Life in a Medieval City (14 page)

On quitting the sick chamber, the doctor may assure the patient that recovery will soon come with God’s help; but with the family, he cannily adopts a graver tone, implying that he did not wish to alarm the sufferer, but that it is a lucky thing that science was called in. He may leave a prescription of herbs and drugs, and recommend diet—perhaps chicken broth, the milk of pulverized almonds, or barley water mixed with figs, honey, and licorice.

Often the doctor is invited to dine with the family. He accepts, without seeming too eager. During the course of the meal he may entertain the table with accounts of illnesses and wounds he has cured, but he makes sure to send a servant two or three times to ask the patient how he fares, thus reassuring him that he has not been forgotten.

If the thirteenth-century doctor’s science is questionable by the standards of a later age, it is nevertheless an advance over the past. In the earlier Middle Ages abbeys and monasteries were the repositories of medical knowledge. The principal effect of their regime was to repeal Hippocrates’ law that illness is a natural phenomenon and to make it appear to be a punishment from on high. This view is not dead in the thirteenth century, and even doctors pay it lip service, but the secular practitioner represents a distinct move toward the rational understanding of illness.

He also represents a move toward commercialization. The same medical text that tells him how to treat a patient gives precise instructions on bill collecting: “When the patient is nearly well, address the head of the family, or the sick man’s nearest relative, thus: God Almighty having deigned by our aid to restore him whom you asked us to visit, we pray that He will maintain his health, and that you will now give us an honorable dismissal. Should any other member of your family desire our aid, we should, in grateful remembrance of our former dealings with you, leave all else and hurry to serve him.” This formula, devised at the world’s first and most famous medical school, that of Salerno, is hard to improve on. The fees which doctors charge are scaled to the patient’s wealth and status. A rich man’s illness may be valued at ten livres or more; kings have been charged a hundred. Setting a broken or dislocated limb is a matter of several sous or even a livre. Popular spite attributes a proverb to the medical profession: “Take while the patient is in pain.”

A second text offers more hints for the general practitioner. “When you go to a patient, always try to do something new every day, lest they say you are good at nothing but books.” And even more cogently: “If you unfortunately visit a patient and find him dead, and they ask you why you came, say you knew he would die that night, but want to know at what hour he died.”

Apothecary at work
, crushing herbs in a mortar (from Chartres

One acerbic writer asserts that the wily physician tells one person that the patient will recover, another that he will succumb, thus assuring his reputation in at least one quarter. “If the patient has the good fortune to survive,” he concludes, “he does so in spite of the bungling doctor, but if he is fated to perish, he is killed with full rites.”

Skeptical barbs notwithstanding, the profession attracts many of the ablest young men of the age. Besides Salerno, there is an almost equally respected school at Montpellier, where Arab and Jewish scholars from Spain mix with Provençals, Frenchmen, Italians, and others. Paris and Montpellier have the only two medical schools in northwest Europe, though there are now several in Italy. After a preliminary three-year course, the prospective physician takes a five-year course, followed by a year’s internship with an experienced practitioner. He is then allowed to take a formal examination, upon successfully completing which he receives from the faculty a license to practice. Since the universities are highly ecclesiastical in makeup, the license is given in the name of the Pope, and is conferred by the bishop in a ceremony in church.

But the Church’s control is nominal. The real shortcoming in medical education is its subservience not to the saints but to astrology and numerology. Constellations and planets are believed to preside over different parts of the body. Numerology provides complicated guides for the course of an illness. The body is believed to have four “humors” and three “spirits,” all of which must be checked by examination of the urine and stool and by feeling the pulse, then adjusted by bloodletting, from the side of the body opposite the site of the disease.

All these ideas are derived from the Greeks, and they go to make up an anatomy and physiology as simple and logical as an arithmetic problem.

Medical textbooks
²
are few and precious. Most of the Greek writings have arrived in the West by a circuitous route, first translated into Arabic, then from Arabic into Latin. The translators who undertake the latter task are often teams of Jewish and Christian scribes working in Spain; the Jewish scholars render the Arabic roughly into Latin, and the Christians polish this version into scholarly language. How many errata and variations creep into a Greek work on its journey to Montpellier and Paris may be imagined.

Their knowledge of Arabic has placed Jewish physicians in the forefront of medicine, and their services are frequently called for by princes and great lords. One of their principal specialties is diseases of the eye. Even a rigorous enforcer of restrictions on Jews like Alphonse de Poitiers, brother of St.-Louis, will consult a Jewish specialist about an eye malady. Like the Arab physicians, Jewish doctors are moving toward a fully rational therapy, yet all medicine—Christian, Arab, and Jewish—is still bound up with astrology, numerology, and magic.

With these aids and his own common sense, the medieval doctor battles valiantly against a variety of ailments. Skin diseases are very widespread in an age when rough wool is often worn next to the skin; when bathing, at least among the masses, is infrequent; and laundry hard to do. Defects of diet—the scarcity of fresh fruit and vegetables—create a dangerous scorbutic tendency in the whole population, and, in the cities especially, insufficient sanitary arrangements facilitate the spread of infection and contagion. In winter dwellings are cold and drafty. Pneumonia is a great killer. Typhoid is common, as are many types of heart and circulatory disease.

But the most frequent demand for medical aid is for treatment of wounds and injuries. Here the medieval surgeon achieves his best success, even showing some understanding of the problem of infection. He applies such medicaments as sterile white of egg to piercing and cutting wounds. A contemporary Italian, Friar Theodoric of Lucca, son of a Crusading surgeon, recommends wine, which of course contains alcohol, and cautions against the complicated salves and nostrums in fashion with some doctors. Surgical instruments include scissors, speculum, razor, scalpel, needle and lancet.

