If the thirteenth-century doctor's science is questionable by the standards of a latter 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's 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 livers 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."
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 Provencals, Frenchmen, Italians, and others. Paris and Montpellier have the only two medical scools in north-west 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 succesfully 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 are few and precious. Most of the Greek writings have arrived in the West by a circuitious 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 dafty. 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 agains 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 cataract 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 drenced with opium, and mandrake, dried, then soaked in hot water and inhaled. Bartholomew Anglicus expatiates 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."
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