Medicine in the English Middle Ages

Medicine in the English Middle Ages

Medicine

in the English

Middle Ages

Faye Getz

princeton university press princeton, new jersey

Copyright © 1998 by Princeton University Press

Published by Princeton University Press, 41 William Street,

Princeton, New Jersey 08540

In the United Kingdom: Princeton University Press,

Chichester, West Sussex

All Rights Reserved

Library of Congress Cataloging-in-Publication Data

Getz, Faye Marie, 1952–

Medicine in the English Middle Ages / Faye Getz.

p. cm.

Includes bibliographical references and index.

ISBN 1-4008-0270-9

1. Medicine, Medieval—England—History. 2. Medicine—

England—History. I. Title.

R487.G47 1998

160′.942′0902—dc21 98-3534

This book has been composed in New Baskerville

http://pup.princeton.edu

For Hal

When a man has sinned against his Maker

Let him put himself in the doctor’s hands.

(Ecclesiasticus 38:15)

Contents

Preface

Acknowledgments

Chapter I.The Variety of Medical Practitioners in Medieval England

Chapter II.Medical Travelers to England and the English Medical Practitioner Abroad

Chapter III.The Medieval English Medical Text

Chapter IV.The Institutional and Legal Faces of English Medicine

Chapter V.Well-Being without Doctors: Medicine, Faith, and Economy among the Rich and Poor

Notes

Bibliography

Name Index

Subject Index

Preface

The triumph of modern scientific medicine in contemporary Western culture has been so complete we often forget that, before science, the person wishing to preserve or regain good health was presented with many alternatives, none of which was entirely satisfactory from a modern point of view. The ways of our early ancestors may seem foolish to us: herbalism, philosophical advice, magic, or so-called folk remedies—all of which seem to be based on luck, superstition, or error. But no person living in a prescientific culture could be expected to count scientific medicine among his or her many healing choices. If we find the medieval medical patron’s obsession with uroscopy or astrology, for instance, to be bizarre or amusing, and wonder why anyone took such methods seriously, then we must also remember that these methods were, like the medical patron, firmly rooted in a particular time and place. In this context, astrological medicine is best understood not as irrational and erroneous but rather as a complexsystem of explanations, many of which could be justified empirically or historically, based on a particular society’s beliefs about the functioning of the natural world.

Claude Lévi-Strauss, in his Structural Anthropology, studied the role of the shaman, or traditional healer, among the Kwakiutl Indians of the Vancouver region.¹ He postulated what he called the shamanistic complex to explain the remarkable success of the shaman among his or her people. This complex consisted of the healer, the afflicted, and what he called the social consensus. The belief of the healer’s audience (which included the afflicted) in the success of the healing practice was more important than any other factor in determining the secure place of a particular shaman in his or her culture. Whether a particular practice really worked, then, was much less important than the audience’s belief that it had. A healer, Lévi-Strauss concluded, did not become a great shaman because he cured his patients; he cured his patients because he had become a great shaman.²

The work of Lévi-Strauss and others confronts one of the most troubling aspects of the history of medicine in prescientific culture: why did people adhere to practices that modern science finds nonsensical? The anthropologist answers that this happened because of the social consensus that such practices were effective. And the social consensus of any culture must derive from the complexities of the culture itself.

In any culture, the reputation of the healer is vital for these practices to flourish. Medicine, like poetry, required an audience to grow. Medical learning in medieval England from about 750 to about 1450 is the focus of

this book, and the central argument concerns how this learning, understood as the medicine that was written down in texts, gained an audience among English people. The struggles of learned physicians to establish a reputation for themselves and for their medicine are an important part of this argument, as are the public character of health and disease, and the struggle of the medical practitioner to develop an audience for medical learning, especially among the elite of later medieval English culture. Evidence from medical texts, university and church records, legal documents, and literary sources have proven rich resources for this study. But as valuable as these primary sources have been, the work of other historians and social scientists has been even more useful. The world of medieval English medical culture is complex, too complex for one historian to grasp. History is a collective enterprise, and the debt any of us owes to the labors of others cannot be ignored. The achievements of past scholars make me humble, and my work is built on theirs.

