MEDIEVAL MEDICINE AND SURGERY the Dominican Priory of Sancta Maria Insula, Cork City

Cork
The shape of Cork city has been governed by its river and marshy islands. Consequently the medieval city was based on two islands in this marshy estuary of the River Lee. The south island compromises the area north of South Gate Bridge to Castle Street/Liberty Street. The north island encompasses the area north of this as far north as North Gate Bridge. The South Island covers seven hectares as does the North Island. The earliest recorded settlement in Cork was on the south bank of the River Lee in the seventh century. This was the monastery founded by Saint Finbar. The Vikings had set up a fortified colony in Cork by the ninth century. This was the earliest town and was situated somewhere on the south island. Immediately south of the South Gate Bridge is considered to be the most likely location for this Hiberno-Norse settlement.
By the twelfth century Cork had been invaded by the Anglo-Normans and a significant settlement had been established on the most southerly of one of two islands. A long spinal main street developed. By 1200 AD the city was enclosed by a fortification of stone walls (several sections of these walls and associated with mural towers were excavated by the author (Power, 1997). Outside the walls there were settlements on the North Island. This suburb has been identified as Dungarvan and may also have been founded by the Anglo-Normans. Other suburbs which had developed by this time were Shandon, north of Dungarvan, and Le Fayth, south of the South Island, on Barrack Street. By 1299 AD the north island was also surrounded by city walls. It had two main bridges: the North Gate at the north end of the main street, linked to Shandon and the South Gate at the south end of the street, linked to Barrack Street. The axial main street, running north to south, had also evolved on the north island. Today the oval shape of the north and south islands of medieval Cork are preserved as North and South Main Street respectively. The medieval property boundaries are still retained in the modern property divisions.

SUMMARY
Following the excavations of the medieval Dominican Priory at Crosses’ Green, in 1993, over two hundred skeletons from burials, were palaeopathologically examined by the author (Power, 1995). The findings discussed here indicate the presence of a caring altruistic society associated with the monastery at St. Mary’s of the Isle, as well as expertise in Cork at the time of individuals knowledgeable in life-threatening conditions and masters of cranial surgery.

INTRODUCTION
In the southern part of Cork City, in 1993 an area at Crosses’ Green, was proposed for redevelopment. This site contained two eighteenth/nineteenth century mills, which were demolished, and subsequently replaced by apartments and offices. Underneath these fine edifices lay a significant archaeological site, the foundations of the medieval Dominican Priory of Sancta Maria de Insula, St Mary’s of the Island, a foundation dedicated to the Mother of God. The church was said to have been a “magnificent” and imposing structure. It contained a much-venerated statue of St Dominic (a name still very commonly used in Cork today).

THE FOUNDATION OF ST DOMINIC
In 1203 St Dominic while passing through southern France, saw the Albigensian ‘heretics’, whose leaders lived an austere life, kept long fasts, travelled on foot, and preached in apostolic simplicity. He became a convert. Dominic set up houses in university cities, at Bologna, Palencia, Montpellier, and Oxford. Thinking of the future he hoped then to enroll university students in the Order.

THE DOMINICAN PRIORY AT ST. MARY’S OF THE ISLE
This site which was designated for modern development had been the location of the Dominican Priory and church. The Priory was founded in 1229, by Philip de Barry, a Welshman living in Barrymore. Like most Dominican priories, it was located outside the walls of a city, ie. Cork.
The Dominicans were initially mendicants and vowed to poverty. The entire island possessed the privilege of sanctuary and hospitality. The friars also entertained travelers such as Edmond Mortimer, Earl of March and Ulster, father of the heir presumptive to the English throne, coming to Cork in 1381 stayed at St Mary’s of the Isle. Many famous men took accommodation here, including Gerald Fitzgerald, the young Earl of Kildare, in the 16th century. Sir John of Desmond, soldier, and father of James the fifteenth Earl of Desmond, also died at St Mary’s of the Isle. James II stayed at St. Mary’s of the Isle, after he had landed at Kinsale (Pochin-Mould, 1957).
The Friars also assisted the community with a wide variety of other social needs, including caring for the higher echelons, the elderly, and pregnant women, to beggars, lepers, etc. They also gave palliative care, and visited homes of others with serious illnesses; as well as giving spiritual guidance. The wealthy of society gave patronage to the friars in the form of money, rights, rents, mills, or tolls etc. Obviously the wealthier gained more than the poor; these benefactors might expect hospitality on visits, secure a burial spot within the monastic burial ground, or receive prayers and masses for their soul or the souls of their families. The Friars at St Mary’s of the Isle had been given many benefits, eg. in 1317 the Friars in Cork were given free access through some newly built city walls nearby (Dwyer, 1896); the priory also had a mill and fishing rights. The walls of this mill were found during excavations in 1998 by the author (Power, C, 1999). Three substantial walls form the western portion of a room that had a mortared floor; its remaining internal dimensions were 1.15m from east to west and 2.3m from north to south. These walls were built on wooden foundation piles. One of these walls extended from the building for a further 9.47m to the west and may be part of a mill-race that carried water to or from a waterwheel via this channel. Maps dating to the medieval period depict a mill in this vicinity.

