Certain routines became standard. The committees appointed to co-ordinate public health measures began to remove the sick to leper houses beyond city limits (hence ‘lazaretto’ came to mean a plague hospital), while also establishing a system of exclusion, banning persons or goods from entering or leaving. Such measures were adopted throughout Italy. In 1377 Ragusa (Dubrovnik, Croatia) instituted a regular thirty-day isolation period on a nearby island for all arriving from plague-infected areas; in 1397 this was increased to forty, thus becoming a true quarantine (quarantenaria, forty days). Marseilles took similar action in 1383; Venice imposed quarantine measures in 1423; in 1464 Pisa followed and Genoa three years later.
Before the fifteenth century such health boards, composed of nobles and officials, were ad hoc creations. In Milan, however, a permanent magistracy ‘for the preservation of health’ was established around 1410, with (by 1450) a staff of a physician, surgeon, notary and barber, two horsemen, three footmen and, sensibly, two grave-diggers. Doctors acted not as full members of such boards but as advisers. Other Italian cities followed; in 1486, Venice appointed a permanent Commission of Public Health, consisting of three noblemen; Florence set up a similar commission of five in 1527, and Lucca one of three in 1549. Bills of Mortality were initiated in Milan, listing names and causes of death. Health Boards extended quarantines and the closing of borders, and health passes were introduced. In these respects, north European towns lagged behind Italy by more than a century.
The regulation of markets, streets, hospitals and cemeteries, the control of beggars, prostitutes and Jews – in short, public health measures – fell under the health boards. Resentment was expressed about their cost and powers, especially since economic disaster was almost inevitable once plague had been declared official, with commerce and travel suspended and markets closed.
Obliquely, therefore, medical practitioners became more involved in public administration. Midwives, too, performed policing functions. Laws required them to report illegitimate births, and to press unmarried mothers for the names of the father, so as to secure financial support for the babies. The oaths sworn by English midwives seeking a bishop’s licence included promises to extract the truth about paternity and to refuse requests for secret births.
MADNESS
Alongside leprosy and plague, another condition of public concern was insanity. Madness remained particularly disputed. On Galen’s authority, medical writers distinguished four main categories: frenzy, mania, melancholy and fatuity, each the result of a particular humoral imbalance. Folklore believed the moon caused lunacy; theology saw it as a consequence of diabolical possession or sorcery. Some viewed it as divinely inspired, perhaps involving the gift of tongues; others praised the innocence of the village idiot; while troubadours might sing of tragic love-madness.
Nor was there agreement over remedies. Some advocated drugs and bleeding to sedate the demented and evacuate peccant humours. Shock treatment might be tried, such as hurling a maniac into a river. For demoniacal possession, there was exorcism, while certain saints had the power to cure madness. Three shrines enjoyed a special reputation: St Mathurin at Larchant and St Acairius at Haspres (both in northern France), and St Dymphna at Geel in Flanders. A hospice built there to house the mentally ill proved too small and many were lodged in village households. From this a special ‘family colony’ developed, in which the mentally ill were tended by the villagers. The Geel community still exists.
Public attitudes towards the insane were mixed. German municipalities sometimes expelled idiots or insane persons, whipping them out of town – though the celebrated ‘ship of fools’ is not a reality but a literary conceit, symbolizing humanity’s follies. The insane were cared for in monasteries; various towns had madmen’s towers (Narrentürme); in Paris, special cells were set aside at the Hôtel Dieu; and the Teutonic Knights’ hospital at Elbing had a madhouse (Tollhaus). Specialized hospitals began to appear, notably under the influence of Islam in Spain: Granada (1365), Valencia (1407), Zaragoza (1425), Seville (1436), Barcelona (1481) and Toledo (1483). The priory of St Mary of Bethlehem in London, founded in 1247, was by 1403 housing six men ‘deprived of reason’; it developed into the notorious Bedlam. Such moves towards incarceration were counterbalanced by the image of the mad person as a holy fool, while in the ‘feast of fools’ medieval society came to terms with mental alienation through the carnival notion of the world turned upside down – madness as dionysian release.
The insane also became linked to witchcraft, with demonic possession serving as an explanation for deranged behaviour. Haunted by plague and heresy, the late medieval church warned against the Devil and his minions; women were considered particularly susceptible to Satan; and during the next 300 years the witch-craze seized Europe, leading to the execution, often after judicial torture, of upwards of 50,000 victims, mainly women (the figure of nine million burnings, often cited in feminist writings, is pure fantasy).
An individual of whom much is known is the English mystic, Margery Kempe (b. 1393). A wealthy woman who owned a brewery in King’s Lynn, she fell victim to puerperal insanity and began to behave oddly. Undertaking pilgrimages to Jerusalem, Rome and Spain, she described her spiritual experiences. The Book of Margery Kempe (c. 1423), perhaps the very first English autobiography, reveals the contested borderland between illness and religious experience. To some of her companions she was a sick woman, indeed a confounded nuisance with her non-stop wailings; to others, she was the mouthpiece of God – or was possessed by the Devil. ‘Many said’, she wrote,
there was never saint in heaven that cried as she did, and from that they concluded she had a devil within her which caused that crying. And this they said openly, amid much more evil talk. She took everything patiently for our Lord’s love, for she knew very well that the Jews said much worse of His own person than people did of her, and therefore she took it the more meekly.
WOMEN
Margery Kempe’s difficulties derived in part from perceptions of her gender; certain disorders were associated with women and their reproductive systems. Giving birth is depicted in medieval texts as an all-female business, the mother being supported by relatives, neighbours and a midwife. Midwives rose in status, as some town councils paid them to act in an official capacity in cases involving female illness, obstetrics and infant care. They were called upon to test for virginity or sterility, and to certify infant deaths.
A few obstetrical texts were directed to female readers, and male writers discussed gynaecological problems and prescribed remedies for female sexual disorders, advising not least on contraception. The Treasury of the Poor, ascribed to Peter of Spain (later Pope John XXI), gave over a hundred prescriptions concerning fertility, aphrodisiacs and contraceptives, presumably derived from popular tradition. Medical attitudes towards sex were far from puritanical, for sexual release was regarded as requisite for humoral balance, and female orgasm was widely believed essential for conception.
Female healers abounded, sometimes learning their craft from a male member of the family, and a few women wrote medical texts. Hildegard of Bingen (1098–1179), who had been put in a convent at the age of eight and began having religious visions soon after, practised medicine in her role as abbess of Rupertsberg. Her main work was the Liber simplicis medicinae (c. 1150–60) [Book of Simple Medicine], on the curative powers of herbs, stones and animals; she also wrote on the natural causes of diseases. These texts summarize traditional lore concerning the medical uses of animals, vegetables and minerals, advising treatments on the principle of opposites, while for terrible diseases like leprosy she commended exotic remedies involving unicorn liver and lion heart. Herbs were God’s gifts; either they would cure or the patients ‘will die for God did not will that they should be healed’.
Another acclaimed woman healer is more enigmatic. Obstetrical writings and other treatises of women’s disorders are attributed to a certain Trotula, said