The two greatest misconceptions about medicine arise primarily from our modern attempts at interpreting the medical system of the Middle Ages. The first misconception is to see medicine in the Middle Ages as an unsophisticated system. Early scholars of medieval medicine found medieval doctors’ theories ridiculous when compared to modern ones. Charles Singer, for example, found medieval medicine demonstrative of “the wilting mind of the Dark Ages.” <1> Singer also believed that medieval medicine, specifically the Anglo-Saxon herbals, “lacked any rational element which might mark the beginnings of scientific advance.”<2> But recently, historians like M.L. Cameron in Anglo-Saxon Medicine and John Riddle in Contraception and Abortion from the Ancient World to the Renaissance attempt to validate medieval medicine in light of modern medicine. By analyzing common herbals, both Cameron and Riddle have found a few recipes that have therapeutic merit.
While Cameron and Riddle are both correct in seeing some validity in medieval medicine, they also commit the other misconception of interpreting the medicine of the Middle Ages: they approach medieval medicine from a positivistic framework. In other words, they attempt to see medieval medicine as a precursor or primitive form of twentieth-century medicine. In order to do this effectively, critics construct a narrative by which the discoveries of the future are foreseen in the documentation of the past. This constructed narrative feeds a type of superficial comparitivism, to borrow Peregrine Horden’s term, in which modern people attempt to see their reflection in the writings of the authors of the Middle Ages.<3> While this method has significant benefits for creating interest in the Middle Ages and even pedagogical worth for undergraduate students attempting to grapple with an alien time period and culture, it does little for the scholar who is attempting to understand the complex medical and social structures of the Middle Ages. However, rather than approach the medieval medical community from a positivistic framework in which the medieval doctor is a primitive reflection of our modern doctor, some historians have adopted a social constructionist viewpoint in which they attempt to evaluate the medieval medical community as part of a larger social system. <4>
Medieval medicine is neither a precursor to our modern medicine, nor a simplistic, primitive system. Rather it is an extremely learned theory that makes sense when one considers the information doctors of the period had to rely on. To do medieval medicine justice, it is necessary to reconstruct the development of this system in relation to health and illness. One must first realize that there are few similarities between medieval and modern medicine, especially in regard to the framework through which each approaches illness. I will limit this discussion to academic medicine, as opposed to folklore medicine, because the records of academic medicine are more accessible through the publications of and translations by numerous medieval doctors and surgeons, whereas folklore medicine tends to be transmitted orally.
During the medieval period, the body reflected one’s state of health, and medieval doctors relied on the body as text. Today, the body as text is rarely used as the sole witness to the health of an individual. Instead, health is evaluated by medical tests.<5> There is an obvious benefit to this: in most cases, when the body does act as a text, the disease has often progressed very far, making it more difficult to cure. However, medieval doctors had little concept of germs as the medium of disease and the cause of illness. Thus, they approached illness through a markedly different framework than do modern doctors. While the body was known to degenerate with age, medieval doctors believed that a healthy body required a state of harmony or balance. An unhealthy body represented an imbalance, usually identified through a change or sign on the outside of the body, either on the skin or from an excreted fluid, such as urine. Thus the body becomes the symbolic text which a doctor needed to interpret in order first to diagnosis and then to cure. In many ways, we can see a parallel in the interpretation of a blood test wherein a modern doctor receives a series of numbers and from them produces a diagnosis and treatment for an identified illness. For medieval doctors, the body, not the test, was the sign that needed interpretation.
Lacking any concept of viruses or bacteria as causes of illness, medieval doctors were left to reason that certain behaviors led to illness. There were three types of possible illnesses: those caused by the body’s natural degeneration, those to which the body was predisposed, and those caused by immoderate living. We have a similar system in that we believe that people who smoke, eat red meat, or sunbathe are more prone to cancer and heart disease. We connect these diseases to either a predisposition, such as a hereditary line for breast cancer or heart disease, or to immoderate lifestyle, such as actions that lead to lung disease or liver cancer. While both medieval and modern medicine have a similar emphasis on the lifestyle causes of illness, medieval medicine’s difference lies in its idea that certain sins could cause certain illnesses. This relation between particular sins and illnesses develops from authoritative Greco-Roman medicine and is influenced and modified by Christian thought.
