In 2003 a preserved human head was sold by a dealer in Paris to a Canadian private collection for an undisclosed amount. In itself this was not an unusual event. Human remains, like any other type of valuable historical artefact, pass back and forth all the time in the busy international markets for medical oddities and prized antiquities. But this object, this body, aroused particular curiosity.
It strikes a vivid first impression. Frozen in a dramatic rigor mortis, its head is thrown backwards from the stubs of two shoulders, throat exposed and mouth agape. A large split makes its way down the face from the centre of its forehead, and we see, when it is flipped around, that the entirety of its cranium has been excavated in a hoop about the head. The top of the skull is missing, popped off like the lid of a biscuit tin, and the brain has been removed, leaving only its shrivelled base and a flat stump of spinal cord.
To understand more about this enigmatic cadaver a team of French paleopathologists were given permission to examine the remains in more detail. Subjecting them to a number of innovative medico-archaeological techniques, all sorts of information about the deceased quickly began to surface. They discovered that the figure was male, originally of Caucasian descent and probably around forty-five years old at the time of death. Short red hairs on the chin and upper lip suggested he had once been of an auburn complexion. And several scans confirmed that his head and shoulders had been preserved using a type of quick-setting, mercury-based metallic wax, injected into the major arteries soon after death to stiffen his pose like a sculptural mould. Most intriguingly, radiocarbon dating estimated that the figure had lived at some point between the years 1200 and 1280: the body was medieval.
For historians like me, such discoveries offer an immediate and enticing gateway onto the past, and not just through the scientific detail of long-dead bones. We know this half-man’s gender, his age, even his hair colour, but his remains still animatedly pose all sorts of other pressing questions. Who was he? Where was he from? What was his story? He is a prompt from the past to dig deeper into what we know of the moment in which he lived. And exploring medieval bodies is particularly vital today, because their era continues to be much misunderstood. The centuries sandwiched between the accolades of ancient Greece or Rome and the classical world reborn in the European renaissance are seen as a static and sequestering time, an idea we read in their different names: the ‘Dark’ Ages or the ‘medieval’, from the Latin medium aevum, a ‘Middle Age’. It is a moment often defined by events outside itself, by what it is not, and when we look at medieval artefacts – be they bodies or poems, paintings or chronicles – we have a tendency to emphasise the negative. We draw them into a sceptical and often quite gruesome narrative of the period that has been handed down to us, just the kind of unpleasant moment in history where people might well have ended up with their head split open and injected with metallic wax.
The pervasiveness of this feeling was recently made crystal clear in a visitor survey undertaken by a major London museum during plans to renovate its medieval and renaissance gallery spaces. An average slice of the visiting public was asked by researchers to project themselves into each of the two eras in turn, first the renaissance and then the medieval, and say what they thought they might see or how they believed they might feel about the world around them. Responses to the renaissance, recorded verbatim by the museum, were bounteous. People seemed genuinely contented, filled with a happy wonder:
I’m in Florence walking by the river at midday. It’s peaceful, I’m smiling. I’m an artist’s model and he’s sculpting the Madonna and Child.
The sunshine sparkles, there’s a little glade and a little lake. There’s philosophy, people sitting round talking about politics, books. Music … I want to stay and dream.
Sounds lovely. But for the same people, envisaging the medieval world meant that things quickly turned sour:
There are soldiers, peasants, high castles, muddy lowlands … Black Death and Plague are all around. It’s raining. People are drunk on mead and fighting among themselves. The artists are not respected.
I’m in a dungeon wearing a potato sack and it’s night. It’s cold, there are rats. The windows have bars at floor level. I stole some potatoes for your newborn child.
It is a stereotype heard often: that from roughly the years 300 to 1500 most people inhabited a time oscillating between Braveheart and Black-adder, a world of generalised misery and ignorance, living in piteous squalor only to make war in the fretful darkness. A useless millennium or so. For at least one of the visitors surveyed by the museum this popular view has even gone so far as to warp their historical placement of people and things. The potatoes they envisage stealing – presumably not fluffy, plump roasties, but hard and cold and raw – would in fact only have reached Europe from the Americas in the 1570s, well after the darkness of this supposedly ‘Dark’ Age is meant to have lifted.
Who or what is to blame for this picture is not entirely clear. In some ways, doing down the past seems a natural reflection of how we wish to see life in the present. To appear enlightened and modern we need a dark and ignorant past to set ourselves starkly against. Pop culture has definitely taken this up with force in the romanticised figure of a Disney princess, cruelly trapped in her ye olde castle, or the bleak violence of nipple-strewn TV dramas like Game of Thrones. It is no coincidence that in Quentin Tarantino’s 1994 cult hit Pulp Fiction, when Ving Rhames’s character Marsellus is poised to take gory revenge on a man who has held him hostage, he bitingly tells his hapless prey, ‘I’m gonna get medieval on your ass.’ The era is evoked at once as a historical fantasy and a vicious threat.
