14.03.24, Baker, Nijdam, and van't Land, eds., Medicine and Space

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Julie Orlemanski

The Medieval Review 14.03.24

Baker, Patricia, Han Nijdam, and Karine van 't Land. Medicine and Space: Body, Surroundings and Borders in Antiquity and the Middle Ages. Leiden: Brill, 2012. Pp. xx, 320. ISBN: 978-90-04-21609-9.

Reviewed by:
Julie Orlemanski
University of Chicago

This collection of essays follows from a 2007 symposium held at Radboud University Nijmegen, in the Netherlands, and sponsored by the Wellcome Trust. The topic announced in the book's title is broad: the co-implication of medicine and space in the ancient and medieval worlds. Despite this wide ambit, however, just more than half the contributions (six of eleven) fall comfortably within the bounds of the stated topic. The other five address either the early-modern period or medical ideas and practices related only tangentially to space. This review first discusses the six essays centrally concerned with medicine and space in antiquity and the Middle Ages; I then examine the other five essays more briefly. Finally, I discuss the editors' introduction and the book as a whole.

Michael McVaugh's "Fistulas, the Knee, and the 'Three-dimensional' Body" is the stand-out essay in the collection. McVaugh shows how surgeons' sense of anatomical space changed at the end of the European Middle Ages, moving fitfully from a "two-dimensional" to a "three- dimensional" model. The "two-dimensional" anatomy elaborated during the thirteenth and fourteenth centuries maintained the separateness of physiological systems: the human body as a whole appeared "as a collection of systems that are not merely functionally discrete but spatially unintegrated" (23). By contrast, the "three-dimensional" anatomy associated with the sixteenth century took account of spatial relationships even when functional connections were lacking. Comparing the fourteenth-century English surgeon John of Arderne and the celebrated Renaissance anatomist Vesalius, McVaugh shows the beginnings of three-dimensional anatomy in Arderne and the vestiges of two-dimensional unintegration in Vesalius. He also proposes a new occasion for medieval surgeons' anatomical learning, their observation of fistulas, or the artificial channels caused by abscesses that occasionally provided windows into patients' bodies.

The medical understanding of bodily interiors is also intelligently explored in Glenda Camille McDonald's essay on the concept of the locus affectus, or the particular place in the body affected by a disease. McDonald analyzes Galen's influential treatise De locis affectis alongside two other late-classical texts to indicate why the localization of disease was controversial in ancient medicine. Caelius Aurelianus's fifth-century Latin treatise, based on a second- century Greek original, lays out the Methodist critique of the locus affectus. Because Methodist physicians sought to concern themselves only with practical treatments, they deemed the body's unobservable interior an inappropriate topic for medical investigation. McDonald’s essay clarifies the technicalities and logic of the Methodist critique at the same time that it draws illuminating comparisons between its three primary sources.

Roberto Lo Presti's compelling examination of the Hippocratic treatise Airs Waters Places turns readers' attention from corporeal interiors to bodies in their environments. The treatise, written in the second half of the fifth century BCE, analyzes the influence of natural surroundings on embodiment and compares European and Asian peoples. While previous scholarship understood the Hippocratic text as an expression of environmental determinism, Presti offers a more nuanced account of its oscillation "between different forms of environment-linked causality and thus between different forms and degrees of determinism" (175). Presti identifies evidence both for a model of continuity, or "reciprocity and similarity" (176), between bodies and land, and for a model of discontinuity, in which human beings react against and work upon hostile environments. He then sets these ideas in the political context of ancient Greece. Airs Waters Places ultimately comes to sound quite humanist, in portraying the human animal "not as a natural being passively affected by climactic changes and other environmental factors, but as one capable of conscious interaction with such factors, and thus capable both of making the environment his own 'laboratory' and of perceiving it as such" (187).

Designated spaces for infirm bodies constitute the topic of the last three essays in the collection. Ralph M. Rosen considers the shift in ancient Greece from sacred healing in temples to Hippocratic medicine --and does so primarily insofar as the transition is described in a passage of Pliny's Natural History. Rosen sets up a strong contrast between the valorized space of the temple and the suspect space of the bedroom. However, this reviewer was unconvinced by the evidence offered to support the claim that a "contrast between spaces of sickness underlies Pliny's suspicion of bedside medicine" (238). Much is made of the fact that the Latin word "clinice," used by Pliny, derives from the Greek word for "bed" and so denotes "bedside" medicine--even though a footnote acknowledges that "In Pliny's time, it seems, 'clinical' medicine for the most part was a fairly generic, unmarked notion, more or less synonymous with the medical profession" (229, note 6). Patricia Baker's account of medieval Islamic hospitals, or bimaristans, also falls short of marshalling evidence in an entirely convincing manner. The essay usefully aggregates information about medieval hospitals that survive in architectural remnants or are described in structural detail in textual sources. However, Baker's analysis of these structures felt extremely speculative: hospitals' solid walls "may" have acted as a symbolic warning to the healthy (265); their central location "was possibly a means" of demonstrating piety (266); bars on the windows "may have" signaled a profound division between major and minor ailments (267); bars in the windows "could have been placed" to prevent insane patients from escaping (267); the proximity of hospitals to public baths "may show" some patients took treatments there, "or perhaps it may represent a general association of an area of the city somehow being connected to healthcare" (267). Clearly, much more research is needed to interpret the significance of the structures catalogued here, both in their architectural specificity and in their medical and civic contexts. Finally, Irina Metzler, a historian at the forefront of the study of disability in the Middle Ages, deploys the idea of "liminality" to discuss medieval hospitals in England, Germany, France, Italy, and Flanders between the thirteenth and early sixteenth centuries. Because the institutions are so various, their settings so diverse, and the records so spotty, it is difficult to arrive at a sense of what the variations in Metzler’s evidence signify--for instance about change over time, regional variation, or differing categories of disability. One is left with the rather bland conclusion that "Medieval hospitals were a heterogeneous set of institutions" (294). Nonetheless, the assembled sources constitute a valuable resource for scholars wishing to investigate further medieval institutions for the infirm.

