This module discusses the role of medicine in medieval culture, with particular attention to Old English texts included in SEAFARER and some of Chaucer's poetry. This module is closely connected to the module on magic.
Contents: the narrative discusses the following topics.
Part 2: The Scope of Medicine in Anglo-Saxon England
Part 3: The Function of Medical Knowledge in SEAFARER Texts
Part 4: Medicine in the Later Middle Ages and in Chaucer's Work
To learn about the Links and Images that accompany this narrative, click on the appropriate hyperlink. We recommend that you consult So What? after you have read one or two parts of the narrative below. Note that the sources used in the narrative are listed in the Bibliography and are cited here only by author and page or by author, title, and page.
Almost any history of medicine will assert that what we think of as medicine began with the ancient Greeks, who were among the first to approach disease "from a rational, naturalistic, and scientific point of view," and not to see it as "a supernatural phenomenon" (Ackerknecht 47). This conclusion is at least somewhat suspect: how do we know what was seen as "scientific" in Greek culture three thousand years ago? At the same time, in Greek culture we find references to physicians who are not religious officials (although also references to physicians who are). Greek medical history is prized because it depends not only on grand ideas derived from natural philosophy but--as the example of Homer shows--it also relied on clinical observation. Medicine in Homer, Ackerknecht points out, consists "almost entirely of military surgery," not religious rites in which cures were sought (49).
The wealth of Greek terms in modern medicine--among others the Hippocratic oath and such common words as "diagnosis"--suggest the extent of medicine's debt to Greek culture. The theory of personality that dominated medieval medicine rested on the idea of the four humors, which was adapted by Greek physicians (possibly by Empedocles, d. c. 433 B.C) from the older idea of the four elements (air, fire, water, earth). These were linked to the four humors. Blood, phlegm, yellow bile, and black bile were thought to originate in the heart, brain, liver, and spleen. The balance of these elements in the body related the individual's well-being--the microcosm--to the composition of the cosmos, the macrocosm. Connections between a person's fate and the four elements are made many times in Old and Middle English texts. We will see that important events, such as bloodletting or giving birth, were observed in conjunction with heavenly bodies.
Roman culture did not greatly alter the Greek foundations of medicine. The last great Greek authority was Galen (A.D. 130-201), who is credited with synthesizing hundreds of years of diverse teachings and practices into over twenty extant volumes. "There is a widespread prejudice against Galen," Ackerknecht writes, "because of the paralyzing role played by his writings in the medicine of the Middle Ages and early modern times" (73). Galen is particularly important because he dissected animal (not human) bodies and thus made "scientific" observation a central part of his writing.
Galen is credited with two ideas that exercised tremendous influence on later Western cultures. The first is a theory of the flow of blood, moving from the intestines to the liver and then to the heart or to the periphery of the body, an idea that survived until the English physician William Harvey (1578-1657) countered it (LINK 1). The second is the theory that female genitalia are exactly the same as male genitalia, but that they are inverted and internalized, so that women are "inverted, and hence less perfect, men" (Laqueur 26). (LINK 2) This term, "invert," also served to indicate homosexuals and appears frequently in nineteenth-century fiction.
Galen's theory of humors was central to his idea of disease or pathology, which followed a program of opposites (e.g., treating hot diseases with cold remedies), an idea of "curing by contraries" that entered Christian theology: vices were corrected by their opposing virtues. In the Irish penitential of Cummean (eighth century), the idea that "Contraries are cured by contraries" is described as a proverb. You can learn more about the use of medical metaphors like this in the Penance module.
Medieval authors frequently compiled extracts from classical works, including Galen's, mixing their sources as they did so (the technique is called compilatio; there is an essay on the topic by Martin Irvine in Speaking Two Languages, on reserve). Amid a host of physicians who wrote tracts on everything from gynecology to recipes for cures, two figures stand out: Pliny the Elder (first century), one of the few Roman authorities on medicine of lasting importance, and Isidore of Seville (early seventh century). Pliny's Natural History and Isidore's Etymologies both contain sections on medicine that were excerpted for centuries.
