The Greatest Benefit to Mankind. Roy Porter

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СКАЧАТЬ would such hospitals have existed at all?

      The Church’s position was clear: the divine was above the temporal. Sometimes the Lord’s will was to punish sinners with plagues; sometimes it was man’s duty to preserve life and health, for the glory of God and the salvation of souls. But the body was to be subordinated to the soul, and healing, like every other temporal activity, had to be under ecclesiastical regulation. Thus in the case of the dying, it was more important that they should be blessed by a priest than bled by a doctor. Concern for salvation occasionally led to suspicions being voiced against Jewish doctors: the Lateran Council of 1215 forbade practitioners not approved by the Church from attending the sick, but this applied only on paper, for the highly valued Jewish doctors were everywhere, especially in Spain.

      Monks and clerics, for long the only body of learned men, commonly practised medicine, while in the northern European universities medical students often entered minor holy orders. Petrus Hispanus (Peter of Spain c. 1210–77), whose Thesaurus pauperum [Treasury of the Poor] was popular despite its recommendation of pig shit to stanch nosebleeds, even became Pope in 1276 as John XXI. (He died a year later when the roof of a palace he had built collapsed; one trusts he was a better doctor than architect.) Various ecclesiastical regulations were passed covering medicine; the aim was not to curb it but to uphold the Church’s dignity and prevent clerics developing lucrative sidelines which would seduce them from holy poverty and divine service. Thus when the Lateran Council of 1215 forbade clerics in higher orders from shedding blood, this was not (as often interpreted) an attack on surgery: it aimed, not unlike the Hippocratic oath, to detach the clergy from a manual and bloody craft. Clerics could continue to practise healing but not for gain. Nor did the Church authorities prohibit dissection: in 1482 Pope Sixtus IV informed the University of Tübingen that, provided the body came from an executed criminal and was finally given a Christian burial, there was no objection to human anatomy.

      The Benedictine rule states that ‘the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them’; hence it is no surprise that monasteries became key medical centres, more important than universities prior to 1300. As well as offering shelter for pilgrims, most had an infirmary (infirmarium) for sick monks. Separate hospital facilities were founded for the general public.

      Healing shrines flourished, and scores of saints were invoked – rather as in Egyptian medicine, each organ of the body and each complaint acquired a particular saint. Supplanting the pagan Asclepius, Damian and Cosmas became the patron saints of medicine. Brothers living in Cilicia (Asia Minor) around the close of the third century, they became celebrated for their healing powers. Their martyrdom under Diocletian is stirring stuff: despite being burnt, stoned, crucified and sawn in half, they survived, perishing only after decapitation. The pair appear in the heraldry of barber-surgeon companies, and churches were dedicated to them, often claiming to house their remains in fine reliquaries. Their chief medical miracle credits them with the first transplant: they amputated a (white) man’s gangrenous leg and grafted in its place that of a dead Moor. In many paintings depicting this scene, the patient, with one leg white and one leg black, lies supine as the spectators stare awestruck upon the miracle.

      In addition to this pair, St Luke or St Michael might be called upon for all manner of illnesses, but other saints were specialists: St Anthony was invoked for erysipelas (St Anthony’s fire); St Artemis for genital afflictions, St Sebastian for pestilence. St Christopher dealt with epilepsy, St Roch protected against plague buboes (he had visited many sufferers on missions of mercy, fell sick himself, then was healed by an angel); St Blaise was good for goitre and other neck complaints, St Lawrence for backache, St Bernardine for the lungs, St Vitus for chorea (St Virus’s dance) and St Fiacre for sore arses. St Apollonia became the patron saint of toothache because all her teeth had been knocked out during her martyrdom, while St Margaret of Antioch was the patron of women in labour. Out walking, she had encountered a dragon, which swallowed her whole. In its stomach, she piously made the sign of the cross; this materialized into a real cross, growing until the dragon burst open, thus delivering the saint.

      Healing shrines developed a great range of relics, pious images and souvenirs. Some, like Bury St Edmunds or Rocquemadour in the south of France, attracted pilgrims by the thousand. The blood of St Thomas a Becket cured blindness, insanity, leprosy and deafness – and ensured Canterbury’s popularity. In Catholic Europe, many medieval shrines continue to this day.

      Certain diseases, for instance the much-feared epilepsy, assumed supernatural connotations and cures; Hippocrates would have turned in his grave! Treatments for the falling sickness involved a mishmash of folklore, humoral medicine, sorcery, pagan beliefs and pious healing. John of Gaddesden (1280–1349), physician to Edward II and compiler of the encyclopaedic Rosa anglica medicinae [The English Rose of Medicine], recommended reciting the gospel over an epileptic patient while bedecking him with peony and chrysanthemum amulets or the hair of a white dog. The folk conviction that mistletoe cured the falling sickness was given a sacred rationalization: keeping watch over his father’s flocks, the young King David saw a woman collapse in a fit. When he prayed for a remedy, an angel appeared to him, announcing, ‘Whoever wears the oak mistletoe in a finger ring on the right hand, so that the mistletoe touches the hand, will never again be bothered by the falling sickness.

      Mistletoe was also used in other ways against epilepsy. In central Europe, the stalk was hung round children’s necks to prevent seizures, while in Scandinavia countryfolk carried a knife with a handle cut from oak mistletoe. In the mid seventeenth century, the leading experimentalist and founder-member of the Royal Society, Robert Boyle, was still endorsing pulverized mistletoe: ‘as much as can be held on a sixpence coin, early in the morning, in black cherry juice, during several days around the full moon’. The pious Boyle believed in religious cures, but sought their scientific basis.

      HOSPITALS

      Medieval hospitals were religious foundations through and through. Those planted in the West had originally been small and mainly for pilgrims; their late medieval successors were often more impressive. St Leonard’s in York had 225 sick and poor in 1287; still larger were the civic hospitals of Milan, Siena and Paris. In Florence alone, a city of some 30,000 inhabitants, there were over thirty foundations by the fifteenth century. Some had only ten beds, others hundreds. In England hospitals and almshouses totalled almost five hundred by 1400, though few were of any size or significance. London’s St Bartholomew’s dates from 1123 and St Thomas’s from around 1215. At Bury St Edmunds six hospitals were endowed between 1150 and 1260 to cater for lepers, pilgrims, the infirm and the aged.

      Small hospitals were essentially hostels or hospices lacking resident medical assistance, but physicians were in attendance by 1231 at the Paris Hôtel Dieu, next to Notre Dame, and Sta Maria Nuova in Florence was gradually medicalized: from twelve beds in 1288 for ‘the sick and the poor’, this ‘first hospital among Christians’, as one Florentine patriot called it, expanded by 1500 to a medical staff of ten doctors, a pharmacist and several assistants, including female surgeons. Although catering largely for the indigent, it had eight private rooms ‘reserved for the sick of the higher classes’. Within hospital walls the Christian ethos was all-pervasive.

      In hospital expansion the Crusades played their part, since crusading orders such as the Knights of St John of Jerusalem (later the Knights of Malta), the Knights Templar, and the Teutonic Knights built hospitals throughout the Mediterranean and German-speaking lands. By the fourteenth century non-military brotherhoods, such as the Order of the Holy Spirit, were also running infirmaries from Alsace to Poland, while the Order of St John of God appeared in Spain in the sixteenth century, building insane asylums and putting up about 200 hospitals in the New World.

      LEARNED MEDICINE

      The great age of hospital building from around 1200 coincided with the flourishing of universities in Italy, СКАЧАТЬ