Medics and Pandemics in Early Ireland

The competent care and personal sacrifices of those working in our healthcare system have been brought home to us during this time of pandemic. And not just the valiant medical profession itself. It is often overlooked that the complex and delicate ecosystem within modern healthcare also depends on the everyday courage and professionalism of countless others, such as cleaners, porters and administrative support staff (to mention just a few).

Thinking about this led me to reflect on the nature of healthcare (such as it was) in early Irish society, through the lens of the Brehon Laws. Who were the medical practitioners and how advanced was their knowledge? How were their activities regulated by law? What forms did medical treatment take? Did earlier pandemics reach Ireland? I try(!) and explore these questions in this article.

Medicine meets Mythology

Image 1: Dian Cécht dressing the wound of King Nuadu after the Battle of Moytura (487 B.C.) as illustrated in Henry Wellcome,Medicine in Antient Erin; An Historical Sketch from Celtic to Mediaeval Times‘ (p. 12) (link)

Evidence of early Irish medicine reaches us via a subset of Brehon Law tracts assigning liability for illegally inflicted physical injuries and governing the practice of ‘sick maintenance’ (othrus). In particular, the Bretha Crólige (‘Judgments of Blood-Lying’) and Bretha Déin Chécht (‘Judgments of Dian Cécht’) tracts provide interesting insights on early Irish physicians’ medical knowledge and some of their legal responsibilities.

The title of Bretha Déin Chécht is synonymous with ‘Dian Cécht’, portrayed as a god of healing and physician to the Tuatha Dé Dannan, a supernatural race in Irish mythology. Dian Cécht’s more notable exploits included the preparation of a medicinal herbal bath from which wounded soldiers emerged healed [1]. Dian Cécht is also credited with treating King Nuadu, leader of the Tuatha Dé Dannan, when he lost his arm during a major battle near Cong, County Mayo (illustration above). Afterwards, a silver hand was manufactured for the king, which is where he got his name: ‘Nuadu of the Silver Hand’ [2] – an early (albeit mythological) example of a prosthetic limb.

The Early Irish Physician

It is likely, at least up until the arrival of Christianity, that magic and medicine were seen as two sides of the same coin, probably wielded by the enigmatic ‘druids’ [3]. The druids occupied positions of high status in pre-Christian Ireland – they were true ‘multi-taskers’, also acting as priests, teachers and astrologers. Their status diminished following the arrival of Christianity [4].

A category of professional physician (liaig or midach) had become established by the 7th-8th centuries. The law tracts do not, however, paint a clear picture of the internal classifications or rankings within the profession – in contrast to the detail provided on judges and lawyers! [5]. Nonetheless, ‘proper’, ‘qualified’ physicians were expected to have a certain degree of medical expertise and public recognition of their craft [6]. Consistent with the nature of early Irish society, most physicians were male though there is reference to female physicians (ban-liaig) as well [7].

There was no developed hospital system at this time, though in some places there might have been designated spaces for convalescence. For example, it has been suggested there was a type of early Irish ‘Royal Hospital’ near Tara [8]. Some monasteries could also have performed such functions on a limited scale.

Unfortunately, little to nothing is known about the early physicians’ formal training and it may be that older medical manuscripts were destroyed during Viking raids and/or during the colonial experience [9]. Still, it is clear from the law tracts that this was a highly regarded, legally privileged and often well-paid line of work [10]. The early profession was likely to have been hereditary. It certainly became so over time. For instance, a hereditary medical school was founded at Aghmacart in County Laois sometime before the 16th century, operating under the patronage of a local prominent family [11].

Later Practitioners

More is known about the education of Irish physicians in the centuries following the arrival of the Anglo-Normans. These later practitioners seem to have been schooled in a type of ‘philosophical medicine’ popular on the European Continent, drawing upon Arabic, Greek and Roman influences [12]. They also produced medical manuscripts, including translations of Continental texts into Irish. The Royal Irish Academy has recently launched a stunning exhibition of these types of Medieval Irish medical texts (link).