A variety of surgical operations are performed for such disorders as cataracts and hernias; lithotomy (removal of stones from the kidney or gall bladder) and trepanning are also practiced. None of these operations promises well for the subject.

Occasionally the agony of the surgical patient may be relieved by some form of narcosis. Theodoric of Lucca speaks of sponges drenched with opium, and mandrake, dried, then soaked in hot water and inhaled. Bartholomew Anglicus expatiates on the value of mandrake as an anesthetic: “Those who take a portion of it will sleep for four hours and feel neither iron nor fire.” However, he adds: “A good leech [physician] does not desist from cutting or burning because of the weeping of the patient.”

Bloodletting, that long-popular health measure, is commonly done by barbers, some of whom have recently abandoned the shave and haircut to devote themselves exclusively to surgery. Many also specialize in pulling teeth. Owing to poor diet, teeth are a chronic health problem, more because of bad gums than cavities. Wealthy patients have been known to pay as much as five livres for an extraction, while barbers get as much as fifteen sous for a bleeding. The lower classes are spared these luxuries.

Mental illness is widespread. Birth injuries often leave brain damage. Collective mental disorders, such as St. Vitus’ Dance, are notorious, though the most famous outbreak of this “dancing mania” will not appear until the fourteenth century. Joining hands, the victims dance in wild delirium until they fall exhausted, foaming at the mouth. This communal fit is treated either by swaddling the victims like babies, to prevent them from injuring themselves and others, or by exorcism.

The mentally ill are rarely confined, though they are sometimes tied to the rood screen in church, so that they may be improved by attending mass. Or the sign of the cross is shaved into the hair of their heads. They are invariably numbered among the armies of pilgrims at the shrines—along with the spastics, the paralytics, the scrofulous, and the very numerous cripples—at Rome, Mont-Saint-Michel, Roc Amadour, Compostella, and on the road to Jerusalem.

In this pathetic troop one never sees the most pitiful of all the medieval sick—the victims of leprosy. This very widespread disease, attended by its frightful disfigurement, has inspired terror in the clergy as well as the laity.

There are two thousand leper colonies in France, including several in the neighborhood of Troyes. A famous one, the Leproserie des Deux Eaux, was founded in the eleventh century by Count Hugo on the eve of his departure for the First Crusade. Before the leper is committed to the enclosure, his isolation is sanctified by a special church ritual. The unfortunate victim is brought to the tribunal of the diocesan official and examined by surgeons. The “separation” is pronounced the following Sunday. The unhappy man, dressed in a shroud, is carried to the church on a litter by four priests singing the psalm, “Libera me.” Inside the church the litter is set down at a safe distance from the congregation. The service of the dead is read. Then, again singing the psalm, the clergy carry the leper out of the church, through the streets, out of town, to the leper colony. He is given a pair of castanets, a pair of gloves, and a bread basket. After the singing of the “De profundis” the priest intones, “Sis mortuus mundo, vivens iterum Deo” (Be thou dead to this world, living again to God), concluding, “I forbid you ever to enter a church or a monastery, a mill, a bakery, a market, or any place where there is an assemblage of people. I forbid you to quit your house without your leper’s costume and castanets. I forbid you to bathe yourself or your possessions in stream or fountain or spring. I forbid you to have commerce with any woman except her whom you have married in the Holy Church. I forbid you if anyone speaks to you on the road to answer till you have placed yourself below the wind.” Then everyone leaves the poor victim condemned to a living death.

The disease is believed to be transmitted not only by touch but by breath. With all the care taken to isolate lepers, from time to time rumors lead to panic and lynching.

Cruel though medieval treatment of leprosy is, it represents a step forward in the history of medicine: recognition of the problem of contagion. Ironically, leprosy (Hansen’s disease) is only slightly contagious, and the frightening disfigurement results not from the disease itself but from loss of sensation in nerve endings and consequent wearing away of tissue. But medieval medicine accurately guesses that diseases are transmitted by contact or through the air.

A still more important contribution of medieval medicine is the hospital, a wholly new idea. Hospitals, like monasteries and abbeys, are favorite recipients of Christian charity. The Hôtel-Dieu-le-Comte in Troyes was founded by Count Henry the Generous some seventy-five years ago, and has continued to profit by gifts not only from the count’s successors but from others as well. One lady bequeathed the revenue of seven chambers of a house facing the public baths. Another gave a carpenter and his family, who were her serfs. A burgher gave a stall in Moneychanger’s Place at the fair. Another gave a fisherman, his family and all his possessions, and his fishing rights in the Seine. Still another endowed the hospital with three garments, worth thirteen sous apiece, and six pairs of shoes a year. A vintner gave income from his vineyards to buy earthenware bowls and cups for the sick and wine to celebrate mass. Other rents, revenues, fees, and taxes from fairs, mills, vineyards, bakeries, farms, and fisheries have poured in.

Counts and popes have accorded this hospital, like many others, their blessing and protection. Eight priests, of whom one is prior and master of the house, staff the hospital, assisted by as many nuns as are needed. When a patient is admitted, he confesses and takes communion, his feet and body are washed, and he is given hospital clothes and food. If his disease is considered contagious, he is isolated—an advance in medicine in itself. The critically ill are also isolated, for intensive care. Upon recovery, indigent patients are furnished with clothes. The hospital does not receive women in childbirth, because their cries may disturb other patients; nor does it take foundlings, the blind, the crippled, and victims of plague (or leprosy), who would swamp the hospital. Responsibility for the care of these unfortunates falls on the parish churches.