Bedside Manners in the Middle Ages

Bulletin of the History of Medicine

Volumn 71, Issue 2, 1997, Pages 201-223

  McVaugh, Michael R ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARNALD OF VILLANOVA; ARTICLE; DOCTOR PATIENT RELATION; EUROPE; HISTORY; HUMAN; MIDDLE AGES; PROFESSIONAL PATIENT RELATIONSHIP; TRUST; UNCERTAINTY; URINALYSIS; WILLIAM OF SALICETO;

ARNALD OF VILLANOVA; MIDDLE AGES; PROFESSIONAL PATIENT RELATIONSHIP; WILLIAM OF SALICETO;

EUROPE; HISTORY, MEDIEVAL; HUMANS; PHYSICIAN-PATIENT RELATIONS; TRUST; UNCERTAINTY; URINALYSIS;

EID: 0031154744     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (87)

1. Henry E. Sigerist, "Bedside Manners in the Middle Ages: The Treatise De Cautelis Medicorum Attributed to Arnald of Villanova," Quart. Bull. Northwestern Univ. Med. Sch., 1936, 20: 135-43; reprinted in Henry E. Sigerist on the History of Medicine, ed. Felix Marti-Ibañez (New York: MD Publications, 1960), pp. 131-40 (page numbers in subsequent citations refer to this edition). Sigerist distinguished four parts in the text (known collectively as De cautelis medicorum), of which the first contained the uroscopic advice mentioned here.
2. Henry E. Sigerist, "Bedside Manners in the Middle Ages: The Treatise De Cautelis Medicorum Attributed to Arnald of Villanova," Quart. Bull. Northwestern Univ. Med. Sch., 1936, 20: 135-43; reprinted in Henry E. Sigerist on the History of Medicine, ed. Felix Marti-Ibañez (New York: MD Publications, 1960), pp. 131-40 (page numbers in subsequent citations refer to this edition). Sigerist distinguished four parts in the text (known collectively as De cautelis medicorum), of which the first contained the uroscopic advice mentioned here.
3. Translated by Sigerist, "Bedside Manners" (n. 1), p. 135.
4. Loren C. MacKinney, Early Medieval Medicine with Special Reference to France and Chartres (Baltimore: Johns Hopkins Press, 1937), pp. 45-46, 162-63; Johannes Duft, Notker der Arzt (St. Gall: Ostschweiz AG, 1972), pp. 45-46.
5. Loren C. MacKinney, Early Medieval Medicine with Special Reference to France and Chartres (Baltimore: Johns Hopkins Press, 1937), pp. 45-46, 162-63; Johannes Duft, Notker der Arzt (St. Gall: Ostschweiz AG, 1972), pp. 45-46.
6. The text has been published as "Anonymi Salernitani De adventu medici ad aegrotum libellus" in Collectio Salernitana: ossia documenti inediti, e trattati di medicina appartenendi alla scuola medica Salernitana, ed. Salvatore de Renzi, vol. 2 (Naples, 1853), pp. 74-80; it was discussed by Loren C. MacKinney in "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bull. Hist. Med., 1952, 26: 1-31, esp. pp. 24- 26. As Sigerist later pointed out, it was subsequently incorporated into the De cautelis attributed to Arnald of Villanova as its third part ("Bedside Manners" [n. 1], p. 133; the text is translated on pp. 137-38). The work is treated by Pearl Kibre, Hippocrates Latinus: Reportorium of Hippocratic Writings in the Latin Middle Ages (New York: Fordham University Press, 1985), pp. 232-33, under the title of [ps.-Hippocrates'] De visitando (visitatione) infirmorum.
7. The text has been published as "Anonymi Salernitani De adventu medici ad aegrotum libellus" in Collectio Salernitana: ossia documenti inediti, e trattati di medicina appartenendi alla scuola medica Salernitana, ed. Salvatore de Renzi, vol. 2 (Naples, 1853), pp. 74-80; it was discussed by Loren C. MacKinney in "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bull. Hist. Med., 1952, 26: 1-31, esp. pp. 24-26. As Sigerist later pointed out, it was subsequently incorporated into the De cautelis attributed to Arnald of Villanova as its third part ("Bedside Manners" [n. 1], p. 133; the text is translated on pp. 137-38). The work is treated by Pearl Kibre, Hippocrates Latinus: Reportorium of Hippocratic Writings in the Latin Middle Ages (New York: Fordham University Press, 1985), pp. 232-33, under the title of [ps.-Hippocrates'] De visitando (visitatione) infirmorum.
8. The text has been published as "Anonymi Salernitani De adventu medici ad aegrotum libellus" in Collectio Salernitana: ossia documenti inediti, e trattati di medicina appartenendi alla scuola medica Salernitana, ed. Salvatore de Renzi, vol. 2 (Naples, 1853), pp. 74-80; it was discussed by Loren C. MacKinney in "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bull. Hist. Med., 1952, 26: 1-31, esp. pp. 24- 26. As Sigerist later pointed out, it was subsequently incorporated into the De cautelis attributed to Arnald of Villanova as its third part ("Bedside Manners" [n. 1], p. 133; the text is translated on pp. 137-38). The work is treated by Pearl Kibre, Hippocrates Latinus: Reportorium of Hippocratic Writings in the Latin Middle Ages (New York: Fordham University Press, 1985), pp. 232-33, under the title of [ps.-Hippocrates'] De visitando (visitatione) infirmorum.