This vast textual background is entirely in Latin and Greek, and in Anglo-Saxon England the texts are thought to have been only in Latin. Medical writing in English does not appear until the late ninth century, indicating that up to this time (and of course after it) physicians in England were learned and probably therefore churchmen of some status. This matter of learning will be important in differentiating what is considered medicine from what is considered folklore, superstition, and magic.
Medical knowledge in England before the Norman Conquest was very highly developed, but such authorities as Ackerknecht would not agree. "Medieval medicine can be subdivided into two periods," he writes, the "Dark Ages" or "period of monastic medicine" the important of which "should not be overestimated," and the period of Arabic influence, which had begun already in the tenth century (Ackerknecht, 80-84). In 1130 monks were forbidden to practice medicine, which became the realm of secular clergy (that is, educated but not in monastic vows).
Dismissive assessments of Anglo-Saxon medicine as "barbaric" and dependent on magic rather than science are difficult to justify. The close association of magic and medicine in this and later periods cannot be denied, but it is also true that there was no clear idea of "science" operating in the period. Moreover, surveys of sources in Latin and Old English show that the Anglo-Saxons had access to a wide range of medical texts. At the beginning of the eighth century, when Bede was a young man, medicine had full standing among the scholarly disciplines (even though medicine is not usually listed among the "liberal arts").
What seems to doom Anglo-Saxon medical practice is not its link to magic but rather to Christianity, which caused the monks to be more interested in the soul than in the body. As you read some Anglo-Saxon texts with this statement in mind, you will find that it rings true. There is little attention to empirical matters--to practice or anatomy--and much attention to the moral causes of disease. Anglo-Saxon medicine looks primitive compared to its Greek roots for other reasons, of course. For example, classical texts often called for materials for recipes that the English sometimes did not have access to. To be fair, Ackerknecht (whose history we have relied on heavily here) notes that some authorities sought to compromise the division between physical and spiritual care. Hildegard of Bingen, a twelfth-century abbess argued that strong bodies better withstood the devil's temptations (Bingen is on the Rhine, west of Mainz, in Germany) (IMAGE01). We will see in the penitentials that her point was grasped earlier: people who were going to work had to eat, and their periods of fasting were adjusted according to their labors.
The place of Hildegard in this discussion raises the large question of women's role in this history of medicine. We have seen above and in LINK 2 that women's bodies were constructed as inferior versions of male bodies. But medical practice was not only something done to or on women; women also practiced medicine, and not only in the culturally "secondary" sense associated witchcraft. A woman physician at the University of Salerno, in Italy (southeast of Naples), known as Dame Trotule wrote several gynecological treatises in the eleventh century. Authorship of these texts was considered to have been male, however, although as late as the fourteenth century female authorship of important medical tracts was not considered implausible (Stuard 347-48). See LINK 8 for more discussion concerning women and medicine.
We have divided our discussion of the knowledge of medicine into two categories, direct and indirect: the latter are more numerous, since they are narrative accounts in which medicine enters in some form, usually by reference to bodily injury or disease or to the "medical metaphor". Direct sources are those used in the practice of medicine in the period or used to transmit medical learning; these sources are more difficult to study, since they are technical and, in the corpus of Old English, relatively rare. The major indirect sources are those by Asser and Bede; we will use them contextualize medicine as a subject, and then treat the direct sources.
A. Medical Knowledge in Bede and Asser
Bede's History of the English Church is the most important historical text from the early English period. The text contains no specific medical knowledge but makes many references to medical and surgical practice. For example, the physician Cynifrid performs an operation on the abbess Etheldrida before her death (she dies a few days later, however; see chapter 4:19) and Herebald, a bishop, calls in a physician to bandage a wound in his skull (274).
