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Medicine in the Middle Ages

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In the second century, Origen wrote, "For those who are adorned with religion use physicians as servants of God, knowing that He himself gave medical knowledge to men, just as He himself assigned both herbs and other things to grow on the earth."


The practice of medicine in the Middle Ages was rooted in the Greek tradition. Hippocrates, considered the "father of Medicine," described the body as made up of four humors—yellow bile, phlegm, black bile, and blood—and controlled by the four elements—fire, water, earth, and air. The body could be purged of excess by bleeding, cupping, and leeching—medical practices that continued throughout the Middle Ages.


By the twelfth century, there were medical schools throughout Europe. The most famous was the school of Salerno in southern Italy, reputedly founded by a Christian, an Arab, and a Jew.

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In 65 A.D., Dioscorides, a Greek, wrote his Materia Medica (13.152.6). This was a practical text dealing with the medicinal use of more than 600 plants. In the second century, Galen synthesized much of what has been attributed to Hippocrates. To further his understanding of bodily functions, he performed animal and even human dissections and was able to demonstrate that the arteries carried blood rather than air. Galenic theories had great longevity, prevailing in western Europe until the sixteenth century.


The Arabs were the great translators and synthesizers of medical texts. Many Greek texts were translated first into Arabic and then into Hebrew. Consequently, Arabs and Jews were renowned for the practice of medicine, and Arabic and Jewish doctors were often employed by kings (for example, James II of Aragon [died 1327]).


One cannot overestimate the importance of medicinal plants in the Middle Ages. Although the original text of Dioscorides is lost, there are many surviving copies. His texts formed the basis of much of the herbal medicine practiced until 1500. Some plants were used for specific disorders, while others were credited with curing multiple diseases. In many cases, draughts were made up of many different herbs. No monastic garden would have been complete without medicinal plants, and it was to monasteries that the sick went to obtain such herbs. Additionally, people might have gone to the local witch or to the apothecary for healing potions.


By the twelfth century, there were medical schools throughout Europe. The most famous was the school of Salerno in southern Italy, reputedly founded by a Christian, an Arab, and a Jew. A health spa as early as the second century, Salerno was surprisingly free of clerical control, even though it was very close to the famous and very powerful monastery of Monte Cassino. The medical faculty at Salerno permitted women to study there.


The medical school at Montpellier traces its roots back to the tenth century, though the university was not founded until 1289. Count Guilhem VIII of Montpellier (1157–1202) permitted anyone who had a medical license to teach there, regardless of religion or background. By 1340, the university at Montpellier included a school of anatomy.


In 1140, Roger of Sicily forbade anyone from practicing medicine without a license, indicating that doctors were clearly under some form of regulation. In the late Middle Ages, apothecary shops opened in important towns. Interestingly, these shops also sold artists' paints and supplies, and apothecaries and artists shared a guild—the Guild of Saint Luke.


Physicians were trained in the art of diagnosis—often shown in manuscripts holding a urine flask up for inspection (54.1.2, Hours of Jeanne d'Evreux, marginal illustration, fol. 143), or feeling a pulse. In fact, in the sixth century, Cassiodorus wrote that "for a skilled physician the pulsing of the veins reveals [to his fingers] the patient's ailment just as the appearance of urine indicates it to his eyes." Observation, palpation, feeling the pulse, and urine examination would be the tools of the doctor throughout the Middle Ages.


Surgery such as amputations, cauterization, removal of cataracts, dental extractions, and even trepanning (perforating the skull to relieve pressure on the brain) were practiced. Surgeons would have relied on opiates for anesthesia and doused wounds with wine as a form of antiseptic.


