Looking for professionals of old: medical practitioners in early medieval Italy

Luca Larpi writes about his research project (funded by the Wellcome Trust and hosted in Classics & Ancient History at Manchester) on early medieval medical manuscripts:

It is quite easy nowadays to identify a doctor. Every time we walk into a hospital, we are usually able to distinguish immediately the medical practitioner from the nurse: the first invariably wears a (once white) coat and has often a stethoscope around his or her neck. These two items, in the context of a place like a hospital or a clinic, allow the patient to assume that the individual in front of him or her has the capability to treat his or her illness.

This assumption is generally justified by the fact that the competence of a medical practitioner is guaranteed by the State, which regulates every aspect of the career structure, from entry requirements to learning and training. In England, for example, before being entitled to a salary from the National Health Service, the student of medicine has to undertake a long period of learning which lasts more than 10 years, from the undergraduate degree awarded by a medical school to the postgraduate training. The doctor thus is “a person licensed to practise medicine”, and such a licence is given by an institution of higher education whose authority to award degrees is recognised by the State. The resulting body of practitioners is narrowly defined, similarly trained, and socially homogenous.

Galen Lecturing

Galen lectures to three students. Italy (Bologna?), 1300(?). Yale Medical Library. Manuscript. 28 [Paneth codex]. (Created by the UCLA Library and used with permission. The Regents of the University of California continue to hold copyright for all UCLA Library Web site content.)

Western conceptions of the medical profession are ultimately the product of a process begun in the Middle Ages. From the eleventh century onwards Europe saw the beginning of what has been called a “war over medical practice”, centred on two main points of debate: the definition of appropriate standards for licensing and practice, and of the organizations which were to establish and enforce them. The university emerged as ultimate winner of such competition: by 1300 medicine was inserted in its curriculum, while the clergy – who played an important part in the study, the diffusion and the practice of medicine during the early medieval period – saw its role dramatically reduced. As a result, by 1500, Europe’s urban body of medical practitioners was “largely lay, Christian and (with the exception of midwives) male” (K. Park, “Medicine and society in Medieval Europe, 500-1500”, in A. Wear (ed.), Medicine in Society, Cambridge 1992, p. 81).

This reassuringly clear-cut view of the medical practitioners fades almost immediately once we turn to the period preceding the eleventh century. The world of antiquity and the early Middle Ages has very little to offer for the historian of medicine in terms of ways to determine the status of the doctor and his position in the social hierarchy: at the time there were no institutions of higher education awarding accreditations, no legal requirement for practice, perhaps not even guild regulations (V. Nutton, “The medical meeting place”, in Ph.J. van der Eijk et al. (eds.), Ancient Medicine in its Socio-Cultural Context, Rodopi 1995, pp. 3-34). It was a fluid world, variegated and concerning virtually every level of the society, ranging from the sophisticated “Philosoph-Arzt” to the self-taught bone-cutter (J. Korpela, Das Medizinalpersonal im antiken Rom, Helsinki 1987, p. 7). This is so dramatically true that even the terms most commonly employed for referring to healers in the Ancient and early Medieval word, the Latin medicus and the Greek ἰατρός, are problematic, as they can denote many different professions, often quite difficult to define with precision.

While the status of medical practitioners in Antiquity has already attracted the attention of many scholars, the same cannot be said for early Middle Ages. The education and training of medici in early medieval Italy, on whose tradition and expertise later medical faculties such as Salerno or Bologna were built, remains a topic which tend to be discussed predominantly by historians working at a local or regional level, and mostly en passant. The central aim of the project “I sign therefore I am. Medici in early medieval Italy, AD 800-1100”, founded by the Wellcome Trust, is to fill the gap, researching the presence of medical practitioners participating in legal transactionsover three centuries in multiple kingdoms (Frankish, Ottonian, Byzantine, Norman and autonomous cities), using the Italian peninsula as a case study.

Bar the occasional reference in literary sources to generic medici, for practically all actual named medical practitioners active anywhere in Europe between AD 800 and 1100 the only way we know even of their existence is through their participation in legal transactions: sales, donations and legal judgements (placita). Italy is exceptionally rich in surviving early medieval charters and legal judgements, including many original documents with autograph signatures.

An important result of this investigation was the completion of a survey of of ca. 17,000 documents held in the archives of twelve Italian cities, using published material with the only exception of the charters held in Lucca and some documents of the archives of Cava dei Tirreni (Salerno), which were consulted personally by me (Luca Larpi)  in 2013.

Map

Archives included in the database.

178 documents mentioning 109 individual medici were identified. The role of these practitioners varies according to the context, the time and the place where the charter was written. While medici acted mainly as witnesses in the first part of the period under study (ss. IX-X), in the following centuries (ss. XI-XII) they appeared mostly as landowners. This depends, at least in part, from a change in local scribal practices, which resulted in the disappearance of the references to witnesses almost everywhere in the Italian peninsula by the 10th century.

The gathered data, currently under scrutiny, is now available on an online database accessible via the University of Manchester website. Once analysed in detail, this material will allow us to understand for the first time the social networks of early medieval medical practitioners, their education and training, and to assess with more clarity the ratio between lay and clerical medici in early medieval Italy. Moreover, the results of this study will also provide a vital background for the understanding of the expansion of Western learning during the 12th century and its links with Arabic scientific and medical knowledge.

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