Medicine from the Black Death to the French Disease

Roger French, Jon Arrizabalaga, Andrew Cunningham, Luis Garcia-Ballester

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780367195342
• eBook ISBN: 9780429515019
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

Published in 1998, covering the period from the triumphant economic revival of Europe after the collapse of the Western Roman Empire, this book offers an examination of the state of contemporary medicine and the subsequent transplantation of European medicine worldwide.

Chapter One
Introduction: The 'Long Fifteenth Century' of Medical History

Roger French

The Black Death of 1348-49 was a watershed in Western history. Since it killed perhaps a third of the population it perhaps could hardly have been otherwise. Its economic and demographic effects were great. In medical terms it marks the end of a period when the medical faculties were instituted and developed in the universities. The university physicians had established themselves on the narrow rung at the top of the medical ladder. It marked the height of scholastic medicine. The form of the commentary reached a degree of elaboration that was never exceeded.

The 'long fifteenth century' of European medicine (i.e. c.l348-c.l500) saw a slow recovery from the major effects of the Black Death, despite recurrent outbreaks. It saw the spread of universities, often modelled on that of Paris, across Europe. Scholastic medicine retained its form but was increasingly challenged from outside by new intellectual movements like Italian civic humanism and eventually by Hellenism. The long century was ended by the introduction of new ideals within medicine and the collapse of some features of the scholastic mode of instruction, events symbolized by the appearance of the editio princeps of the printed Greek Galen and the disappearance of the medieval textbook. The long century ended, as it had begun, with the arrival of a dreadful new disease; both had their effects on European medicine.

One of these effects was to put pressure on the medical hierarchy. The university-trained doctors claimed a monopoly of the practice of internal medicine on the grounds of the superior effectiveness of their medicine. But their claim could only be enforced under certain circumstances, normally where there was an important faculty. The university physicians were few in number and competed for custom with a range of other practitioners, from travelling purveyors of nostrums to surgeons and medical specialists who had legitimate but partial licences from corporations other than the faculty, mostly guilds and civil examination boards. Minorities like Jews and women could practise legitimately, or at least without harassment, in niches of the medical market.

But the market could be disturbed at moments of medical crisis, as by the two epidemics we consider here. Scholarly medicine before the Black Death was not designed to cope with general catastrophes. University physicians believed that disease was a personal imbalance of humours: they studied their patients' particular constitutions and managed their regime over a long period of time. Indeed, an ideal career was to become attached to a court or a household of a great man as a medical retainer with constant advice on his lips. The great epidemics did not fit this pattern. The Black Death killed its victims in a few days. The French Disease stubbornly resisted attempts to achieve a balance of the humours. Both were entities, diseases that happened to people, rather than individuals submitting to their own innate or acquired weaknesses and hence coming to have 'unbalanced' humours. And both were widespread, happening much more, in absolute terms, to the mass of people who could not afford the physician's fees than to those who could.

The physicians were uncertain about what to do. Some took their own advice and fled quickly, stayed away a long time, and came back slowly. Those who stayed could not easily identify either of the new diseases and accordingly could not agree on a treatment. Other kinds of practitioners took advantage of the absence or uncertainty of the physicians. Empirics often had their favoured remedies, and in the absence of elaborate and impressive theory they now had what was marketable: specific medicines for a specific disease, at a price well below the level of the physician's fees.

In the long medical fifteenth century the physicians' strategy ultimately worked, and they maintained their position. They sold their medicine in the market on the grounds of its rationality and learning. It was ultimately an Aristotelian rationality, recognized by all who had been to a university as the proper way to argue. Deep learning in the accepted Greek and Arabic authorities persuaded the patient that the doctor knew about his case. This medicine was scholastic in a good sense, before a pejorative meaning had been attached to that term and before the term 'middle ages' had been introduced. The physicians' image was attractive. When towns began to hire medical men, they wanted ones trained in the universities. If they gave a contract to a bachelor of medicine, sometimes they paid him also to go back to university and become a doctor. Successful surgeons who had been trained as apprentices, often indentured to their fathers, not infrequently sent their sons for a medical training at a university. Women who practised illegally aped the learned language of the doctors to impress their patients. Jews, excluded from the schools, often learned scholastic medicine in their own way, obtained civil licences by examination and rose to eminence.

