Medicine Before the Plague: Practitioners and Their Patients in the Crown of Aragon, 1285-1345 (review)

In 1333 Pere Teixidor of Oristà was denounced as a leper in Vic, in Catalonia. At Pere’s request, the court asked the municipal physician, Martí de Soler, to inspect him for signs of the disease; assured by Martí that he was free of the disease, the court discharged Pere, noting that “the doctor must be believed in matters relating to his art” (p. 221). The court’s formulation—with its emphasis on the weight of medical authority—encapsulates a number of the most important themes of Michael McVaugh’s impressive study of medical organization and practice in late-thirteenth- and early-fourteenth-century Spain. In particular, it illustrates his central contention, that the territories of the Crown of Aragon saw a dramatic increase in the authority of medicine among the lay public, municipal and ecclesiastical authorities, and in the eyes of the king of Aragon himself. This development led to what McVaugh calls a pervasive “medicalization” of health care that began in the 1290s and accelerated into the fourteenth century, drawing its impetus from the success and prestige of the new medical learning elaborated in the nascent medical faculties of Italy and France. By the 1330s, according to McVaugh, the unique expertise of physicians and surgeons was widely recognized: formal procedures had been established for medical licensing, and physicians were not only widely consulted by private clients, but were also called on by local officials as forensic experts (as well as judges of leprosy) and were asked to provide publicly subsidized medical care to the inhabitants of many moderate-sized towns.

McVaugh makes his case using evidence from contemporary medical treatises—notably, works attributed to the Aragonese physician Arnau de Vilanova and the surgeon Henri de Mondeville (both associated with Montpellier, the principal university serving the Crown of Aragon)—and, especially, documents from more than twenty-five archives in fifteen cities in Aragon, Catalonia, and Valencia. He has amassed a huge body of material that provides a remarkably detailed picture of medical practice in the Crown: approximate numbers of practitioners and their distribution, by religion, location, and type of practice; the varieties of contexts in which they worked, and the medical and social functions they were asked to perform; the kinds of therapeutic interventions they offered; and their relations with both institutional and private clients.

A short review cannot do justice to the richness and importance of McVaugh’s book. Meticulously documented and densely argued, it provides the most detailed account to date of medical organization and practice in any region of medieval and Renaissance Europe. In addition, it fills a large gap in our understanding of the emergent medical order of the early modern period. As McVaugh suggests, this order, the expectations that underlay it, and the institutions that structured it—ranging from a recognizable system of medical licensing to medically organized hospitals—emerged at different periods in different parts of Europe, appearing first in Italy, only shortly afterward in Aragon, and later (in the fifteenth century) in France and (in the sixteenth century) in England.

McVaugh portrays this medical order in the process of formation—not largely constituted, as has been the case in the local studies of other southern European cities, which have focused on the period after 1348. As a result, he is able for the first time to provide a plausible dynamic for this process, arguing that the impetus came not from the physicians themselves—who, he claims, had little sense of corporate interests and identity—but from the patients who sought reassurance in conceding control over their health to their physicians, and from the individuals and municipal officials who saw in physicians and surgeons a group of experts qualified to resolve a wide range of social and legal disputes. The result—looking ahead to the later fourteenth century—was the creation of an emergent body of specialized medical...