Looking back through history, this sense of a nasty medievalism is encountered pretty regularly. In the nineteenth century the idea of a gruesome Middle Ages was a particularly potent fascination for the Victorians, who happily distorted the past to suit their flamboyant taste for the neo-Gothic and the macabre. The idea goes back further still, present in the writing of thinkers during the Enlightenment. In the 1580s trashing the medieval was so widely accepted that the English antiquarian William Camden felt he could skip disparagingly over the entire period when writing his comprehensive, grand history of Britain, offering little more than a paragraph or two: ‘I will’, he says, ‘only give you a taste of the Middle Age, which was so o’ercast with dark clouds, or rather thick fogs of ignorance.’ Rather touchingly, medieval thinkers themselves seem to have been the first to conceptualise their age as having a certain middleness to it, stuck between two brighter, more exciting points of history. The Italian author Francesco Petrarca wrote with a mixture of longing and optimistic excitement about a shift of cultural values that he was observing around him in Italy during the fourteenth century and which he hoped might drag the medieval world forward in its wake:
There was a more fortunate age and probably there will be one again; in the middle, in our time, you see the confluence of wretches and ignominy … My fate is to live among varied and confusing storms. But for you perhaps, if, as I hope and wish, you will live long after me, there will follow a better age. When the darkness has been dispersed, our descendants can come again into the former pure radiance.
Whenever it originated, this view of the medieval period is unquestionably distorted. Revealing the realities of the Middle Ages from this warped impression has been part of my work for more than a decade and is at the very heart of this book. We cannot patronise this seemingly distant moment in time simply to make ourselves feel better. Rather, in order to truly grasp any aspect of the medieval world we need to engage with it on its own terms. We need to try, as best we can all this while later, to see life as it was understood by our French half-man before his body was frozen in time, indeed by a whole cast of different characters who one by one will fall into focus: a physician treating a patient in sixth-century Ravenna, a Persian poet writing a piece of epic verse in twelfth-century Azerbaijan, a seamstress sewing a garment in the East End of fifteenth-century London, and many more. We need to look beyond caricature to the nitty-gritty detail of life. Or, in the case of this book, the detail of life and death and art. And when we do, we will always discover there is another story to be had beyond that of a backwards, muddy Middle Ages.
Beginnings?
What, then, was medieval life really like? How we start to answer this question depends on where and when in the great span of the Middle Ages we want to look, for the term captures in two short words an enormous period, a whole multiplicity of peoples, cultures, religions and geographies.
A moment so glittering and diverse understandably comes with blurred beginnings and contested endings. We could officially set the medieval clock ticking after the collapse of the Roman Empire, which had dominated and unified enormous swathes of Europe, Africa and Asia for the preceding centuries, kick-starting the Middle Ages in the year 476, when the last of the western Roman emperors, Romulus Augustulus, was deposed by the Germanic king Odoacer, bringing imperial rule to an end in Europe. But in reality this empire had already been in serious decline for some time. We could just as easily begin talking of the medieval in the early 400s, when northern European tribes started regularly crossing the Rhine to invade Italy, or even a whole two centuries earlier, when the over-expanded Roman world first began to experience political instability and economic slowdown. Yet these early medieval moments can be particularly difficult to pin down for lack of hard evidence: few complete buildings or objects survive, even fewer written sources, and the archaeological record can be sparse. Much of this book, then, by necessity aims at the better-documented, later parts of the medieval narrative, but at this end of the period too, sources are far from bounteous, and a formal full stop for the Middle Ages is equally difficult to find. A move into something resembling the renaissance did not happen overnight. The kind of changing ideas, actions or artworks that signalled to some that a paradigm shift was under way in fourteenth-century Italy might have only come into fashion a full century later in London or Seville, Tunis or Jerusalem. Some two hundred years separate the earliest self-aware critics of the medieval world – people like Petrarca – from the work of sixteenth-century renaissance big-hitters like Michelangelo, Cervantes or Luther, all of whom still lived in a world tangibly buzzing with the influence of the medieval. Historical change is, after all, a human thing. It does not sweep uniformly across regions in an instant.
Nonetheless, a shared classical heritage undeniably binds together the medieval history of the regions on all sides of the Mediterranean, separating them somewhat from the busy parallel stories of the Far East, India, China, sub-Saharan Africa or the pre-Columbian Americas. Three principal inheritors of the legacy of Rome come to the fore, each representing a slightly different texture of the medieval bodies that I want to try to trace.
The first is Byzantium, a Greek-speaking, Christian empire which at its height extended throughout Greece and the Balkans, Anatolia, north Africa and much of the Levant. The Byzantines saw themselves less as inheritors of the classical Greco-Roman world than as a direct continuation of it. Their seat of government was Constantinople, a thronging metropolis of architectural sophistication and political grandeur which had been founded as the easternmost of the Roman Empire’s two capitals in the year 330, when Emperor Constantine rededicated a city formerly known as Byzantion in his own name. Byzantine emperors continued for centuries to rule in a direct lineage from Constantine’s unshakable Roman roots, and although its territories and influence would slowly shrink, the city itself only finally fell to the Ottoman Turks at the very end of the Middle Ages in 1453, after nearly a millennium of Byzantine control.