One of the reasons that communes engaged medical men was to treat the poor, generally free of charge. The commune was buying the constant attention of a resident doctor, which meant that he could practise his preferred long-term, regimen-based medicine. But he also had to face sudden epidemics among the poor and had to think in terms of public health - what could be done to avert an epidemic, whether to segregate the sick, and related questions. The poverty of the sick poor was met not only by the town's doctor but by charitable actions of the townsfolk. Hospitals, once refuges for the deserving needy, increasingly became medical institutions, some specializing in acute cases (where the charitable 'turnover' was rapid) and others acting as charitable medical establishments for the chronically ill. The doctors and surgeons who attended hospitals, like those hospitals set up for victims of the French Disease, or who were under contract to towns that faced repeated epidemics of plague, necessarily had a notion of medicine that differed from that of the medical men who were concerned with confirming a place for their subject in the new universities, and who thus preferred the largely literary revival of Greek medicine.

The history of medieval medicine is not yet at a point where these changes can be explored in detail. What must come first is putting the various kinds of practitioner into their contexts and seeing how they interacted with society at large, both in normal times and at moments of crisis. Some of these contexts are met with in the chapters that follow, and here we can only suggest some of their diversity.

One common thread is the medical marketplace, concerned with supply and demand, and the structures that allowed exchange to take place. It is notorious that in the ancient world there was no control over the practice of medicine: there was a free market and no licensing. It is also well known that the twelfth and thirteenth centuries were a period of the corporation: guilds, voluntary associations, fraternities; the legal person in general. The members of such bodies had some interest in common and collectively controlled entry into the body. They also gained authority by being recognized at some superior level in society. The universities were bodies of this kind, and in the North, where they were closely connected with the Church, the bishop or his chancellor claimed the right of granting the licence. This extended to medicine, and a common procedure for medical licensing was examination of the candidate by an agent of the bishop advised by a panel of medical men.

The consortium of medical men licensed in this way was the faculty of medicine. The power of their monopoly was maintained by the small number of full licences given, a number controlled by the length and expense of a full medical education (which was used in turn to justify the monopoly). The university physician claimed that his knowledge encompassed that of the surgeon and apothecary and that their ignorance of his high theory not only justified his monopoly but explained why surgeons and apothecaries were often dangerous to their patients. In practice surgeons and other specialists often got their licences on the grounds of competent practice, and before a panel of established surgeons, set up by a guild, or other civic authority, or chaired by the king's physician.

The medical marketplace centred in towns. Here there were those who could pay fees and the concentration of people in a small area provided even specialists (who often combined their specialism with another trade) with a steady, if small, niche. In the countryside the market was much more diffuse. There could be such a thing as a 'general practitioner', a man who prescribed, made up and administered internal medicines and at the same time undertook surgical cases. If he was a full-time practitioner he probably had to travel from place to place to make a living. Probably few university-trained physicians found such a practice attractive or saw such practitioners as competitors; the country doctor without a full licence did not suffer the persecution of the urban empiric by the learned physicians.

Despite the physicians' claim that their medical knowledge was all-inclusive, in practice medical knowledge was exercised in a compartmentalized way. Surgical knowledge was partly that gained by practical training and experience, and this is what the licence rewarded. Morphological anatomy was important to the surgeon and was often learned formally alongside the physicians. But in practice the surgeon's anatomy was a business limited to comparatively superficial structures and the bodily orifices; when he placed too much credence on what he was told by anatomists he could be misled.

Anatomy indeed was a specialism that did more than serve surgery and medicine. Anatomical knowledge was a compartment of medical knowledge that served anatomists, just as medical knowledge of the rational and learned practitioner served to identify the kind of doctor he was. In an age of guilds and strict separation of the arts, knowledge of the arts was technical know-how that was the protected stock-in-trade of the knower, the artisan. It mattered in the marketplace: not only to make the art effective, but to persuade the customers it was so. Anatomists, surgeons, empirics, specialists and learned doctors all used knowledge in these ways. The learned doctor was seen as having the best corner of the market, both by those below, who emulated him, and by those lawmakers above, to whom he had been convincing about the superiority of scholastic medicine. When the first successful attacks on school medicine were made, at the end of the long fifteenth century, they came at the top, with powerful figures being persuaded by groups of activists that the Latin, disputatious and commentatorial medicine of the schools was in fact not the most effective. The new Greek Galen and the Hellenists were only partly successful in their attack, and school medicine, with its disputations and Arab authors, lasted for well over another century. But the Hellenists and classicists, in identifying their own time and preferences with the ancient world, had begun to see the period between in a new and unattractive light. The 'middle' ages had been invented.