THE ARCHAEOLOGICAL EXCAVATION

Excavations carried out at Crosse’s Green in 1993 exposed a number of phases of the Dominican Priory. These included the north range, where the refectory was located which contained stone wall benches and a mural staircase. The eastern half of the cloister, and the ambulatory were also uncovered . The cloister contained about fifty burials. To the south, some of the church walls were located. One hundred and fifty burials were excavated in this area, though many more remained unexcavated (PLATES I & II). Numerous burials had been interred in slab-lined graves/lintel graves. Primarily the burials in the church area date to the 13/14th century and those in the cloister and garth are 15th/16th century in date.

 

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PLATE I. BURIALS IN THE AMBULATORY OF THE MEDIEVAL DOMINICAN PRIORY AT ST MARY’S OF THE ISLE, INCLUDING ONE IN A STONE-LINED GRAVE.

 

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PLATE II. AN EXCAVATED SKELETON.

 

Excavating human skeletal remains in Crosses' Green, Cork City

Excavating human skeletal remains in Crosses’ Green, Cork City

PLATE III. EXCAVATING THE BURIALS IN MEDIEVAL DOMINICAN PRIORY AT ST MARY’S OF THE ISLE, CORK

The graveyard was used by a relatively wide community, both lay and religious. A large number of burials were laid in a simple pit, without a coffin and more than likely wrapped in a shroud. Many graves were reused, probably in a family plot. Many burials were in stone-lined graves and one was in a stone sarcophagus. There was also the discovery of two charred wooden coffins, and two possible 13th-century tomb effigies. .
The Dominicans resided on this island in Cork for six hundred and sixty-seven years. In 1697 an Act Of Parliament ordered all clergy to leave the country, or they would be put to death. Then, followed the demise of the Monastery on the island. The priors moved to the northern side of the city, near Shandon Street. Later they settled at Dominick Street, and finally to Pope’s Quay. During the famine years of 1847, the Dominicans of St. Mary’s performed great charity work.

When the Dominicans left the island of St. Mary’s, the Mayor of Cork resided there. Later it was called the ‘great house of St. Dominic’. The Earl of Inchiquin also used this house as his town house.The Order of Preachers (OP) is better known as the Dominicans. The Order was founded by St Dominic de Guzmán in 1216, in response to the increase in the influence of the Albigensian cult. The cult saw the material world as evil, and escape from it the only route to salvation. It is thought that Dominic’s sermons placed a strong emphasis on the goodness of creation and of the human body. The Dominican priors would travel widely beyond their priories to preach and teach, but they would always return to be renewed by the regular life of their priory: community life, liturgical prayer, study, personal prayer….
The first Dominicans came to Ireland in 1224, three years after St Dominic’s death. The first foundation was in Dublin, but other foundations followed quickly: Drogheda in the same year, Kilkenny (1225), Waterford (1226), Limerick (1227), Cork (1229)….

MEDICINE IN HISTORY
There were a variety of different medical practices available to people in Medieval Times. There were charlatans, as well as trained doctors using Hippocrates teachings.
Hippocrates Asclepiades, of Cos (460-377 BC) had lived during the “golden age of Pericles,” which was the pinnacle of ancient Greek civilization. He was known as the ‘father of modern medicine’ a discipline which he had established in Greece. Medicine at the time was something which had been laden with superstitions and mysticism, throughout the world. Using the principles of observation and clinical examination, he led the intellectual evolution of medicine, including surgery and neurosurgery.
When the Domincan Priory at St. Mary’s was functioning, reading ancients texts was considered to be the best method for the diagnosis and treatment of illnesses, pain etc. It was believed that the human body was made up of the humours: blood, phlegm, bile and black bile. Medicine, in medieval universities had used Aristotelian logic and natural philosophy. The writings of Aristotle, and Galen were still the main principles for treating patients. By now medicine had become a successful and lucrative profession in Europe and aspects were taught in European universities by 1300. Early physicians in Italy were monks or priests. In Cork medical teaching did not begin until the eighteenth century.
The relief of pain was profitable. Wine was used to relieve pain and also acted as an antiseptic. A wound was first purified with wine, and dried out, by evaporation. Opiates were well known in medieval times and the apothecaries and physicians constantly tried to control the market. Ice was also used as a painkiller. Other methods of cure included blood letting, purgatives, mercury etc. However the use of superstitions also abounded, such as astrological seals. Some physical cures were given for purely superstitious reasons, such as herbal remedies being approved to rid the body of evil spirits.
Infection was recognized as being of great danger, and drainage of wounds took place. Dirty water was avoided for cleaning. During the medieval period, tumours, nasal polypi, as well as cysts and cataracts were successfully removed. Doctors also knew about the necessity of the closure of wounds as quickly as possible. It was also known how to diagnose fractures of the skull. Surgery was taught in all of the fifteen great Italian universities. Guy de Chauliac, the father of modern surgery recorded the use of pain killers during operations, such as opium, morel, hyoscyamus, mandragora, ivy, hemlock and lettuce. He also described anaesthetic by inhalation, by a sponge soaked in various sleep-producing drugs.