Second were those medieval peoples living in western and central Europe, from Scandinavia in the north to Italy in the south, some of whom had actually toppled Rome itself. Unlike the united empire of Byzantium to its east, in the earlier Middle Ages this region was far more fractured and from the fifth century constantly reconstituted its borders. Power shifted between a range of clashing cultural groups – the Franks, Angles, Saxons, Celts, Vikings, Visigoths, Slavs, Magyars, Lombards, Bulgars, Avars – whose kingdoms relied on battlefield successes for both political legitimacy and for military plunder to finance the state. It is perhaps for this reason that their names have since been transformed into some of our more derogatory modern terms: think, for instance, of the Barbarians or the Vandals, both words used in the Middle Ages to refer to actual historical groups. But, their political violence aside, these states were far from filled with the impoverished potato-snatchers conjured up in the London museum survey. Bolstered by an alliance with the Roman Church, from around 800 onwards these polities began to stabilise, making a more conscious effort to encourage learning and culture in the mould of the Roman Empire they had conquered. By the later Middle Ages many had fully concretised into the complex nation-states that would form the backbone of early modern Europe and from there go on to colonise huge swathes of the globe.
The third and perhaps most unexpected of these Roman heirs was the Islamic world. Emerging from the sparsely populated Arabian Desert in the 630s, Muslim peoples clearly had no immediate geographical proximity to the lands of Constantine, Julius Caesar or Plato. But as a combined religious and political force they were to expand with serious speed, their armies moving so quickly into territories once held by the Byzantine and Persian empires that only a century or so later the caliphate – derived from the term khalifah (
), or ‘successor’, given to Islam’s leaders after the Prophet Muhammad – encompassed the Iberian Peninsula, north Africa and most of the Middle East, stretching all the way to modern-day Afghanistan and Pakistan. Like western Europe, the caliphate was far from a unified state. Internal rifts soon turned into full-on civil war and the foundation of several competing medieval Muslim kingdoms. But, unlike its Christian neighbours, Islam was united by a common language, Arabic, and a flourishing literary movement centred around Baghdad saw the mass translation of multiple ancient writings into the Muslim lingua franca, preserved by copyists working from languages as diverse as Greek, Syriac, Persian, Sanskrit and Pahlavi. This Islamic world was to fall into a near-constant tension with the rest of Europe, especially after the launch of the First Crusade to reclaim the holy sites of Jerusalem in 1095. Yet, particularly in their early moments of expansion, these Muslim kingdoms thrived through a tolerance of different religions and peoples, and remained a consistent partner of many in the West for trade, commerce and cultural exchange throughout the entirety of the period. Whenever we might think the Middle Ages began or ended, it is the positive interaction between the political spheres of Byzantium, Europe and Islam, not only their opposition, that provides the key to understanding the era as a coherent moment, multiple complex cultures indelibly bound together through a shared Mediterranean past.
You, a Thousand Years Ago
For all the logic of its unifying Roman foundations, if you or I were to be transported back a thousand or so years from the present into the medieval past, we would find ourselves in an uncanny place at once startlingly different from and yet strangely familiar to our own.
Most striking might be its apparent emptiness. Demographically speaking, medieval populations were significantly smaller: there are roughly as many people in the United Kingdom today as there probably were across the entirety of Europe in the Middle Ages. Many of them lived in small towns and villages, the cumulative engines of a largely agricultural economy, and in the absence of jet planes and motorways life might feel surprisingly quiet. At the same time we might visit larger civic centres such as medieval Cairo, Paris, Granada or Venice, whose crowded streets, busy markets and generally condensed living would feel just as bustling as many modern cities. The biggest of these would reach populations of half a million or more and harboured elaborate centres of political power, diverse industries and, later, a university-trained intellectual elite.
Religion would be something we recognise too from modernity, yet it played a much greater role in the fundamentals of medieval life in a way now largely lost. This is not to say, as the caricature sometimes suggests, that Christianity, Islam or Judaism was all anyone ever talked about. A good parallel would be the way we think and speak about science today. We do not go around slapping each other on the back and congratulating ourselves on the existence of gravity, constantly expressing gratitude and awe that Newtonian physics stops us from floating off the earth’s surface into space. Rather, it is a baseline for how we see and understand this world, its past, present and future. Religious tenets like the biblical story of Creation or the potential daily intervention of the Almighty were an accepted but not necessarily all-consuming part of a medieval worldview.