The invention was not noticed by the men of the schools. They were proud to call themselves scholastic because in medicine it meant mastery of a technically difficult discipline. They recognized the linguistic skill of the Hellenists outside the universities but suspected that they could not handle the finer points of philosophy or medicine. The medical establishment continued in its admiration of the systematic and vastly detailed Arabic textbooks. The demand for scholastic writings of the high Middle Ages continued undiminished until well after the French Disease had arrived. Works of Taddeo Alderotti, Gentile da Foligno, Dino del Garbo, Jacobus de Partibus and others were printed in quantity by men who knew the state of the medical market. These works sold because of the very subtlety and comprehensiveness of their discussions. Scholars of the thirteenth and fourteenth centuries who could 'conciliate' differences between philosophers and physicians, or 'speculate' further into theory than others or simply out-comment the others remained valuable assets for Renaissance printing-houses. Indeed, there is a strong sense in which the height of medical reasoning reached by scholasticism before the plague was never reached again afterwards.

Chapter Two
Jewish Treatises on the Black Death (1350–1500): A Preliminary Study*

Ron Barkai

In 1347 there was such a great pestilence and mortality throughout almost the whole world that in the opinion of well-informed men scarcely a tenth of mankind survived. The victims did not linger long, but died on the second or third day. The plague raged so fiercely that many cities and towns were entirely emptied of people ... Some say it was brought about by the corruption of the air; others that the Jews planned to wipe out all the Christians with poison and had poisoned wells and springs everywhere. And many Jews confessed as much under torture: that they had bred spiders and toads in pots and pans, and had obtained poison from overseas ... God, the lord of vengeance, has not suffered the malice of the Jews to go unpunished. Throughout Germany, in all but a few places, they were burnt.¹

In these words, the Franconian Franciscan friar, Herman Gigas, describes in his chronicle (1349) the plight of the Jews of Europe while the plague was raging at its worst. Not only did they - along with the rest of the population - fall victims to the fatal disease; they were also accused of having brought it on, and many thousand of Jews were slaughtered by the ignorant, horrified mob. The double distress of Europe's Jews, plague on the one hand, and persecution on the other, is reflected in various genres of Jewish literature.² However, the medical literature on the Black Death written by medieval Jewish physicians was almost completely neglected by modern historians, a fact which gave birth to the idea that 'After 1348, when Jews were accused of initiating the plague, some Jewish writers composed original works, like Abraham Caslari's Pestilential Fevers ... These were isolated efforts, however, and did not amount to a genuine medical tradition'.³ However, a careful examination of the available Jewish medical manuscripts demonstrates that the Jews of Christian lands, especially of Spain and southern France, showed a great deal of interest in the medical aspects of the plague: relatively to their number in the population, they possessed a considerable quantity of treatises, translated from Latin and Arabic or originally written by Jewish physicians. My intention in the following pages is to survey these treatises, most of them never published or studied, and to underline their peculiarities.⁴

Translated works on the plague

Most popular of the translated treatises on the Black Death was that of John of Burgundy, written in 1365.⁵ It was, in fact, translated twice: first by Benjamin ben Rabbi Isaac Karkashoni (of Carcassonne), in 1399;⁶ and later by Joshua of Bologna in the fifteenth century.⁷ The first translation is titled 'Ezer elohī, ma'mar be-'ipush ha-avir ve-ha-dever (Divine Help: A Treatise on the Corruption of the Air and the Plague), to which the Jewish translator added an introduction. This preface indicates that the original treatise was written 'in the year 1349, and that along with the medical treatise, its author wrote an astrological chapter explaining the forces of Nature which had brought the plague'. Referring to the motivation of the translation, Benjamin of Carcassonne states that having observed that this work was kept locked away by the Christians, and that it had been 'examined and verified by noteworthy physicians', he had made the effort 'to take it out of their hands and to translate it from t...

Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• Contents
• List of Contributors
• 1 Introduction: The 'Long Fifteenth Century' of Medical History
• 2 Jewish Treatises on the Black Death (1350-1500): A Preliminary Study
• 3 Mater Medicinarum: English Physicians and the Alchemical Elixir in the Fifteenth Century
• 4 Fascinating Women: The Evil Eye in Medical Scholasticism
• 5 Medicine at the German Universities, 1348-1500: A Preliminary Sketch
• 6 Stones, Bones and Hernias: Surgical Specialists in Fourteenth- and Fifteenth-Century Italy
• 7 Treatment of Hernia in the Later Middle Ages: Surgical Correction and Social Construction
• 8 Thomas Fayreford: An English Fifteenth-Century Medical Practitioner
• 9 The Death of a Medieval Text: The Articella and the Early Press
• 10 Epidemics and State Medicine in Fifteenth-Century Milan
• 11 Coping with the French Disease: University Practitioners' Strategies and Tactics in the Transition from the Fifteenth to the Sixteenth Century
• 12 Anatomical Rationality
• Index