Millennium Page 7

  Medicine

  One branch of twelfth-century scholarship that did have a direct effect on people was medicine. Of course, medicine itself was not new. There had been physicians in the ancient world, and medical ideas had been transmitted in numerous forms down the centuries. Anglo-Saxon leechbooks’ and their continental equivalents were available, and so were herbals. Hrabanus Maurus included a chapter on medicine in his encyclopedia, and the seventh-century writer Isidore of Seville inserted a dozen or so texts by the second-century physician Galen into his compendium of knowledge. But there was no systematically arranged corpus of medical texts. There were very few physicians, and no surgeons as such. Nor was there any formal medical education. Moreover, there was a belief that medical intervention was an attempt to undo God’s work. Early medieval Christian writers such as Gregory of Tours had stressed the immorality of medicine, as physicians sought to change God’s judgement. He gave examples of men and women being rightly punished for seeking medical help – and others being cured miraculously with holy oil after physicians had failed. That such views persevered into the early twelfth century is evident from Bernard of Clairvaux’s statement that ‘to consult physicians and take medicines befits not religion and is contrary to purity’.10

  The apparent harshness of Bernard’s view is perhaps more understandable if we look at some of the medical strategies adopted in the tenth and eleventh centuries and realise that superstition played a major role in medicine. Recipes for medicines, for example, often called for excrement or the body parts of animals to be included, together with incantations and charms. One example, taken from an Anglo-Saxon leechbook, must suffice here:

  Against cancer, take goats’ gall and honey, mingle together both of equal quantities, and apply to the wound. [Alternatively] burn a fresh hound’s head to ashes, and apply them to the wound. If the wound will not give way to that, take a man’s dung, dry it thoroughly, rub it to dust and apply it. If with this you are not able to cure him, you will not be able to do so by any means.11

  In this context, Bernard’s statement that medicine is ‘contrary to purity’ makes perfect sense.

  The contribution of the twelfth century to medicine was that of systemising knowledge, introducing more scientific approaches, teaching medical and surgical techniques and, most of all, eradicating many of the superstitions that had hitherto pervaded the discipline. It is true that a large dose of astrology remained wrapped up in the medical corpus, but this too was now systemised and treated as a science, replacing the incantations and charms that had previously characterised medical treatments.

  There were some home-grown monastic advances in medical knowledge in the twelfth century. The substantial compilation of medical recipes by Abbess Hildegard von Bingen is a prime example, even if it is not as famous as her music. However, most of the new methods that became available in the West were imports from the Arab world, including works both by the ancient Greek physicians Hippocrates and Galen, and by the influential Arabic medical practitioners who had built on their work, namely Avicenna, Rhazes, Albucasis and Johannitius. Hippocrates, the ‘father of medicine’, was a fifth-century BC physician known for a corpus of medical writings; even today the Hippocratic Oath is sworn, in a modified form, by most newly qualified doctors. Galen, who lived in the second century AD, extended Hippocrates’ understanding of the theory of the four humours: black bile, yellow bile, blood and phlegm. Only by keeping these humours in balance could you maintain good health. About 17 of his minor works were available in Latin in the eleventh century, but dozens more were translated in the twelfth.12 Avicenna was an eleventh-century Islamic scholar who had absorbed Galen and Hippocrates’ works and synthesised an encyclopedia of medical writing in five volumes, entitled The Canon of Medicine. This was translated by Gerard of Cremona and proved a most enduring educational textbook, providing the basis of medical understanding at the famous Montpellier medical school until 1650. Rhazes, a Persian physician who died in the tenth century, was responsible for a huge number of medical books, including two important medical encyclopedias (The book of medicine dedicated to Mansur and The comprehensive book of medicine), works on specific diseases, and a general critique of Galen. Albucasis was the pre-eminent Arabic writer on surgery. Johannitius had translated 129 works by Galen into Arabic, thereby saving them for posterity. In addition, he wrote an influential introduction to the ancient physician’s works, which was translated into Latin as the Isagoge.

  These translations meshed with the development of systematic medical education. By 1100, the city of Salerno in southern Italy already had a reputation for medical teaching, thanks largely to the initiative of its bishop, Alphanus, who was able to draw on the work of Constantine the African, from Tunis, who had translated a large number of important medical treatises in the late eleventh century. In the first half of the twelfth century a syllabus for medical students was assembled in Salerno. Called the Articella, it consisted of the Isagoge, Hippocrates’ Aphorisms and his Prognostics, Theophilus’s On urines and Philaretus’s On pulses; by 1190, Galen’s Tegni had been added to this list. Those who qualified in Salerno could expect lucrative employment in the royal households of Europe. But lesser lords too could take advantage of the presence of medical men at court: as John of Salisbury declared, physicians ‘have only two maxims that they never violate: never mind the poor and never refuse money from the rich’.13 For the less well off, methods of maintaining good health – regimens – were soon devised and taught at Salerno, and circulated in the form of poems and advisory texts. Thus, whereas in 1100 hardly anyone was sufficiently well versed in medical texts to take responsibility for understanding and treating diseases, by 1200 there was a small but growing cadre of qualified physicians who professed to know the systems that governed the health of the body, and would treat the few who could afford their services.

