Life in a Medieval City

by Frances Gies

  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.”

  Apothecary at work, crushing herbs in a mortar (from Chartres

  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 Provençals, Frenchmen, Italians, and others. Paris and Montpellier have the only two medical schools in northwest 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 successfully 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 textbooks2 are few and precious. Most of the Greek writings have arrived in the West by a circuitous 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 drafty. 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 against 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 cataracts 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 drenched with opium, and mandrake, dried, then soaked in hot water and inhaled. Bartholomew Anglicus expatiates on the value 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.”

  Bloodletting, that long-popular health measure, is commonly done by barbers, some of whom have recently abandoned the shave and haircut to devote themselves exclusively to surgery. Many also specialize in pulling teeth. Owing to poor diet, teeth are a chronic health problem, more because of bad gums than cavities. Wealthy patients have been known to pay as much as five livres for an extraction, while barbers get as much as fifteen sous for a bleeding. The lower classes are spared these luxuries.

  Mental illness is widespread. Birth injuries often leave brain damage. Collective mental disorders, such as St. Vitus’ Dance, are notorious, though the most famous outbreak of this “dancing mania” will not appear until the fourteenth century. Joining hands, the victims dance in wild delirium until they fall exhausted, foaming at the mouth. This communal fit is treated either by swaddling the victims like babies, to prevent them from injuring themselves and others, or by exorcism.

  The mentally ill are rarely confined, though they are sometimes tied to the rood screen in church, so that they may be improved by attending mass. Or the sign of the cross is shaved into the hair of their heads. They are invariably numbered among the armies of pilgrims at the shrines—along with the spastics, the paralytics, the scrofulous, and the very numerous cripples—at Rome, Mont-Saint-Michel, Roc Amadour, Compostella, and on the road to Jerusalem.

  In this pathetic troop one never sees the most pitiful of all the medieval sick—the victims of leprosy. This very widespread disease, attended by its frightful disfigurement, has inspired terror in the clergy as well as the laity.

  There are two thousand leper colonies in France, including several in the neighborhood of Troyes. A famous one, the Leproserie des Deux Eaux, was founded in the eleventh century by Count Hugo on the eve of his departure for the First Crusade. Before the leper is committed to the enclosure, his isolation is sanctified by a special church ritual. The unfortunate victim is brought to the tribunal of the diocesan official and examined by surgeons. The “separation” is pronounced the following Sunday. The unhappy man, dressed in a shroud, is carried to the church on a litter by four priests singing the psalm, “Libera me.” Inside the church the litter is set down at a safe distance from the congregation. The service of the dead is read. Then, again singing the psalm, the clergy carry the leper out of the church, through the streets, out of town, to the leper colony. He is given a pair of castanets, a pair of gloves, and a bread basket. After the singing of the “De profundis” the priest intones, “Sis mortuus mundo, vivens iterum Deo” (Be thou dead to this world, living again to God), concluding, “I forbid you ever to enter a church or a monastery, a mill, a bakery, a market, or any place where there is an assemblage of people. I forbid you to quit your house without your leper’s costume and castanets. I forbid you to bathe yourself or your possessions in stream or fountain or spring. I forbid you to have commerce with any woman except her whom you have married in the Holy Church. I forbid you if anyone speaks to you on th
e road to answer till you have placed yourself below the wind.” Then everyone leaves the poor victim condemned to a living death.

  The disease is believed to be transmitted not only by touch but by breath. With all the care taken to isolate lepers, from time to time rumors lead to panic and lynching.

  Cruel though medieval treatment of leprosy is, it represents a step forward in the history of medicine: recognition of the problem of contagion. Ironically, leprosy (Hansen’s disease) is only slightly contagious, and the frightening disfigurement results not from the disease itself but from loss of sensation in nerve endings and consequent wearing away of tissue. But medieval medicine accurately guesses that diseases are transmitted by contact or through the air.

