04.09.07, Guardo, Los pronosticos medicos en la medicina medieval

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Jean Dangler

The Medieval Review baj9928.0409.007


Guardo, Alberto Alfonso. Los pronosticos medicos en la medicina medieval: el "Tractatus de Crisi et de Diebus Creticis" de Bernardo de Gordonio. Series: Linguistica y Filologia, vol. 54. Valladolid: Universidad de Valladolid, 2003. Pp. 514. ISBN: 84-8448-233-2.

Reviewed by:
Jean Dangler
Tulane University

Medieval Iberian healing is one of the richest areas of investigation in medieval studies, due in part to the numerous medical treatises composed on the peninsula, as well as to the far-reaching effects of medicine and healing in, for instance, the legal realm, the domestic sphere, and economics. Medieval medicine and healing have become increasingly popular topics during the last ten to fifteen years, as evidenced by the numerous articles and books on subjects as diverse as the Black Death, women's cosmetics, and Muslim and Jewish contributions to peninsular medical practice, by scholars such as Jon Arrizabalaga, Montserrat Cabré i Pairet, Luis García Ballester, and Michael McVaugh. In addition, researchers including María Teresa Herrera of the University of Salamanca and Enrique Montero Cartelle of the University of Valladolid have coordinated and composed a vast array of editions of medieval medical treatises. Also, numerous editions of treatises in Arabic, along with their translation into Castilian have been produced under the auspices of the Consejo Superior de Investigaciones Ciéntificas (CSIC). These medical treatises are available to modern scholars in three formats: transcriptions on microfiche or CD-ROM, Castilian translations, and at times English translations. Such formats make these works increasingly accessible to researchers without a specialty in Arabic, Latin, or Iberian studies.

Alberto Alonso Guardo's edition of Bernard of Gordon's late thirteenth-century Latin treatise on prognosis, Tractatus de crisi et diebus creticis, is a fine addition to this expanding corpus of medical works. The edition consists of the Latin treatise, as well as Alonso Guardo's translation into Castilian, which he hopes will make it more available to a broad audience of historians of medicine, historians of science, and other medievalists (9). Alonso Guardo divides the edition into six main sections: 1. "El autor y su entorno cultural" [The Author and His Cultural Milieu]; 2. "El Tractatus de crisi et de diebus creticis: una obra científico-didáctica" [The Tractatus de crisi et de diebus creticis: A Scientific-Didactic Work]; 3. "Tradición textual" [Textual Tradition]; 4. "Edición crítica, traducción y notas" [Critical Edition, Translation, and Notes]; 5. "Glosario e índices" [Glossary and Indexes]; and, 6. "Bibliografía" [Bibliography].

The critical edition is well organized, with one minor flaw. Since Iberomedievalists in general are not apt to be familiar with the De crisi (they probably know Gordon's wide-ranging treatise on health called the Lilium medicinae [Lilio de medicina]), I wish that Alonso Guardo had included early on a brief narrative about what the treatise entails. Waiting until page 32 of the second section for a general overview made it somewhat difficult to contextualize Alonso Guardo's introduction in section one. I would have liked to have known, for instance, that the aim of the De crisi was to teach physicians how to make correct prognoses of bodily illness. Additionally, it would have been useful to know the division of the treatise in five parts: 1. prognosis according to different diseases; 2. prognosis according to the seasons of the year, customs, age, region, winds, and complexion; 3. prognosis according to paroxysms (a severe attack or an increase in violence of a disease); 4. prognosis according to symptoms; and, 5. definition and types of crisis, as well as critical days. Alonso Guardo could have briefly presented a definition of critical days earlier in the edition, especially since he avers that the concept is crucial to understanding prognosis in the medieval world, which he ably explains in the second section (51-56). He defines critical days as those that generate a crisis of the disease with a positive result, such as days 4, 7, 11, and 14 of an illness (51).