Bede also reports that John of Hexham saw a nun dying because a bloodletting wound in her arm had become infected (Book 5:3). (For the location of the monastery at Hexham, see IMAGE02.) John criticized those in charge because they had bled this nun on the wrong day of the moon, a striking instance of the Church's authority to regular medical practice and also an example of how the failure to obey religious authority was used to rationalize loss of life (LINK 3). It's an elaborate series of hierarchies--male and female, bishop and nun, medical expert (Theodore, the "doctor") and misguided novices (the monks and nuns; the "nurses").
Cures in Bede are miracles, even when physicians accomplish them. Bede also tells us that John found a young man from a village near the church at Hexham (near an oratory where the bishop used to pray). The young man was not only poor but had so many scabs on his head that little hair grew there; he was also dumb. The bishop built a little hut for him "in the enclosure of their dwelling," blessed his tongue, and taught the boy to speak. Having cured his dumbness, the bishop called for a physician to cure his scabbiness "with the help of the bishop's blessing and prayers," and this happened. "So the youth gained a clear complexion, ready speech, and beautiful curly hair, whereas he had once been ugly, destitute, and dumb" (Bede, Book 5, Ch. 2). Here is a combination of miraculous and medical intervention; the boy's cure requires both, but it clearly the "unloosing" of his tongue, the bishop's work which frees his mind, that takes priority over the physician's aid.
A peaceful and indeed pastoral illustration of how medicine operated in Anglo-Saxon life is Bede's account of the poet Caedmon, which ends with the poet's death in an infirmary or monastic hospital. See the Monastery and Monastic Life modules to learn more about the place of caring for the sick in this period. The lives of Ceolfrith and Leofgyth, as you will see below, generally conform to the image of medicine we find in Bede: not at all technical but rather entirely spiritual.
Asser's Life of King Alfred (d. 899), written c. 896, is a more informative indirect source. Asser describes the King's various illnesses, including the affliction that struck him on his wedding night in 868. After feasting "day and night," the king was overcome "by a sudden severe pain that was quite unknown to all physicians," certainly to those attending the wedding feast (88-89). Asser tells us that this illness added to the burdens of government (76), and that it continued to elude medical help from the king's 20th to his 40th year "and beyond" (89). Asser wrote this text while Alfred was still alive and obviously his treatment of the king's infirmities is discreet. But there is a scholarly controversy about his sickness that can teach us something important about the relation of the hero (any hero) to history. We learn something about the status of physicians here: they are guests at royal feast. (LINK 4)
Another important issue raised by Alfred's sickness is the relation of illness to sexual repression. That he was struck on his wedding night might suggest fear of sexuality. Indeed Asser tells us (Chapter 74) that before his marriage the king sought to control his carnal desires with prayer and asked that God send some illness to mortify his body. That is why, Asser says, Alfred contracted piles; the illness at the wedding replaces piles as the king's worst infirmity.
Lapidge and Keynes, translators of the Life of Alfred, suggest that Alfred was almost morbidly concerned with his health (255-56). At least we know that Alfred actively sought to increase medical learning in England, since Asser's text mentions a letter sent to the king by Elias that contain recipes for various illnesses. Elias was patriarch of Jerusalem (c. 879-907). We have supporting information for this connection to Elias from the Old English medical text known as Bald's Leechbook, which may have been compiled during Alfred's reign and which might, therefore, be concrete evidence of Alfred's interest in medicine. Irish pilgrims visited Alfred's court, the Anglo-Saxon Chronicle says, and were probably en route to Rome. The Navigation module discusses Augustine's journey from Rome to Canterbury in 596 (IMAGE03); Augustine and his retinue also stopped at various royal courts along the way, and that is perhaps what the Irish were doing. Thus, royal courts became points for the transfer and dissemination of knowledge, and England is easy to imagine as a point between Ireland and the East (LINK 5).