CRANIAL SURGERY AT ST MARY’S OF THE ISLE
The skeletal remains of two men (BURIAL 138 & BURIAL 147) from St Mary’s of the Isle who survived a surgical operation known as trepanation, each displayed an opening on the side of the head (Plate IV)(Power, 1995). Both men were buried in stone-lined graves within the church; each skeleton was in a poor state of preservation (PLATE II). One man (BURIAL 147) was aged in the late twenties, and the other (BURIAL 138) in the early thirties.
Each opening on the cranium was circa 3cm x 2.5cm in diameter and healing had taken place (Plate IV). During life each opening was not sealed by bone because the portion of bone had been lost at the time of the impact. Eventually, new skin would have grown over the hole. BURIAL 138 and BURIAL 147 were buried in stone-lined graves. Helmets were probably not worn by these men during these particular encounters.
Trepanning is the art of boring a hole in the skull for medical, and mystical reasons, including treatment for insanity, headaches, epilepsy etc. Trepanation is supposed to expel a possessed ghost or spirit from the tormented patient’s. Another theory is that opening the skull provided the person with the offer of an ecstatic spiritual experience! Archaeological evidence of trepanning is worldwide. Most patients survived and many cases were to release evil spirits. Trepanation is advocated in modern times by The International Trepanation Advocacy Group based on the premise that as we age our brains get locked in the old skullcase, and trepanation restores that space.

 

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PLATE IV. THE OPENING ON THE FRONT LEFT PART OF THE CRANIUM OF AN ADULT MALE FROM ST. MARY’S OF TH ISLE, CORK.

One trepanation instrument is a trephine, which is a small circular saw with a center pin mounted on a strong hollow metal shaft to which is attached a transverse handle (Figure 1). It was used in surgery to remove circular disks of bone from the skull (2009). The origin of the word trefine is derived from the presence of three ends which formed part of the instrument itself. Other tools required for the operation would have been a sharp knife, with which to slice the skin of the skull and pull back the flaps, also files, brushes. This operation would have taken a long time. The specialist cut the scalp and then broke the bone with one of the instruments on the table, taking care not to damage the brain. Once the operation was finished, the soft tissues would be sewn closed. The fragment of bone from the skull could not be reinserted. High medical standards with surgical skills were achieved by those who carried out the operations on the men buried at St. Mary’s of the Isle. These men survived for some time after these operations; the wounds were well healed, with no sign of infection. The pain relief, if any, used at Crosses’ Green is impossible to establish. However, opiates and or alcohol were no doubt part of the procedures.

There were three skulls in the grave of BURIAL 147, and one set of jumbled postcranial bones, therefore it was not possible to determine to which skull these belonged with. However, there was evidence of a healed sinus representing a wound on the posterior surface of the midshaft of a right femur; a life-threatening infection called osteomyelitis had occurred.
This bone infection usually caused by bacteria, spreads through the bloodstream, spreading from nearby tissue, or directly invading the bone. The bone can be infected after a few days or weeks. trepanation. Such an infection may start in an area damaged by an injury, or cancer, or in a skin ulcer (particularly a foot ulcer) caused by poor circulation or diabetes. This man not only survived this episode of severe ill health, but also survived serious cranial surgery. An object such as the point of a sword or other sharp object could have caused this injury. The man may have had a couple of injuries (one to the back of his thigh and one to his head) at the time and was brought for care and recuperation to the infirmary at St. Mary’s of the Isle. His return to good health was a success indicating that well-experienced carers were at the infirmary; this man survived an unknown amount of time, perhaps a number of years, but time enough to heal the bone of the skull and the femur.
The other man, aged in his thirties, who was trephined, suffered from degenerative joint disease in the right hip, also healed strains to his feet, and healed infection on his shins/tibiae.
At St Mary’s of the Isle two other medieval men (BURIAL 150 & BURIAL 157) died from weapon injuries. Both men were aged in their twenties, one 168cm in height and the other 176cm. In one man (B150) there were three unhealed cutmarks: one to the posterior surface of the left elbow and a third, the final blow, to the frontal bone just above the right eye socket. He was attacked probably by a right handed assailant, with a sword, either when he fell or was attacked from behind. Death may have occurred immediately or within a few hours or days. The cutmarks show the sharpness of the weapons as well as their efficacy.
In the second individual (BURIAL 157) there were eight unhealed cutmarks caused by a sword or axe. They occurred on the right forearm and right lower leg. Death could have resulted instantly from a severed artery. The cuts to his forearm probably took place when he was shielding his face and the final blow to his leg occurred when he fell to the ground or if he had been on horseback. BURIAL 150 was buried, with two other individuals, in a stone-lined grave while BURIAL 157 was in an unmarked grave; both men were buried in the church.

