1. Medical Doctors

Medicine and surgery were carefully studied in Ireland from the very earliest times. There was a distinct professional class of physicians who underwent a regular course of education and practical training, and whose qualifications and privileges were universally recognised. Those intended for the profession were usually educated by being apprenticed to a physician of standing, in whose house they lived during their pupilage, and by whom they were instructed. This profession, like others in ancient Ireland, became in great measure hereditary in certain families.

The Irish, like the Greeks and other ancient nations, had their great mythical physicians, of whom the most distinguished was the Dedannan leech-god Diancecht [Dianket]. His name signifies “vehement power”, and marvellous stories are related  p.265 of his healing skill; similar to those of some old Greek physicians. He is mentioned in certain Irish Glosses and Incantations for health, written in the eighth century: so that at that early time he was regarded as a god, belonging to a period looked back to, even then, as the dim twilight of antiquity.

He had a son Midach and a daughter Airmeda, both of whom in some respects excelled himself; and in one of the old tales we are told that he grew at last so jealous of Midach that he killed him. And after a time there grew up from the young physician's grave 865 herbs from the 865 joints and sinews and members of his body, each herb with mighty virtue to cure diseases of the part it grew from. His sister Airmeda plucked up the herbs, and carefully sorting them, wrapped them up in her mantle. But the jealous old Diancecht came and mixed them all up, so that now no leech has complete knowledge of their distinctive qualities “unless”—adds the story—“the Holy Spirit should teach him.”

Medical doctors figure conspicuously in the Tales of the Red Branch Knights. A whole medical corps, under one head physician, accompanied each army during the war of the Táin. Each leech of the company carried, slung from his waist, a bag—called a lés [lace]—full of medicaments; and at the end of the day's fighting, whether between numbers or individuals, they came forward and applied their salves.

Though the profession continued uninterruptedly from the most distant ages, the first notice of an individual physician we find in the annals of  p.266 Christian times occurs under A.D. 860, where the death is recorded of Maelodar O'Tinnri, “the best physician in Ireland”: but from that period downwards the annals record a succession of eminent physicians, whose reputation, like that of the Irish scholars of other professions, reached the Continent. In the beginning of the seventeenth century, when medicine had been successfully studied in Ireland for more than a thousand years, Van Helmont of Brussels, a distinguished physician and writer on medical subjects, gave a brief but very correct account of the Irish physicians of his time, their books, and their remedies, and praised them for their skill. He says:—
‘The Irish nobility have in every family a domestic physician, who has a tract of land free for his remuneration, and who is appointed, not on account of the amount of learning he brings away in his head from colleges, but because he can cure disorders. These doctors obtain their medical knowledge chiefly from books belonging to particular families left them by their ancestors, in which are laid down the symptoms of the several diseases, with the remedies annexed; which remedies are the productions of their own country. Accordingly the Irish are better managed in sickness than the Italians, who have a physician in every village.’ ()

From the earliest times reached by our records the kings and great Irish families had physicians attached to their households, whose office was, as in other professions, hereditary. The O'Callanans were physicians to the Mac Carthys of Desmond; the O'Cassidys, of whom individuals of eminence are recorded, to the Maguires of Fermanagh; the O'Lees, to the O'Flahertys of Connaught; and the  p.267 O'Hickeys, to the O'Briens of Thomond, to the O'Kennedys of Ormond, and to the Macnamaras of Clare.

The O'Shiels were physicians to the MacMahons of Oriel, and to the MacCoghlans of Delvin, in the present King's County: and their hereditary estate, which is near the village of Ferbane, is still called Ballyshiel, “O'Shiel's town”. Colgan states that in his time—seventeenth century—the O'Shiels were widely spread through Ireland, and were celebrated for their skill in natural science and medicine. Only quite recently—in 1889—Dr. Shiel, an eminent physician of Ballyshannon, left by his will a large fortune to found a hospital for the poor in that town. So that even still the hereditary genius of the family continues to exercise its benign influence.