B. Direct Sources for Medical Knowledge in Old English
There are there central medical documents in Old English: Leechbook, Lacnunga, and the Old English version of the Latin Hebarium (Cameron, 1990: 5-6). The Leechbook is actually a three-part text. The first two parts are known as Bald's Leechbook--we don't know who Bald was, however--and were written near the end of the ninth century--that is, during Alfred's reign. The third part, which is anonymous, was written at about this time, possibly later, but, Cameron thinks, during Alfred's life. For the meaning of "leech" in this context--a meaning that continued to be valid into the present century--consult the Lexicon. You will find a guide to Chaucer's use of the term in LINK 10.
The Leechbook is filled with startling recipes for all manner of ailment. "If a man be over-virile," one entry reads, "boil water agrimony [a plant] in welsh ale [a brew]; he is to drink it at night, fasting. If a man be insufficiently virile, boil the same herb in milk; then you will excite it" (presumably excite him). The Leechbook also discusses "the time at which bloodletting is to be avoided, and at which to be allowed": no bloodletting for "a fortnight before Lammas [a harvest festival] for thirty-five days afterward, because then all poisonous things fly and injure men greatly." (Crossley-Holland, 273.) Disease, which could be caused by evil spirits (as with elfshot), was believed to travel through the air, so during this period people were told to stay in their houses. Certain minerals, such as jet, were thought to have power in detecting illnesses. The Leechbook tells us that Elias sent certain medical remedies to Alfred, including those for constipation, diarrhea, spleen disease, and other internal disorders. (See Keynes and Lapidge, 270 note 220 for further details; Leechbook, Book 2, Ch. 64.) Not surprisingly, scholars long regarded these materials as more magical than medical. See LINK 6.
The second chief source, Lacnunga, could be a century later. It is a collection of some 200 remedies, recipes, and charms; much of its contents derive from classical sources, although Irish (Celtic) influence is also present. Lacnunga is much closer, in scholarly eyes, to magic than it is to medicine; the text was dismissed by recent editors as "the last stage of a process that has left no legitimate successor, a final pathological disintegration of the great system of Greek medical thought" (Grattan and Singer, 94; note the ironic "pathological": who says scholars have no sense of humor?). In addition to the two chief texts, a third, the Herbarium describes the healing properties of plants (and another text, not in Old English, the Medicina de Quadrupedibus, describes those of animals. For further information about the nature of these texts, which are known as herbals, consult the works by Cameron and Kitson in the Bibliography.
Additional knowledge about medicine comes from charms, laws which explain compensation for injuries to parts of the body, and so-called "confessional prayers" in which certain sins are confessed according to the part of the body that committed them. A charm against bees requires one to take earth in the right hand, throw it under the right foot and say:
I have it underfoot. I have found it.
Behold! Earth avails against all kinds of creatures,
it avails against malice and evil jealousy
and against the mighty tongue of man.
When the bees swarm, the charm says to continue:
Alight, victorious women, alight on the earth!
Never turn wild and fly to the woods!
Be just as mindful of my benefit
as is every man of his food and his fatherland!
(quoted from Crossley-Holland, 271)
You can see that this charm addresses a practical problem: how to keep bees loyal (so to speak) to their owner; note also that the bees are worker or female bees. Bees are important links in our reading--we find them in this charm, in Scriftboc, and in other contexts in Old English literary and material culture. (LINK 7)
If you want to read some confessional prayers that seem to cross the borders of magic, medicine, and penance, consult the Penance module.
We can learn more about medicine from texts that treat the subject less directly--that is, closer to Bede's or Asser's discussions rather than to the Leechbooks. We take up three SEAFARER texts in which medicine is important--Ceolfrith, the Dream of the Rood, and Scriftboc, and three in which it is less prominent: Leofgyth, the Voyages and the Colloquy.