Cooksville, Wisconsin

Acknowledgments

Research for this publication was funded in part by NIH Grant LM005144 from the National Library of Medicine. It was also funded with the assistance of a grant for college teachers and independent scholars from the National Endowment for the Humanities. I am deeply grateful to both agencies for their faith and support.

Edward Tenner solicited the book manuscript and Lauren Osborne made invaluable suggestions along the way. Brigitta van Rheinberg guided the book to completion with uncommon skill and total professionalism. I would also like to thank Princeton’s production staff, especially Kim Mrazek Hastings, who copy edited the text superbly. Katharine Park and an anonymous reader made suggestions for improvement that were offered with both tact and wisdom. Much that is good in this book can be attributed to their time and learning. Nothing that is bad can be blamed on anyone but me.

I would also like to thank the libraries of the Wellcome Institute for the History of Medicine in London, the Institute of Historical Research, the Warburg Institute, and the Public Record Office; the British Library, the Middleton and Memorial Libraries of the University of Wisconsin-Madison, the Bodleian Library, and the library of Leiden University, The Netherlands.

Part of chapter 3 appeared in an earlier version in Roger Bacon and the Sciences, edited by Jeremiah Hackett (Leiden: E. J. Brill, 1997). Part of chapter 4 appeared in an earlier version in The History of Medical Education in Britain, edited by Vivian Nutton and Roy Porter (Amsterdam: Rodopi, 1995). Both are reproduced by permission.

Peter Murray Jones selected the illustration for this book. It would not have been possible without his unfailing friendship and professional support.

The generosity offered by members of the academic community made it possible for me to continue my work even without a job. So many have shown me collegiality throughout the years that they cannot all be named. I am especially grateful to Keith Benson, Mario Biagioli, James Bono, Allan Brandt, Joan Cadden, the late William Coleman, William Courtenay, Ralph Drayton, William Eamon, Mordechai Feingold, Eric Freeman, A. Rupert Hall, Marie Boas Hall, Caroline Hannaway, Stanley Jackson, Stuart Jenks, David Lindberg, Michael MacDonald, Michael R. McVaugh, Robert Martensen, John Neu, Nicholas Orme, Margaret Pelling, Roy Porter, Shirley Roe, Walton O. Schalick, Jane Schulenburg, Nancy Siraisi, the late Charles

Talbot, Godelieve Van Heteren, Linda Ehrsam Voigts, John Harley Warner, and Charles Webster.

I also would like to thank my friends, who never failed to take me seriously as a scholar, whether I deserved it or not: Dorothy Africa, the Beukers family, Martha Carlin, Cathy Cornish, the Kerkhoff family, David Harris Sacks, and Eleanor Sacks. I regret that my friend Gemmie Beukers, of Leiderdorp, The Netherlands, did not live to see the completion of one more scholar’s work that her hospitality made easier. Her untimely death makes the world a less civilized place, and she is mourned by all who knew her.

Finally, I am happy to thank my husband, Harold Cook. His high scholarly ideals and devotion to workplace equality have served as an example for his many students, among whom I count myself. All that is good in this book is dedicated to him.

MEDICINE IN THE ENGLISH MIDDLE AGES

Chapter I

The Variety of Medical Practitioners in Medieval England

In the summer of 1205, Hubert Walter, archbishop of Canterbury, suddenly fell ill with a deadly fever and carbuncle (anthrax) while traveling to Boxley in Kent. So severe was his illness that he was forced to divert to a nearby manor of his, Teynham. The carbuncle erupted around his waist, at the third-from-last vertebra of his back, with the inflammation extending around so as to threaten his private parts.

The archbishop, a remarkable lawyer who helped develop Henry II’s legal and financial system, had accompanied Henry’s son Richard the Lion-Hearted on a crusade to Palestine. In his illness, Hubert was attended by Master Gilbert Eagle (Gillbertus del Egle, also called Gilbertus Anglicus), a medical authority whose career was in its own way no less remarkable. Gilbert, from a prominent Essex family, may have visited the Holy Land himself. He attended Richard’s brother John, was summoned to Rome in 1214 for continuing to perform priestly duties while England was under the Interdict of Innocent III, and was the author of a massive medical and surgical text, the Compendium medicine (Compendium of medicine), one of the first works to take advantage of new Latin translations of Arabic medical and philosophical texts.