Of course, while I am arguing that we have misjudged the Middle Ages, there is no getting away from the fact that it was in many ways extremely tough. By the standards of the present day, almost everyone in the pre-modern world right up to the 1800s would be classed as living in extreme poverty. Yet medieval people were also aware that, when it came to the shape and fabric of individual living, we are all hostages to fate: our fortunes can rise as well as fall. An illustration from a tenth-century Spanish manuscript shows the image of Fortuna, the Roman goddess of fortune who was also particularly popular with medieval moralists. Crowned and throned, the stunning Queen of Fate spins her wheel to twist a set of figures to and fro. In this grand image those shown at fortune’s behest are four kings. Some are in the ascendancy, while others are having their world flipped completely upside down. Tossed through time, the destiny of each is labelled in Latin beside them: regnabo (‘I shall reign’), regno (‘I reign’), regnavi (‘I have reigned’), sum sine regno (‘I am without reign’). But one more crank of the handle and everything will change again. Far from being an exclusively royal hazard, the vagaries of chance were a reality of daily life for all. In the words of the English poet John Lydgate (c.1370–1450):
2. The goddess Fortuna spinning her wheel to change the fate of four kings and their rule. The image was added in the eleventh century to a Visigothic manuscript written in Cardeña in 914 by a scribe named Gomez.
The enuyous ordre of fortunat meuyge
In worldly thynge false and flykerynge
Ne wyll nat suffre vs in this present lyfe
To lyven in reste without werre or stryfe
For she is blynde fykell and vnstable
And of hir course false and full mutable
The envious order of Fortune’s moving,
In worldly things false and vacillating.
None will not suffer it in this present life,
To live in rest without war and strife.
For she is blind, fickle, unstable,
And her course is false and mutable.
Clearly the Middle Ages saw itself as having both winners and losers. Most medieval cultures were indeed heavily stratified in this manner, with divisions between the haves and the have-nots reinforced by patterns of wealth and work. Those who owned land, at home or abroad, had both financial control of its produce – wool, wheat, wood, slaves, iron, furs, ships – and, by extension, political control of the people who wished to live or labour on it. This is not to say that medieval living was entirely constituted of emperors and peasants, two camps polarised at totally different extremities of income: in between was a broad spectrum encompassing all sorts of groups, from busy professionals through to skilled craftsmen and an aspirational merchant class. Yet a king could still expect his comfortable surroundings and ample diet to see him greatly exceed the average life expectancy of a labourer harvesting his royal lands, who might have struggled to make it to forty. The daughter of a wealthy lord might receive a thorough schooling at home, while her working-class counterpart would be unlikely ever to be able to read or write. The son of an aristocratic landowner could be welcomed through familial connections into the political ruling class or well-funded religious institutions, while the son of a farmer was expected to toil in the fields for his entire working life. Like today, for those who found themselves at opposite ends of Fortuna’s Wheel, standards of living could be strikingly different.
Giggles and Disgust
The bodies of these medieval men and women would, of course, have been equally varied, but none would have been that dramatically unlike our own. Contrary to the stereotype, people in the Middle Ages were not necessarily much smaller than us. One recent archaeological study of a group of bodies buried over the course of 900 years in a small rural parish in Lincolnshire reveals almost no difference in people’s height between the Middle Ages and the Victorian era, averaging around 5 feet 7 inches for a man and 5 feet 3 inches for a woman. Nor were these people all toothless, crippled or constantly sick. True, they lacked a detailed modern understanding of infection which could have helped fight against large-scale disease events like the Black Death, a quick-spreading bacterial epidemic thought to have decimated nearly a quarter of the global population in the 1340s. Yet the air they breathed and the food they ate would have been free of modern chemicals and pollutants, and potentially far healthier than our own.
What was dramatically different, however, was the way medieval people thought their bodies worked. On the whole, the biological and medical notions of the Middle Ages tend to elicit two types of response. First, giggles. Surviving medieval sources advocate subjecting the body to all sorts of strange happenings in order to cure it, many of which can seem weirdly comical in their wrong-headedness: the application of fresh cow dung to help problematic tear ducts, a combination of vinegar and honey rubbed onto the head to fight baldness, the insertion of peppercorns into the vagina after intercourse as a contraceptive. But this amusing silliness can quickly shift to a rawer sense of discomfort or even disgust at methods of the past. In the Middle Ages a headache might be treated by puncturing the neck and draining the body of several pints of blood, a concoction of boar’s bile and potentially deadly hemlock could serve as an anaesthetic, and a range of ailments were thought to be alleviated by burning multiple points on the body’s surface with red-hot metal rods. From a modern vantage point these ‘cures’ seem worse than useless, even torturous.
