The Greatest Benefit to Mankind. Roy Porter

and each complaint acquired a particular saint. Supplanting the pagan Asclepius, Damian and Cosmas became the patron saints of medicine. Brothers living in Cilicia (Asia Minor) around the close of the third century, they became celebrated for their healing powers. Their martyrdom under Diocletian is stirring stuff: despite being burnt, stoned, crucified and sawn in half, they survived, perishing only after decapitation. The pair appear in the heraldry of barber-surgeon companies, and churches were dedicated to them, often claiming to house their remains in fine reliquaries. Their chief medical miracle credits them with the first transplant: they amputated a (white) man’s gangrenous leg and grafted in its place that of a dead Moor. In many paintings depicting this scene, the patient, with one leg white and one leg black, lies supine as the spectators stare awestruck upon the miracle.

      In addition to this pair, St Luke or St Michael might be called upon for all manner of illnesses, but other saints were specialists: St Anthony was invoked for erysipelas (St Anthony’s fire); St Artemis for genital afflictions, St Sebastian for pestilence. St Christopher dealt with epilepsy, St Roch protected against plague buboes (he had visited many sufferers on missions of mercy, fell sick himself, then was healed by an angel); St Blaise was good for goitre and other neck complaints, St Lawrence for backache, St Bernardine for the lungs, St Vitus for chorea (St Virus’s dance) and St Fiacre for sore arses. St Apollonia became the patron saint of toothache because all her teeth had been knocked out during her martyrdom, while St Margaret of Antioch was the patron of women in labour. Out walking, she had encountered a dragon, which swallowed her whole. In its stomach, she piously made the sign of the cross; this materialized into a real cross, growing until the dragon burst open, thus delivering the saint.

      Healing shrines developed a great range of relics, pious images and souvenirs. Some, like Bury St Edmunds or Rocquemadour in the south of France, attracted pilgrims by the thousand. The blood of St Thomas a Becket cured blindness, insanity, leprosy and deafness – and ensured Canterbury’s popularity. In Catholic Europe, many medieval shrines continue to this day.

      Certain diseases, for instance the much-feared epilepsy, assumed supernatural connotations and cures; Hippocrates would have turned in his grave! Treatments for the falling sickness involved a mishmash of folklore, humoral medicine, sorcery, pagan beliefs and pious healing. John of Gaddesden (1280–1349), physician to Edward II and compiler of the encyclopaedic Rosa anglica medicinae [The English Rose of Medicine], recommended reciting the gospel over an epileptic patient while bedecking him with peony and chrysanthemum amulets or the hair of a white dog. The folk conviction that mistletoe cured the falling sickness was given a sacred rationalization: keeping watch over his father’s flocks, the young King David saw a woman collapse in a fit. When he prayed for a remedy, an angel appeared to him, announcing, ‘Whoever wears the oak mistletoe in a finger ring on the right hand, so that the mistletoe touches the hand, will never again be bothered by the falling sickness.

      Mistletoe was also used in other ways against epilepsy. In central Europe, the stalk was hung round children’s necks to prevent seizures, while in Scandinavia countryfolk carried a knife with a handle cut from oak mistletoe. In the mid seventeenth century, the leading experimentalist and founder-member of the Royal Society, Robert Boyle, was still endorsing pulverized mistletoe: ‘as much as can be held on a sixpence coin, early in the morning, in black cherry juice, during several days around the full moon’. The pious Boyle believed in religious cures, but sought their scientific basis.

      HOSPITALS

      Medieval hospitals were religious foundations through and through. Those planted in the West had originally been small and mainly for pilgrims; their late medieval successors were often more impressive. St Leonard’s in York had 225 sick and poor in 1287; still larger were the civic hospitals of Milan, Siena and Paris. In Florence alone, a city of some 30,000 inhabitants, there were over thirty foundations by the fifteenth century. Some had only ten beds, others hundreds. In England hospitals and almshouses totalled almost five hundred by 1400, though few were of any size or significance. London’s St Bartholomew’s dates from 1123 and St Thomas’s from around 1215. At Bury St Edmunds six hospitals were endowed between 1150 and 1260 to cater for lepers, pilgrims, the infirm and the aged.

