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."
Singer also believed that medieval medicine, specifically the Anglo-Saxon
herbals, "lacked any rational element which might mark the beginnings of
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
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.
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
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.
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.
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
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)".
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.
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:
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.
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>
<1> Charles Singer, A Short History of Medicine
(New York: Oxford UP,1962), p. 31. <return>
<2> M.L. Cameron, Anglo-Saxon Medicine (Cambridge:
Cambridge UP, 1993), p. 3. <return>
<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. <
<4> See Deborah Lupton, Medicine as Culture:
Illness, Disease, and the Body in Western Societies (London: Sage,
1994) pp. 11-13. <return>
< 5> Lupton, 98. See also Herzlich and Pierret,
Illness and Self in Society (Baltimore: Johns Hopkins UP, 1987)
pp. 76-82. <return>
<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. <return>
<7> Temkin, p. 19. <return>
<8> Temkin, p. 19. <return>
<9> Temkin, p. 32. <return>
<10> 61. <return>
<11> David Lyle Jeffrey, ed., The Dictionary
of Biblical Tradition in English Literature (Michigan: Wm. B. Eerdnabs
Publishing, 1992) p. 614. <return>
<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. <return>
<13> Amundsen, pp. 187-8. <return>
<14> 210. <return>
<15> Maxwell Luria and Richard L. Hoffman, eds.
Middle English Lyrics. (New York: W.W. Norton, 1974) p. 112. <
SUGGESTIONS FOR FURTHER READING
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Galen. Galen: on Respiration and the Arteries. David J. Furley
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---. 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.
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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:
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John Arderne. Treatises of Fistula in Ano. Ed. D. Power. London:
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Luisa Cogliati Arano. Tacuinum Sanitatis: The Medieval Health Handbook.
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Ogden, Margaret Sinclari, ed. The 'Liber de Diversis Medicinis.'
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Paracelsus Aureolus Theophrastus Bombastus von Hohenheim. Paracelsus:
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Rawcliffe, Carole, ed. Source for the History of Medicine in Late
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The School of Salernum: Regimen Sanitatis Salerni. Ed. Sir John
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Soranus of Ephesus. Soranus' Gynecology. Trans. Oswei Temkin.
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History of Medicine
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Cameron, M.L. Anglo-Saxon Medicine. Cambridge: Cambridge UP,
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Sexuality and Medicine
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