"Bedside Manners in the Middle Ages"

The title of this paper is a deliberate echo of another one, the title of an article published just fifty years ago by Henry Sigerist in the Quarterly Bulletin of the Northwestern University Medical School. There Sigerist translated and discussed a short Latin text, attributed to the late-thirteenth-century physician Arnald of Villanova, that set out some of the ways in which physicians needed to behave toward their patients. Sigerist saw no real reason to doubt this attribution, although I will try to explain why it seems to me more likely to be a picture of the medical world as it was in the twelfth century, and even earlier, than of the late thirteenth. What clearly intrigued him about the treatise was its opening section, where the author explained to his readers certain precautions they should take when examining urine specimens brought to them for diagnosis—it was accepted that a patient’s condition could be determined by studying the color, sediment, and so forth of his urine. ¹ These precautions will introduce us to the question of the interaction between healers and patients in the Middle Ages, and of how this changed in the twelfth and thirteenth centuries. The description may seem to confirm all our worst preconceptions about medieval medicine—most people are convinced that it must have been ludicrous, bordering closely on farce—but we need to have a sense of the healer-patient encounter that it reveals. In the fifty years since Sigerist called attention to this text we have considerably expanded our understanding of the social and institutional setting of medieval medical and surgical practice, and that understanding should help to give the text some historical perspective.

Actually, Sigerist’s title is quite misleading, at least as regards the part of the text that most interested him, because these precautions do not show the physician studying the urine at the bedside; he only encounters the patient by proxy. The author takes it for granted that the physician is being brought the urine by an intermediary, a messenger from the patient. You need to determine at the beginning, the text explains, whether the urine is human, or of another animal, or another fluid altogether—stewed thistles, perhaps; stare hard at the person who brings it to you, and if she blushes furiously, accuse her immediately of trying to trick you. If you think that she may be trying to fob you off with white wine, pour out a little of it in such a way that some gets on your finger; then stop and pretend to blow your nose with the same hand, sniffing the finger as you do so, and if you smell wine, tell her you know that she’s trying to mislead you. If it really is urine that you have been given, and you can’t learn anything from it about the patient, says our text,

say that he has an obstruction in the liver. [The messenger] may say: “No, sir, on the contrary he has pains in the head, or in the legs or in other organs.” You must say that this comes from the liver or from the stomach; and particularly use the word, obstruction, because they do not understand what it means, and it helps greatly that a term is not understood by the people. ²

And so on: the author offers many such nuggets of advice, all very much of a piece, and all immediately suggesting to a modern reader that medieval medical practice was no better than an elaborate charade without any intellectual content at all. Yet on the contrary, this physician-patient exchange over a urine-flask has something serious to tell us about medical relationships in the Middle Ages.

If there is any one stock image of the medieval physician in the public mind today, it is one showing him gazing deeply into a urine-flask, and the same thing was true in the Middle Ages: medieval manuscripts show that scene over and over again. And whereas for us the scene is good for a condescending giggle or...