Magic works. Sometimes.
That doesn’t mean to say that the reason it works has anything to do with the supernatural. It might be luck, psychology or fraud. The medieval mind was alive to all these possibilities, but this did not mean that they automatically ruled out the uncanny. And even if magic had no effect whatsoever, that could still be a positive. One of the major factors behind the success of magical healers was that they rarely did any damage. Unlike the professional physicians of the Middle Ages, they would not bleed their patients or deliberately make them throw up. The medicines they prescribed were not usually poisonous and tended to be for exterior use only. Praying at a saint’s shrine was the safest course of all and consequently, in all likelihood, the most effective. Scholarly medicine operated in competition with both magic and miracles, but its ‘cures’ were far more likely to be actively harmful. Physicians could make good money hastening their patients to the grave.1
Being Ill in a Medieval City
Place yourself in Paris in 1300. The narrow streets are full of students, craftsmen and beggars. Occasionally, moving through the throng, you might catch sight of a priest or one of the brightly attired administrators attached to the royal court. You hardly care because you are sick. You have had a headache that has grown steadily worse. It keeps you awake all night and now your vision is becoming blurred. What to do?
Essentially, you have two options; three if you have money. There is the church, the local healer or a qualified doctor. All three will expect a fee, but the first two are far more likely to keep their charges down to a level that the poor can afford. The church can offer spiritual nourishment, of course, but it also runs Europe’s hospitals. Next door to the great cathedral of Notre Dame de Paris was the Hôtel Dieu, an early hospital where medical assistance is given to those who can’t stretch to a doctor.2 But they are full and probably won’t admit you. The establishment is intended for those who are too ill to look after themselves and have no family to help out.
You should, of course, visit the cathedral itself and pray for God to heal you. You might think that asking a priest for a blessing or praying to a saint for a cure would be no different from asking the local witch. However, as far as people in the Middle Ages were concerned, there was a fundamental difference between magical and miraculous cures. With magic, the magician was supposed to have the power to effect a cure of his own accord, as long as he does his job right. Properly carried out, a magic spell should always work. A religious cure is different. The supplicant realises that God may or may not cure him depending on a number of unknown factors. He has no right to expect a cure and no way to compel God to provide one. Whereas the magician might claim that he can bind demons to do his bidding, there is no obligation on God to do anything.3 So, it was wise to try alternatives and most people would patronise more than one source of healing.
The Church had no objections to physicians or even village healers who abstained from diabolical magic. According to Christians, God was ultimately responsible for illness but had also provided the means in nature to deal with it. Canon law did forbid priests from moonlighting as physicians, partly because the secular physicians did not like the competition and partly because it was not the priest’s job.4 Only with great scourges like the Black Death of 1347–50, before which all the physician’s arts were powerless, did people come to rely exclusively on religious help.
So if you have a chronic headache in the Middle Ages, you had better visit the local healer. She lives in a small, unremarkable house. Little differentiates her from her neighbours except that she is treated with extra respect and perhaps a tinge of fear. Her fees are very reasonable and as you are a local, you will already be known to her. Her consulting room is just the ground floor room of her house. It is full of the sort of paraphernalia that you would expect a wise woman to have, including clay pots of herbs and a small iron cauldron. In one corner are a couple of small books. These are not just for show; the healer can read and write. She was taught by her mistress who also handed down many of the recipes that she uses for her ointments.5 Sitting down, you explain your symptoms to her. The close proximity of the university medical faculty means that the healer has pretensions towards the methods of the academic physicians. She takes your pulse and then produces a small glass flask, asking for a urine sample. Without embarrassment, you produce one and hand it to her. She examines the colour carefully and shakes the flask to determine if it contains any foreign matter. Finally, she has a good sniff and sips a little.
No matter what is wrong with your head, there is nothing therapeutic that the wise woman or any other physician in 1300 can do to cure it. You will either heal naturally or grow worse until you die. What she can do is offer palliative support that may both lessen your pain and strengthen the body’s ability to get well by itself. She gives you two treatments. The first is an amulet to wear attached to your head. It consists of a small piece of parchment, made from the skin of a ram, upon which the healer has written a line of scripture. She rolls up the scrap tightly and ties it together with a piece of wool. The second treatment is a herbal tincture made from walnuts. As a mere patient, you are unlikely to know why these remedies are supposed to work, but if you believe in them anyway, then they might do some good. Nonetheless, there is a logic behind the wise woman’s methods which depends on the theory of magic current at the time.