The amount of remuneration of a family leech depended on his own eminence and on the status of the king or chief in whose household he lived. The stipend usually consisted of a tract of land and a residence in the neighbourhood, held free of all rent and tribute, together with certain allowances and perquisites: and the physician might practise for fee outside his patron's household. Five hundred acres of land was a usual allowance: and some of these estates—now ordinary townlands—retain the family names to this day. The household physician to a king—who should always be an ollave-leech, that is, one who had attained the highest rank in the profession (p. 185, supra)—held a very dignified position, and indeed lived like a prince, with a household and dependents of his own. He was  p.268 always among the king's immediate retinue, and was entitled to a distinguished place at table.

Speaking generally, the best physicians were those attached to noble households. Those unattached lived by their fees; the amounts for the several operations or attendances being defined by the Brehon Laws. A qualified physician—as we have said—kept pupils or graduates who lived in his house and accompanied him in his visitations to learn his methods. We have already seen (p. 88) that a man who inflicted a wound had, on conviction, to pay a certain eric-fine to the wounded person. A leech who, through carelessness, or neglect, or gross want of skill, failed to cure a wound, had to pay the same fine to the patient as if he had inflicted the wound with his own hand; and if he had received his fee, he should return it.

It is worthy of remark that in our legendary history female physicians are often mentioned: and so we see that in ancient Ireland the idea was abroad which is so extensively coming into practice in our own day.

2. Medical Manuscripts

The physicians of ancient Ireland, like those of other countries, derived a large part of their special learning from books, which in those times were all manuscripts. The members of each medical family had generally their own special book, which was handed down reverently from father to son, and which, at long intervals, when it had become damaged and illegible through age, was carefully  p.269 transcribed into a new volume. Several of these venerable leech-books are still preserved, as mentioned farther on.

But besides these special books belonging to particular families, there were many others, which were copied and multiplied from time to time; so that the chief medical families had libraries containing such medical knowledge as was then available. There are still preserved in various libraries a great number of Irish medical MSS., forming a collection of medical literature in Irish, probably the largest in existence in any one tongue.

The manner in which these books were generally compiled and the motives of the compilers may be gathered from the following translation of a prefatory statement in Irish by the writer of a medical manuscript of the year 1352, now in the Royal Irish Academy,—a statement breathing a noble spirit, worthy of the best traditions of the faculty:—
‘May the merciful God have mercy on us all. I have here collected practical rules from several works, for the honour of God, for the benefit of the Irish people, for the instruction of my pupils, and for the love of my friends and of my kindred. I have translated them into Gaelic from Latin books containing the lore of the great leeches of Greece and Rome. These are things gentle, sweet, profitable, and of little evil, things which have been often tested by us and by our instructors. I pray God to bless those doctors who will use this book; and I lay it on their souls as an injunction, that they extract not sparingly from it; and more especially that they do their duty devotedly in cases where they receive no pay [on account of the poverty of the patients]. I implore every doctor, that before he begins his treatment be remember God, the father of health, to the end that his work may be finished prosperously. Moreover, let him  p.270 not be in mortal sin, and let him implore the patient to be also free from grievous sin. Let him offer up a secret prayer for the sick person, and implore the Heavenly Father, the physician and balm-giver for all mankind, to prosper the work he is entering upon.’ (RIA MS 23 F 19 (see CELT file G600011).)

The Book of the O'Lees in the Royal Irish Academy is a large-sized vellum manuscript, written in 1443, partly in Latin and partly in Irish. It is a complete system of medicine, treating of most of the diseases then known. The Book of the O'Hickeys, now in the Royal Irish Academy, commonly known as the Lily of Medicine, is a translation into Irish of a Latin work, originally written by Bernard Gordon—a Continental physician—in 1303. The Book of the O'Shiels, now also in the Royal Irish Academy, which was transcribed in 1657, from some manuscript of unknown date, contains a system of medical science still more complete and scientific than even the Book of the O'Lees. There are many other medical manuscript books belonging to particular families.