Gilbert, worried that his patron’s fever would rise, advised him to confess his sins. On doing so, the fire of the archbishop’s remorse and charity rose up and caused the moisture in his brain to dissolve, bringing forth from him a torrent of tears and great relief. After this, he was able to eat and drink a bit. Gilbert then advised him to make out his will, which he did in good order. At dawn the next day, Gilbert secretly observed the ill man and advised Hubert to receive last rites. Another physician, Henry le Afaitie, disagreed and advised him to wait. The poisonous matter that was causing the fever then went to the archbishop’s brain and he became delirious. He had to be brought back to himself with physical remedies (remedia physicalia) and shortly thereafter followed Gilbert’s advice.

After last rites, Hubert was much relieved, and joined others in praying and rejoicing. He was also able to conclude some last matters of business before fever returned and weariness overcame him. He could not be roused either by friends or by medicines. There was no medicine for this kind of weariness (languor) but death alone, for disease sapped his body of vitality, and the furnace of fevers compelled his soul to leave the seat of the body at last.¹

The chronicler of this dramatic episode, Ralph of Coggeshall, was anxious for his readers to understand that the archbishop of Canterbury had not died intestate, as some had asserted. Far from it; Hubert’s death was a tidy one, with things done in the correct order at the correct time. Ralph described each event on the day and canonical hour it unfolded (at prime, after vespers, etc.), and the only disruption in the archbishop’s procession to his death came from a medical practitioner who put physical remedies ahead of spiritual ones. The author of Hubert’s orderly passing was the most famous physician of his time. But Gilbert administered not a single drug, nor was he said to have viewed the dying man’s urine or to have taken his pulse. Instead, the great doctor exercised his peerless judgment, knowing his master so intimately that he could tell by a glance that death was at hand. Confession, not potions, brought the archbishop relief, and the oil of the last rites enabled Hubert to take care of worldly matters before the inevitable stilled the hand of the renowned cleric and man of affairs forever. Gilbert was presented as the hero of this episode, not because he saved the archbishop, but because he used his learned judgment to recognize that death was unavoidable, and that the life of a great man must be shepherded to its end with ritual and dignity.

Gilbert’s doubtless heroism reminds one more of King Arthur or Theseus than it does of Pasteur or Salk. Gilbert in this telling anecdote was presented as the master of time and the bringer of order, not the deliverer of mere physical remedies. Like all learned physicians of his day, Gilbert was an astrologer, which allowed him not to predict the future but to recognize the stages of progress according to God’s will and as a consequence of humanity’s actions. What is more, as an Aristotelian philosopher, Gilbert was not distracted by the accidents, or side effects, of the process of dying. Instead, he concentrated his learned judgment on the important issue before him—a decorous exit from the physical world for the archbishop’s immortal soul.

We do not now think of the duties of the medical professions in this way. The universals of disease, suffering, and death unite us with the distant past, but the otherness exposed by stories like that of Gilbert and the archbishop must inevitably draw us away from facile comparisons. The welfare of the soul lies outside the modern medical practitioner’s purview: the priest, physician, friend, and adviser are nowadays not the same person. In an age before scientific medicine, a medical practitioner was almost never simply a practitioner. Instead, he or she could perform a number of different functions, not all of which we associate with medical practice. A survey of these medical practitioners therefore opens up issues of social status, gender, literacy, income, institutional affiliation, and relationship to sources of patronage. And yet, much as such an approach may promise, medieval English healers defy any easy attempts at classification or characterization. Were men like Gilbert primarily physicians, or were they rather philosophers, priests, or teachers? And what about the less elite medical practitioners? What was the range of their activities?

The most distinctive feature of medieval English medicine is indeed the variety of people who practiced it. Unlike other medieval professions that survive today—the ministry, legal and notarial arts, and teaching—medieval medical practice embraced men and women, serfs and free people, Christians and non-Christians, academics and tradespeople, the wealthy and the poor, the educated and those ignorant of formal learning. Such a wide diversity among healers suggests that the term profession cannot be applied to medieval English medical practice in any meaningful way.