  The skill of the surgeon advanced in tandem with these developments in medicine. At the start of the century, Western surgery amounted to little more than letting blood, cauterising corrupt flesh with a hot iron, draining swellings, binding broken limbs with bandages, dressing wounds and burns with herbs, and amputating gangrenous and cancerous limbs. In moving beyond this, the Christian encounter with Jews and Muslims in the Holy Land was important, as soldiers and pilgrims were ministered to by physicians of all religions and nationalities. One famous account tells of a Syrian physician who treated a knight with an abscess in his leg and a woman troubled with a fever. To the knight’s leg he applied a small cataplasm, and the wound started to heal. The woman was similarly recovering through his ministrations (which were largely dietary) when a Christian physician took over their care, refusing to accept that a Syrian could possibly help them. This physician now asked the knight whether he would rather live with one leg or die with two. On being given the obvious answer, he called for an axe and had the man’s leg chopped off. It took a couple of blows, ‘which caused the marrow to flow from the bone, and the patient died immediately’. As for the woman, after she too was treated by the Christian physician, she returned to her old diet and fell ill again, with a rising fever. When he saw her condition had deteriorated, the physician cut a cross in her scalp through to the bone and rubbed in salt. Unsurprisingly, she too died soon afterwards.14 Whatever the truth of these cases, it is clear that in the Holy Land, where Islamic and Christian physicians and surgeons attended the same patients, the more systematic approach of the Arabs made an impression.

  Surgery also made advances through education. The translations of Rhazes, Albucasis and Avicenna led to the collection by 1170 of a corpus of chirurgical, or surgical, knowledge. The works of Albucasis in particular showed the instruments necessary for the performance of operations, so that surgeons could do more than merely dress wounds and amputate limbs. By this time surgery was being taught as a distinct art not only at Salerno but also in northern Italy, most notably by Roger Frugardi. In his Practica chirurgiae, edited by his pupil Guido Aretino around 1180, surger
y was presented for the first time by a Western writer as a systematic science.

  Pharmacy, the third of the medical sciences, also came to be studied in southern Europe in the twelfth century. Some medical recipes had been prescribed since ancient times: autumn crocus, for example, had been known for centuries to give relief from gout. But the herbals of the previous centuries presented relatively few effective remedies. Once again, it was the Arab polymaths who changed this. Gerard of Cremona’s translation of Avicenna’s Canon of Medicine proved particularly valuable in laying out a theory of pharmacy, employing not only herbs but also minerals. Today we still use Arabic words such as ‘alcohol’, ‘alkali’, ‘alchemy’ and ‘elixir’, which indicate the depth of Arabic influence on our scientific common knowledge. By 1200, Latin writers were compiling their own pharmacopoeias. The Antidotarium Nicolai was put together about this time, probably at Salerno. This also showed a medicinal response to ailments that was stripped of superstition, incantations and charms. And because much of this knowledge had been translated from Arabic, like many of the other medical texts it was relatively free of Christian dogma too.

  As we will see throughout this book, the medicalisation of Western society took place in numerous stages. In 1100, there were very few practitioners of medicine in Europe, but by 1200, there were hundreds who had the expertise to relieve sickness or injuries – or were believed to have such knowledge. Of course, only a tiny fraction of the population would have been able to afford their services; nevertheless, the twelfth century marks the start of the process by which men and women came to trust their fellow human beings rather than God with their physical salvation, and systematically employed medical strategies to cope with sickness rather than relying on prayer or magic. Overall, this has to be counted as one of the most profound changes under consideration in this book.

  The rule of law

  In the previous century, the law had been a patchwork across Europe. Some Italian city states preserved corrupted versions of the old civil law of the Roman Empire, otherwise known as Roman law. Others had adopted Lombard feudal law. In the north, old Frankish and Germanic tribal laws were maintained. There was no such thing as statute law, still less international law. Law codes were also subject to considerable local variation: so few people could read that the laws were not distributed in written form, and judges therefore relied on memory – and their own opinions. When England was conquered in 1066–71, the law of the land changed only in part to reflect the feudal Norman law, while some of the old ‘dooms’ (laws) and customs of the Anglo-Saxons were retained. In some places a jury would be empanelled to hear a case; in others the accused might have to undergo an ordeal – trial by water (being bound and thrown into a river), trial by fire (being forced to carry a red-hot iron) or trial by battle (a straightforward combat). Trial by battle was also sometimes used to decide between two opposing parties in a legal case, such as a dispute over the ownership of land. Even the law governing the Church – canon law – existed in regional variations, as local bishops drew up compilations of those restrictions that they felt should apply in their dioceses. Given this messy situation, it should not surprise us that the law was not properly studied: there was no jurisprudence.