These medieval notions of disease and morality are not simply metaphors; instead, they were considered literal truths. But only by understanding the authoritative medical tradition through which doctors learned that immorality caused illness can we begin to see the social construction of disease in a variety of discourses. If, for example, one believes that a certain form of moral transgression causes illness, then the only way to alleviate illness is to correct moral failings. In this sense, literature plays an essential role in the health of the community: literature helps to inform people about the consequences of immorality in the hope that people will relinquish sin and thereby help to abate epidemic diseases which threaten to destroy society. Consequently, we find a significant amount of moral literature during the time of the Bubonic Plague, a disease thought to be caused by the communal sin of pride.
The connection between morality and illness is not a medieval creation, but part of the heritage of Greco-Roman medicine. Galen unified two competing theories, the Empiricists and the Dogmatists into one philosophy which became the foundation of medieval medicine. The Empiricists believed in experience as the greatest teacher of medical learning.<6> The Dogmatists, on the other hand, “granted logical arguments a place in medical thought.”<7> This latter sect believed that all medical knowledge could be gained not through clinical experience, but through authoritative medical writers. The Dogmatists relied on a learned tradition and propounded a notion of a microcosm and macrocosm. <8> The microcosm consisted of the four bodily humours: blood, phlegm, black bile, and yellow bile. Each of the four humours reflected the elements of the macrocosm: air, water, earth, and fire, respectively. The humours also had temperature and moisture properties. Blood was hot and wet, phlegm was cold and wet, black bile was cold and dry, and yellow bile was hot and dry. According to this theory, when a person became sick, one of the four humours was out of balance. To balance the humours, one needed to take a prescription, usually made from some combination of plants or animals. Doctors categorized all plants and animals by their temperature and moisture. Thus, if a patient’s illness was caused by an imbalance of phlegm, which is cold and wet, he or she needed to counteract that humour with its opposite, yellow bile. Therefore, he or she would need to take a prescription made from plants and animals that were hot and dry. According to this system, humans are inherently connected to the natural elements because these elements, not germs, influence health.
Galen believed that authoritative learning was important but must not be accepted blindly; “rather, [medical authorities] are authorities in as far as they are proved right” through clinical experience. <9> Essentially, Galen saw medicine as a cumulative process in which one studied medical authorities and appended or altered the authoritative corpus through clinical experience. Consequently, the humoural system became the lens through which doctors until the nineteenth-century viewed disease.
Galen’s emphasis on immoderation as a cause of illness appealed especially to early Christians. Oswei Temkin notes, “By A.D. 350 [Galen’s] acceptance as the leading authority was clearly established, and from about that time his position was secured in Alexandria, once more the center of medical learning.”<10> Greco-Roman medicine’s emphasis that illness was a consequence of immoderation fit nicely into a Christian framework. Consequently, Greco-Roman medicine was not rejected by Christian thinkers but was Christianized. In the Old and New Testaments, disease is often a punishment for individuals who transgress God’s law; consequently, Christ becomes the physician who can cure both spiritual and physical diseases.<11> While Christ was thought to be the perfect physician, his followers also gain acclaim as healers and curers. David Lyle Jeffrey recognizes, “The apostle Luke, one of the four evangelists and author also of the Acts of the Apostles, is referred to by Paul as ‘the beloved physician’ (Col. 4:14)”. <12> The image of Christ as the perfect doctor finds a permanent place in Christian thought with the writings of Saint Ambrose (339-97 A.D.) Saint Augustine (354-430 A.D.), and Boethuis (480-524 A.D.).