      Small hospitals were essentially hostels or hospices lacking resident medical assistance, but physicians were in attendance by 1231 at the Paris Hôtel Dieu, next to Notre Dame, and Sta Maria Nuova in Florence was gradually medicalized: from twelve beds in 1288 for ‘the sick and the poor’, this ‘first hospital among Christians’, as one Florentine patriot called it, expanded by 1500 to a medical staff of ten doctors, a pharmacist and several assistants, including female surgeons. Although catering largely for the indigent, it had eight private rooms ‘reserved for the sick of the higher classes’. Within hospital walls the Christian ethos was all-pervasive.

      In hospital expansion the Crusades played their part, since crusading orders such as the Knights of St John of Jerusalem (later the Knights of Malta), the Knights Templar, and the Teutonic Knights built hospitals throughout the Mediterranean and German-speaking lands. By the fourteenth century non-military brotherhoods, such as the Order of the Holy Spirit, were also running infirmaries from Alsace to Poland, while the Order of St John of God appeared in Spain in the sixteenth century, building insane asylums and putting up about 200 hospitals in the New World.

      LEARNED MEDICINE

      The great age of hospital building from around 1200 coincided with the flourishing of universities in Italy, Spain, France and England, sustained by the new wealth and confidence of the High Middle Ages. Paris was founded in 1110; Bologna in 1158; Oxford in 1167, Montpellier in 1181, Cambridge in 1209, Padua in 1222 and Naples in 1224. The universities extended the work of Salerno in medical education. By the 1230s Montpellier was drawing medical students from afar; there, as in Paris, Bologna, Oxford and other centres, medical teaching initially developed informally, but teachers later banded themselves into an official faculty.

      There were some differences between the clerically dominated universities of the north like Paris, Cologne and Oxford, where the theology faculty was supreme, and the more secular ones of Montpellier and Italy, where arts and law faculties led; but all had much in common. The Bachelor of Medicine (MB) took around seven years of study, including a preliminary Arts training; a medical doctorate (MD) was awarded after around ten years’ study. Hence there were hardly swarms of medical students: Bologna granted 65 degrees in medicine and only one in surgery between 1419 and 1434; Turin a mere 13 between 1426 and 1462. The single big school and true centre of excellence was Padua, where medical students comprised one tenth of the student population. Its medical faculty was unusually large, numbering 16 in 1436 – Oxford had only a single MD teaching.

      Following the model established in universities at large, medical education was based on set books, usually parts of the Articella and Avicenna’s Canon, expounded in lectures. It was also heavily influenced by the new Aristotelianism associated with Thomas Aquinas (1226–74) and Albertus Magnus (1200–80). A Dominican monk who taught at the new university of Cologne, Albert was wrongly credited with many medicinal recipes and occult treatises, as well as with the De secretis mulierum [On the Secrets of Women], all of which blocked his canonization until 1931.

      After perhaps seven years’ study beyond the Arts degree, doctoral graduation rested on having attended the requisite lectures, disputations and oral examinations and – at some universities, including Bologna and Paris – on having worked under a physician (such clinical experience had to be acquired extra-murally). From about 1300 at Bologna and a generation later at Montpellier, university requirements further demanded that students attend a dissection, to supplement traditional anatomical lessons on dead animals. The academic justification of a medical education lay in the acquisition of rational knowledge (scientia) within a natural philosophical framework. Medical professors aimed to prove that their discipline formed a noble chapel of the temple of science and philosophy; the learned physician who knew the reasons for things would not be mistaken for the hireling with a knack for healing.

      Renaissance humanists and subsequent historians have sneered at medieval academic medicine for its Galenolatry and its abstract disputation topics (‘Can sleep be harmful?’).