Medical Duties and Liability

In its earliest forms, ‘sick maintenance’ required perpetrators of certain physical injuries to ensure their victims were nursed back to health under the direction of a physician, arrange substitutes to cover their work, host their victims’ associates etc. This onerous practice evolved over time until it became more usual just to pay a fee (‘leech fee’), depending on the rank of the victim and the injury suffered [13].

Physicians had important diagnostic and supervisory roles according to the law tracts. Following physical injury inflicted on a person, a period of nine or ten days would elapse before a physician would give their verdict [14]. That verdict would then determine the course of treatment (if any) and associated legal liability of the perpetrator.

A physician could also be called upon again later to deliver a type of prognosis, informing a judgment or conclusion (iarmbrethemas) as to whether an injury would leave lasting disfigurement or disability. That prognosis could result in even further liability for the perpetrator [15].

Physicians could be held responsible for their own negligence too. While they could draw blood when attempting a medical intervention, they would themselves become liable if they damaged a joint or tendon in the process [16]. Commentaries on the law tracts made by later scribes furthermore suggest that a physician would be liable if they aggravated an injury or failed to properly supervise an injured person’s diet [17].

Physicians who fell foul of their obligations could have their lancets and horse whips confiscated – the latter was probably calculated to frustrate their ability to move from place to place [18].

Medical Knowledge in the Law Tracts

A solid understanding of anatomy shines through in the law tracts. They identify ‘Twelve Doors of the Soul’ (doras .x. anma fil i. curp duine), a kind of priority listing of potentially fatal injuries for which physicians were entitled a very high fee for treating. The Twelve Doors included, for instance, injuries to the ‘hollow of the temple’ (temporal fossa) and the ‘apple of the throat’ (thyroid cartilage) [19]. Different types of facial wounds and dental damage were also categorised. Bone fractures, along with other kinds of serious and less serious injuries (e.g. inindraig – ‘bandage wounds’), were addressed too [20].

Surgical interventions seem to be contemplated in the law tracts but the exact methods actually used are unclear [21]. There are intriguing tales of surgeries in the apocryphal sources though. A legendary cranial procedure (‘trepanning’) carried out on an Irish chieftain involved removing parts of his injured brain (his ‘brain of forgetfulness’), apparently resulting in significantly improved mental performance [22].

The physician played an active role in supervising the diets of people recovering from certain injuries. For example, the law tracts state that not every patient of lower societal rank is entitled to ‘ale’ unless this has been directed by a physician – equivalent to a medical prescription for beer! There is a strong emphasis on the healing properties of honey and herbs (especially celery), a principle echoed in sagas [23].

The law tracts also recognise the negative impacts of psychological stressors on patients. Irritants such as bad news, shouting and dog fighting within earshot of a person recovering from injury were therefore forbidden [24].

Other forms of treatment: the hot air bath

Image 2: An ancient Irish hot air bath (or ‘sweat house’), as illustrated in W. F. Wakeman, ‘Inis Muiredaich, Now Inismurray, and Its Antiquities’ (1885) 7(64) The Journal of the Royal Historical and Archaeological Association of Ireland 175, at p. 212

There are some indications (outside the law tracts) that primitive therapeutic sauna and plunge pool treatments were also used in Early Ireland, especially for relieving rheumatic pains and asthma. In the late nineteenth and early twentieth centuries a number of ancient ‘hot air bath’ (or ‘sweat house’) sites were rediscovered. Most of these were found in the northern part of Ireland, extending to Rathlin Island in County Antrim [25], but there is evidence they existed at least as far south as Schull in County Cork [26].

These structures seemed to vary in size, having dome-shaped roofs with openings to control the interior temperature. In broad terms, a fire would be lit in the interior and allowed to burn out, water would be thrown on hot stones, and patients would then sit inside until they began to perspire heavily. Afterwards, they might either plunge into a cool body of water nearby or, in the case of older weaker patients, retire to bed [27].

