Luke Demaitre, Medieval Medicine: The Art of Healing from Head to Toe. (Praeger Series on the Middle Ages) Santa Barbara, Denver, Oxford: Praeger, 2013. pp. xiv, 351, 21 b & w illustrations (15 from manuscripts, 6 from incunables), 5 tables. Ca. £22.82. ISBN: 978-0-275-98485-4. ebook ISBN: 978-0-313-03842-6.
By 1300 medicine had pretty well sorted itself out into four loosely overlapping groups. At the top, by their own modest admission, were the Academic Physicians: Taddeo Alderotti (d. 1298) at Bologna, Arnaldo of Villanova (d. 1313) at Montpellier, Pietro d’Abano (d. 1315) at Padua and Paris, to mention only these. Academic Physicians discussed medicine philosophically, analysing lemmata from Hippocrates and Galen much as a theologian might discuss a lemma from Augustine or Peter Lombard. Just a notch below these were the Practitioners / Compilers, a more hands-on group. They were the ones who practiced medicine both to heal and to teach, and their written work was designed to instruct others in the practical healing arts. Such men—for they were invariably men—as Bernard of Gordon (d. 1308), Gilbertus Anglicus (d. 1260), Guillelmus of Varignana (d. 1339), John of Gaddesden (d. ca. 1349) presented their findings in a head-to-foot fashion, with separate chapters for afflictions such as fevers and aposthemes that were not restricted to single area of the body. Surgeons competed keenly with Practitioners for second place—and may in fact have achieved it. Such men (again) as William of Saliceto (d. ca. 1277), Henri de Mondeville (fl. 1306), Guy de Chauliac (fl. 1365) also wrote treatises similar in organisation to those of the Practitioners, similar to the Physicians in their grasp of medical theory and the breadth of their medical learning.
At the bottom of the heap come the empirics: the tooth-drawers, the bone-setters, the sages femmes (at last, women!), the eye specialists—a group usually dismissed by those above them as charlatans and mountebanks, when felt to be encroaching on territory reserved for their betters, or sometimes grudgingly referred to as specialists, when their particular speciality was needed. In contrast to the upper reaches of the hierarchy, most of these empirics are known today only through various official and unofficial records attesting to their existence and their efficacy. That is, with some significant exceptions, they wrote little.
Professor Demaitre’s new book expounds the work of the second group, the Practitioners, and expounds it with verve and with learning gracefully expressed. His strategy is to identify a group of Practitioners who compiled head-to-toe treatises and to deal with them as very nearly contemporary with one another. That is, he is less concerned to demonstrate the development over time of medical knowledge and procedures, more to reveal the broad area of agreement. Those who figure prominently among his Practitioners stretch from Gariopontus (fl. ca. 1050) and Copho (fl. 1100-1150) to Guillelmus de Varignana (ca. 1270-1339) and Giovanni Savonarola (1385-1466), touching in passing such others as Bernard of Gordon (1258-1308), Gilbertus Anglicus (fl. 1240-1260) and John of Gaddesden (ca. 1280-1349). This strategy enables him to present a coherent picture of medieval disease and its treatment such that a medievalist specializing in any other area can get a solid and reliable grasp of medieval medical practice as it might have existed for, let’s say, Orme or Langland or Malory or Walther von der Vogelweide or Dante—or anyone else from roughly the eleventh to the sixteenth century. The Archpoet in poem VI, on his visit to Salerno, would have encountered medicine just like this, and Chaucer’s Doctour of Phisik relies on several of the Practitioners mentioned by Demaitre:
Averrois, Damascien, and Constantyn, Bernard, and Gatesden, and Gilbertyn. (“General Prologue,” ll. 429-34)
An understanding of practitioners like these will make far more difficult the facile judgment that medieval medicine was pretty much an empty hoax practiced on the gullible.