Magic in the Middle Ages
Medieval magic depended on two great dichotomies: microcosm versus macrocosm and sympathy versus antipathy. Through his understanding of these, it was believed that a magician could manipulate the hidden powers of the universe and harness them for his use. The macrocosm is the whole universe but most especially applies to the stars, the signs of the zodiac and the planets. The microcosm means our own domain of the surface of the earth, or alternatively the human body itself. A fourteenth-century alchemist, Bernard of Trevisan, laid out the essence of the microcosm/macrocosm dichotomy. ‘When that which is above is made by that which is below’, he explains, ‘and that which is below is like that above, then miraculous occurrences will from thence appear.’6Everything on earth, the healer believed, had some sort of correspondence with something in the heavens. If you could figure out what these correspondences were, then you could use them for healing and magic.
The ancients recognised seven pure metals – gold, silver, mercury, copper, iron, tin and lead – which they associated with the seven planets, respectively the sun, moon, Mercury, Venus, Mars, Jupiter and Saturn. It is easy to see how gold corresponded to the sun or reddish tin to Mars. Some of the other associations seem rather more contrived. Copper was linked to Venus only because the goddess of that name was supposedly born on the island of Cyprus, which also hosted the ancient world’s major copper mines.7Consequently, copper was the appropriate metal with which to make a love charm.
The planets were also linked to parts of the body and animals. For example Picatrix, a medieval tome of magic, explains:
Mercury is the origin of the power of understanding. Among the external parts of the human body, it has a special relationship with the tongue and among the internal parts, with the brain … among minerals with quicksilver … among animals with mankind, small camels, monkeys and wolves.8
In a similar way, the signs of the zodiac also related to different parts of the body. Many beautiful manuscripts from the Middle Ages illustrate these correspondences between specific organs and the constellations. The sign for the head was Aries, the Ram. This is why a medieval healer in Paris would have made an amulet out of the skin of a sheep (preferably a male one) and tied it together with wool. The passage of scripture would be an attempt to borrow the power of the Christian God for healing. It would be best that the Church did not know about this intrusion into its prerogatives.
Figuring out all the correspondences was an arduous task and there was very little agreement between authorities beyond the basics. People imagined that nature was like a giant medicine cupboard filled with pills and tablets of all shapes and sizes. But none of them had an unambiguous label revealing what they did. Instead, there was the equivalent of a cryptic picture on each packet of tablets to help in identifying its purpose, and people had to guess from the picture what a particular medicine was for. In reality, it was the appearance of individual plants that provided the visual clues as to their purpose, but the principle is the same.
The reason why the correspondences were believed to exist in the first place was tied up with the magical worldview. For the magician, different parts of the universe were connected together so that the various things that corresponded to each other showed some outward sign of this fact. This is what was meant by ‘sympathy’. Sometimes, this was obvious and is even reflected in the names we still give to plants. For instance, the leaves of liverwort (Hepatica) were said to resemble the liver. This resemblance was called the plant’s signature and enabled a skilled observer to identify the best herb to use for each condition. Of course, it was rarely so easy. Deciding how the shapes and forms of particular herbs demonstrated their uses required great skill. Or, alternatively, some inspired guesswork.
The reason our Paris healer would have offered a potion made from walnuts for a head ailment becomes obvious the moment you look at a walnut, even today. No inspired guesswork is required. The nut has a hard outer shell which, when cracked open, reveals a soft craggy interior divided into hemispheres. The similarity between the edible part of a walnut and the brain must have struck herbalists as undeniable. This signature was nature’s way, or God’s way for a Christian healer, of showing man which plant to use to treat a head complaint. Sadly, nature was being disingenuous. Neither walnuts nor liverwort really cure the ailments they were believed to. Healers had more success prescribing willow bark for pain relief. We now know that this plant contains salicylic acid, the active ingredient in aspirin.9
As a commoner, the local wise woman would have been your only option. However, a rich lawyer working in the royal courts would have had no need to visit a local crone when he became ill. He would have taken to his bed and the university-trained doctors would have come to him. The medical faculty at Paris was well regarded but comparatively small compared to the great schools of the south at Montpellier and Padua. This meant that Paris attracted physicians from abroad who were keen to cater for the large market of rich councillors and clergy. The university tried to ensure that only those who were properly qualified could practise as doctors, and especially wished to keep such undesirables as women and Jews away from patients’ bedsides. The doctors that would have appeared at a lawyer’s house – and a rich individual would usually insist on consulting more than one – used similar means of diagnosis to the wise woman, in other words taking both the pulse and a urine sample. The treatment, however, was likely to be much more involved, expensive and painful.