The Life of Ceolfrith
The chief medical relevance of this text is the pestilence referred to several times in the text (paragraphs 3, 13, and 14). In the first of these sections (3,13), the plague is simply accepted as a fact: it clearly killed a lot of people and created a crisis in monastic government. The third section suggests that the real significance of the disease is that it nearly wipes out the learned community, making the survival of learning precarious (the entire text is about the difficulty of establishing learned traditions in early Christian England). Other references--e.g., Benedict Biscop's and Sigefrith's illness (15, 17)--suggest no special medical significance but rather the effects of age, and this is true of Ceolfrith's death, too (32, 35). Care of the sick is important in this text (See 34). But is there a suggestion here that the monks try to cure the sick? Or is their task to relieve the suffering, or instead to pray for them? This is a good example of a text that takes medical facts for granted, even using them to develop its rhetorical points, but not supplying information that informs us about the details of caring for the sick.
The Dream of the Rood
This poem makes rich use of the medical metaphor likening the bodily physician to the priest: just as the former cured the diseases of the body, the latter cured the faults of the soul, and both exercise their healing power by causing pain: that is, just as physical remedies could hurt, the penance needed to heal the sins of the soul was also painful. the Dream links sins with wounds in the dreamer's analysis of his own condition (line 14: wounded with sin), and with this image introduced proceeds to associate the wounds on Christ's body with the sins of mankind.
In addition to this metaphorical treatment of medicine, which you can learn more about in the Penance module, the Dream also describes the process of crucifixion, although not in great detail. We know that the Cross (which narrates the second section of the poem) is covered in blood from Christ's wounds (line 48, line 62). The Cross shares Christ's sufferings (see l. 59 for example); at the same time the Cross is able to heal sinners who worship it (lines 85-86).
You will see, if you research scholarship on this poem, that discussions of the metaphorical aspect are far more common than analyses of the physical process of crucifixion, which was, in Roman culture, a common death for criminals. But note that in the poem the cross is also called a "gallows" (line 40), indicating that the instrument of death is a combination of traditional Christian and Germanic teaching. Criminals in Anglo-Saxon England were hanged; IMAGE04 shows a gallows clearly constructed from trees, explaining why the "tree" of the cross can be conflated with the "tree" of the gallows. For a considerably more graphic description of a medieval crucifixion, read the York Cycle crucifixion play in the Norton Anthology, a fifteenth-century example.
Scriftboc
This text is a very good source of information about how the Anglo-Saxons sought to regulate the body and how they regarded responsibility for physical well-being. One of the chief connections to medicine in the text is injury (which is also an important connection in legal texts). For example, we find: "Whoever wounds one of his kinsman or maims him, let him compensate for the injury and do his work until the wound heals, and pay the physician's fee to the physician and fast two fasting periods or three; if he does not know how he can pay the fee, he must fast twelve months" (17.03). We also find compensation in the next paragraph (17.04); the following (17.05) also concerns penalties for those who do bodily harm to others, in the latter case connecting the act to intention.
Certain provisions strike us humane and sensible; paragraph 26.07.0, for example, permits the sick to eat "at any time that he [or she] wishes." Paragraph 14.06.0, about "a woman [who] kills someone with her poisonous drugs," also makes practical sense. Some practices concern sexual relations; para. 15.11 concerns "a woman who drinks her husband's blood as a remedy." Other regulations aimed at women, such as para. 16.03, concerning a superstitious practice (burning grain) "to give health to living men and to the house." Para. 16.04 concerns food offered to devils (16.04) and is obviously intended to suppress magical practices.
Other sections of the Scriftboc are directly related to diet, not only to religious restrictions, but to sanitation. You should examine sections 23-26 in this regard, an extensive section that details various concerns about the purity of the water supply and the preparation of food for consumption. Note that some of these restrictions have their source in the Book of Leviticus and that their relevance to "lived experience" is therefore unclear. Some of these provisions might reflect social practice; others might be listed because they are supposed to be there--that is, for the sake of tradition.
Many of these sections in the Scriftboc concern female sexual practices that the Church tried to regulate. Abortion, which is likened to murder, is also a major issue. The Anglo-Saxons did not think that the foetus had a soul at conception but that the soul entered later. See LINK 8, which discusses women's medical practices.