Aside from this small structural lack, Alonso Guardo's initial studies and analyses are excellent. The first section on Bernard of Gordon provides a good introduction to his work in medicine at the medical faculty of the University of Montpellier from the end of the thirteenth century to the beginning of the fourteenth. It also clarifies the author's origins as likely from a French town, and not an English village (20). Alonso Guardo emphasizes the practical quality of Gordon's early treatises, which include the De crisi (21-23), but illuminates the notable differences between Gordon's early and later works, such as the tendency of the latter to be long, speculative, and poorly organized (27-28).

The second section examines the treatise itself, which was completed on January 25, 1295. Alonso Guardo details why the treatise would have been important to medieval medical students and physicians, citing Gordon's four reasons from the prologue of the De crisi. Aside from protecting a patient from future risks, a correct prognosis secured the patient's confidence in the physician, caused the doctor to build his reputation, and allowed him to apply the necessary treatments. Alonso Guardo further points out that the medical professor who taught ably the way to arrive at correct prognoses increased his own fame and attracted new students (33). Alonso Guardo rightly gives the reader a brief description of the medieval concept of disease (34-36), and lists the various ways that physicians made prognoses (36-37). His description and explanation of the contents of the treatise are admirable, and indeed serve to illuminate certain aspects that might otherwise appear odd to the modern reader, such as the fact that Gordon devotes the majority of the first part of his treatise to prognosis and fevers. Alonso Guardo explains the fixation on fevers with the importance of heat in medieval medical theories of the body; innate heat was charged with maintaining corporeal functions (41). Indeed, this point cannot be overstated, since scholars such as Katharine Park have suggested that in the Middle Ages heat constituted the main element that differentiated human bodies from one another; hence the physician's interest in fevers and corporeal imbalance.

Alonso Guardo explains that the De crisi derived from works on the same topic by Hippocrates and Galen, which were part of the curriculum at Montpellier (56-59). The last part of this second section is devoted to an analysis of Gordon's didactic style, and of linguistic concerns (59-72).

The third section on the textual tradition discusses manuscripts and editions. Alonso Guardo provides a useful list of the manuscripts he used in composing his critical edition, those he consulted, and those he did not use at all, totaling fifty-nine in all. He also describes the ten printed Latin editions of the fifteenth, sixteenth, and seventeenth centuries, and declares that the De crisi was translated into various languages, including Castilian (75-94). Medical scholars and philologists alike will find Alonso Guardo's discussion provocative of the division between two "families" of manuscripts and their variants. A noteworthy observation involves the concentration of variants in the second part of the manuscript (on prognoses according to seasons of the year, habits or customs, age, regions, winds, and complexion), which Alonso Guardo attributes to the non-technical character of natural philosophy. He believes that the second section of the De crisi was more susceptible to change because scribes who were untrained in medicine nevertheless were empowered to correct and amend material related to natural philosophy (95-96). While the explanation is intriguing, I wonder how it holds up in the face of the occasional overlap in the Middle Ages of medicine and natural philosophy. Alonso Guardo ends the third section with notes on the criteria used in creating the critical edition.

The fourth part of the book contains the treatise and its parallel translation. Alonso Guardo provides many Latin variants at the bottom of each page, and useful notes regarding sources and other concerns related to the Castilian translation. The book's fifth section consists of the helpful glossary on medication and medicinal substances, such as resins, plants, and breads, and of the word index for access to specific lexicon in the treatise. The bibliography constitutes the book's sixth and final part.

This critical edition is a fine contribution to the burgeoning field of medieval Iberian medicine and healing. Alsonso Guardo demonstrates that Bernard of Gordon's De crisi is fundamental to understanding medieval medical practice, and that it demands future scholarly attention. Gordon's work illustrates the complex ways in which disease, prognosis, and the body were formulated in the medieval period. His attention to the various factors associated with prognosis, that is, fevers, the non-naturals (forces that affected the body and caused corporeal imbalance, such as customs, habits, and geographical placement), paroxysms, symptoms, and critical days shows the breadth of medieval medicine's scope, and the range of knowledge that a late medieval physician was expected to possess.

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Jean Dangler

Tulane University