A third misconception about medieval medicine concerns ascribing the belief to medieval people that all illness was connected to moral failings. In fact, some illnesses were believed to occur naturally or as a result of old age. The cautions that Darrel W. Amundsen makes concerning modern interpretations of medieval beliefs is worthwhile to quote at length:
Another commonplace encountered in modern assessments of the early Middle Ages is the assertion that early medieval people saw sin as the cause of most sickness. Here there is room for much confusion because the relationship of sin with sickness can appear at three different levels. First, sin was certainly regarded by early medieval authors as the cause of sickness in the sense that without sin there would have been no material evil. This, although not expressed, was an underlying assumption of the sources. Second, one’s own general sinfulness was often given as the cause of one’s own sickness. Third, sickness, it was thought, might result from a specific sin. This last statement is very seldom encountered except in denunciations of and warnings to entire communities, and then the emphasis was often on general moral laxity, which makes it nearly indistinguishable from the second category. We should also note that it is one thing to maintain that a person is sick as a punishment for a specific sin to which he or she is obstinately and tenaciously clinging, but it is quite another matter to attribute one’s own sickness to one’s general sinfulness and see the sickness as part of God’s punitive and refining process. <13>
While dysentery or gum disease certainly would have unclear moral connections, leprosy and bubonic plague are two diseases which clearly fit Amundsen’s categories. Amundsen rightly recognizes this when he writes, “Sin was commonly regarded as the immediate cause of plague, or at least the catalyst behind God’s sending the plague. This was collective sin. Individual sin was seldom seen as the cause of sickness, whether mental illness or physical ailments. One notable exception was leprosy, which was associated with a variety of sins, but especially with lust and pride.” <14>
While Amundsen correctly identifies that leprosy and bubonic plague were associated with individual and collective sins respectively, a detailed study of the variety of sins associated with leprosy demonstrates that leprosy was not connected with lust as much as it was connected to a variety of sins, including envy, wrath, and simony.
In many ways, we still retain some of the medieval connection between illness and morality, a connection that influences literature as well as society. The clearest literary example of both the influence of medicine on literature and the connection between morality and illness appears in our own adjectives: sanguine, choleric, phlegmatic, and melancholy. At one time, these adjectives referred both to the emotional and moral state of the individual as well as to his or her physical constitution. More importantly, these adjectives are used throughout the literature of the Middle Ages, but few critics have examined them in a literal way. For example, in the Middle English lyric, “Thirty Dayes Hath November,” the author sums up the moral and physical associations:
Sluggy and slowe, in spetinge muiche,
Cold and moist, my natur is suche;
Dull of wit, and fat, of contenaunce strange,
Fleumatike, this complecion may not change.
Deliberal I am, loving and gladde,
Laghinge and playing, full seld I am sad;
Singing, full fair of colour, bold to fight,
Hote and moist, beninge, sanguine I hight.
I am sad and soleynge with heviness in thoght;
I covet right muiche, leve will I noght;
Fraudulent and suttill, full cold and dry,
Yollowe of colour, colorike am I.
Envius, dissevabill, my skin is roghe;
Outrage in exspence, hardy inoghe,
Suttill and sklender, hote and dry,
Of colour pale, my nam is malencoly. <15>
Each one of these ailments corresponds to an emotional state–an emotional state that could lend itself to sin. The assumptions which underlie this poem are that the phlegmatic is prone to the sin of idleness, the sanguine is prone to the sins of lust and overindulgence, the choleric is prone to the sins of covetousness, and the melancholic is prone to the sins of deceit and envy. When a medieval author used these adjectives to describe literary characters, the medieval reader would have easily connected the adjective to its equivalent sin. Not only were humours connected to sins, but so were certain diseases, such as leprosy and Bubonic Plague. Around each of these diseases lies a complex discourse which infuses the medical, theological, and literary disciplines, a discourse which we misconceive at our own peril.
<1> Charles Singer, A Short History of Medicine (New York: Oxford UP,1962), p. 31.
<2> M.L. Cameron, Anglo-Saxon Medicine (Cambridge: Cambridge UP, 1993), p. 3.
<3> Peregrine Horden, “Disease, dragons, and saints: the management of epidemics in the Dark Ages,” Epidemics and Ideas: Essays on the Historical Perception of Pesitlence, Ed. Terrence Ranger and Paul Slack (Cambridge: Cambridge UP, 1992), pp. 45-76. < return>
<4> See Deborah Lupton, Medicine as Culture: Illness, Disease, and the Body in Western Societies (London: Sage, 1994) pp. 11-13.
< 5> Lupton, 98. See also Herzlich and Pierret, Illness and Self in Society (Baltimore: Johns Hopkins UP, 1987) pp. 76-82.