The Life of Leofgyth
Here we have a good example of the medical metaphor. in Section 17 we learn that Boniface goes to Friesland to visit "with celestial medicine the people who were given over to pagan rites and lay sick with the disease of heathenism." Heathenism, like sin, is a disease; the archbishop is like the physician who heals them. The reference to "everlasting health" in Leofgyth's letter to Boniface (at the end of the text) is another example, although it merges physical and spiritual well-being. In this letter she refers to the "great infirmity" of her still-living mother and asks prayers for her. Although much in the text tells us about medical practice in this period, we know that Boniface wanted to leave Leofgyth in the care of Lull, the bishop of Mainz. There is a letter written in 754 by the bishop of Winchester, Cyneheard, asking Lull for medical books and noting that the books available to the English sometimes ask for ingredients not obtainable in England. (See Cameron, "The Sources," 137)
The Colloquy
The only medical information here would seem to concern food and diet (142 to the end); and of course references to beating at the start of the text (4-5), and to the sufferings of the plowman and other manual laborers (e.g., 11-21). The fisher is concerned about unclean fish (56) and about the danger created by whales for small boats (70); the former example has medical relevance related to the concern with "unclean foods" in the Scriftboc (see below).
The Voyages
Except for section 12, on diet, there is not much information on medical issues in this text; the technique of keeping the body cold after death, like that of cooling beer or other liquids (14) has potential medical importance, but it is not regarded in the context of physical well-being here.
In Link 1 above we discuss the relation of Galen's theory of the blood and the humors to the Knight's Tale. There are several ways to approach medical knowledge in the later medieval period and its impact on Chaucer. The most obvious is his Physician's Tale; others include the idea of the "malady of love" or the "pathology of love," which figures into the Knight's text as well as into Troilus and Criseyde.
We discuss the critical problems of the Physician's tale in LINK 9 . Here we discuss Chaucer's Physician himself as described in the General Prologue. This character is not a typical "medicus" or an ordinary "leche," since he holds an advanced degree, i.e., he is a "doctour" (A 411). Moreover, he is a doctor of both "phisik" and "surgerye." This is a significant detail: if the physician draws blood he cannot be a cleric but must instead be a layperson. Physic and surgery were distinct professions; the Church had forbidden clerics to practice any form of shedding blood (that is, of surgery). Surgery was not, as we have seen, the clinical procedure we know it to be. Surgeons were also barbers and in the later Middle Ages the barber-surgeon was a commonplace figure. The functions of barbering and surgery were only separated, according to the Oxford English Dictionary, in the sixteenth century (under Henry VIII).
The physician's portrait is equally rich in indications of magic in Chaucer's time and it explains why, in terms of medieval intellectual history, it is so difficult to separate "magic" from "medicine." The physician needs to know astronomy, because the stars were believed to influence bodily wellbeing. The four humors are essential to his practice (see lines 420-30 in the General Prologue). Hence the reference to "magyk natureel" (A 416) indicates approval of the physician's knowledge of the stars and not "black" or forbidden magic, as some critics have suggested.
Chaucer's portrait of the doctor has been put to several uses. The most traditional gesture is to use the portrait as an interpretive lens on the tale the physician tells, but this is a very confined gesture. Some think that Chaucer was satirizing a contemporary doctor (the same has been said about the portrait of the Sergeant of Law). But surely the most remarkable thing about the portrait in the Prologue is that it serves as a brief digest to medical knowledge in Chaucer's time, including the historical figures, Galen and others, whose teachings dominated fourteenth-century medicine (see lines 429-35). Another useful detail is the stress on diet for good health, a link to the portrait of the poor widow in the Nun's Priest's Tale.
Chaucer also makes many references to the "leech" or physician both literally and figuratively. Chaucer employs "leech" more often than "physician" in part because the former term allows more metaphorical range. His figurative references are not always religious. Although the Pardoner will refer to "Crist, that is oure soules leche" (916), we often find one lover called the "leche" of the other's soul (as in Troilus and Criseyde, Book 2:571 or 2:1066). (LINK 10)
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