Doctors were trained to treat each patient as an individual. In order to offer effective care, they would take down their patient’s entire medical history, details of his diet and as much information as possible about the illness. Feeling for the pulse and examining the urine sample were taken to much greater lengths by the professional physician than by the wise woman (who was probably only doing it for show). They noted the strength, timing, depth and rhythm of the pulse. Doctors classified the shape of a patient’s arteries alone in over two dozen ways. As for urine, it was such a common medium of diagnosis that the standard way to recognise a physician in a medieval illustration is that he will be holding a flask of it up to the light.10
6. Thirteenth-century manuscript illumination of a doctor with a flask of urine
Learned doctors tended to prescribe not just medicine, but a lifestyle or ‘regimen’. Bed rest, a special diet and relaxation were most often recommended. This was, at least, unlikely to do much harm and might help the body heal itself. Unguents, potions and other herbal treatments would also be prescribed. The doctor himself would not prepare these, but instead would employ the services of a specialist apothecary to mix the ingredients. Despite the enormous array of herbs that doctors could use, the main function of any medicine that the patient imbibed was to make him vomit.
The most notorious form of medieval treatment, which remained common until the nineteenth century, was bleeding.11 Again, the doctor would not do this himself because such manual work was beneath a professional person. Instead, a barber-surgeon would be sent around to drain blood from the patient at specified times. Bleeding, as we now know, would have been actively harmful but many patients insisted on it. Peter the Venerable, the abbot of Cluny who gave Peter Abelard shelter in the last years of his life, once complained that his respiratory infection was worsened because he had postponed his regular bleeding session.12 In the Middle Ages, some physicians were browbeaten by their clients into bleeding them half to death. Even so, bleeding was not irrational; it was consistent with the theory of disease that all physicians respected. To understand its justification, we need to take a look at the intellectual foundation of academic medicine in the Middle Ages.
The Origin of Learned Medicine
Before about 1100, educated people did not consider medicine to be a professional field. Because doctors used their hands to treat patients, their skills were equivalent to those of a craftsman rather than a scholar.13 All this changed with the appearance of Arabic and Greek medical texts in the twelfth century. It was clear that an impressive array of theory lay behind ancient medical practice. Laden with this cerebral ballast, medicine claimed its own faculty at many of the new universities.
Taddeo Alderotti (c.1223–95) of Bologna championed the new approach and made a fortune in the process. His prestige as a scholar helped to enhance his reputation as a healer so that even the Pope paid him a substantial salary.14 After Alderotti, the medical faculty at the university of Bologna enjoyed almost as much influence as the law school.
An important reason for the acceptance of academic medicine was that it could trace its origins back to Greek scholars every bit as revered as Aristotle. For example, Galen of Pergamum, the source of much medieval medical knowledge, was born in about AD129. He trained in medicine in Alexandria before returning home to practise as a doctor. His first job was patching up gladiators who had been injured in the local amphitheatre. It was not the most glamorous of roles and he quickly realised that he was not going to find fame and fortune in a provincial city like Pergamum. In AD161, he departed for the imperial capital of Rome where he established a successful medical practice whose clientele reached the heights of society. He even ended up treating the emperor himself.
Galen appears to have been an accomplished showman who gave public lectures that featured the vivisection of animals. Torturing pigs was his favourite spectacle. He showed how, by severing the spinal cord of a live sow, he could paralyse first its hindquarters and then its front legs.15 He was certainly a prolific writer and two million words of his medical works survive. That is without even his philosophical writing, destroyed by fire during his lifetime when the library of the Temple of Peace in Rome burnt down.16He died early in the third century, by which time his vast literary output meant that his legacy was secure. He became the standard authority on medicine in both the Roman and Muslim worlds. However, western Europeans in the Middle Ages did not have access to very many of his original works because he wrote in Greek. They had to make do with Arabic commentaries and medical encyclopaedias that had been translated into Latin during the twelfth century.
The essence of Galen’s medical theory, which he inherited from even earlier Greek writers, was that the body contains four ‘humours’: blood, phlegm, yellow bile and black bile. These four substances were never found in their pure forms. Even real blood contained a mixture of all four humours. Yellow bile was the major component of pus, phlegm belonged mainly in the lungs and black bile was responsible for putrefaction. But all four humours were present throughout the body and they were all essential, in their way, to its proper functioning.