  Things began to change at the end of the eleventh century in northern Italy. Long-distance trade between city states required a form of law that was robust and standardised. By 1076, a copy of the Digest, a compendium of the best jurisprudence from the old Roman Empire, had resurfaced in Bologna. It was only part of a larger body of legal writing on Roman law, the Corpus Juris Civilis, which had been drawn together under the command of Justinian, the sixth-century Byzantine emperor. But before long, the whole Corpus had been identified and was being studied. In the early twelfth century, Irnerius, a brilliant exponent of the law at Bologna, explained to his students the meaning of each part of the Corpus through a series of glosses and commentaries. In addition, he wrote a series of Questions on the subtleties of the law, and thereby encouraged debate about the apparent contradictions in the legal authorities. In the next generation, a group of men known to historians as the Glossators carried on his work, constantly revising the Digest to give it relevance to twelfth-century society. Bologna’s law school consequently grew in fame and importance, and in 1155, an imperial decree placed it under the emperor’s protection. Irnerius’s legacy was not only the establishment of Bologna as the major centre for the study of the law but also the revival of jurisprudence throughout the Mediterranean and the southern part of the Holy Roman Empire. By the end of the century, Roman law was starting to become the international legal language of continental Europe.

  About the year 1140, a monk called Gratian, who had almost certainly lectured at Bologna, compiled a definitive collection of canons – laws on subjects that fell under the authority of the Church. The result, formally entitled A concord of discordant canons but more popularly called the Decretum, was an attempt to reconcile the differences in major canon collections circulating in Europe. In doing so, he adopted Peter Abelard’s dialectical method, first displayed in Sic et non, listing the differences and providing the arguments for and against each interpretation. Soon the Decretum was widely accepted as the basic authority on canon law, and it began to be extended by the decretals or religious laws of the popes, especially those of Pope Alexander III, who held the apostolic see from 1159 to 1181. The importance of this for the whole of Christendom cannot be overestimated: one set of laws now governed the whole Church and every person in it. For canon law was not only concerned with the rules of the clergy (such as simony and clerical marriage) and crimes committed by clergymen; it also regulated the moral behaviour of every Christian – his or her sexual conduct; commercial relations and work; fraud, bribery and forgery; baptism, marriage and burial; holy days, the writing of wills and the swearing of oaths. No one was outside the scope of canon law.

  In addition to Roman law and canon law, the twelfth century saw the introduction of legislation. In this the papacy again provided the inspiration. If, acting like a head of state, the pope issued decretals that laid down the law for all his ‘subjects’, then kings could do likewise. The emperor Frederick Barbarossa issued statutes for the maintenance of the peace from 1152, and the kings of France and the counts of Flanders were similarly promulgating statutes by the end of the century. One particular result was that the death penalty became more common. The message was simple: obey the law or die.

  England took a different path. Vacarius, an expert in Roman law, was brought to the country by the archbishop of Canterbury in 1143, but King Stephen felt that this new sort of law was a threat to the royal prerogative and silenced him. Thus the old Anglo-Saxon dooms and customs were maintained, supplemented by Norman law. But the law in England did not stand still for long. The next king, Henry II, revolutionised it through administrative acts of the royal council. In 1164, the Constitutions of Clarendon defined the border between the jurisdictions of temporal (that is, secular) and ecclesiastical courts. Two years later, the Assize of Clarendon was issued, requiring the sheriffs in each county to enquire as to who had committed murder, robbery and theft since the king had come to the throne in 1154, and who might be harbouring the criminals who had carried out these acts. Regardless of individual lords’ privileges and local customs, these perpetrators were to be rounded up, juries were empanelled, and the accused were forced to undergo trial by water. This was the first time that England as a whole had been required to assemble juries to report on crimes. Royal judges toured the country to give judgement on cases in the assize courts. In the assize of Northampton in 1176, Henry II added further crimes for sheriffs to search out and punish: counterfeiting, forgery and arson. He also set up a system whereby judges would travel on six ‘circuits’ of the kingdom and try all the felons apprehended by the local authorities, marking the origin of modern circuit judges. Royal coroners were to confiscate the chattels of the guilty on behalf of the Crown. By the end of the century sheriffs presided
over courts in every county, as did lords of manors and hundreds. There were also central courts for the administration of justice at Westminster, where private citizens could take legal action against each other. This judicial revolution provided the context for Ranulph de Glanvill’s Treatise on the laws and customs of the kingdom of England of about 1188, the first work on what would later become the common law of England and, in due course, the foundation law of the United States, Canada, Australia and New Zealand.

  Conclusion

  The question of change in the twelfth century reveals starkly how relative our historical perceptions are. If you were able to ask a twelfth-century man about the most important event of his time, his answer would probably be the loss of Jerusalem to Saladin in 1187. It was a landmark in the relationship between Christians and God: a crisis of confidence for those who believed God would always favour the Christian cause. But from our point of view, the loss of Jerusalem and the Third Crusade that followed are of limited significance. So too are most of the technological discoveries of the age. Mariners might have started to use the magnetic compass (first described by Alexander Neckham in this century) and the astrolabe, but no great geographical discoveries were made. The use of these instruments remained very restricted.