9. The text has been published as "Anonymi Salernitani De adventu medici ad aegrotum libellus" in Collectio Salernitana: ossia documenti inediti, e trattati di medicina appartenendi alla scuola medica Salernitana, ed. Salvatore de Renzi, vol. 2 (Naples, 1853), pp. 74-80; it was discussed by Loren C. MacKinney in "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bull. Hist. Med., 1952, 26: 1-31, esp. pp. 24- 26. As Sigerist later pointed out, it was subsequently incorporated into the De cautelis attributed to Arnald of Villanova as its third part ("Bedside Manners" [n. 1], p. 133; the text is translated on pp. 137-38). The work is treated by Pearl Kibre, Hippocrates Latinus: Reportorium of Hippocratic Writings in the Latin Middle Ages (New York: Fordham University Press, 1985), pp. 232-33, under the title of [ps.-Hippocrates'] De visitando (visitatione) infirmorum.
10. Vivian Nutton, "Beyond the Hippocratic Oath," in Doctors and Ethics: The Earlier Historical Setting of Professional Ethics, ed. Andrew Wear, Johanna Geyer-Kordesch, and Roger French (Amsterdam: Rodopi, 1993), discusses "the fate of Hippocratic deontology" in late antiquity and the early Middle Ages (pp. 22-26).
11. Many of these texts are printed or summarized in Ernst Hirschfeld, "Deontologische Texte des frühen Mittelalters," Archiv für Geschichte der Medizin, 1928, 20: 353-71; and MacKinney, "Medical Ethics" (n. 4), pp. 1-31.
12. Many of these texts are printed or summarized in Ernst Hirschfeld, "Deontologische Texte des frühen Mittelalters," Archiv für Geschichte der Medizin, 1928, 20: 353-71; and MacKinney, "Medical Ethics" (n. 4), pp. 1-31.
13. I have used the text of William's work provided in the unpublished paper by Charles W. Clark, "William of England and Astrological Medicine in the Early Thirteenth Century," which Professor Clark has generously shared with me.
14. Excellent accounts are Luis García-Ballester, "Galen as a Clinician: His Methods in Diagnosis," in Aufstieg und Niedergang der Römischen Welt, ed. Wolfgang Haase and Hildegard Temporini, part 2, vol. 37.2 (Berlin: De Gruyter, 1994), pp. 1636-71; and Vivian Nutton, "Galen at the Bedside: The Methods of a Medical Detective," in Medicine and the Five Senses, ed. W. F. Bynum and Roy Porter (Cambridge: Cambridge University Press, 1993), pp. 7-16.
15. Excellent accounts are Luis García-Ballester, "Galen as a Clinician: His Methods in Diagnosis," in Aufstieg und Niedergang der Römischen Welt, ed. Wolfgang Haase and Hildegard Temporini, part 2, vol. 37.2 (Berlin: De Gruyter, 1994), pp. 1636-71; and Vivian Nutton, "Galen at the Bedside: The Methods of a Medical Detective," in Medicine and the Five Senses, ed. W. F. Bynum and Roy Porter (Cambridge: Cambridge University Press, 1993), pp. 7-16.
16. Cf. the criticism of uroscopy in the Aphorisms of "Johannes Damascenus" or Mesue, one of the newly translated texts that was widely quoted by thirteenth- and fourteenth-century physicians: "Gloriosorum superbiam et ad urinale multiloquium, si sapias, contempnas, nec te egrum per omnia interrogare pudeat; urina enim, nisi cum morbus intra venas extiterit, fallax est" (Yūh + (Combining dot below)anna ibn Māsawayh [Jean Mesue], Le livre des axiomes médicaux (Aphorismi), ed. Danielle Jacquart and Gérard Troupeau [Geneva: Droz, 1980], pp. 148-49).
17. Nancy G. Siraisi, Taddeo Alderotti and His Pupils: Two Generations of Italian Medical Learning (Princeton: Princeton University Press, 1981), pp. 124-25.
18. "De omnibus inquirendum est a medico in collocutionibus ad investigandum essentiam morbi, sed non sunt omnia scribenda in libris tanquam artis principia. . . . Per accidentia possumus intelligere nocumenta que sentiunt infirmi ab egritudinibus suis, et etiam iuvamenta et nocumenta que sentiunt infirmi a rebus sibi oblatis vel approximatis, puta si aliquis habens causonem et bibit aquam frigidam, refert medico interdum quod contulit, interdum quod nocuit. . . . Illa quidem que debent fieri nota medico absque inditio egri sunt significationes quibus egritudinem cognoscimus, et quibus super illam pronosticamur non percepte ob infirmis, sicut urina talis vel talis et pulsus talis vel talis et qualitas corporis talis vel talis; per has enim significationes ignotas infirmis cognoscit medicus speciem egritudinis et eius causam et scit pronosticari super ipsam. Item significationes curative per quas cognoscimus res cum quibus fit cura et qualiter approximari debeant debent esse note medico absque inditio egri. . . . Vult hic Hippocras quod diversitas accidentium eiusdem egritudinis in diversis corporibus faciat difficultatem in arte, que difficultas est ignota vulgo et nota medico - verbi gratia in febre continua alia accidentia possunt apparere in cholerico et alia in flegmatico et alia in puero et alia in iuvene et alia in sene et alia in fabro et alia in piscatore, ex quibus fiunt diverse cognitiones et pronosticationes et curationes. . . . Talis enim diversitas aliquando habet magnam difficultatem quam non cognoscit vulgus": Thaddei Florentini in preclarum regiminis acutorum morborum Hippocratis volumen expositio (Venice, 1527), comm. to Lib. I Textus ii, fol. 247va- b. Also discussed in Siraisi, Taddeo Alderotti (n. 10), p. 124.