After an opening chapter on the learned origins of western medicine, the centrality of book-knowledge, traditional knowledge, and practical knowledge, Demaitre starts with Hippocrates and emphasizes the limits of medicine based solely on empiricism (chiefly, it makes a guinea pig of the patient). He then delineates the transmission of medical knowledge from the ancient Greeks to the medieval Arabs to the Latin west, and provides most useful pages on describing the nature of Galenic medicine, emphasising that its theoretical framework provided both a justification for effective treatment and a paradoxical deterrent against further advances in medicine. He stresses the organisation of medical knowledge and its transmission in books and who the major authorities were. In short for those with little disposable time available, the first chapter offers a compendious description of medical theory and practice during the Middle Ages.
From that point on Demaitre follows the example of the Practitioners. That is, he has a chapter on fevers, pestilence, and poison and a second on tumours and trauma (this includes herpes, lupus, leprosy, cancer rather than the battlefield trauma we think of most readily today)—afflictions that may strike any part of the body. This is followed by chapters on each of the major areas of the body: the head, the face and the senses, uvula to diaphragm, gullet to gut, and haunches to heels (including the genitalia). These chapters contain some of the most interesting revelations—for example, the inordinate amount of attention paid to the hair of the head, the relative neglect of the heart and its functions (“The heart, though ranked as the most or second most noble organ, had a considerably lower profile than the lungs or even the breasts” [p.204]), cures for epilepsy (p. 146), the relatively small amount of attention given to Avicenna’s detailed description of the nervous system (p. 149), Bernard of Gordon’s mention of a magnifying glass (p. 175)—to mention only these.
But what chiefly makes Demaitre’s book useful, perhaps even indispensable, to any medievalist, not just those interested in medicine, is the author’s authoritative acquaintance with what I’d like to call the Medieval Mind. His grasp of early and modern languages, his long acquaintance with the authors and texts he describes, his knowledge of modern medicine—all give him an easy authority with the medical material he deals with. He knows enough not to try retrospective diagnosis, yet he also knows where medieval symptoms may describe a modern disease. He knows when to take the medical theory seriously and to have confidence in its efforts to deal with illness and when to recognise its limitations. He recognises that Harvey’s discovery of the circulation of the blood was a vital advance in medicine, yet he also knows that it did not shake the fundamental conviction that Galen was essentially right. In short he demonstrates an enviable and to a certain extent communicable familiarity, an at-home-ness, with the Middle Ages.
Particularly noteworthy is Demaitre’s extended treatment of the medieval understanding of the eye and the sense of sight (pp. 154-78). He even describes conflicting theories of vision, discussing clearly the reception of and amendments to Plato’s theory of vision as extramission, i.e., the eye emitting a power, a sort of ray, to encounter phenomenal reality, and Aristotle’s theory of intromission, i.e., the eye receiving light reflected from the phenomenal object. Strictly speaking, these theories have more to do with optics than with medicine, but Demaitre shows how such men as Gilbertus Anglicus made them central to their ophthalmic medicine. He notes, and I think most historians of medicine would agree, that “Descriptions of the eye were more detailed than for any other part of the body, but they proved almost entirely copied from the accumulated translations from Greek and Arabic” (p. 157) and thus had little effect on actual treatment of eye diseases. Most interestingly he notes how several compilers seemed to have stumbled on incidences of contagion and dimly recognised it as such (p. 159). And chiefly he makes an observation worth quoting in its entirety: “… in premodern nosology, diseases were not pathological entities but qualitative conditions, and in learned discourses, most definitions hinged on semantics rather than on empirical induction” (p. 172), a comment that could apply to all aspects of medieval medicine, not just to the eyes. I could quibble with his parenthetical explanation of the “spider web” on p. 155—it surrounds the lens rather than the retina. But it is a minor quibble and certainly does not affect the fine quality of the whole.
At the end of the book (pp. 325-7) there is a chronology of medieval medical men, a glossary of medieval medical terms (pp. 329-31), a bibliography of primary sources (pp. 333-5--each with a most useful website), a bibliography of secondary sources (pp. 337-40), and an index (pp. 341-50).
Laurence Eldredge, University of Ottawa
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