Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts
Social History of Medicine, Vol. 13 No 2 (2000)
The character of early medieval medical manuscripts makes it difficult to generalize about the nature of medical knowledge in this period. In order to reconstitute one field of medical science, namely diagnosis and prognosis, while avoiding the pitfalls of unjustified generalization, this essay limits itself to reconstructing the understanding of pulse and urine inspection available in a particular place and time: the Italian monastery of Monte Cassino at the end of the first millennium. The available texts reveal little about the rationale behind these bedside techniques; indeed, pulse and urine seem to be signs without any semiotics, any underlying theory. The clue to this paradox is the fact that these texts see pulse and urine as primarily prognostic rather than diagnostic. Prognosis was understood to be analogous to forms of intuition, judgement, revelation, and prophecy that operated outside the logic of causality. Hence a fully rationalized semiotics was not regarded as necessary for effective medical practice.
You should not visit every patient in the same way, but if you listen to all of this, you shall learn. As soon as you approach the patient, ask him if perchance he is in pain. And if he says that he is, ask if the pain is strong or not and persistent or not. Afterwards feel his pulse and see if he has a fever or not. If he is in pain, feel his pulse, which will be fluid and rapid. And ask him if the pain comes when he is cold; also if he is wakeful. And ask if the wakefulness is due to this illness, or to some other activity, and if his bowels and urine are normal. And inspect both parts, and see if there be some danger to him . . . ask about the onset of the illness, and about what the other physicians who visited him said, and whether they all said the same thing or not. And enquire concerning the condition of the body, whether it is cold or the like, whether the bowels are loose, sleep interrupted, and if the disease is persistent, and if he has ever had such ailments before. When you have enquired into all these things, it will be easy for you to discern the causes \facile eius causas agnoscis] and the cure will not seem difficult for you.
This summary guide to history-taking and physical examination is found in a handful of manuscripts dating from before or around the year 1000. One of these is a compendium made for the abbey of Monte Cassino in central Italy around the year 900, and preserved there under the shelf-mark 97.