<6> Oswei Temkin, Galenism: Rise and Decline of a Medical Philosophy (Ithaca: Cornell UP, 1973) p. 15 and David C. Lindberg, The Beginnings of Western Science (Chicago: Chicago UP, 1992), p. 188.
<7> Temkin, p. 19.
<8> Temkin, p. 19.
<9> Temkin, p. 32.
<11> David Lyle Jeffrey, ed., The Dictionary of Biblical Tradition in English Literature (Michigan: Wm. B. Eerdnabs Publishing, 1992) p. 614.
<12> 614. See also Darrel W. Amundsen, Medicine, Society, and Faith in the Ancient and Medieval Worlds (London: John Hopkins UP, 1996), pp. 133-4.
<13> Amundsen, pp. 187-8.
<15> Maxwell Luria and Richard L. Hoffman, eds. Middle English Lyrics. (New York: W.W. Norton, 1974) p. 112. < return>
SUGGESTIONS FOR FURTHER READING
Clendening, Logan, ed. Source Book of Medical History. New York: Dover, 1942.
Dawson, W.R. A Leechbook or Collection of Medical Recipes of the Fifteenth Century. London: Macmillan, 1934.
Galen. Galen: on Respiration and the Arteries. David J. Furley and J.S. Wilkie, ed. Princeton UP, 1984.
—. Galen: on the Parts of Medicine, Cohesive Causes, Regimen in Acute Disease in Accordance with the Theories of Hippocrates. Trans. Malcolm Lyons. Berlin: Akademie-Verlag, 1969.
Getz, Marie Faye, ed. Healing & Society in Medieval England: A Middle English Translation of the Pharmaceutical Writings of Gilbertus Anglicus. Madison: University of Wisconsin, 1991.
Grant, Edward, ed. A Source Book in Medieval Science. Cambridge: Harvard UP, 1974.
Guy De Chauliac. The Middle English Translation of Guy De Chauliac’s Anatomy. Ed. Bjorn Wallner. Lund: Lund University, 1964.
—. The Cyrurgie of Guy de Chauliac. Ed. Margaret S. Ogden. London: Early English Text Society, 1971.
Horrox, Rosemary, trans. and ed. The Black Death. Manchester: Manchester UP, 1994.
Hunt, Tony. The Medieval Surgery. Woodbridge: Boydell, 1992.
—. Popular Medicine in Thirteenth-Century England. Cambridge: D.S. Brewer, 1990.
John Arderne. Treatises of Fistula in Ano. Ed. D. Power. London: Early English Text Society, 1910.
Kibre, Pearl, ed. Hippocrates Latinus: Repertorium of Hippocratic Writings in the Latin Middle Ages. New York: Fordham UP, 1985.
Luisa Cogliati Arano. Tacuinum Sanitatis: The Medieval Health Handbook. Trans. Oscar Ratti and Adele Westbrook. New York: George Braziller, Inc., 1976.
Ogden, Margaret Sinclari, ed. The ‘Liber de Diversis Medicinis.’ London: Early English Text Society, 1938.
Paracelsus Aureolus Theophrastus Bombastus von Hohenheim. Paracelsus: Selected Writings. Ed. Jolande Jacobi. Princeton: Princeton UP, 1979.
Rawcliffe, Carole, ed. Source for the History of Medicine in Late Medieval England. Kalamazoo: Medieval Institute Publications, 1995.
The School of Salernum: Regimen Sanitatis Salerni. Ed. Sir John Harington. Rome: Edizioni Saturnia, 1959.
Soranus of Ephesus. Soranus’ Gynecology. Trans. Oswei Temkin. Baltimore: Johns Hopkins UP, 1956.
History of Medicine
Amundsen, Darrel W. Medicine, Society, and Faith in the Ancient and Medieval Worlds. London: John Hopkins UP, 1996.
Cameron, M.L. Anglo-Saxon Medicine. Cambridge: Cambridge UP, 1993.
Garcia-Ballester, Roger French, Jon Arrizabalaga, and Andrew Cunningham, eds. Practical Medicine from Salerno to the Black Death. Cambridge: Cambridge UP, 1994.
Lindberg, David C. The Beginnings of Western Science. Chicago: Chicago UP, 1992.