19. "De omnibus inquirendum est a medico in collocutionibus ad investigandum essentiam morbi, sed non sunt omnia scribenda in libris tanquam artis principia. . . . Per accidentia possumus intelligere nocumenta que sentiunt infirmi ab egritudinibus suis, et etiam iuvamenta et nocumenta que sentiunt infirmi a rebus sibi oblatis vel approximatis, puta si aliquis habens causonem et bibit aquam frigidam, refert medico interdum quod contulit, interdum quod nocuit. . . . Illa quidem que debent fieri nota medico absque inditio egri sunt significationes quibus egritudinem cognoscimus, et quibus super illam pronosticamur non percepte ob infirmis, sicut urina talis vel talis et pulsus talis vel talis et qualitas corporis talis vel talis; per has enim significationes ignotas infirmis cognoscit medicus speciem egritudinis et eius causam et scit pronosticari super ipsam. Item significationes curative per quas cognoscimus res cum quibus fit cura et qualiter approximari debeant debent esse note medico absque inditio egri. . . . Vult hic Hippocras quod diversitas accidentium eiusdem egritudinis in diversis corporibus faciat difficultatem in arte, que difficultas est ignota vulgo et nota medico - verbi gratia in febre continua alia accidentia possunt apparere in cholerico et alia in flegmatico et alia in puero et alia in iuvene et alia in sene et alia in fabro et alia in piscatore, ex quibus fiunt diverse cognitiones et pronosticationes et curationes. . . . Talis enim diversitas aliquando habet magnam difficultatem quam non cognoscit vulgus": Thaddei Florentini in preclarum regiminis acutorum morborum Hippocratis volumen expositio (Venice, 1527), comm. to Lib. I Textus ii, fol. 247va- b. Also discussed in Siraisi, Taddeo Alderotti (n. 10), p. 124.
20. "Puta si aliquis habeat lapidem in vesica, essentia huius morbi indicat ablationem lapidis et hoc notum est omnibus. . . . Scientia vero rerum cum quibus debest lapis expelli et quomodo et rerum cum quibus debet fieri unitio partium solutarum, non est nota omnibus, sed peritis in arte, unde in quantum illa que sunt nota vulgo sunt fundamentum eorum que sunt nota solum sapientibus, dico quod talia nota vulgo debent in arte poni, quamvis sint levia": Thaddei . . . expositio (n. 11), comm. to Lib. I Textus ii, fol. 247vb.
21. "Iam narravit Hippocrates in hoc sermone iuvamentum primum ex tribus iuvamentis que acquiruntur ex scientia pronosticationis in sermone suo ita ut provocet infirmos ad confidendum et committendum se in manibus medici propter sanitatem que antecessit et quam indicat eis et consequitur illud ut sit dignus quod de eo fiducia habeatur quod ipse est potens scire res infirmorum scilicet naturam egritudinis et causam facientem ipsam. Erit ergo conclusio demonstrationis super illum secundum modum hunc quando antecedit medicus et infirmis illud quod futurum est indicat et creditur de eo quod est potens scire res scilicet naturam egritudinis secundum veritatem et de quo habetur fiducia quod ipse est potens scire naturam egritudinum. . . . Quando ergo audiunt infirmi a medico aliquid horum preter quod ipsi nuntiaverunt ei illud admirantur de eo et dignum est ut admirentur de eo": Galieni. . . in Pronostica Hippocratis, Lib. I texts 2-3, in Articella (Venice, 1523), [ii] fol. 141ra-b. On the genesis of such attitudes, see Ludwig Edelstein, "Hippocratic Prognosis," in Ancient Medicine, ed. Owsei Temkin and C. Lilian Temkin (Baltimore: Johns Hopkins Press, 1967), pp. 65-85.
22. My sources for these authors are as follows: (1) William of Saliceto, Summa conservationis, capitulum generale, in MS Cambridge, Trinity College 1202, fols. 1rb-2va (folio numbers in subsequent citations refer to this source); printed in Summa conservationis et curationis magistri Gulielmi Placentinique Gulielmina dicitur: noviter impressa diligenterque correcta (Venice, 1502), fol. 2ra-vb.
23. My sources for these authors are as follows: (1) William of Saliceto, Summa conservationis, capitulum generale, in MS Cambridge, Trinity College 1202, fols. 1rb-2va (folio numbers in subsequent citations refer to this source); printed in Summa conservationis et curationis magistri Gulielmi Placentinique Gulielmina dicitur: noviter impressa diligenterque correcta (Venice, 1502), fol. 2ra-vb.
