James I – Viral Infection, Medieval Infectious Diseases and Mortality
Professor Richard Oram.
Medical knowledge in the time of James I had no awareness of bacterial or viral infection. It was centuries yet before germ theory emerged and scientific equipment was invented that enabled microbial forms to be studied. Although surgical techniques had grown in sophistication through the Middle Ages and some advanced anatomical and physiological knowledge had filtered into western Europe from the Arab-speaking world in the eleventh and twelfth centuries, the most common medical training still largely revolved around the writings of the second-century Roman philosopher-physician Galen. His work combined close anatomical observation – all completed without any human dissection and so making a series of critical errors, such as misunderstanding the link between the heart and lungs in pulmonary circulation – and detailed recording of symptoms and their progression to develop a prognosis, alongside a theory of human mood being governed by the (im)balance of four substances called ‘humours’ in the body. The humours were blood, black bile, yellow bile and phlegm, each of which was associated with a character or behavioural type, respectively sanguine, melancholic, choleric, and phlegmatic. The characteristics associated with these humours were: sanguine as extroverted and social individuals; choleric bringing energy and strong passion, and also an attractive charisma; melancholics, rather than being depressives, were creative, compassionate, and considerate; phlegmatics were reliable, caring, and loving. In a healthy individual these humours were in balance. Where they were not, the individual would fall ill and require treatments to restore that balance. Treatments could range from dietary regimes and exercise to the best-known medieval medical tradition, blood-letting.
In the earlier fifteenth century, there was also some awareness of a link between certain types of weather and physiological illnesses, usually expressed in terms of combinations of dry/wet and cold/hot. Notions of ‘bad air’ or miasmas were not yet prevalent, but there was, for example, a long-established understanding of a link between disease and marshes, which was expressed in terms of illnesses caused by foul marsh-gasses rather than insect-borne sicknesses like malaria. We can see several of these notions coming together in Walter Bower’s account of the 1420 epidemic of the disease labelled qwhew. The most recent translation of Bower’s Scotichronicon expresses it:
This sickness [which he introduced in a preceding section as the cause of death of several leading Scottish noblemen] by which not only magnates but also numberless men of the people were snuffed out was called ‘le qwhew’ by the common people. The physicians say it was caused by an inequality or excess in the preceding winter, spring and summer, for the winter [of 1419/20] was very dry and northern, spring was rainy like autumn, and so it was inevitable that in summer fevers, eye-inflammations and dysenteries became acute, especially in damp places. In winter dry humours, checked by the cold, are whetted. But in spring waste matters are generated in conditions of excessive intemperate dampness and are dispersed by warmth. In summer to be sure when the warmth is not strong enough to consume them, it causes putrefaction and so generates acute fevers and brings on many other diseases. If indeed a winter has been warm and damp, but spring cold and dry, it is inevitable that in summer men will fall sick and pregnant women will have miscarriages for a trifling reason. (Walter Bower, Scotichronicon, ed D E R Watt, volume 8 (Aberdeen, 1987), 117.
Modern medicine would express this more in terms of context, where conditions were ripe for the spread of infectious diseases, for example through more indoors close contact during periods of extreme cold or wetness. A possible respiratory tract infection like the qwhew would have spread like wildfire in the warm confinement of lordly castles and peasant cottages alike, ready to circulate freely when folk emerged from the winter to congregate for the religious festivals of Easter, and in fairs and markets, and for parliament or councils. They could not see the need for self-isolation, indeed, with no understanding of infectious disease, would have been unable to comprehend its purpose. The devastating loss of life that resulted in 1420 should be a stark enough lesson for us all to understand why self-isolation is a discipline we need to practice in these times of Covid-19.
Image: Les Très Riches Heures du duc de Berry Février. Public Domain