The five essays in the volume that are less straightforwardly relevant to the interplay of medicine and space in antiquity and the Middle Ages nonetheless contain valuable insights. Helen King offers a cogent discussion of how bodily space was gendered in English medical writings of the seventeenth century. Through a close comparison of Jane Sharp's 1671 Midwives Book with its sources and contemporaries, King elucidates the "history of the penis in the early modern period" (48), observing, for instance, that the most important aspect of the male reproductive system was thought to be "not the Yard [penis], but the seed" (57). Karine van 't Land tackles the complex topic of etiology in her essay, considering the distinction between "extrinsic" and "intrinsic" causes in medieval scholastic medicine. Land moves effectively between three schemes of causation but loses clarity in attempting to relate her topic to space, since intrinsecus and extrinsecus are not properly spatial concepts but philosophical ones, as she acknowledges (97). The discussion of bathing by Fabiola I. M. W. van Dam is marred by the selection of texts for comparison. The three sets of texts--a fourteenth-century treatise on health, a selection of the thirteenth- century biological writings by Albertus Magnus, and some twelfth- century Cistercian religious writings--differ so starkly from one another that it is difficult to evaluate what the variations in their portrayals of bathing might indicate. In her essay, Maithe A. A. Hulskamp discusses the role of "cosmological astronomy" in Hippocratic writings. She argues that although cosmological research is often thought to be philosophical in purpose, it "served a distinctly practical medical purpose to at least one Hippocratic physician" (153). Counter-Reformation Rome is the topic of Catrien Santing's essay, which details the city's sixteenth-century management of the burial of corpses and especially the role of confraternities in maintaining public health and bolstering civic pride.

As these summaries suggest, the contents of the collection are extremely wide-ranging and unfortunately outrun the already capacious boundaries marked out in the book's title. The editors' introduction might have partly overcome this disparateness by surveying the most important recent scholarship on ancient and medieval interchanges between medicine and place, identifying overarching themes, and suggesting future avenues for research. Unfortunately, the introduction as it stands is extremely general and does little to engage the vibrant recent historiography of ancient and medieval medicine. It instead spends a great deal of time reviewing now- familiar concepts that were once foundational for making "the body" a field of cultural research, including those in Mary Douglas's 1966 Purity and Danger, George Lakoff's and Mark Johnson's 1980 Metaphors We Live By, and Nancy Scheper-Hughes's and Margaret Lock's 1987 "The Mindful Body: A Prolegomenon to Future Work in Medical Anthropology." In focusing on the most universalizable relations between medicine and space, the editors ignore what is specific to those relations during the periods in question. In light of such anthropological and cognitive heuristics, how do ancient and medieval practices appear in their distinctiveness? Readers interested in recent historiography are encouraged to read Monica Green's "Integrative Medicine: Incorporating Medicine and Health into the Canon of Medieval European History" (History Compass 7 (2009): 1218-45). Though not specific to spatial themes, that article's bibliography includes references to such space-related topics as public health, the healing power of sacred places, paleoepidemiological geographies of disease (including plague), centers of medical education in the medieval world, pharmaceutical trade, and the premodern history of dissection and anatomy. (I am unaware of a similar recent survey for ancient medicine.)

The production quality of the volume is mixed. It includes a truly impressive number of images, in both monochrome (43 figures) and color (22 plates)--appropriate to its appearance in the series Visualising the Middle Ages. Unfortunately, the number and quality of images outstrips their intellectual contribution. I found myself rarely referred to the images (located at the front of the volume), and when I was, the point was often peripheral to the main argument of the essay. The collection's Bibliography does not, it seems, include citations for primary sources. It also contains many small mistakes and inconsistences: for instance, the historian Katharine Park is listed once with her first name misspelled ("Katherine") and twice with it abbreviated ("Katy"), neither reflecting the original publications. In the List of Contributors, the format of biographies varies from one entry to another. This collection of essays, then, is a mixed result. It contains a number of compelling contributions to our knowledge of premodern medicine and space, but it might have been much stronger.

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Julie Orlemanski

University of Chicago