This is the true difficulty of getting to grips with medieval bodies: their owners conceived of them through theories that have since been totally disproven to the point of absurdity but which nevertheless could not have seemed more vivid or logical in the Middle Ages. We think of our bodies now as a relatively closed and contented circuit, our skin a clear border between the inside and outside of ourselves. But the human form in the medieval period was considered a far more open and porous group of organs and systems. As a result, an understanding of the world circling around the body was crucial to an understanding of what lay within. Natural philosophers and theorists of the preceding Greek and Roman eras had passed on to medieval thinkers the notion that nature was composed of four primary base elements – fire, water, air and earth – and that the disposition of this quartet could affect the external appearance and internal properties of all things. Each element was also aligned with two further fundamentals, moisture and heat: fire was hot and dry, water wet and cold, while earth was dry and cold, and air hot and wet. Substances associated with each element also contained these inherent properties, and in a direct reflection of these natural surroundings medieval bodies were thought to contain four corresponding viscous internal agents known as the humours: blood, phlegm, yellow bile and black bile. A person’s constitution was determined by the equilibrium of these vitalising substances inside themselves, each in turn linked back to a particular element.
This biological system is perhaps not as abstract as it first seems. Some sense of it can still be felt in our own conceptions of health:
3. A diagram from a book written in the fi rst decade of the twelfth century, known as the Thorney Computus. It shows the macroscopic medieval conception of the world as fundamentally intertwined, outlining the correspondences of the four elements (Terra, Aqua, Aer, Ignis) with the months, the zodiac, the winds, the lunar cycles and the ages of man. The fi rst letters of the Latin names for the four cardinal directions are made to spell out the name ‘ADAM’: mankind thus inhabits the centre of this swirling image.
we often talk of our bodies being ‘not quite right’ or ‘slightly out of balance’ when evoking the off-kilter feeling of being ill, a sense that the machine of the body is not tuned quite as it should be. But in the Middle Ages the four humours were at once much more formalised and potentially far more severe than this modern queasiness. Misalignment had the ability to plunge someone into serious ill-health or even death. The primary job of many medieval medics was to prevent or correct a toxic imbalance of these humours through a variety of stabilising treatments. Excesses could be drawn out by purging the body, while tailored prescriptions could use the natural properties of dry, fiery roots and spices or cooling herbs and balms to restore the patient to balanced good health.
This idea did not stop at simple medicines. The grand scope of medieval medical thought took the logic of this link between people and nature to extremes. The time of year could bring natural shifts to the body’s balance, each season linked with a particular element: airy spring, fiery summer, earthy autumn and watery winter. Human development over time, too, brought with it elemental change, with different stages of life from childhood through to old age heralding a gradual cooling of the body and a shift in humoral foundation. Even the astrological goings on of the stars and the planets revolving around the earth were drawn into this grand anthropocentric system, with heavenly bodies from Capricorn and Aquarius to the Moon and Jupiter all holding sway over the sensitive make-up of mankind. It is little wonder that, when medieval thinkers came to plot out this intertwined vision of man and the world on the pages of their manuscripts, the resulting diagrams are packed with beautifully dense networks of correspondences and connections. Understanding the body was just one part of an attempt to make sense of the universe in its entirety.
A medical field born of this sort of thinking clearly must have looked and felt quite different from one founded on modern clinical principles of experiment and trial and error. Given that these systems were based so heavily on an inherited and deeply theoretical tradition, long-standing written texts played an important role across large sectors of medieval practice. Upholding the seemingly abstract concepts that underpinned treatment were many centuries of discourse and debate on the work of ancient and more recent authors, generations of scholars who copied, edited, synthesised, commented on and re-copied a whole range of writings that governed both the scope and specifics of medicine with a strict internal logic. So revered were these texts that they often took precedence over observation of the actual medieval body itself. This goes some way towards explaining why anyone might have kept going with cow dung, boar’s bile or bleeding. Consistency in implementing the medicine of their learned forebears was the paradigm of this medical movement, not innovation. Even if a particular method seemed questionable or ineffective – and at times they must have – to find a new route through medieval bodies would have required the overturning of centuries of thought. Change would only arrive on the back of major scientific revolutions, and it would not come quickly. Humorism, inflected with its medieval commentary, was to survive as a stalwart of medical practice well into the eighteenth century.
Histories and Healers
Who would the medieval man or woman have turned to when their bodies began to fail? Although many are peppered throughout this book, it can be tricky to get a proper grip on the different healers that populated this medical world. Most left behind only the lightest of footprints on the historical record, and we are often stuck pondering them from little more than a name scribbled in a margin, the excavated foundations of a hospital or the fragments of a gravestone marked simply medicus, ‘physician’.
But we do know that, like the Roman era before it, the earlier Middle Ages had no real state-controlled systems of medical qualification and no set path or expected background for becoming a trained doctor. Instead, local schools and institutional clusters taught a much more fluid form of medical curriculum, with particular regions becoming internationally renowned for their strengths in the healing arts. From the 700s onwards, Muslim Middle Eastern cities were amongst the most important centres for medicine, particularly well known for their ability to enrich the classical European texts they had preserved in Arabic with numerous Asian imports from Chinese and Indian traditions. Specialists in Baghdad, Damascus and Cairo built up extremely detailed and complex bodies of medical writings, as well as developing various new methods in surgery and pharmacy.