Each of these men had endured physical hardship during their lives, perhaps from labouring in the fields or on the battle field, it is hard to tell. Each man had old healed soft tissue injuries and vertebral degenerative joint disease. BURIAL 150 had strained, or torn ligaments on his collar bone and his right knee. He had also strained several of his ribs. BURIAL 157 also had torn ligaments of his left knee, left hand, and his ankles. During adolescence BURIAL 157 he had suffered from some herniated discs.

DISCUSSION                                                                                                                                                          It is not known if the Domincian Priory at St. Mary’s of the Isle had a hospital. Hospitals arrived in Ireland, at the time of the Anglo-Norman Invasion. As in England, Ireland too at the time most certainly had some infirmary within the confines of most monastic establishments (Orme and Webster, 2010). The infirmary may have been organized by the monks or some lay people, such as rich female benefactresses etc. The infirmary would have provided a place of caring for the sick, elderly, pregnant women, the dying etc (Figure 2).

In the 12th century AD Cork had a hospital for the sick and poor, though sometimes not well maintained (Nicholls, 2005); this was a Benedictine foundation set up around what is now known as Cove Street. A later 19th century medical school existed here; it is not unreasonable to believe that such a tradition existed there since medieval times. The Knights Hospitallers of St. John of Jerusalem, set up a house in what is now Douglas Street, in the 12th century. At the time two leper hospitals were also located in Cork. Accordingly, the two men, with trepanations, found at St. Mary’s of the Isle in Cork City, may well have had surgery in a hospital on the island or nearby in one at Cove Street (called St. John Evangelist Street). They then recuperated at the infirmary on the Island for a lengthy period of time. With such major surgery, it would not be surprising that each man suffered from severe headaches or epilepsy etc for the rest of his life, or perhaps in the first instance these conditions might have been the reason for carrying out the operation. They would have received care at the Island of St. Mary’s. In the 14th century, when the population of Cork and the rest of Europe was devastated by the Bubonic Plague / the Black Death, the infirmary may have had a huge impact on the caring of the sick and dying. The bacterium (yersinia pestis), was carried by the fleas on the black rat. As in most crowded and squalid urban areas of the time, Cork was probably infested with fleas.

There are a number of other explanations why the two men with evidence of healed surgery were buried at St. Mary’s of the Isle. ?

REFERENCES

Dwyer, James, Rev. 1896, The Dominicans of Cork City and County, Guy & Company Ltd., Cork.

Nicholls, K. 2005, The Anglo-Normans and Beyond, in J.S., Devoy, R.J.N., Linehan, D & P. O’Flannagan, (eds) Atlas of Cork City, Cork University Press, 104-105.

Orme, N. & M. Webster, 2010, The English Hospital, Yale University Press, 1070-1570.

Pochin-Mould, DC., 1957, The Irish Dominicans,

Power, C, 1995, A medieval demographic sample, in Excavations at the Priory of St. Mary of the Isle, Crosses’ Green, Cork, pp. 66-83, Cork.

Power, C, 1997, North Main Street, Castle Street, Adelaide Street, Liberty Street, Daunt Square, Paradise Place, Cork, Excavations.ie, Wordwell Books.

Power, C, 1998, Adelaide Street, Kyle Street, Liberty Street, North Main Street, Paul Street, South Main Street, Cork, Excavations. ie, Wordwell Books.

Power, C, 1999. Christchurch Lane/Hanover Street/Kift’s Lane/Little Cross Street/St Augustine Street/St Patrick Street/Emmet Place/Tuckey Street, Cork, Excavations.ie, Wordwell Books.

Power, C, 1999, ST. Mary’s of the Isle, Cork, Excavations.ie, Wordwell Books.

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