24. Arnald of Villanova, Repetitio super canone "Vita brevis," in MS Munich, CLM 14245, fols. 13v-38v. A very defective text of Arnald's Repetitio can be found in the various sixteenth-century editions of his Opera medica. I am presently preparing a critical edition for the Opera Medica Omnia being published by the Universitat de Barcelona.
25. Henry de Mondeville, Chirurgia, ed. Julius Leopold Pagel, in "Die Chirurgie des Heinrich von Mondeville (Hermondaville)," Archiv für klinische Chirurgie, 1890, 40: 153-311, 653-752, 869-904; 1891, 41: 122-73, 467-504, 705-46, 917-68; 1891, 42: 172-228, 426-90, 645-708, 895-924. Pagel subsequently published a corrected version of the text as Die Chirurgie des Henri de Mondeville (Berlin, 1892) - but because this version is difficult to obtain, and because the changes to the second version are few and relatively minor, my references are all to the first, as well as to the French text published by E. Nicaise, Chirurgie de maître Henri de Mondeville (Paris, 1893).
26. Henry de Mondeville, Chirurgia, ed. Julius Leopold Pagel, in "Die Chirurgie des Heinrich von Mondeville (Hermondaville)," Archiv für klinische Chirurgie, 1890, 40: 153- 311, 653-752, 869-904; 1891, 41: 122-73, 467-504, 705-46, 917-68; 1891, 42: 172-228, 426-90, 645-708, 895-924. Pagel subsequently published a corrected version of the text as Die Chirurgie des Henri de Mondeville (Berlin, 1892) - but because this version is difficult to obtain, and because the changes to the second version are few and relatively minor, my references are all to the first, as well as to the French text published by E. Nicaise, Chirurgie de maître Henri de Mondeville (Paris, 1893).
27. Manuel Morris, Die Schrift des Albertus de Zancariis aus Bologna (inaug.-diss., Leipzig, 1914). Some of these texts have been briefly considered by Mary Catherine Welborn, "The Long Tradition: A Study in Fourteenth-Century Medical Deontology," in Medieval and Historiographical Essays in Honor of James Westfall Thompson, ed. James Lea Cate and Eugene N. Anderson (Chicago: University of Chicago Press, 1938), pp. 344-57.
28. Manuel Morris, Die Schrift des Albertus de Zancariis aus Bologna (inaug.-diss., Leipzig, 1914). Some of these texts have been briefly considered by Mary Catherine Welborn, "The Long Tradition: A Study in Fourteenth-Century Medical Deontology," in Medieval and Historiographical Essays in Honor of James Westfall Thompson, ed. James Lea Cate and Eugene N. Anderson (Chicago: University of Chicago Press, 1938), pp. 344-57.
29. "Est fiducia etiam infirmorum de eo commitendi se illi vehementior, et de quo confidunt infirmi et in cuius manibus se committunt ipse sanat plus egritudines": Galieni . . . in Pronostica Hippocratis (n. 13), Lib. I text 2, fol. 141rb.
30. "Per hanc enim tuam visitationem iam habes quod infirmus per fidem quam habebat de te non se commitit in manibus tuis sed potius tu te committis in manibus suis, et sic eins fides revolvitur in contrarium tue intentionis": Saliceto, Summa conservationis (n. 14), fol. 2ra.
31. Morris, Zancariis (n. 14), pp. 13-14.
32. This general trend, and the fact that uroscopy is virtually ignored in Arnald of Villanova's Repetitio, is the reason why the first part of the De cautelis translated by Sigerist now seems to me not to date from the late thirteenth century - or at least not to be the work of an academic physician of that period, like Arnald. I should perhaps emphasize that I have no intention of minimizing the role of uroscopy for medieval diagnosis, which persisted for centuries; my point is simply that for the academically trained physician (if not for empirics), the relative importance of the information supplied by it diminished. Carole Rawcliffe, Medicine and Society in Later Medieval England (Stroud, England: Alan Sutton, 1995), pp. 46-50, stresses the continuing place of uroscopy in diagnosis in the later Middle Ages, especially for the beginner ("the rudiments could easily be mastered with the help of a coloured chart and some practical guidance from a senior colleague" [p. 49]); so does Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice (Chicago: University of Chicago Press, 1990), p. 125.
33. This general trend, and the fact that uroscopy is virtually ignored in Arnald of Villanova's Repetitio, is the reason why the first part of the De cautelis translated by Sigerist now seems to me not to date from the late thirteenth century - or at least not to be the work of an academic physician of that period, like Arnald. I should perhaps emphasize that I have no intention of minimizing the role of uroscopy for medieval diagnosis, which persisted for centuries; my point is simply that for the academically trained physician (if not for empirics), the relative importance of the information supplied by it diminished. Carole Rawcliffe, Medicine and Society in Later Medieval England (Stroud, England: Alan Sutton, 1995), pp. 46-50, stresses the continuing place of uroscopy in diagnosis in the later Middle Ages, especially for the beginner ("the rudiments could easily be mastered with the help of a coloured chart and some practical guidance from a senior colleague" [p. 49]); so does Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice (Chicago: University of Chicago Press, 1990), p. 125.
