Physicians practised in Ireland from earliest times. The Book of Genealogies lists Capa and Eaba as the first male and female doctors in Ireland. The first historical reference to a physician is in the Annals of the Four Masters, where the death of Maelodhar Ua Tindridh, ‘the most learned physician of Ireland’, is recorded in 860. Medicine was a hereditary profession. In post-Norman Ireland specific families were physicians to ruling dynasties. Exactly how physicians were trained is unknown, but early medical schools existed, such as at Aghmacart in modern County Laois. In the schools, leech books were compiled and contemporary European medical texts were translated. The trained doctor (midach téchtae) had status in the túath, but masters (ollam) and unqualified physicians (midach étéchtae) were also known. Healing by the use of herbs was very important, but the qualified physician was allowed to shed blood (fuil midaig téchta), a possible reference to surgery. If a physician was not fit to practice, he was distrained by the removal of his lancet (fraig) and horsewhip (echlasc), and by the tying of a thread round his ring finger. Physicians’ fees were based on the wounds sustained and the status of the patient.

While most of the law texts deal with status, property and contracts, a number of the texts are of medical interest. Bretha Déin Chécht (Judgement of Déin Chécht), Bretha Crólige (Judgement of Blood Lying) and Di Ércib Fola (Fine for Bloodshed) all deal with medicine. Déin Chécht (leech) was one of the craft gods of the Tuatha De Danann; the others were Goibniu (smith), Luchta (wright) and Credne (metal-worker).The medical texts prescribed the level of compensation to be paid to a victim and the care of the injured.

D.A. Binchy, who published the Brehon Laws as the Corpus Iuris Hibernici in 1978, described early Irish society as ‘tribal, rural, hierarchical and familiar’.

A person who assaulted another unlawfully was liable to pay a fine (éric or corpdíre) for the injury plus an honour-price based on the status of the victim. The offender also had to provide sick-maintenance (othrus), i.e. to look after the victim until he or she had recovered. Legally inflicted injuries (e.g. in self-defence) were not liable for othrus and were called fuil slán (free blood). Minor injuries did not carry any obligation to provide othrus but the perpetrator had to pay the éric for the injury, calculated as a fraction of the fine for homicide.A person accused of inflicting an injury was required to agree to abide by the rule of the court. The plaintiff’s allegation was admitted or denied by the defendant. If denied, the plaintiff called witnesses and made a formal oath asserting the truth of his allegations, supported by three ‘oath-helpers’. The defendant then gave his version, supported by witnesses and ‘oath-helpers’. In this hierarchical society a king’s oath outranked the oath of a freeman, and a churchman’s oath topped all others. If a verdict could not be determined on the evidence, it was established by drawing lots, by ordeal or by duel. Three pieces of wood (corcrann) were used as lots to decide the verdict: ‘guilty’, ‘not guilty’ or ‘not proven’. The common ordeal used was fir coiri or the ‘proof of the cauldron’. The suspect immersed his hand in a cauldron of hot water; after a specified time, the hand was examined and guilt determined by the presence of scald marks. A duel was conducted before witnesses and the winner was deemed to have justice on his side. Having identified a guilty party, the éric, the honour-price and sick-maintenance costs were decided.

A very detailed classification of wounds existed, based on the site and severity of the wound. The éric was calculated on the wound and on the status of the victim. The physician’s fee was 50% of the éric for wounds to any of the ‘twelve doors of the soul’, which were defined anatomical sites, e.g. the top of the head. The same was true for any of seven distinct fractures, e.g. of the femur, or for wounds inflicted in seven different situations, e.g. in battle. The severity of the wound was also classified. There was an increasing scale of fines, based on the type of injury sustained, ranging from two séts for a ‘white blow’ (mbanbeimen) to 21 milking cows for homicide (croligiu chuntabartach báis).Nine days after the injury, a determination was made on the wounds inflicted (derosc cacha fola). A physician gave a prognosis with four possible outcomes. (a) The injured person had died: the defendant was liable for the éric for homicide, which was paid to the victim’s nearest relatives, plus the honour-price, paid to the derbfine. (b) The injured person had made a full recovery: the defendant paid the éric according to the nature of the wound; a permanent blemish/disability carried an extra fine. (c) The injured person was unlikely to recover: this was crólige mbáis and the defendant was liable for a fine similar to the homicide fine. (d) The injured person was likely to recover: this was fuil othrusa; the defendant was obliged to remove the victim (dingbáil) to a place where he could be nursed back to health under medical supervision. If he subsequently died, the rules for crólige mbáis applied.

There was an obligation on the guilty person to provide proper nursing care and a work-substitute for the victim. There was a duty on the victim to accept the standard of care due to him and to resume his normal role immediately when cured. In the presence of witnesses, the injured person was taken to a safe place for nursing care—if a cleric to a monastery, if a layman to any place deemed suitable for othrus, e.g. not the dwelling of the defendant or a place where the wounded individual feared further injury. It was stipulated that the sick man should be ‘. . . taken to a proper house with four doors (ceitri dorais ass) so that the sick man may be seen from every side, and water across the middle of it (ocus uisci tar a lar); that fools or female scolds be not let into the house and that he not be injured by forbidden food’.

The food to be provided to the injured party during othrus was described in great detail. The guilty person also had to provide for the invalid’s retinue while on othrus; each attendant was entitled to one loaf of bread daily and appropriate condiments. The invalid’s friends were entitled to visit every ninth day and they, as well as the leech, had to be entertained at the expense of the guilty host. Even as the law texts were being written, however, a change in the system was occurring. In one text it is stated that ‘Sick-maintenance does not exist at the present time, but rather the fee for his worthy qualities [is paid] to each according to his rank, including leech’s fee and ale, and refection (tincisin), and also the fee for blemish, hurt, or loss of limb’.

Thus the onerous orthus regulations seem to have been converted into a nursing fee, which was equivalent in amount to the honour-price of the injured party. The victim was then nursed back to health in his own home. In pre-Norman Ireland there was no centralised system of law enforcement. If a fine was not paid, the law allowed an individual to enforce his claim by seizing the plaintiff’s goods (athgabál) or taking possession of land (tellach). In the case of murder, the murderer could be executed or sold into slavery by the victim’s relatives. The church was much keener on physical punishment than the secular courts. Hanging (crucifix), death by starvation in a pit (góla) and slaying with a sword (guin) were all used.

Ancient Laws of Ireland: Uraicect Becc and Certain Other Selected Brehon Law Tracts

Image | Ruins of Culahill Castle, Co Laois, near which the medical school of Aghmacart existed during the sixteenth and seventeenth centuries | Image credit: G Hill