Exactly when and how this practice reached Ireland is uncertain but it became common over time across Europe (including ancient Rome) and further afield [28]. In Ireland it has been described, at least in certain places, as existing from ‘time immemorial’ [29]. If that is the case, it is reasonable to assume it was practiced during the Brehon Law period.

Pandemics (and Epidemics) in Early Ireland

Image 3: Ptolemy’s World Map (with Ireland – ‘Hibernia’ – in the upper left hand corner), credited to Francesco di Antonio del Chierico, public domain, via Wikimedia Commons

In earlier times unknown diseases may have been placed under the general heading of ‘fairy strokes’ (millteoireacht), blamed on evil spirits or demons [30]. The concepts of ‘plague’, ‘pestilence’ and ‘epidemics’ were known to the Brehon Laws, though they may have been used as broad shorthands for various kinds of mysterious ailments. From a legal standpoint, Irish kings could issue emergency decrees during times of plague [31] but other historical sources, especially the annals, shed more light on the subject of diseases.

Referred to as blefed, belfeth, and belefeth, ‘Justinian’s Plague’ (a forerunner to the later ‘Black Death’) is thought to have reached Ireland between 540-545 A.D. [32]. Not long after that (c. the early 550s A.D.) the annals record an outbreak of something called buide chonnaill, involving jaundice-type symptoms [33]. There are differing views as to what this was – some have suggested ‘Yellow Fever’ (transmitted by a type of mosquito) or a ‘relapsing fever’ associated with famine, a distinct possibility after the ravages of Justinian’s Plague. A more recent suggestion is viral hepatitis, which attacks the liver and can cause jaundice [34].

Another (likely bubonic) plague struck around 664 A.D. [35]. Smallpox is thought to have cast a shadow in the late 670s A.D., and may have been periodically recurring. Later on around 708 A.D. a lameness (baccach), possibly polio or some other mutated disease contracted from cattle, stalked the land [36]. An affliction termed riuth fola (possibly translated as ‘bloody flux’) is recorded in the 760s and 770s A.D. Dysentery has been suggested for this, particularly as the outbreak coincided with adverse weather events [37]. An outbreak of influenza-related pneumonia (scamach) may have occurred around 783 A.D. [38].

These disasters would have caused societal and political upheavals. An early Irish building boom is recorded after Justinian’s Plague, which may have been motivated by a desire, at least amongst the elites, to isolate from strangers carrying unknown disease [39] – an early attempt at ‘social distancing’ perhaps!

Major political centres, such as Tara, were also abandoned during the mid-6th century, potentially in the midst of plague [40]. Interestingly too, these periods of disease witnessed the growing influence of the early Christian church. That, coupled with a renewed focus on contemplation and learning activities generally, were fertile conditions for the Brehon Laws to be committed to writing [41].

Though speculative, it is reasonable to assume that early Irish physicians would have been called upon to try and diagnose and mitigate these calamities, presumably with little if any success. And surely many would have lost their own lives in the process.

Tellingly, even hundreds of years later a scribe named Aedh MacAedhagáin (Hugh MacEgan), who was copying the earlier Brehon Law tracts, sought divine rather than earthly protection from a plague (likely the Black Death) raging during his own time:

One thousand three hundred and fifty years until to-night since…Christ… and in the second year after the coming of the plague into Ireland that was written. And I myself am full twenty-one years old, that is, Aedh son of Conchobhar Mac Aedhagaiin, and let everyone who shall read this utter a prayer of mercy for my soul; Christmas Eve to-night, and under the safeguard of the King of Heaven and earth who is here to-night I place myself…and may He put this great Plague past me and past my friends, and may we be once more in joy and happiness…Aedh son of Conchobhar son of Gilla na Naemh, son of Donnshleibhe Mac Aedhagaiin wrote that in the book of our own father in the year of the great plague…’ [42].

Whether because of divine intervention, sound medical advice or just prudent social distancing, evidence suggests that Aedh survived!