  A still more important contribution of medieval medicine is the hospital, a wholly new idea. Hospitals, like monasteries and abbeys, are favorite recipients of Christian charity. The Hôtel-Dieu-le-Comte in Troyes was founded by Count Henry the Generous some seventy-five years ago, and has continued to profit by gifts not only from the count’s successors but from others as well. One lady bequeathed the revenue of seven chambers of a house facing the public baths. Another gave a carpenter and his family, who were her serfs. A burgher gave a stall in Moneychanger’s Place at the fair. Another gave a fisherman, his family and all his possessions, and his fishing rights in the Seine. Still another endowed the hospital with three garments, worth thirteen sous apiece, and six pairs of shoes a year. A vintner gave income from his vineyards to buy earthenware bowls and cups for the sick and wine to celebrate mass. Other rents, revenues, fees, and taxes from fairs, mills, vineyards, bakeries, farms, and fisheries have poured in.

  Counts and popes have accorded this hospital, like many others, their blessing and protection. Eight priests, of whom one is prior and master of the house, staff the hospital, assisted by as many nuns as are needed. When a patient is admitted, he confesses and takes communion, his feet and body are washed, and he is given hospital clothes and food. If his disease is considered contagious, he is isolated—an advance in medicine in itself. The critically ill are also isolated, for intensive care. Upon recovery, indigent patients are furnished with clothes. The hospital does not receive women in childbirth, because their cries may disturb other patients; nor does it take foundlings, the blind, the crippled, and victims of plague (or leprosy), who would swamp the hospital. Responsibility for the care of these unfortunates falls on the parish churches.

  The regimen of the hospital is strict and simple, with emphasis on common sense. In fact, there remains a considerable fund of common sense in medieval man’s attitude toward health. Many sound health rules are contained in aphorisms and verses, one of the most famous compendiums of which is known as the Health Rule of Salerno. It is said to have been inspired by Robert of Normandy, wounded in the First Crusade, during his stay at the famous medical center. Written in Latin verse, it contained these recommendations, given here in the Elizabethan translation of Sir John Harington:

  A King that cannot rule him his diet

  Will hardly rule his realm in peace and quiet.

  For healthy men may cheese be wholesome food,

  But for the weak and sickly ’tis not good.

  Use three doctors still, first Dr. Quiet,

  Next Dr. Merry-man and Dr. Diet…

  Wine, Women, Baths, by art of nature warme,

  Us’d or abus’d do men much good or harme.

  Some live to drinke new wine not fully fin’d,

  But for your health we wish that you drink none,

  For such to dangerous fluxes are inclin’d,

  Besides the lees of wine doe breed the stone.

  But such by our consent shall drink alone.

  For water and small biere we make no question

  Are enemies to health and good digestion;

  And Horace in a verse of his rehearses,

  That water-drinkers never make good verses.

  9.

  The Church

  I know you need a short sermon and a long table. May it please God not to make the time of the mass last too long for you.

  —An Easter sermon by ROBERT DE SORBON

  Churches in the thirteenth century are places where people go not only to pray or visit the shrines of saints, but for secular purposes, because churches are often the only large public buildings in town. Business life often centers around a town’s principal church. In Troyes the fairs crowd the precincts of St.-Jean and St.-Rémi. In Provins the stalls of the moneychangers are set up in front of St.-Ayoul. In many towns churches are used for town meetings, guild meetings, and town council sessions.

  Everywhere the church is a familiar, friendly place. It is not, however, particularly comfortable. There are no benches or pews.1 Some worshippers bring stools and cushions, some kneel on the straw-covered floor. The building is chilly, even in mild weather, and in the winter many of the congregation come armed with handwarmers—hollow metal spheres holding hot coals.

  A bell signals the start of service. The congregation stands as the procession of priests, choir, and clerks enters singing a hymn. The melody of Gregorian chant, seeming to wander at will, actually follows strict rules in mode, rhythmic pattern, phrasing, accent, and relationship of words to music. The group sings in unison, or sometimes in an antiphon between choir and cantor or between two halves of the choir. A momentous change is just taking place, however—the birth of polyphonic music. Out of a part of the chant in which the melody is accompanied by a sustained note in the tenor, music for more than one voice part is developing. First the tenor, from a single note of indefinite length, becomes a separate melody with its own rhythm; then another voice is added; and out of this grows a “motet,” a sort of little fugue. Another important innovation is the beginning of modern notation, with rhythm indicated as well as pitch.