34. Villanova, Repetitio (n. 14), fols. 28v-29v; Morris, Zancariis (n. 14), pp. 14-16.
35. Villanova, Repetitio (n. 14), fols. 28v-29v; Morris, Zancariis (n. 14), pp. 14-16.
36. Villanova, Repetitio (n. 14), fol. 28v; English translation slightly adapted from Michael R. McVaugh, Medicine Before the Plague: Practitioners and Their Patients in the Crown of Aragon, 1285-1345 (Cambridge: Cambridge University Press, 1993), p. 231.
37. Villanova, Repetitio (n. 14), fol. 28v; English translation slightly adapted from Michael R. McVaugh, Medicine Before the Plague: Practitioners and Their Patients in the Crown of Aragon, 1285-1345 (Cambridge: Cambridge University Press, 1993), p. 231.
38. "Non enim statim cum accedit ad patientem debet tangere pulsum, maxime si patiens expectavit medicum cum magno desiderio et habet salvam cognitionem; nam si amisisset eam, tunc propter adventum medici vel presentiam neque gaudium neque tristitiam pateretur, nec per consequens pulsus immutaretur": Villanova, Repetitio (n. 14), fol. 29v.
39. "In pulsu vero debet medicus cum maxima instantia et boatu quo ad laycos considerare sed veritatem ignorare non convenit astute tangere et quiete pulsum infirmi est conveniens; et est bonum videre ut medicus multum sit intentus de hac re, nam omnia talia de medico hominibus fidem faciunt, que est valde utilis in convenienti operatione medicinali, et per istud astantes habent bonam presumptio de medico": Saliceto, Summa conservationis (n. 14), fol. 1rb-va.
40. "Nam talis inquisitio cum deliberatione reddit medicum auctoritabilem et scientem inter laycos et amicos infirmi et facit de se et scientia sua per talem inquisitionem fidem infirmo et astantibus - etiam si ipse debilis aut parve scientie fuerit; et per hoc confortatur mens infirme super eius operationem et fit operatio medicinarum nobilior et confortatur in tantum anima infirmi per hanc fidem et ymaginationem quod operatur qua infirmitatem forcius et nobilius et subtilius quam faciat medicus cum instrumentis et medicinis": ibid., fol. 1va.
41. Villanova, Repetitio (n. 14), fol. 30r-v.
42. "Infirmi confidentia de medico vigoretur propter illius legalitatem et diligentiam manifestam et ut ab eius animo excitandi tedium excludatur": ibid., fol. 31v.
43. "Si tamen adverteret medicus quod infirmus esset ex suo more naturali vel acquisito impatiens aut festinus, vel quod amici eius essent impetuosi et inportuni, et ipse nollet aut commode et honeste non posset eum deserere, debet ad vitandum murmur illorum et patientis angustiam atque languorem mentalem ordinare aliqua medicamina que virtute aliqua possent prodesse infirmo quantum ad aliquid, licet ad morbum pellendum non habeant directum aspectum": ibid.
44. "Primo debent discutere de morbo praesenti videndo diligentissime et palpando. . . . Et hoc faciant omnes, unus post alterum; deinde advertant, si expediat, iterum simul omnes considerando sibi invicem signa morbi et particulares considerationes notabiles et etiam patientis; postmodum aliquis eorum, et sit ille, qui est magis autenticus inter ipsos et maxime, si est medicus, dicat patienti: Domine, bene vidimus factum Vestrum et bene videtur nobis, et multum debetis gaudere et laetari, quia sumus hic tot et tanti, qui deberemus sufficere uni regi, et quorum minor deberet sufficienter discutere, prosequi et perficere curam Vestram. Deinde quaerat ab ipso circumstancias suas morbi dicens: Domine non displiceat Vobis nec habeatis pro malo, quamdiu est, quod Vos arripuit primitus ille morbus, et sic deinceps ab ipso multas facial quaestiones . . . ; deinde factis a patiente diligenter omnibus quaestionibus conferentibus ad intentum, exeant omnes camera patientis et subintrent aliam, in qua non sint aliqui nisi ipsi, quoniam in omni collatione magistri disputant inter se, ut melius discutiant veritatem, et quandoque gratia disputationis prorumpunt in verba, quare videretur extraneis assistentibus, quod esset discordia vel litigium inter ipsos, et ita est aliquando": Mondeville, Chirurgia (n. 14), 1890, 40: 723; Nicaise, Chirurgie (n. 14), p. 190.