3. Diseases

All the chief diseases and epidemics we are now acquainted with were known and studied by the Irish physicians, and called by Irish names. In early times great plagues were of frequent occurrence all over the world; and Ireland was not exempt. The victims of a plague were commonly buried in one spot, which was fenced round and preserved as in a manner sacred. In Cormac's Glossary it is stated that the place of such wholesale interment was called tamhlacht, i.e. “plague-grave”, from tamh,  p.271 a plague, and lacht, a monument or memorial over the dead. Tamhlacht, which is still a living word, has given name to the village of Tallaght near Dublin, where the Parthalonian colony, who all died of a plague in one week, were interred. On the side of Tallaght hill are to be seen to this day a number of pagan graves and burial mounds. Within historic times, the most remarkable and destructive of all the ancient plagues was the Blefed, or Buide-Connaill [boy-connell] or yellow plague, which swept through Ireland twice, in the sixth and seventh centuries, and which, we know from outer sources, desolated all Europe about the same time. The Irish records abound in notices of its ravages.

The idea that a plague could not travel over sea farther than nine waves was very general, both in pagan and Christian times. During the prevalence of the yellow plague, St. Colman of Cloyne, with his terrified companions, fled to an island somewhere near Cork, so as to put a distance of nine waves between them and the mainland.

Some cutaneous disease, very virulent and infectious, known by names—such as lobor, clam, and trosc—that indicate a belief that it was leprosy, existed in Ireland from a very early date: but experts of our day doubt if it was true leprosy. Whatever it was, it would seem to have been a well-recognised disease in the fifth century; and after that time our literature, especially the Lives of the Saints, abounds with notices of the disease.

The annals record several outbreaks of smallpox and many individual deaths from it. It was known by two names, both still in use in different parts of  p.272 the country:—bolgach or “pustule disease” (bolg, “a bag or pustule”), and galar-brecc, the “speckled disease.”

Consumption was but too well known, then as now: a usual name for it was serg, i.e. “withering” or “decaying”. In Cormac's Glossary a person in consumption is called by an Irish name signifying “without fat.”

“Gout in the hand”, is explained in Irish by crupán na lám, “cramp or spasm of the hands”: and ophthalmia is galar súla, “disease of the eye.” This word crupán [cruppaun], “a spasm or seizure”, is still used in parts of Ireland to denote a paralytic affection in cattle: it was also applied to convulsions. In the Tripartite Life and other old documents, colic is designated by tregat, which is still a spoken word. One of the early kings of Ireland was called Aed Uaridnech (A.D. 603 to 611), or “Aed of the shivering disease”, no doubt ague. Palsy was known by the descriptive name crith-lám [crih-lauv], “trembling of the hands”, from crith, “shaking”, and lám(h), “a hand.”

St. Camin of Inis-Caltra died in 653 of teine-buirr, “fire of swelling” —St. Anthony's fire or erysipelas —which withered away all his body. In one of Zeuss's eighth-century glosses, cancer is designated by two Irish words, tuthle and ailse, the latter of which is still in use in the same sense: and elsewhere in the same glosses another native word for the same disease occurs, úrphasiu. Diarrhoea was called in Irish buinnech, i.e. “flux”, from buinne, “a wave or stream.” These are only a few examples of Irish names of diseases.

4. Treatment

Hospitals.—The idea of a hospital, or a house of some kind for the treatment of the sick or wounded, was familiar in Ireland from remote pagan times. In some of the tales of the Táin we read that in the time of the Red Branch Knights there was a hospital for the wounded at Emain called Bróinbherg [Brone-verrig], the “house of sorrow.” But coming to historic times, we know that there were hospitals all over the country, many of them in connexion with monasteries. Some were for sick persons in general; some were special, as, for instance, leper-houses. Monastic hospitals and leper-houses are very often mentioned in the annals. These were charitable institutions, supported by, and under the direction and management of, the monastic authorities.

but there were secular hospitals for the common use of the people of the túath or district. these came under the direct cognisance of the Brehon Law, which laid down certain general regulations for their management. Patients who were in a position to do so were expected to pay for food, medicine, and the attendance of a physician. In all cases cleanliness and ventilation seem to have been well attended to; for it was expressly prescribed in the law that any house in which sick persons were treated should be free from dirt, should have four open doors, and should have a stream of water running across it through the middle of the floor. these regulations — rough and ready as they were, though in the right direction — applied also to a house or private hospital  p.274 kept by a doctor for the treatment of his patients. The regulation about the four open doors and the stream of water may be said to have anticipated by a thousand years the present open-air treatment for consumption.

