The Liber Ysagogarum also broadened and gave greater prominence to the Galenic idea of the ‘six non-naturals’ – food and drink, environment, sleep, exercise, evacuations (including sexual) and state of mind; by regulating these, natural body balance could be preserved in the medical analogue to monastic rule. Stressing regimen, the non-naturals set the mould for medieval therapeutics, particularly in popular health books emanating from Salerno. The Regimen sanitatis salernitanum [Salernitan Regime of Health], a book of verses probably compiled in the thirteenth century and sometimes credited to Arnald of Villanova (1240–1311), supplied tips for healthy living from youth to old age, highlighting hygiene, exercise, diet and temperance. The first of the home health manuals, its enduring popularity is shown by the number of later printed editions: some 240 versions in Latin and other European languages, as well as Hebrew and Persian. And no wonder, since it was simple and even entertaining in its advocacy, alongside Galenic venesection, of Drs Quiet, Diet and Merryman.*
Salernitan translations and teachings created a new canon of medical authority known as the Articella [Little Art of Medicine], which included the Liber Ysagogarum and Hippocrates’ Aphorisms and Prognostic, supplemented by Galen’s Tegni and the Hippocratic On Regimen in Acute Diseases in a translation by Gerard of Cremona (fl. 1150–87). Rapidly becoming canonical, the Articella or Ars medicinae marked a turning point in the revival of medicine in the West. It combined translations from Greek and Arabic; it was concerned with theory, providing a basis of philosophical knowledge organized around key themes; its discussions set medicine within a wider conception of nature; and its Aristotelian orientation appealed to university scholastics. Not least, the Articella gave medicine a distinctly Galenic complexion. Pre-Salernitan compendia had included texts drawn from the Methodist as well as the Hippocratic tradition; Galen had not eclipsed all others. But the Articella texts were wholly Galenic: a proper doctor could thenceforth be defined as a man who knew his Galen.
Learned medicine continued to develop, thanks to the rise of universities (discussed below) and further access to scholarship via translation. The business of Latin translation proceeded through several stages. The first, the Salernitan, involved both Greek and Arabic texts. From the 1140s, there was a great outpouring of Latin translations from Arabic made in Muslim Spain, sometimes by way of Hebrew intermediaries. This development, which included philosophical texts, especially Aristotle, as well as medical, was led by Gerard of Cremona. Settling in Toledo, he translated an incredible quantity of material from Arabic – twenty-four works on medicine alone, including the Qanun of Avicenna, the Liber Almansorius of Rhazes (al-Razi), the last part of Albucasis’ De cirurgia, the Ars parva and other works of Galen, and the Commentary on Galen’s Art of Medicine by Haly Rodoan (Ali-ibn Ridwan). The Qanun or Canon of Medicine became the cornerstone of the medical curriculum at the University of Montpellier, remaining a textbook there until 1650! These translations created a richer terminology for learned medicine in Latin and provided Galenic medicine with a logical backbone. Medicine could now speak the language of scholasticism.
A century later there came a further burst of translations, mainly in Spain and Italy, latinizing other major works of Arabic science. These included the Continens [All-Embracing Book] of al-Razi (trans. 1282); and the Colliget [The Book of Universals] of Ibn Rushd, translated in Padua in 1283. The key figure in this drive was Arnald of Villanova. After studying medicine at Montpellier, he became a teacher and a polymath. Not only a translator of medical works, he was physician to the popes and the Aragonese royal family in Spain; later in life, he pored over theology, propounding heterodox ideas – his astrological computations predicted the world would end in 1378. As a theoretician, Arnaud aspired to rationalize Galenic medical theory with mathematical precision, by drawing on Arabic writers, notably al-Kindi and Averroës.
His Italian contemporary Pietro d’Abano (1257-c. 1315) made versions directly from Greek manuscripts he had carried back from Constantinople, including the beginning of a translation of Galen’s On the Use of the Parts of the Body. Niccolò da Reggio (fl. 1315–48) translated over fifty Galenic writings, many for the first time, including the entire text of that work. There was also translation from Latin into the vernacular, in growing demand when town life was reviving and courts and burghers were hungry for knowledge. The Surgery of John of Arderne (c. 1307–70), discussed below, exists in both Latin and English versions, and Bartholomew the Englishman’s (d. 1260) De proprietatibus rerum (1246) [On the Properties of Things] also enjoyed wide circulation in both tongues. Parts of the Articella were made available in French and English, and even in Welsh and Gaelic. For a couple of centuries, the translation movement had no less momentous consequences in Europe than in Islam, bolstering the prestige of antiquity and canonizing a Galenic medicine set in an arabized Aristotelian framework. Medical knowledge was buttressed not just by its classical heritage but by its place within the divine scheme of Christianity.
RELIGION
Medicine and religion intersected at many points. Conventional histories of medicine still retail the view that the Church arrested medical progress, for instance, by supposedly banning dissection. Some ecclesiastics did indeed disparage medicine – St Bernard of Clairvaux (1090–1153) asserted that ‘to consult physicians and take medicines befits not religion and is contrary to purity’ – and it was a popular gibe that ubi tres physici, ibi duo athei (where there are three doctors, there are two atheists); but in general such judgments miss the mark. Medieval hospitals have been criticized for their religious ethos, but without the Christian virtue of charity would such hospitals have existed at all?
The Church’s position was clear: the divine was above the temporal. Sometimes the Lord’s will was to punish sinners with plagues; sometimes it was man’s duty to preserve life and health, for the glory of God and the salvation of souls. But the body was to be subordinated to the soul, and healing, like every other temporal activity, had to be under ecclesiastical regulation. Thus in the case of the dying, it was more important that they should be blessed by a priest than bled by a doctor. Concern for salvation occasionally led to suspicions being voiced against Jewish doctors: the Lateran Council of 1215 forbade practitioners not approved by the Church from attending the sick, but this applied only on paper, for the highly valued Jewish doctors were everywhere, especially in Spain.
Monks and clerics, for long the only body of learned men, commonly practised medicine, while in the northern European universities medical students often entered minor holy orders. Petrus Hispanus (Peter of Spain c. 1210–77), whose Thesaurus pauperum [Treasury of the Poor] was popular despite its recommendation of pig shit to stanch nosebleeds, even became Pope in 1276 as John XXI. (He died a year later when the roof of a palace he had built collapsed; one trusts he was a better doctor than architect.) Various ecclesiastical regulations were passed covering medicine; the aim was not to curb it but to uphold the Church’s dignity and prevent clerics developing lucrative sidelines which would seduce them from holy poverty and divine service. Thus when the Lateran Council of 1215 forbade clerics in higher orders from shedding blood, this was not (as often interpreted) an attack on surgery: it aimed, not unlike the Hippocratic oath, to detach the clergy from a manual and bloody craft. Clerics could continue to practise healing but not for gain. Nor did the Church authorities prohibit dissection: in 1482 Pope Sixtus IV informed the University of Tübingen that, provided the body came from an executed criminal and was finally given a Christian burial, there was no objection to human anatomy.
The Benedictine rule states that ‘the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them’; hence it is no surprise that monasteries became key medical centres, more important than universities prior to 1300. As well as offering shelter for pilgrims, most had an infirmary (infirmarium) for sick monks. Separate hospital facilities were founded for the general public.
Healing shrines flourished, and scores of saints were invoked – rather as in Egyptian medicine, each organ of the body and each complaint acquired a particular