These cities’ wealthy elites were also among the first to be moved by a sense of charitable giving to endow the earliest large-scale hospital complexes. These bimaristans (
), as they were known, could grow to an enormous size, complete with internal wards corresponding to specialisation and incorporating complementary services such as baths, libraries and teaching faculties. A Baghdadi bimaristan, founded in around 981 by the Buyid emir ‘Adud al-Dawlah, dramatically described by one visitor to the city as rivalling its largest palaces in splendour, was an expansive network of beautiful buildings open to rich and poor, male and female, and Muslims and non-Muslims alike.
4. A physician, seated on the right, speaks to two patients, one with eyes bandaged and the other with a bulbous stomach. The image accomponies a text on pharmacology originally by the first-century Greek doctor Dioscorides, copied into Arabic in Baghdad in 1224.
The reach of this Arabic-speaking medical expertise was impressive, stretching west across Muslim north Africa all the way to southern Spain, and practitioners in the rest of Europe benefited greatly from the ability to work at the pinch points between western and Middle Eastern cultures. Both men and women in the southern Italian city of Salerno, for instance, had by the eleventh century accrued a formidable medical reputation. Healing there was helped by Salerno’s position as a diverse cultural melting pot, combining the wealth and learning of its local Benedictine monasteries with proximity to both Arabic thinkers in Muslim Sicily and the classical heritage of nearby Greek-speaking territories. So apparently impressive was this multilingual Salernitan healing that wealthy patrons were willing to voyage from far and wide to seek treatment at the hands of its experts. In the 980s a bishop of Verdun named Adalbero even recorded undertaking an expensive cross-continental expedition to Salerno over the Alps from his diocese in north-eastern France, braving long and often dangerous roads just for an improved chance of cure.
The steady growth of this cross-pollenated medicine was cemented in Europe by the emergence of the first universities, founded from the late eleventh century onwards in Bologna, Paris, Oxford, Cambridge, Montpellier, Padua and elsewhere. Rather than specialising in a particular medical field, university-trained physicians were encouraged to slowly accrue as diverse a breadth of knowledge as possible. The best students could discourse encyclopedically on many different aspects of bodily cure, especially those rooted in the sort of textual studies familiar to other more popular subjects like law or theology. But these physicians themselves were far from diverse. Universities were open only to men, and men of good character and breeding at that, who were expected to subscribe to the moral and intellectual standards of what were largely religious institutions, as well as having the substantial wealth needed to support their studies. Moreover, this type of elite, theoretical and highly academic medicine would not always have been of immediate use when presented with an average actual sick individual: it is hard to imagine how a patient gushing blood from the head or in the throes of a violent fever would have appreciated an extended Latin quotation sourced from the Hippocratic Aphorisms, Johannitus’ Isagoge or Galen’s On the Utility of Breathing. In reality, such high-ranking university professionals were unlikely to have been the first port of call for many. These figures were very much the tip of the medical iceberg, a relatively small group of well-schooled, well-to-do individuals whose elite bearing and high prices saw them catering exclusively to the upper echelons of medieval society.
Instead, for most medieval people treatment would have been sought from a far broader range of healers sometimes gathered together under the term ‘empirics’: surgeons, midwives, apothecaries, barbers, dentists, all considered more practically minded craftsmen and craftswomen. Although their work was underpinned by the same fundamental ideas – that the body was founded on balanced humours in deep confluence with the environment around it – these empirics differed significantly from their university counterparts in turning this understanding into practice. Theirs were professions learned not in classrooms but in workshops or in the field, serving as apprentices to more experienced masters in the same manner as young carpenters, butchers, potters or other artisans. Most would not have been literate, yet just as much knowledge was involved in craft as in academia. An apprentice surgeon would have to watch carefully at his master’s side for the minuscule subtleties of the knife moving over the skin, of the right way to apply salves and tie complex bandaging, or to pick up a cleverly deployed detail of expert bedside manner at just the right moment to reassure an anxious patient. While the physician’s knowledge was safeguarded by the elite Latin language, preserved on parchment in exclusive libraries, the empiric’s livelihood was protected through the keeping of professional secrets within family networks and artisanal guilds. These organisations could grow into powerful social institutions. In large cities such as Paris or Florence medical guilds patrolled the practice of their members while fiercely advocating for their rights and privileges, supporting craftsmen in old age or ill-health, overseeing local government and processing colourfully through the town on feast days with songs and banners. But neither physicians nor empirics necessarily needed to set up permanent practice in these major centres. Many were like the fifteenth-century French surgeon Jean Gispaden, who journeyed extensively to serve a wider range of clientele. We know of Jean’s work through a surviving notebook that he kept, its small, worn pages recording all sorts of details from his practice, and even some careful line drawings of his surgical instruments. These knives, pincers, forceps, scissors and other fierce-looking instruments would have travelled with him on his peripatetic surgeries, offering his skilled relief across a large area of the western Alps, trading his training and reputation for a potentially lucrative fee.
5. The surgical tools of the fifteenth-century travelling healer Jean Gispaden, who sketched them across a series of pages in the back of his notebook.