If a person wounded another or injured him bodily in any way, without justification, he was obliged by the Brehon Law to pay for “Sick maintenance”, i.e. the cost of maintaining the wounded man in a hospital, either wholly or partly, according to the circumstances of the case, till recovery or death; which payment included the fees of the physician, and one or more attendants according to the rank of the injured person. Moreover, it was the duty of the aggressor to see that the patient was properly treated: — that there were the usual four doors and a stream of water; that the bed was properly furnished; that the physician's orders were strictly carried out — for example, the patient was not to be put into a bed forbidden by the doctor, or given prohibited food; and “dogs and fools and talkative noisy people” were to be kept away from him lest he might be worried. If the wounder neglected this duty, he was liable to penalty. Leper hospitals were established in various parts of Ireland, generally in connexion with monasteries, so that they became very general, and are often noticed in the annals.

Trefining or Trepanning.—In the Battle of Moyrath, fought A.D, 637, a young Irish chief named Cennfaelad [Kenfaila] had his skull fractured by a blow of a sword, after which he was a year under cure at the celebrated school of Tomregan in the present County Cavan. The injured portion of the skull  p.275 and a portion of the brain were removed, which so cleared his intellect and improved his memory that on his recovery he became a great scholar and a great jurist, whose name — “Kennfaela the Learned” — is to this day well known in Irish literature. He was the author of the Primer of the Poets, a work still in existence. Certain Legal Commentaries which have been recently published, forming part of the Book of Acaill, have also been attributed to him; and he was subsequently the founder of a famous school at Derryloran in Tyrone.

The old Irish writer of the Tale accounts for the sudden improvement in Kennfaela's memory by saying that his brain of forgetfulness was removed. It would be hardly scientific to reject all this as mere fable. What really happens in such cases is this. Injuries of the head are often followed by loss of memory, or by some other mental disturbance, which in modern times is cured, and the mind restored to its former healthful action — but nothing beyond — by a successful operation on skull and brain. The effects of such cures, which are sufficiently marvellous, have been exaggerated even in our own day; and in modern medical literature physicians of some standing have left highly-coloured accounts of sudden wonderful improvements of intellect following injuries of the head after cure. Kennfaela's case comes well within historic times: and the old Irish writer's account seems merely an exaggeration of what was a successful cure. We must bear in mind that the mere existence in Irish literature of this story, and of some others like it, shows that this critical operation — trefining — was well known and recognised, not only among the faculty  p.276 but among the general public. In those fighting times, too, the cases must have been sufficiently numerous to afford surgeons good practice.

Stitching Wounds. — The art of closing up wounds by stitching was known to the old Irish surgeons. In the story of the death of King Concobar mac Nessa we are told that the surgeons stitched up the wound in his head with thread of gold, because his hair was golden colour.

Cupping and Probing. — Cupping was commonly practised by the Irish physicians, who for this purpose carried about with them a sort of horn called a gipne or gibne, as doctors now always carry a stethoscope. An actual case of cupping is mentioned in one old tale, where the female leech Bebinn had the venom drawn from an old unhealed wound on Cailte's leg, by means of two fedans or tubes; by which the wound was healed. It is stated in the text that these were “the fedans of Modarn's daughter Binn”, a former lady-doctor, from which we may infer that they were something more than simple tubes — that they were of some special construction cunningly designed for the operation. We find a parallel case among the Homeric Greeks, where the physician Machaon healed an arrow-wound on Menelaus by sucking out the noxious blood and applying salves. The lady-physician Bebinn also treated Cailte for general indisposition by administering five successive emetics at proper intervals, of which the effects of each are fully described in the old text. Bebinn prepared the draughts by steeping certain herbs in water: each draught was different from all the others, and acted differently; and the treatment restored the  p.277 patient to health. A probe (fraig) was another instrument regarded, like the cupping-horn, as requisite for a physician.