45. "Primo debent discutere de morbo praesenti videndo diligentissime et palpando. . . . Et hoc faciant omnes, unus post alterum; deinde advertant, si expediat, iterum simul omnes considerando sibi invicem signa morbi et particulares considerationes notabiles et etiam patientis; postmodum aliquis eorum, et sit ille, qui est magis autenticus inter ipsos et maxime, si est medicus, dicat patienti: Domine, bene vidimus factum Vestrum et bene videtur nobis, et multum debetis gaudere et laetari, quia sumus hic tot et tanti, qui deberemus sufficere uni regi, et quorum minor deberet sufficienter discutere, prosequi et perficere curam Vestram. Deinde quaerat ab ipso circumstancias suas morbi dicens: Domine non displiceat Vobis nec habeatis pro malo, quamdiu est, quod Vos arripuit primitus ille morbus, et sic deinceps ab ipso multas facial quaestiones . . . ; deinde factis a patiente diligenter omnibus quaestionibus conferentibus ad intentum, exeant omnes camera patientis et subintrent aliam, in qua non sint aliqui nisi ipsi, quoniam in omni collatione magistri disputant inter se, ut melius discutiant veritatem, et quandoque gratia disputationis prorumpunt in verba, quare videretur extraneis assistentibus, quod esset discordia vel litigium inter ipsos, et ita est aliquando": Mondeville, Chirurgia (n. 14), 1890, 40: 723; Nicaise, Chirurgie (n. 14), p. 190.
46. "Nam omnes layci propter discordiam repertam inter medicos solum sermonibus et aliquando inquisitione causarum et egritudinum artem medicinalem reputant vanitatem, et dicunt medicos non rationabiliter contra egritudines sed ut plurimum casualiter operare, et hoc est quia numerus ignorantium veritatem in arte medicinali verum non ignorantium excedere consuevit": Saliceto, Summa conservationis (n. 14), fol. 1vb. Cf. Morris, Zancariis (n. 14), p. 20: "Si medicus tibi in cura consocius sit plebejus, cum illo non conferas, ne hoc sibi in signum aliqualis scientiae redundareat, cum totaliter sit privatis. Si vero medicinali scientia fuerit doctrinali, qui sociantur in cura, cum eis plane et benivole et in secreto circa infirmum conferas de gerendis."
47. "Nam omnes layci propter discordiam repertam inter medicos solum sermonibus et aliquando inquisitione causarum et egritudinum artem medicinalem reputant vanitatem, et dicunt medicos non rationabiliter contra egritudines sed ut plurimum casualiter operare, et hoc est quia numerus ignorantium veritatem in arte medicinali verum non ignorantium excedere consuevit": Saliceto, Summa conservationis (n. 14), fol. 1vb. Cf. Morris, Zancariis (n. 14), p. 20: "Si medicus tibi in cura consocius sit plebejus, cum illo non conferas, ne hoc sibi in signum aliqualis scientiae redundareat, cum totaliter sit privatis. Si vero medicinali scientia fuerit doctrinali, qui sociantur in cura, cum eis plane et benivole et in secreto circa infirmum conferas de gerendis."
48. "Inhonestum et indecens est communicari infirmo et laycis de causis infirmitatis et operationibus disputando determinare, nam et isto modo inquisicionis layci tanquam veritatem ignorantes et veritatis causas sapientem deprimunt et ignorans multotiens ab eisdem pro phisico reputatur. . . . Taciturnitas cum humilitate et facie depressa in qua videatur cogitatio cum sollicitudine facit fidem hominibus": Saliceto, Summa conservationis (n. 14), fol. 1vb. Cf. Yūanna ibn Māsawayh, Aphorismi (n. 9), p. 149: "Si interrogatus semper velociter respondeas, dubitandus es."
49. "Inhonestum et indecens est communicari infirmo et laycis de causis infirmitatis et operationibus disputando determinare, nam et isto modo inquisicionis layci tanquam veritatem ignorantes et veritatis causas sapientem deprimunt et ignorans multotiens ab eisdem pro phisico reputatur. . . . Taciturnitas cum humilitate et facie depressa in qua videatur cogitatio cum sollicitudine facit fidem hominibus": Saliceto, Summa conservationis (n. 14), fol. 1vb. Cf. Yūhanna ibn Māsawayh, Aphorismi (n. 9), p. 149: "Si interrogatus semper velociter respondeas, dubitandus es."
50. "Et ideo medicus prudens semper dicit infirmo et aliis quod ordinet usum talis aut talis antidoti ad talem vel talem preparationem introducendam in egro, ad hoc ut ipsum egrum et alios retineat semper in spe ulterioris et necessarii operis, ut animo non fatigentur aut perturbentur": Villanova, Repetitio (n. 14), fol. 32r.
51. Mondeville, Chirurgia (n. 14), 1890, 40: 692, 694-95; Nicaise, Chirurgie (n. 14), pp. 144-45, 148.
52. Mondeville, Chirurgia (n. 14), 1890, 40: 692, 694-95; Nicaise, Chirurgie (n. 14), pp. 144-45, 148.
53. The treatise has recently been studied and edited by Judith Wilcox and John M. Riddle, "Qust + (Combining dot below)ā ibn Lūqā's Physical Ligatures and the Recognition of the Placebo Effect," Mediev. Encount., 1995, 1: 1-50.
54. "Nunquam deserit veritatem et semper tendit ad commodum proximi": Villanova, Repetitio (n. 14), fol. 32r. See also Mondeville, Chirurgia (n. 14), 1891, 41: 934; Nicaise, Chirurgie (n. 14), pp. 480-81.
55. "Nunquam deserit veritatem et semper tendit ad commodum proximi": Villanova, Repetitio (n. 14), fol. 32r. See also Mondeville, Chirurgia (n. 14), 1891, 41: 934; Nicaise, Chirurgie (n. 14), pp. 480-81.
