein was tapped for melancholy or migraine.  Every malady had its vein, and every vein its malady.

Wounds were cleaned and washed with salted water as a first aid measure. Splinting and traction were employed in the treatment of fractures. Broken skull bones were treated by elevation of the depressed fragments, while trephining was resorted to when necessary.  Wounds involving soft tissues were sutured & severed blood vessels were ligatured as the tying up of bleeding arteries & veins had begun to replace the cautery as haemostatic. The wound was then dressed with tow or wool.  In injuries of the mouth which rendered the intake of food difficult or impossible, nourishment administered by means of nutrient enemas. (From The Medical History of Malta, Paul Cassar, 1964)

The innovators

Paracelsus, a Protestant, wanted to build a new science of medicine on the study of nature. He insisted—radically—that physicians should rely on their eyes and ears rather than the words of the ancients, an idea which did not find great favor. He justified the use of a wide variety of folk cures (scorned, at least in theory, by many physicians)

Andreas Vesalius (1514 -1564), a battlefield surgeon, supervised artists (including Titian) who drew more accurate illustrations based upon direct observation: a blasphemy that was not easily forgiven by the Church.

Ambroise Pare (1510-90), was self-taught, serving as an army surgeon and surgeon to the king. He devised new surgical instruments, introduced the use of artificial limbs and eyes, suspected flies of carrying disease, and even attempted the implantation of artificial teeth. His most important contribution was the development of successful techniques for battlefield amputations. He reintroduced the old Roman practice of employing ligature prior to amputation, which greatly reduced bleeding and shock. He abandoned the brutal technique of plunging the limb into boiling elder oil mixed with treacle. Having run out of oil on one occasion, he treated the raw limb with a mixture of egg yolk, oil of roses, and turpentine. The results were remarkable. He tried similar poultices on gunshot wounds, and noticed a reduction in infection.  From this he reached the radical conclusion that gunshot wounds were not by themselves poisonous, theorizing that somehow infection was introduced into the wound from outside.  He used wine as an antiseptic, and taught the repeated debridement of wounds. His use of adhesive bandages also promoted healing.  Pare's ideas, though demonstrably effective, did not take hold in a medical culture afraid of change. The practice of treating traumatic amputation with cautery and boiling oil survived another 300 years.

Though a man of science, Pare believed in witches and devils, and of course in the miraculous cures of God, whom he never failed to credit for his successes..

Assorted medical wisdom of the 16th century:

  • God implanted the soul in the embryo forty days after conception. The soul controlled growth and nutrition, sensation and motion, and all rational activity.

  •  The liver created blood, which was used by the brain to create invisible nervous spirits which flowed through the nervous system and were vectors of sensation and motion. 

  • Women were nothing more than imperfect versions of men.

  • Individuals were either sanguine (hot and moist), choleric (hot and dry), phlegmatic (cold and moist) or melancholic (cold and dry) according to their predominant temperaments.

  • Disease struck when one or more parts of the body became disturbed by an external cause.  According to Hippocratic tradition, there were six non-naturals, whose good or bad management maintained the body in a state of health or provoked disease. These were air, food, and drink, exercise (including sex) and rest, sleep and wakefulness, bodily evacuations, and the passions of the soul.

  • Gluttony, over-exercise, anger, and sexual athleticism were the sure harbingers of disease.  Hunting to excess could raise the body’s temperature, overheat the heart, and launch a fever. 

  • Diagnoses could be made from the nature of excrement, and tint of skin. A lemon-yellow color suggested a blockage of the liver; a brown complexion an obstruction of the spleen; a black tongue, an ardent fever; hooked nails, phthisis, red cheeks, peripneumonia.

--from The Medical World of Early Modern France
Laurence Brockliss & Colin Jones
. Oxford, 1997.

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