  The singers may be accompanied by a “portative organ,” which looks like the fruit of a union between an accordion and a full-sized organ. It is suspended from the player’s neck; he operates the bellows on the back of the instrument with his left hand and the keyboard with his right. Some churches have standard organs, powerful, clumsy, and generally out of tune. The one constructed at Winchester in 980, with four hundred pipes and two manuals, produced a noise so great that everyone “stopped with his hand his gaping ears, being in no wise able to draw near and hear the sound.” Instrumental keys, introduced in the twelfth century, are so heavy and stiff that they must be played with the clenched fist. Organs have a range of three octaves, and are the first instruments to become entirely chromatic.

  The Gregorian liturgy, having triumphed over several rivals, is in use throughout western Europe. In almost any church in France, England, Germany, Italy, or Spain the service is celebrated exactly as it is in Troyes. The congregation stands, kneels, and sits in accordance with the ritual; otherwise, however, it takes little active part in the service.

  Few present understand Latin, but sermons are delivered in the vernacular, except when the audience is clerical. The sermon usually lasts half an hour, measured by the water clock on the altar. The priest mounts the pulpit and begins by making the sign of the cross, then gives his thema or text in a short Latin passage from the Gospels, which he translates for the benefit of the congregation. This he follows with a rhetorical introduction explaining his unfitness to discuss the subject (the sentiments are humble but the language is flowery) and with an invocation to the divine spirit. Then he develops his text.

  Frequently he runs over the time limit in order to get in his “example.” This indispensable part of the program consists of a story, illustrative of the sermon’s text, told with dramatic flair. For a sermon on the Christian virtues, a popular example goes like this:2

  A merchant is returning from the fair, where he has sold all his merchandise and gained a large sum of money. Pausing in a city—such as Amiens or Troyes—he finds himself before a church, and goes into the chapel to pray to the Mother of God, Holy Mary, putting his purse besid
e him on the ground. When he rises, he forgets the purse and goes away without it.

  A burgher of the city is also accustomed to visit the chapel and pray before the blessed Mother of God Our Lord, Holy Mary. He finds the purse and sees that it is sealed and locked. What is he to do? If he lets it be known that he has found it, people will cry that they have lost it. He decides to keep the purse and advertise for its owner, and he writes out a notice in big letters, saying that whoever has lost anything should come to him, and posts it on the door of his house.

  Religious objects, often richly decorated, were the products of prosperous city craftsmen. Among the most beautiful of the thirteenth century are this enamel eucharistic dove and censer. (Metropolitan Museum of Art; Cloisters Collection, Purchase 1947 and 1950)

  When the merchant has gone a good distance, he realizes that his purse is missing. Alas, all is lost! He returns to the chapel, but the purse is gone. The priest, questioned, knows nothing about it. Coming out of the chapel, the merchant finds the notice, enters the house, sees the burgher who found the purse and says to him, “Tell me who wrote those words on your door.” And the burgher pretends he knows nothing but says, “Good friend, many people come here and put up signs. What do you want? Have you lost anything?” “Lost anything!” cries the merchant. “I have lost a treasure so great that it cannot be counted.” “What have you lost, good friend?” “I lost a purse full of money, sealed with such and such a seal and such and such a lock.” Then the burgher sees that the merchant is telling the truth, so he shows him the purse and returns it to him. And when the merchant finds the burgher so honest, he thinks, “Good sir God, I am not worthy of such a treasure as I have amassed. This burgher is far worthier than I.” “Sir,” he says to the burgher, “surely the money belongs to you rather than to me, and I will give it to you, and commend you to God.” “Ah, my friend,” says the burgher, “take your money; I haven’t earned it.” “Certainly not,” says the merchant, “I will not take it.” And he leaves.