One of the most difficult tasks in teaching medieval medicine is finding a way to accurately portray medical practice for students in the face of the overwhelmingly theoretical thrust of the surviving evidence. Many teachers of medieval medicine (this reviewer included) in the Anglophone world have tried to create a balance between theory and practice by pairing a textbook like Nancy Siraisi's Medieval and Early Renaissance Medicine (1990) with primary sources in translation, such as those published in Faith Wallis's recent Medieval Medicine: A Reader (2010), that preserve (we hope) evidence of actual practice. However, most of the documents in that latter volume are also theoretical in nature and representative more of intellectual history than of the history of healing. With Medieval Medicine: The Art of Healing, from Head to Toe, Luke Demaitre has gone some way toward alleviating this difficulty for teachers and scholars, producing a survey of medieval medicine that shows how medical theory was understood, employed, and modified by medical authors and practitioners. To do this, Demaitre bases his survey of medieval medicine on a dozen Latin medical manuals written between the eleventh and fifteenth centuries by authors in England, France, and Italy (as compared to Siraisi's survey, based mostly on later medieval Italian physicians), and can thereby demonstrate the small, but important, differences between individual medical authors and practitioners.
Medieval Medicine shares the topics and methods of Demaitre's earlier monographs. Bernard de Gordon's Lilium medicine, the subject of his first book, [1] features prominently among the authors of medical manuals employed for the survey. And the meticulous analysis of the words and definitions used by medieval physicians and philosophers in Latin and the vernacular, seen in Demaitre's Leprosy in Premodern Medicine, [2] is likewise evident in his Medieval Medicine. In every chapter he unpacks the variable meanings and multiple valences of medical terms in Latin and the vernacular, constantly demonstrating his conviction that in the absence of material survivals we must necessarily employ such linguistic analyses. In this, his newest book, Demaitre does not shy away from the theoretical models and Latin terminology seen in his earlier works, while still keeping in mind the student or novice scholar of medieval medicine, as witnessed by his translations of passages from the manuals, many made for the first time in English, or in his clear definitions of key medical terms like complexio, krasis, anddiscrasia. Comparisons between medieval encyclopedic texts and Wikipedia or between medieval theories and modern medical concepts (e.g. allopathic and homeopathic, or the medieval influence on the modern names "acute rheumatic fever" and "Query fever") also provide students with familiar beacons in the strange land of medieval medicine.
The value and appeal of Demaitre's Medieval Medicine lies, somewhat paradoxically, in his refusal to cover the entire Middle Ages, or every type of practitioner, method, or malady. Rather, he employs one important genre in a pivotal period to provide a snapshot of the mainstream of literate medicine in Western Europe. Researchers interested in other practitioners, such as women, the illiterate, or Jews will have to look elsewhere. Demaitre carefully defines his selected genre of medical manuals as comprehensive and practical handbooks on the body and its afflictions, guided by scholastic medical theory but not blindly following it. The practical medical manual is distinguished from surgical manuals, scholastic commentaries and summae, and the numerous extant medieval recipe books (though clearly practical in focus), all of which Demaitre consciously excludes from his study. He also ignores the addenda made to many of these manuals, which variously cover antidotes, dietetics, surgery, cosmetics, and travel advice. It should be clear that this book hardly provides a complete survey of "The Art of Healing," as suggested by the title, but rather a representative snapshot of one tradition of healing. The authors of these medical manuals belonged to the Latinate and scholastic tradition (portrayed nicely in several of the illustrations) yet, as Demaitre stresses, they were also active practitioners or the teachers of practitioners. Their manuals allow us to bridge the gap between the teaching of medicine, in which organs and humors serve more as explanatory devices, or mental grids overlaid with elements and qualities, and the practice performed on them as biological realities. Demaitre also emphasizes the originality (within limits) of these medical authors: while all quote the same Hippocratic works, their respective analyses of his enigmatic aphorisms, for example, show great variety. Nonetheless, most of these authors also believed, with Hippocrates, that experience is misleading and frequently allowed their practice to yield to authority.
In his first two chapters Demaitre provides the historical, institutional, and theoretical backgrounds to the many examples in his later chapters. In Chapter 1, "Learning to Heal," he repeats the master narrative of learned medicine being transferred and modified from the works of Hippocrates and Galen, to Avicenna and Constantinus Africanus, and to their medieval scholastic disciples, but he nonetheless emphasizes that this book learning formed the foundation of practice and that physicians like Arnau de Vilanova prove in their writings the practical aims of their theoretical discussions. He usefully employs Chaucer's description of the Physician as a touchstone in his outline of later medieval medical knowledge and practice, particularly because about half of Chaucer's named medical authorities wrote the medical compendia used by Demaitre. Novel in Demaitre's treatment of this narrative is its culmination in the medical compendia of the central and later Middle Ages, from the early Italians Gariopontus and Constantinus, to their later medieval heirs Gilbertus Anglicus, Bernard de Gordon, and Valesco de Tharanta. I would have liked an entire chapter (as opposed to eight pages) on these and the other medical authors whom Demaitre used for his survey, but doing so might have put off the broad readership sought by Praeger in their "Series on the Middle Ages." Chapter 2, "Paradigms of Disease: Fever, Pestilence, and Poison," is probably the most difficult, but also the most important, chapter. A firm grasp of medieval ideas about fever, understood as an umbrella term for a variety of specific diseases and not simply as a symptom, is necessary for understanding much of the medical theory and practice found in the remaining chapters. As Demaitre explains, the three topics of fever, pestilence, and poison are linked by the concept of bad air, or miasma, and its corrupting and putrefying effects on the body. It is only in this chapter that Demaitre explores in any depth medieval approaches to diagnosis (uroscopy in particular) and treatment by dietetics, regimen, and herbal recipes, concepts that should be carried across to all later chapters.