Terms like profession gain their meaning from the way scholars use them. Judged by this standard, medieval England lacked a medical profession. One major work on the professions in medieval England omits medicine entirely.² Histories of the professions in the early modern period (from about 1500 to 1700) have been more forthcoming, drawing attention away from the traditional emphasis on a few university-educated doctors and embracing a variety of tradespeople.³ Some have suggested that the term medical profession in the sixteenth and seventeenth centuries is deceptive, since it ignores the diversity of types of practitioners, the lack of social consensus about standards of conduct, and the domination of medical practice by people who acted only part-time.⁴ Harold Cook has argued that during the sixteenth and seventeenth centuries a scholastically educated medical elite exerted legal authority over medical practice in a way it never had in medieval England. Even so, the powerful London College of Physicians was not a professional monopoly, but rather one of many competitors in England’s medical marketplace, albeit the most powerful one, whose fortunes rose and fell according not to superior healing abilities but to the growth in the monarchy’s public power.⁵

What early modernists have suggested for their period by and large holds true for medieval England as well. No single group of practitioners distinguished itself by force of numbers, by healing skill, or by civic sanction as a dominant medical profession.⁶ Although the structure of trade guilds and university education helped set a certain standard of conduct in a commercial and legal sphere for a few practicers, the vast majority of medics operated independently, and, from the educated elite to the tradesperson, often part-time. This allowed for diversity of every sort, which changed little throughout the medieval period and beyond.⁷

Most people involved in medical learning or practice, then, fell under no particular heading. They might have involved themselves in medicine only on occasion, written about it as a part of general knowledge, or healed as a religious duty. Others were independent tradespeople: nurses, midwives, toothdrawers, or country practitioners, whose training and methods varied enormously. Most medicine must have been practiced by the family or by neighbors, whose lives and methods remain hidden.⁸

The historical sources for the lives of all medical people in medieval England are of course found in written documents and are as a consequence biased toward the famous or the notorious. Learned physicians and surgeons sometimes composed texts containing biographical details about themselves, their friends, and their rivals. The university-educated man left his mark in institutional documents, whereas people in organized trade were enrolled in guild registers or called upon by municipal officials for expert opinion. We also have the records of payments given to doctors who attended clerics and royal or noble persons. The ordinary practitioner, however, is most often known indirectly through legal documents, either as a party in the transfer of property or as a litigant. Knowledge about people involved in medicine is therefore very incomplete, especially with regard to women, who could enter into the records of the law, university, and church only rarely, and yet by their patronage showed themselves to be both knowledgeable about and interested in medicine.⁹

One way of thinking about the various types of medical practitioners is to divide them into tradespeople or ordinary practitioners and clerical or elite practitioners. These divisions should be thought of not as rigid categories but rather as polarities: clerical practitioners often had the characteristics of tradespeople, and tradespeople at times adopted some trappings of clerical practitioners, especially with regard to the ownership or production of surgical texts.

Medical tradespeople practiced medicine in the same way people did any other trade. They sold care and drugs sometimes as a member of a guild or with the license of a municipal authority. Sometimes they worked for a monastery, or in a royal or noble household. Some solicited clients on the street or worked from a shop. The great majority were free men or women, but there are occasional records of serfs practicing medicine. The tradesperson/medical practitioner could receive payment for services in cash, either in the form of an annuity or for services rendered. Many were given gifts, especially of clothing and food. The practice of medicine in return for payment is found on all social levels throughout the medieval period.¹⁰

The clerical practitioner dealt not in payment for services but in healing as a part of clerical duty. Even the religious required material support, however, and the clerical practitioner derived income not directly from clients but from the church. Powerful patrons were able to gain multiple ecclesiastical incomes for their favorites, and the clerical practitioner was no exception: many royal doctors were notable pluralists, holding multiple incomes, sometimes to the outrage of the less generously endowed. Courtly medical practitioners gained similar preferments from royal and noble prerogatives. But in theory, at least, the clerical practitioner lived in imitation of Christ, and dispensed the healing that could come only from God in the same way he dispensed the sacraments—as a part of charitable duty.¹¹