McVaugh, Micheal R. Medicine before the Plague: Practitioners and Their Patients in the Crown of Aragon 1285-1345. Cambridge: Cambridge UP, 1993.
Miller, Timothy. The Birth of the Hospital in the Byzantine Empire. Baltimore: Johns
Hopkins UP, 1997.
Park, Katherine. Doctors and Medicine in Early Renaissance Florence. Princeton: Princeton UP, 1985.
Rawcliffe, Carole. Medicine & Society in Later Medieval England. Phoenix Mill: Allan Sutton, 1997.
Siraisi, Nancy G. Medieval & Early Renaissance Medicine. Chicago: Chicago UP, 1990.
Talbot, Charles H. Medicine in Medieval England. London: Oldbourne, 1967.
Temkin, Oswei. Galenism: Rise and Decline of a Medical Philosophy. Ithaca: Cornell UP, 1973.
—. Hippocrates in a World of Pagans and Christians. London: Johns Hopkins UP, 1991.
“A Thirteenth Century Clinical Description on Leprosy.” Ed. and trans. Charles Singer. Journal of the History of Medicine 4 (1948): 237-239.
Brody, Saul. The Disease of the Soul: Leprosy in Medieval Literature. Ithaca: Cornell UP, 1974.
Richards, Peter. The Medieval Leper. New York: Barnes & Noble, 1977.
Bullein, William. A Dialogue against the Feuer Pestilence. Ed. Mark W. Bullen and A.H. Auden. London: Early English Text Society, 1888.
Campbell, Ann Margaret. The Black Death and the Men of Learning. New York: Columbia UP, 1931.
Carmichael, Ann. Plague and the Poor in Renaissance Florence. Cambridge: Cambridge UP, 1986.
Dols, Michael W. The Black Death in the Middle East. Princeton: Princeton UP, 1977.
Gottfried, Robert S. The Black Death: Natural and Human Disaster in Medieval Europe. New York: Macmillan, 1983.
Platt, Colin. King Death: The Black Death and its aftermath in late-medieval England. Toronto: University of Toronto, 1997.
Zinsser, Hans. Rats, Lice and History: A Chronicle of Pestilence and Plagues. New York: Black Dog, 1935.
Syphilis and Other Diseases
Arrizabalaga, Jon, John Henderson, and Roger French. The Great Pox: The French Disease in Renaissance Europe. New Haven: Yale UP, 1997.
Bloch, Marc. The Royal Touch: Monarchy and Miracles in France and England. Trans. J. E. Anderson. New York: Dorset, 1961.
Cambell, Sheila, Bert Hall and David Klausner, eds. Health, Disease, and Healing in Medieval Culture. New York: St. Martin’s, 1992.
Grmek, Mirko D. Diseases in the Ancient Greek World. Trans. Mireille Muellner and Leonard Muellner. Baltimore: Johns Hopkins UP, 1989.
Quetel, Claude. History of Syphilis. Trans. Judith Braddock and Brian Pike. Baltimore: Johns Hopkins UP, 1990.
Watts, Sheldon. Epidemics and History: Disease, Power, and Imperialism. New Haven: Yale UP, 1997.
Doctors and Surgeons
Beck, Theodore R. The Cutting Edge: Early History of the Surgeons of London. London: Lund Humphries, 1974.
Bullough, Vern L. The Development of Medicine as a Profession. New York: Hafner, 1966.
Kealey, Edward J. Medieval Medicus: A Social History of Anglo-Norman Medicine. Baltimore: Johns Hopkins UP, 1981.
Pouchelle, Marie-Christine. The Body & Surgery in the Middle Ages. Trans. Rosemary Morris. New Brunswick: Rutgers UP, 1990.
Sexuality and Medicine
Cadden, Joan. Meanings of Sex Difference in the Middle Ages: Medicine, Science, and Culture. Cambridge: Cambridge UP, 1993.
Jacquart, Danielle and Claude Thomasset. Sexuality and Medicine in the Middle Ages. Trans. Matthew Adamson. Princeton: Princeton UP, 1988.
Riddle, John M. Contraception and Abortion from the Ancient World to the Renaissance. Cambridge, Harvard UP, 1992.