This article may be cited as J. Biggins, ‘Medics and Pandemics in Early Ireland’, The Brehon Lawyer (December 2020)

Sources for this article

Aoibheann Nic Dhonnchadha, ‘The Medical School of Aghmacart, Queen’s County’ (2006) 2 Offaly, Laois and Leinster 11.

D.A. Binchy, ‘Bretha Crólige’ (1938) 12 Ériu 1 (‘Binchy 1’)

D.A. Binchy, ‘Bretha Déin Chécht’ (1966) 20 Ériu 1 (‘Binchy 2’)

D.A. Binchy, ‘Sick Maintenance in Irish Law’ (1938) 12 Ériu 78 (‘Binchy 3’)

D. B. Mulcahy, ‘An Ancient Irish Hot-Air Bath, or Sweat-House, on the Island of Rathlin’ (1891) 1(7) The Journal of the Royal Society of Antiquaries of Ireland 589

Donnchadh Ó Corráin, ‘What Happened Ireland’s Medieval Manuscripts?’ (2011-12) 22-23 Peritia 191

Eileen M. Hickey, The Background of Medicine in Ireland (Chairman’s Address to the Belfast Branch of the BMA, November 1938)

Fergus Kelly, A Guide to Early Irish Law (Dublin Institute for Advanced Studies, 2009) (‘Kelly 1’)

Fergus Kelly, ‘Medicine and Early Irish Law’ (2001) 170 Irish Journal of Medical Science 73-76 (‘Kelly 2’)

Francis Shaw, ‘Irish Medical Men and Philosophers’ in Seven Centuries of Irish Learning 1000-1700, ed. Brian Ó Cuív (Mercer Press, 1971)

Henry Wellcome, Medicine in Antient Erin; An Historical Sketch from Celtic to Mediaeval Times (Burroughs Wellcome & Co, London, 1909)

James Buckley, ‘An Ancient Hot-Air Bath House near Schull, County Cork’ (1913) 19 Journal of the Cork Historical and Archaeological Society 1

Pierce A. Grace, ‘From blefed to scamach: pestilence in early medieval Ireland’ (2018) 118 Proceedings of the Royal Irish Academy: Archaeology, Culture, History, Literature 67

Royal Irish Academy, Gaelic Medical Manuscripts from the Academy Collections (link)

William P. MacArthur, ‘The Identification of Some Pestilences Recorded in the Irish Annals’ (1949) 6 Irish Historical Studies 169

Endnotes

[1] Wellcome, p. 11

[2] Wellcome, p. 13

[3] Wellcome, p. 10

[4] Kelly 1, pp. 59-60

[5] Binchy 2, pp. 5-7

[6] Kelly 1, p. 58

[7] Kelly 2, p. 73

[8] Hickey, p. 69

[9] Hickey, p. 69; Ó’Corráin

[10] Binchy 2, pp. 6-7, 10

[11] Nic Dhonnchadha

[12] Shaw

[13] Binchy 3

[14] Binchy 1, p. 15, 33

[15] Binchy 2, pp. 15-16

[16] Kelly 1, p. 59

[17] Binchy 1, p. 37; Binchy 2, p. 16

[18] Kelly 2, pp. 75-76

[19] Binchy 2, p. 25

[20] Kelly 2, p. 73, 75

[21] Kelly 1, p. 59

[22] Wellcome, p. 42

[23] Binchy 1, p. 37, 39-41

[24] Binchy 1, p. 49

[25] Mulcahy

[26] Buckley

[27] Buckley, p. 5

[28] Buckley, pp. 3-4

[29] Mulcahy, p. 589

[30] Wellcome, p. 33

[31] Kelly 1, p. 21

[32] Grace, pp. 80-82

[33] Grace, pp. 82-84

[34] Grace, pp. 82-84

[35] Grace, pp. 85-86

[36] Grace, pp. 87-88

[37] Grace, pp. 89-90

[38] Grace, pp. 89-90

[39] Grace, p. 91

[40] Grace, p. 91

[41] Grace, p. 91

[42] MacArthur, p. 177-178