The key to good health was to ensure that the proportions of the humours remained in the correct balance. Different people thrived with a different balance so that one of the four normally prevailed over the others. Someone with a natural excess of blood was sanguine (from the Latin for blood). Alternatively, they might be phlegmatic, bilious or jaundiced (the latter derived from the Latin for yellow) if a different humour predominated. These adjectives have now slipped their medical moorings and become part of general English.
The best way to restore balance to the humours, once they got out of kilter, was to drain the one that was present in excess from the body. First of all, the physician had to determine which of the humours was causing the problem. The theory assigned the qualities of being ‘hot’ or ‘cold’ and of being ‘wet’ or ‘dry’ to each of the humours. For instance, blood was ‘wet’ and ‘hot’ while phlegm was ‘wet’ and ‘cold’. If someone was suffering from too much of one of the humours, this would manifest itself in symptoms that reflected the qualities of the excess humour. For instance, a patient who was chilled and clammy to the touch was suffering from excess phlegm, which was cold and wet. If he was running a temperature and sweating from a fever, the doctor would recognise that the symptoms included being hot (from having a high temperature) and wet (from sweating). From these symptoms he could diagnose that the patient’s illness resulted from an excess of hot and wet blood. The appropriate treatment was bleeding to siphon off the surplus blood. The properties of being hot and cold, wet and dry were assigned to herbs as well. To deal with a fever, plants with cold and dry properties, such as quince or rose, would be used to counteract the heat and moisture of the fever. A doctor might also use a purgative to make the patient throw up. Vomit was held to contain bile and so being sick could reduce a glut of this humour.
The twin treatments of bleeding and purging must have been very unpleasant. Neither could have done the slightest bit of good and were much more likely to weaken patients just when they needed all their strength to fight off the illness. Any success that doctors had was due to the ‘placebo effect’ whereby patients’ beliefs that they are being cured help to reinforce the body’s natural defences. The situation was much the same for the healers who claimed to use magic, only they were less likely to harm their customers because their treatments were less invasive. The most effective medical treatment available in the Middle Ages was probably to visit a saint’s shrine. Miracles aside, ‘the placebo effect’ can be just as easily activated by religious faith as by a doctor’s bedside manner. And praying, at least, is unlikely to lead to any ill effects. Analysed in this light, it is surprising that the medical profession survived at all. The prestige of an ancient Greek pedigree, coupled with a university degree, must have made up for the doctors’ complete inability to cure their clients.
The one genuine skill that medieval doctors did possess was the ability to identify diseases. This meant that they could often predict the outcome of the patient’s illness even if they could not do anything about it. Still, doctors were taught that it usually paid to be pessimistic about the prognosis. One instruction manual advises, ‘When you have left the patient, say a few words to the members of the household. Tell them that he is very sick. For, if he recovers, you will be praised more for your skill. Should he die, his friends will testify that you had given him up.’17 Taddeo Alderotti once forgot to follow this advice and declared a nobleman he was examining to be on the mend. The next day he returned to find his patient had declined almost to the point of death. The family remonstrated with him and it looked like he might lose his fee. Casting around for an excuse, Taddeo noticed that a window had been opened in his absence. This, he declared, was the reason for the near-fatal turn the nobleman had taken. The physician could not be blamed.18
The Doctor of Physic in Geoffrey Chaucer’s The Canterbury Tales used a combination of natural magic, probably derived from traditional herb lore, and Greek medical theory based on Galen. Chaucer writes, when he introduces the good doctor in his General Prologue:
For, being grounded in astronomy,
He watched his patient’s favourable star
And by his natural magic knew what are
The lucky hours and planetary degrees
For making charms and magical effigies.
The cause of every malady you’d got
He knew, and whether dry, cold, moist or hot;
He knew their seat, their humour and condition.19
In the first line, Chaucer tells us something else about medieval doctors that we might not expect. They relied a great deal on astrology in the course of their work. The stars would determine when bleeding or other treatment should take place. The famous physician Bernard Gordon (c.1258–c.1320), who is actually mentioned by Chaucer, admitted that he once had got the time of a bleeding wrong without any ill effect to his patient.20 But even he still advised sticking to the received wisdom. A horoscope would also form part of a patient’s medical history because the disposition of the heavens at the moment of their birth helped determine their bodily chemistry. But astrology went much further than setting the time for medical treatments. As we will see, it was, like alchemy, a learned discipline in its own right.