Sleeping-Draught. — In one of the oldest of the Irish Tales it is stated that the warrior lady Scathach gave Cuchulainn a sleeping-draught to keep him from going to battle: it was strong enough to put an ordinary person to sleep for twenty-four hours: but Cuchulainn woke up after one hour. This shows that at the early period when this story was written — seventh or eighth century — the Irish had a knowledge of sleeping-potions, and knew how to regulate their strength.

Materia Medica.— I have stated that some of the medical manuscripts contain descriptions of the medical properties of herbs. But besides these there are regular treatises on materia medica consisting of long lists of herbs and a few mineral substances, such as copperas and alum, with a description of their medical qualities, their application to various diseases, and the modes of preparing and administering them, the Latin names being given, and also the Irish names in case of native products. The herbs are classified according to the old system, into “moist and dry”, “hot and cold”.

The Irish doctors had the reputation — outside Ireland — of being specially skilled in medicinal botany.

Vapour Bath and Sweating-House. —We know that the Turkish bath is of recent introduction in these countries. But the hot-air or vapour bath was well known in Ireland, and was used as a cure for rheumatism down to a few years ago. It was  p.278 probably in use from old times; and the masonry of the Inishmurray sweating-house, represented opposite, has all the appearance — as Mr. Wakeman remarks — of being as old as any of the other primitive buildings in the island. The structures in which these baths were given are known by the name of Tigh 'n alluis [Teenollish], “sweating-house” (allus, “sweat”). They are still well known in the northern parts of Ireland — small houses, entirely of stone, from five to seven feet long inside, with a low little door through which one must creep: always placed remote from habitations: and near by is commonly a pool or tank of water four or five feet deep. They were used in this way. A great fire of turf was kindled inside till the house became heated like an oven; after which the embers and ashes were swept out, and water was splashed on the stones, which produced a thick warm vapour. Then the person, wrapping himself in a blanket, crept in and sat down on a bench of sods, after which the door was closed up. He remained there an hour or so till he was in a profuse perspiration: and then creeping out, plunged right into the cold water, after emerging from which he was well rubbed till he became warm. After several baths at intervals of some days he commonly got cured. Persons are still living who used these baths or saw them used.

In the descriptions of the various curative applications given in old Irish medical books there is an odd mixture of sound knowledge and superstition, common in those times, not only among Irish physicians, but among those of all countries. Magic, charms, and astrological observations, as aids in  p.280 medical treatment, were universal among physicians in England down to the seventeenth century.

Popular Herb-Knowledge. — The peasantry were skilled in the curative qualities of herbs and in preparing and applying them to wounds and local diseases; and their skill has in a measure descended to the peasantry of the present day. There were “herb-doctors”, of whom the most intelligent, deriving their knowledge chiefly from Irish manuscripts, had considerable skill and did a good practice. But these were not recognised among the profession: they were amateurs without any technical qualification; and they were liable to certain disabilities and dangers from which the regular physicians were free, like quack-doctors of the present day. From the peasantry of two centuries ago, Threlkeld and others who wrote on Irish botany obtained a large part of the useful information they have given us in their books. Popular cures were generally mixed up with much fairy superstition, which may perhaps be taken as indicating their great antiquity and pagan origin.

Poison. — How to poison with deadly herbs was known. The satirist Cridenbel died by swallowing something put into his food by the Dagda, whom the people then accused of murdering him. After Coffagh the Slender of Brega had murdered his brother Laery Lorc, king of Ireland, he had Laery's son Ailill murdered also by paying a fellow to poison him.