Many people would have sought out the local healer for care, or might have gone to the barber to be bled or even leeched. Midwives took care of childbirth (21.168) and childhood ailments. For the sick and dying, there were hospitals. Although many large monasteries did have hospitals attached to them—for example, Saint Bartholemew's in London and the Hotel Dieu in Paris—and all would have had at least a small infirmary where sick and dying monks could be cared for, it is unclear just how much time the monks dedicated to care of the sick. The medicus in a monastery would have devoted himself to prayer, the laying on of hands, exorcizing of demons, and of course the dispensing of herbal medicine. The hospital of Santa Maria della Scala in Siena was initially administered by the canons of the cathedral (23.166; 16.154.5). It was renowned for its efficient administration and, supported by wealthy patrons, was richly endowed with works of art (1975.1.2488; 32.100.95). Many communities had hospitals to care for the sick that were independent of monasteries.


Some of the most notorious illnesses of the Middle Ages were the plague (the Black Death), leprosy, and Saint Anthony's fire. From 1346, the plague ravaged Europe, and rich and poor alike succumbed with terrifying speed (69.86). Pneumonic plague attacked the lungs and bubonic plague produced the characteristic buboes; there was no cure for either form. The only hope for those who escaped the dread disease was prayer or pilgrimage. While leprosy (54.1.2, Hours of Jeanne d'Evreux, Louis Feeding the Lepers, fol. 123v) was very disfiguring and therefore sufferers were feared and kept apart, in fact, leprosy has a very slow incubation period and may not have been as contagious as it was believed. Lepers were obliged to live outside a town or village and to carry a bell to warn people of their approach. Many medieval parish churches in England have leper "squints" that allowed a leper to see the Mass and even receive the sacrament without coming into contact with other parishioners.


Sufferers from St. Anthony's fire were afflicted with burning extremities. As the disease, caused by the ingestion of tainted rye, progressed, the bright red extremities—hands, feet. and whole limbs—could become gangrenous and fall off. There were many Antonine hospitals to which patients flocked (1990.283a,b). These hospitals, dedicated to Saint Anthony Abbot (1988.159), gave patients a mixture called Saint Vinage. and cooling herbs such as verbena and sage were applied to soothe the burning heat. Amputations of the affected limbs were also performed.


Many people died of much less dramatic diseases. Women often died in childbirth or succumbed to postpartum infections. Children frequently did not live into adulthood. Laborers must have had multiple problems, such as accidents, osteoarthritis, and fractures. Kidney disease, dental problems, hemorrhoids, and heart disease would have been common. Battle-related injuries were frequent and often fatal.


The most important exemplar for any healer was Jesus himself. The Gospels recount that Jesus healed the blind, caused the paralyzed to walk, cast out devils from the possessed, healed a woman with an issue of blood, and even raised the dead. The healing touch was appropriated by English and French kings, and many miraculous cures were attributed to the royal laying-on of hands. In England, for example, the King's Touch was believed to heal scrofula, a form of tuberculosis. Prayers to Christ, the Virgin, and saints were always considered the most efficacious form of help. Saint Margaret was invoked for help in childbirth (47.101.65); Saint Fiacre (25.120.227; 17.190.353) for relief from hemorrhoids. Pilgrimage to a shrine might also lead to miraculous healing. Often these sites and the relics they displayed were related to specific diseases and to specific saints.


Objects associated with the shrine of Saint Thomas Becket attest to the importance of Canterbury as a pilgrimage site where many sick people received miraculous cures. Becket was described as "the best physician of virtuous sick people" and the thirteenth-century windows at Canterbury provide a vivid record of miraculous cures of blindness, leprosy, drowning, madness, and the plague. At Canterbury, the saint's blood was believed to be particularly beneficial—ampullae containing blood mixed with water were distributed at the shrine (2001.310). Canterbury seems to have been a particularly important pilgrimage destination for people suffering from bleeding disorders—perhaps because of the blood shed by Thomas at his martyrdom (17.190.520).


Pilgrims arriving at their destination would be able to touch the relics and even carry home with them secondary relics—perhaps a piece of cloth that had been applied to a reliquary, or an ampulla of liquid that had been poured over a tomb (17.194.2291). These secondary relics could then be used to heal those who were too ill to make the journey. Ultimately, the power of faith was potent medicine for the sick in the Middle Ages.

Sigrid Goldiner
Department of Medieval Art and The Cloisters, The Metropolitan Museum of Art
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