Demaitre models the bulk of his book (Chapters 3-8) on the very medical manuals he studies, many of which list remedies "from head to heel" (a capite ad calcem), and like those manuals he focuses primarily on the specific interpretations of nosology and pathology, and only briefly and incidentally on treatments. (He objects a bit too strenuously in his introduction to the publisher's insistence that the book's subtitle include "from head to toe," the better-known English phrase.) Demaitre thus begins with the surface of the body and conditions not particular to one part (Chapter 3, tumors and trauma); moving on to the head and hair (Chapter 4); the face and senses (Chapter 5); the organs for conducting and transforming the vital spirit, or "Uvula to Diaphragm" (Chapter 6); the nutritive members, in "Gullet to Gut" (Chapter 7); and "Haunches to Heels," which focuses on the members of expulsion and generation (Chapter 8).
These topical chapters can be examined collectively for this brief review. Demaitre begins each with a quote from an influential medical author (Constantinus, Avicenna, Savonarola, etc.), which he explains and uses a touchstone for the remainder of the chapter. Each chapter is divided into the diseases and humoral imbalances best known to afflict that section of the body; the surface of the body, for example, suffers from tumors, smallpox, measles, various apostemes, lupus, herpes, and cancer. For each condition Demaitre gives a definition and a set of causes generalized from the medical manuals, providing variant terms and treatments from individual authors to illuminate how the medical manuals can differ. Special attention is given to difficult cases like leprosy, headaches, cataracts, and consumption (ptisis), which engendered significant debate among the authors of medical manuals. Chapters 4 and 5 form a pair devoted to the head, in which Demaitre delves necessarily into some medieval psychology and theories of the soul. Conditions such as frenzy, love sickness, and melancholy were understand in both physiological and psychological terms, as were the instruments of the five senses, whose afflictions are examined in Chapter 5. The final three chapters (6-8) are framed, and fittingly so, according to the passiones of the three lower faculties: spiritual, nutritive, generative. More than in the preceding three chapters, Demaitre focuses in this final trilogy on individual organs (lungs, heart, stomach, intestines, etc.) and their respective passions. Despite this focus, we are constantly reminded that medieval physicians saw the body more as a constantly fluctuating system of humors (in which the organs all served as humoral receptors and transmitters) than as a network of mechanical organs each with its own function.
The book is well illustrated, but not overly so, with clean, black and white images taken mostly from original manuscripts and early printed books in the image collection of the Wellcome Library, London. The captions give in most cases the specific library, book, and folio containing the image, along with their code numbers in the Wellcome Images database; this shows a great respect for images as historical primary sources and will allow students to approach and use images more easily in their research. Demaitre includes a Glossary of medical terms in Latin and English, and a chronology and bibliography of Latin medical manuals at the end of the volume. Students and teachers will especially appreciate the inclusion of Web addresses in the Bibliography of Sources for digitized versions of manuscript and early printed editions of the manuals. The one index covers primarily medical concepts and diseases, attesting to Demaitre's declared organization and purpose for the book. However, a serious lacuna is the absence of an index of the medical authors and works that Demaitre cites many times in each chapter. The few references to texts or authors in the index are misleading: only two pages are given for both Canon medicine or Constantinus Africanus, but they are named dozens of times each throughout the book. While Medieval Medicine is not strictly a study of individual authors or texts, but uses them collectively to create a coherent picture of medieval medical ideas, it could nonetheless be a valuable resource for students first approaching the works of Avicenna, Gilbertus Anglicus, John of Gaddesden, and others, and would be far more accessible in this respect had such an index been included.
Luke Demaitre has written a useful survey of scholastically informed medical practice in the Middle Ages, by synthesizing a large corpus of complex, Latin texts and presenting their information in a memorable format. It will serve as a convenient resource for scholars of medicine on one of the most influential schools of thought about body parts and their maladies in the Middle Ages. More importantly, it will complement existing textbooks and sourcebooks on medieval medicine by revealing the relationships between texts about illness and their authors' approaches to healing.
--------
Notes:
1. Luke Demaitre, Doctor Bernard de Gordon, Professor and Practitioner (Turnhout: Brepols, 1980).
2. Luke Demaitre, Leprosy in Premodern Medicine: A Malady of the Whole Body (Baltimore: Johns Hopkins University Press, 2007).