With variation, though, came division among these many different types of healer. The literary learning of the universities carried a greater price tag and prestige than the gritty manipulation of actual bodies by surgeons and other empirics. In some centres the two groups were on good terms, working together to heal patients with their parallel expertise. But in others they seem to have inhabited totally distinct and even highly antagonistic social realms. Even today the terminology of modern medicine recalls the fractious diversity of this medieval moment: surgeons still choose the epithet Mr rather than Dr, avowing their profession’s origins in the world of tangible craft and not the doctoral confines of the academic university.
Folks and Folklore
The patients who frequented these different types of medical expert came from equally diverse backgrounds. Inevitably we know most about the wealthy, whose ample accounts record substantial spending on systems of care. King Edward II of England (1284–1327) employed an international group of at least twelve physicians and surgeons to attend members of the royal household and its extended court, supplying each with valuable medicaments, clothes, valets, a sizeable daily salary and horses (plus hay). Expensive illustrated luxury health books, particularly popular in Italian and French patrician circles, also give us a closer glimpse of this specific class of patron. Lavishly decorating the remedies of their age, the manuscripts are stuffed with large, gilded vignettes of doctors, patients and workers gathering the ingredients for medical treatments. Often they recommend expensive medicines, rest from overbearing thought, quiet, comfortable surroundings and copious fresh air, all cures aimed at a reader clearly unrestricted by the daily labour of a lower-class existence.
Still, we can try to paint at least a partial picture of more ordinary patients from the surviving records of various medical professionals. The notes of the thirteenth-century physician Taddeo Alderotti, a professor of medicine based in Bologna, record a range of varied house visits, from the grand palazzo of the Doge of Venice to more local, lower-status clients scattered across towns in northern Italy. Practitioners like Taddeo would have customised treatment to suit the pockets of different patients, making up pricey prescriptions of precious spices and minerals for their more comfortable clients while offering simpler remedies made from more freely available materials for the less well-off. The good health of the poor was also aided by an increased attention to public sanitation, which in the later parts of the Middle Ages began to be regulated by local administrators in many European and Middle Eastern cities. Various civic infrastructures were implemented, including regular waste disposal, formalised street cleaning and sewage networks for the supply of fresh water, while the quality of foodstuffs began to be more and more carefully regulated. Depending on where you lived, provision of free medical care might even be made available at the expense of the state, ensuring at least a modicum of treatment for the most needy. These patients, a poorer and more generic sick, are the least likely to make the history books, unless perhaps a botched operation by a surgeon or mistaken poisoning by a dodgy apothecary meant that they featured in accounts of the frequent legal cases brought against healers of the period. Even in the generally well-kept records of larger-scale public hospitals we only tend to hear of these lower-class patients as being placed two to a bed in long wards, waiting to be comforted in their final days.
A great leveller of this medical playing field, however, was religion. Whoever the patient and wherever they were being attended to, almost everyone in the Middle Ages would have upheld a strong belief that their physical health was directly related to their spiritual well-being. For the predominantly Christian peoples of medieval Europe and the Islamic populations of north Africa and the Middle East, an illness could be understood as stemming from accident, aggression or imbalanced humours, but it might just as likely be an externally presenting symptom of a more deep-rooted, sinful sickness. Medicine’s conflation of the body and the natural world fitted quite happily with religious teachings of an ultimate and all-seeing maker who created mankind as the central element of a broader universe. Christian doctrine made clear that disease was one of the many postlapsarian burdens that men and women simply had to bear, meted out at God’s behest. And in the views of Judaism and Islam, too, ill-health could stem from ill-living, with rampant epidemics interpreted as divine punishment for wider-scale wantonness.
Yet religion offered hope as well as despair in the medical realm. Just as powerful as the certain sickness of holy transgression was the ever-present possibility of miraculous cure. This belief in a link between spiritual morality and earthly health kept medieval healing in dialogue with much older forms of pragmatic folklore and magical superstition. In the Islamic world, for instance, the old Aramaic practice of harnessing sacred power through ritualised drinking had continued currency in the Middle Ages, prompting the creation of a series of bronze bowls endowed with superstitious healing properties. Inscribed instructions running around the bowls direct the patient to fill it with infusions of different tastes and at different temperatures depending on the effect required. One surviving brass bowl from around 1200, now in the David Collection in Copenhagen, combines engravings of Qur’anic verses wishing for auspicious childbirth with circles and squares of magical numbers, as well as images of poisonous animals, perhaps intended to ward against a sudden or unforeseen death. Imbibing the water from such a vessel was thought to cure disease and fend off future sickness, the liquid imbued with prophylactic powers through contact with the verses and images etched onto its surface.