56. "Nunquam deserit veritatem et semper tendit ad commodum proximi": Villanova, Repetitio (n. 14), fol. 32r. See also Mondeville, Chirurgia (n. 14), 1891, 41: 934; Nicaise, Chirurgie (n. 14), pp. 480-81.
57. "Nullo modo presumas coram infirmo neque ipso andiente aliquam debilitatem de ipsius natura proferre neque aliquid mali de eo, etiam si de eius salute fueris desperatus; sed medico semper convenit infirmo salutem promittere ut ymaginacione bone disposicionis et salutis firma in infirmi anima remaneat; nam tibi firmitas ymaginacionis de salute operationem medici iuvat in omni re, et effectus medicinarum contra infirmitates melior et nobilior reperitur": Saliceto, Summa conservationis (n. 14), fol. 1vb.
58. "Si vero econtra de morte provideat, semper tamen in tali casu alloquens medicus sit dubius, in sermone ipsum conditionans sic dicens: 'certe mihi videtur, quod, si constent, quae apparent, et aliud non superveniat, quod praesenter non supervenire videtur, sanabitur hic, vel morietur alter'": Morris, Zancariis (n. 14), pp. 17-18.
59. Darrel W. Amundsen, Medicine, Society, and Faith in the Ancient and Medieval Worlds (Baltimore: Johns Hopkins University Press, 1996), pp. 201-2, 273-77. Amundsen quotes (p. 202) a paragraph from Sigerist's translation of the "Arnaldian" De cautelis to show that it echoes this provision of Lateran IV. As it happens, however, that passage is omitted from the Latin text published in de Renzi, Collecttio Salernitana (above, n. 4), and this suggests that the third section of the De cautelis in its "Arnaldian" form is indeed a compilation of the thirteenth century, though not necessarily by Arnald himself. See also McVaugh, Medicine (n. 20), p. 171 n. 13.
60. Darrel W. Amundsen, Medicine, Society, and Faith in the Ancient and Medieval Worlds (Baltimore: Johns Hopkins University Press, 1996), pp. 201-2, 273-77. Amundsen quotes (p. 202) a paragraph from Sigerist's translation of the "Arnaldian" De cautelis to show that it echoes this provision of Lateran IV. As it happens, however, that passage is omitted from the Latin text published in de Renzi, Collecttio Salernitana (above, n. 4), and this suggests that the third section of the De cautelis in its "Arnaldian" form is indeed a compilation of the thirteenth century, though not necessarily by Arnald himself. See also McVaugh, Medicine (n. 20), p. 171 n. 13.
61. Morris, Zancariis (n. 14), pp. 19-20.
62. Mondeville, Chirurgia (n. 14), 1890, 40: 671; Nicaise, Chirurgie (n. 14), p. 112.
63. Mondeville, Chirurgia (n. 14), 1890, 40: 671; Nicaise, Chirurgie (n. 14), p. 112.
64. "Verum quia ignis est terribilis et multi in opere insaniantur pre timore ipsius ignis, elegi michi illum de cauterio potenciali": Guy de Chauliac, Inventarium, VI.2.7, ed. Michael R. McVaugh, vol. 1 (Leiden: Brill, 1997), p. 375. Cf.: "Et licet extirpacio cum ferris sit securior (cum cito facta sit et cito transeat illata impressio) quam cum medicinis, que sunt acute et longo tempore dolorem et febrem inferentes, nichilominus quia multi sunt timidi et plus vellent mori quam sustinere ferrum - et cum hoc, in aliquibus locis est periculosa incisio - oportet uti medicinis exurpativis": ibid., VII.1.6 (ed. McVaugh, 1: 443).
65. "Verum quia ignis est terribilis et multi in opere insaniantur pre timore ipsius ignis, elegi michi illum de cauterio potenciali": Guy de Chauliac, Inventarium, VI.2.7, ed. Michael R. McVaugh, vol. 1 (Leiden: Brill, 1997), p. 375. Cf.: "Et licet extirpacio cum ferris sit securior (cum cito facta sit et cito transeat illata impressio) quam cum medicinis, que sunt acute et longo tempore dolorem et febrem inferentes, nichilominus quia multi sunt timidi et plus vellent mori quam sustinere ferrum - et cum hoc, in aliquibus locis est periculosa incisio - oportet uti medicinis exurpativis": ibid., VII.1.6 (ed. McVaugh, 1: 443).
66. "Sextum documentum est quod claudantur oculi pacientis, aut stet in loco obscuro ut non possit videre sanguinem suum neque inspicere res rubeas; ymmo semper dicatur sibi quod amplius non fluit et si fluit quod est ad utilitatem ipsius, et ita confortatur virtus naturalis per contrariam ymaginacionem. Et propter hoc dicebat Avicenna quod generis accidencium animalium movencium ymaginacionem est motus sanguinis et consecucio eius qui preparatus est ad eum, cum multum intentus fuerit ad considerandum res rubeas": ibid., III.1.3 (ed. McVaugh, 1: 168).
