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St Columba's case book

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7233.494/a (Published 19 February 2000) Cite this as: BMJ 2000;320:494
  1. Duncan Hunter, assistant professor in community health and epidemiology
  1. Kingston, Ontario, Canada

    Was St Columba of Iona a doctor or a saint? St Columba was an early Christian saint who founded a monastery on Iona, but his Life, published at the end of the fifth century by Adomnán, suggests that he was also one of Britain's early GPs.1 Written a century after his death, the stories rely heavily on Christian symbolism as they were based on tales circulating among the monks and were written by an abbot, about an abbot. However, if you ignore the miraculous hyperbole, Book II can be read as a description of early British medicine. Columba seems to have been a widely respected GP with some knowledge of public health medicine.

    He investigated two epidemics, once by identifying a point source infection from a well (anyone who drank from the well or intentionally washed his hands or feet in it was struck down—people became leprous or half blind or were afflicted) and once by attempting to treat a possible smallpox outbreak (awful sores of pus on the bodies of people and on the udders of cattle) with penicillin (bread dipped in water). Columba can be forgiven for not recognising that the virus would not respond to penicillin, which in any case was not discovered for another 13 centuries. He was also unlikely to have heard of trichinosis, but he knew enough to warn of the dangers of eating undercooked pork. One impatient farmer did not wait and slaughtered a pig too soon (he was impatient to have his first taste of the meat—as soon as a morsel of meat was cooked, he called for it to taste it), and he died.

    Columba was ready to treat whoever showed up at his clinic and sometimes did house calls. A young woman stumbled on her way home and broke her hip in two; while Columba does not reveal the contents of his doctor's bag (a little pinewood box), the bone successfully mended. A young man presented with a chronic nosebleed, which Columba healed by applying pressure to the nostrils with the thumb and forefinger of his right hand. A couple came for counselling when a patient complained that his wife would not sleep with him. She told Columba, “Do not make me share a bed with Luigne.” Columba successfully recommended a combination of controlled dieting (fasting) and counselling. On another occasion, he was called out at night to attend a woman in labour who was suffering great pains during a difficult childbirth. Columba chose prayer or “watchful waiting.”

    Perhaps Columba's most interesting intervention came in cardiology. A middle aged man with type A personality (Broichan's heart was hard and unbending) suffered a heart attack, attributed to a heavy blow from an angel, which left him struggling for breath and near to death. Columba prescribed the cardiac drug of choice, perhaps a nitrate (a white rock dipped in water, that floated miraculously on the water like an apple or a nut). The patient took the draught and completely recovered. This miracle drug healed many people and was so effective that it was kept in the royal treasury until it was used up.

    Little acknowledgement of Dr Columba's contribution to medicine remains today. A monastery on Iona still exists and is the destination for many persons seeking spiritual healing. Those requiring treatment for physical problems must travel by ferry across the Sound of Iona to Mull or await the Oban ambulance.

    We welcome articles of up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.

    References

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