Seeking religious intervention was thought by virtually all patients to be just as effective as a humour-balancing herb, and prayers often mingled alongside pharmaceuticals in the pages of mainstream medical treatises. As with the Syrian bowls, the idea that proximity to the holy or fortuitous word could heal was also prominent in Jewish and Christian cultures. Amuletic scraps of parchment carrying the name of God, a saint or short hopeful ditties were sometimes worn around the neck or even swallowed by a patient for protection and speedy recovery. Equally efficacious might be a visit to a pilgrimage shrine to see and touch holy sites or revered remains. This was a more direct form of miraculous cure, where crawling beneath the decorated caskets of saints or sleeping in the presence of sacred spaces might engender the sympathies of the holy who could bring immediate physical aid. Heavenly healing like this was transactional. Good deeds on earth might be traded for instant good health, and pilgrims often left money, candles or wax effigies of afflicted body parts at shrines in the hope of tipping the spiritual economy in their favour. But beyond the miraculous, religious institutions were often also key points of more everyday care. In smaller communities rabbis, priests and imams doubled as local healers, albeit with limited knowledge, and the emphasis placed on learning and charity as two pillars of the medieval monastery meant that communities of monks also gained a widespread reputation for medical expertise. At once more complicated and more humane than mere superstition, religious healing worked alongside the more secular theories of humoral cure to offer both physical and psychological relief to those in pain.
6. A magical brass healing bowl, engraved with Qur’anic phrases and superstitious images, made around 1200 in Syria.
Beyond Words
This, sketched ever so briefly, is the rough shape of the medieval bodies that this book is poised to delve into. Medicine in the Middle Ages inherited from the classical world a highly developed theoretical and practical framework for understanding health. But it also built up its own uniquely dense socio-cultural and spiritual hierarchies, within which a number of lively competing practitioners and patients jostled for attention. Where exactly the red-haired half-man with whom I began fell within this broad spectrum still remains to be seen. Perhaps evolving technologies will soon provide new ways to examine his preserved body even more closely for further traces of his particular past life. But far from an impenetrable historical fog, the era in which he lived featured numerous exciting conceptions of the human form and how to care for it.
In fact, I think we can push these medieval bodies even further. They were not only the very centre of human existence in the Middle Ages, a malleable whole open to oscillating cycles of sickness and health. They were also a powerful metaphor, a creative body which could be made by healers, writers and craftsmen alike to stand in for almost anything, from the locus of everlasting metaphysical salvation to the recurring machinations of the seasons and the planets. Our routes through this material therefore have to be vast and varied, multiple modes of layered evidence spread across the best part of a thousand years. We will unpack the detail of medical textbooks written by learned authors and comb through the accounts of doctors and records of institutions. We will consider more lyrical written responses to sickness and cure made by all sorts of medieval people in their poems and prayers. But we will also look to the visual. For artworks and objects are another persuasive body of material that survive from the Middle Ages to communicate a vast range of ideas about how the human form was seen and understood. In an age without diary-keeping, where personal points of view are very few and far between, images offer a powerful inroad when texts fall silent. And they do so with particular emotion and vigour. For all that we can read a surgical treatise or a hospital’s ledger for facts and figures, we learn something perhaps more immediate from looking at the carved faces of the faithful who smile as their sculpted bodies are cured by the miraculous touch of a healing saint. Ideas of health and these artistic objects are completely, happily entangled.
7. A marble sculpture of Saint Elzéar of Sabran healing three lepers. Elzéar was a Franciscan monk and mystic, whose healing touch earned him a name derived from the miraculously revived Lazarus of the Bible. In this scene he is shown curing three beaming lepers, their faces covered with the rounded buboes typical of the disease. The piece was carved to decorate the lower sections of Elzéar’s tomb in the town of Apt in southern France around the year 1373.
Born, bathed, dressed, loved, cut, bruised, ripped, buried, even resurrected, medieval bodies are a path to understanding the very essence of everyday life in the past. In the chapters to come I want to revive them along the very same lines as those laid down by thinkers of the Middle Ages. When a medieval medical author sat at their desk to write a record of their accumulated cures, they would often chose the body’s own skeleton to act as their literary form, presenting treatments a capite ad calcem – ‘from head to heel’ – working their way from baldness and the brain down to twisted ankles and splinters in the toes. What follows is just this sort of unravelling, piece by bodily piece: the head, senses, skin, bones, heart, blood, hands, stomach, genitals and, finally, feet. By fleshing out each of these anatomised elements in turn, we can build up a picture of medieval bodies as more than just the sum of their parts, encompassing contemporary attitudes to life and death, pain and beauty. This is the body in its very broadest sense, a jumping-off point for exploring all kinds of aspects of medieval life. The head leads to thought, skin to clothing, bones to burial practice, feet to travel. Because once loosed from the confines of a distant ‘Dark’ Age, we can begin to see that the lives of these past bodies are not so very far from our own. Skeletal structures of the great medieval cathedrals still stand at the centre of our cities. Anatomised saintly bones survive in relics and reliquaries preserved in museums and galleries around the world. And a bygone anatomical terminology still lurks at the very heart of our modern language. Far from dead and buried, medieval bodies are alive today.