La busqueda de la salud: Sanadores y enfermos en la Espana medieval (review)

For more than a quarter century, students of medieval medicine have drawn inspiration as well as information from Luis García-Ballester's Historia social de la medicina en la España de los siglos XIII al XVI, vol. 1, La minoría musulmana y morisca (1976). The vigorous study and intense humanity of that pathbreaking work also grace La búsqueda de la salud, which is presented as the sequel—though, interestingly, neither as "Volume 2" nor with a corresponding subtitle. It is sad that this planned continuation, delayed by the author's illustriously prolific career and professional leadership, had to be completed with his final strength and published posthumously; Jon Arrizabalaga guided the substantial volume (with more than 1,800 footnotes) through the press with energy and diligence worthy of his mentor, "el infatigable Luis" (p. 6).

The subtitle, Sanadores y enfermos en la España medieval, is both more and less inclusive than the book itself. The volume covers the territories of Castile, whose health care is poorly documented and largely unexplored; it leaves aside the lands of the Crown of Aragon, which, in contrast, bequeathed a wealth of documentation and afforded a steady flow of scholarship—much of it under García-Ballester's aegis. And while La búsqueda de la salud never loses sight of "sanadores y enfermos," its purview ranges from the intellectual foundations to the social margins of medical practice.

The starting point is the anchoring of medicine in natural philosophy, with considerable help from translators in the frontier town of Toledo. The evolution of the craft into a science led to new views and forms of medical assistance. Castilian grandees and towns appropriated the services of university-educated physicians, but also of learned Jews—even as these were persecuted by the Christian majority (well before the Spanish Inquisition) and denounced by Jewish religious leaders for their rationalism (p. 496). Most people, whether Christian or Jewish or Muslim, were attended by practitioners trained outside institutional confines, in a "modelo abierto" (p. 213 and passim). This care came under increasing royal and municipal control, most notably in the reforms by Queen Isabella in 1477 and in the Ordinances of Toledo around 1487. The latter regulated the relationship between physicians and apothecaries, which is analyzed in the final chapter of the book. This entire chapter, on pharmacy in Valencia, is a valuable monograph in itself, although the author had a keen sense of what remains to be done.

La búsqueda points out many other avenues for further work, ranging from the recognition of Muslim practitioners to the edition and analysis of sources. By the same token, it is not immune to the fallibility inherent in dependence on secondary information and recourse to speculation. Thus, on the authority of one historian, lepers are stereotypically described as "una auténtica minoría marginada" (p. 533). From a paraphrase by another historian, Gabriele Zerbi's caution about writing prescriptions is expanded into "secretismo" (p. 604). A speculative interpretation, of a law that decreed death for a woman using an abortifacient, oversimplifies the possible connection with the Hippocratic oath (p. 581 n. 60). In a different simplification, Scholasticism is presented one-sidedly as heuristic and innovative, without mention of its didactic and derivative aspects (pp. 104-15): as a result, it is difficult to evaluate how much of the broad appeal of medical Scholasticism was based on its ready teachability, and how much on its Aristotelian and, above all, Galenic premises.

García-Ballester's emphasis on the role of Galenic terminology, physiology, diagnostics, and therapeutics caps a lifelong outlook. His first published monograph was Galeno en la sociedad y en la ciencia de su tiempo (1972). It...