Ordinary Practitioners Alone and in Family-Like Groups

The ordinary practitioner or tradesperson should no doubt be the principal focus of any study of the variety of medical practitioners in medieval England, and yet it is this person about whom the least is known. References to the independent medical tradesperson, both urban and rural, occur frequently throughout the medieval period but are almost always incidental to nonmedical matters. Charles Talbot and Eugene Hammond, in their biographical register of medieval English practitioners, have noticed in taxation records from the late thirteenth century for the city of Worcester that among nearly ten thousand names only three are called physicians.¹² This suggests that medical care, if given by medical practitioners at all, was provided by people recognizable as such only occasionally.

For example, Richard Knyght, known because of the complex trail of litigation he left in London courts during the middle of the fifteenth century—some of it in conjunction with his brother John, a tailor—was known variously as ffecissian (physician), ironmonger, surgeon, and dogleche (dog doctor).¹³ He seems to have practiced his various vocations on his own, not as part of any group.

Some seem to have practiced medicine independently by soliciting patients on the street. The record of the court of John of Preston, sheriff of London, states that one John of Cornhill approached Alice of Stocking on Fleet Street, London, in June 1320. Claiming to be a surgeon (ad eam accessit usurpando sibi officium surgici), he offered to cure her of a malady of the feet. As a result of his treatment, she claimed, she was unable to put her feet to the ground. While she was bedridden, John entered her dwelling and stole bedclothes and clothing. Alice was awarded damages of more than £30.¹⁴

Very little work has been done on medical care in agrarian communities, but legal documents do give occasional hints of medical practitioners performing healing at least part-time. For example, in a charter establishing a Cistercian abbey at Revesby, Lincolnshire, in 1143, one of the tenants displaced from the new abbey’s lands was called William, medicus. He seems to have been a serf.¹⁵

Other independent practitioners seem to have engaged in a variety of trades. In 1327 the Italian fiscisien Francisco de Massa Sancti Petri, who practiced in London, was a party in a petition to the king revealing his involvement in the wool trade.¹⁶ In 1348 the London surgeon Henry de Rochester left his brewery on Barbican Street to his wife Johanna.¹⁷ Another brewer-physician was a certain William who in 1325 was fined 2s. 8d. (2 shillings and 8 pence) for brewing and selling without a license in Lancashire.¹⁸

Essex country doctor John Crophill made his principal living not from medical practice but from his duties as bailiff (acting principally as a rent collector) for a Benedictine nunnery in the mid-fifteenth century. He also was appointed ale taster for the local lord of the manor, both of which duties left him ample time for a popular medical practice.¹⁹ The gift to Crophill of some ale tankards from a local friar occasioned a drinking party, at which the doctor made dedication speeches in verse to the women present—revealing yet another talent.²⁰ Elsewhere, Crophill recorded how he brewed ale at his home in Wix.²¹

Surgeons especially seem to have engaged in metalworking as a trade, probably making surgical instruments for themselves and for sale purposes. John Bradmore, the London surgeon, was also called gemestre, possibly indicating involvement in the jewelry trade. Bradmore is credited with devising a surgical instrument for the extraction of an arrow from the head of the future Henry V in 1403.²² Another apparent metalworker was the apothecary (appotagarius) John Hexham, who had a shop in London in 1415. He apparently counterfeited coin, for which he was hanged.²³

The most frequently encountered designations in medieval legal documents are the well-known titles barber (a haircutter who might perform bloodletting or minor surgery on the skin), barber-surgeon (a barber who also performed surgery), leech,²⁴ le mire,²⁵ medicus,²⁶ chirurgus or sururgicus,²⁷ and physicus.²⁸ A rare title is archiater.²⁹ Often one encounters the designation master or its Latin translation magister, which was used both in reference to a master tradesman and to suggest a man who had formal education or was a teacher.³⁰

Legal documents use several titles interchangeably throughout the later medieval period, in distinct contrast to more scholarly sources, which employ medical terminology more