67. Villanova, Repetitio (n. 14), fol. 33r; discussed in McVaugh, Medicine (n. 20), p. 167.
68. Villanova, Repetitio (n. 14), fol. 33r; discussed in McVaugh, Medicine (n. 20), p. 167.
69. Huling E. Ussery, Chaucer's Physician: Medicine and Literature in Fourteenth-Century England (New Orleans: Tulane University, 1971), pp. 99-117, supplies a convenient survey of the way in which Chaucer's physician has regularly been perceived by commentators, though Ussery himself tries to defend the character against many of their charges.
70. Recent discussions of this topic are Carole Rawcliffe, "The Profits of Practice: The Wealth and Status of Medical Men in Later Medieval England," Soc. Hist. Med., 1988, 1: 61-78; and Luis García-Ballester, "Medical Ethics in Transition in the Latin Medicine of the Thirteenth and Fourteenth Centuries: New Perspectives on the Physician-Patient Relationship and the Doctor's Fee," in Wear, Geyer-Kordesch, and French, Doctors and Ethics (n. 5), pp. 38-71.
71. Recent discussions of this topic are Carole Rawcliffe, "The Profits of Practice: The Wealth and Status of Medical Men in Later Medieval England," Soc. Hist. Med., 1988, 1: 61- 78; and Luis García-Ballester, "Medical Ethics in Transition in the Latin Medicine of the Thirteenth and Fourteenth Centuries: New Perspectives on the Physician-Patient Relationship and the Doctor's Fee," in Wear, Geyer-Kordesch, and French, Doctors and Ethics (n. 5), pp. 38-71.
72. "Recitatur fabulose vel historice ab antiquis, quod medicis respectu patientis triplex vultus ostenditur: divinus, diabolicus et humanus. Divinus quidem dum infirmus vehementi languore vexatur, ipsum humiliter deprecatur de restituenda corporis sospitate. Diabolicus vero, dum sanatus infirmus medico non satisfecerit condecenter, ipsi non obvians, illum fugat velut diabolicis vestigiis consignatum. Sed humanus, dum curatus infirmus sananti satisfecerit, ut oportet, illum sibi reputans velut dominum et amicum": Morris, Zancariis (n. 14), p. 19.
73. For example, Rawcliffe, "Profits" (n. 43), p. 62; García-Ballester, "Medical Ethics" (n. 43), pp. 51-52; Welborn, "Long Tradition" (n. 14), pp. 355, 356-57; and E. A. Hammond, "Incomes of Medieval English Doctors," J. Hist. Med., 1960, 15: 154-69, esp. pp. 155-56. On the other hand, Sigerist's assessment of Mondeville's sardonic comments was, typically, nonjudgmental: see Henry E. Sigerist, "Sidelights on the Practice of Medieval Surgeons," Proceedings of the Annual Congress on Medical Education, Hospitals, and Licensure, February 1953, pp. 18-19, reprinted in Marti-Ibañez, Henry E. Sigerist (n. 1), pp. 141-45.
74. For example, Rawcliffe, "Profits" (n. 43), p. 62; García-Ballester, "Medical Ethics" (n. 43), pp. 51-52; Welborn, "Long Tradition" (n. 14), pp. 355, 356-57; and E. A. Hammond, "Incomes of Medieval English Doctors," J. Hist. Med., 1960, 15: 154-69, esp. pp. 155-56. On the other hand, Sigerist's assessment of Mondeville's sardonic comments was, typically, nonjudgmental: see Henry E. Sigerist, "Sidelights on the Practice of Medieval Surgeons," Proceedings of the Annual Congress on Medical Education, Hospitals, and Licensure, February 1953, pp. 18-19, reprinted in Marti-Ibañez, Henry E. Sigerist (n. 1), pp. 141-45.
75. For example, Rawcliffe, "Profits" (n. 43), p. 62; García-Ballester, "Medical Ethics" (n. 43), pp. 51-52; Welborn, "Long Tradition" (n. 14), pp. 355, 356-57; and E. A. Hammond, "Incomes of Medieval English Doctors," J. Hist. Med., 1960, 15: 154-69, esp. pp. 155-56. On the other hand, Sigerist's assessment of Mondeville's sardonic comments was, typically, nonjudgmental: see Henry E. Sigerist, "Sidelights on the Practice of Medieval Surgeons," Proceedings of the Annual Congress on Medical Education, Hospitals, and Licensure, February 1953, pp. 18-19, reprinted in Marti-Ibañez, Henry E. Sigerist (n. 1), pp. 141-45.
76. For example, Rawcliffe, "Profits" (n. 43), p. 62; García-Ballester, "Medical Ethics" (n. 43), pp. 51-52; Welborn, "Long Tradition" (n. 14), pp. 355, 356-57; and E. A. Hammond, "Incomes of Medieval English Doctors," J. Hist. Med., 1960, 15: 154-69, esp. pp. 155-56. On the other hand, Sigerist's assessment of Mondeville's sardonic comments was, typically, nonjudgmental: see Henry E. Sigerist, "Sidelights on the Practice of Medieval Surgeons," Proceedings of the Annual Congress on Medical Education, Hospitals, and Licensure, February 1953, pp. 18-19, reprinted in Marti-Ibañez, Henry E. Sigerist (n. 1), pp. 141-45.
77. For example, Rawcliffe, "Profits" (n. 43), p. 62; García-Ballester, "Medical Ethics" (n. 43), pp. 51-52; Welborn, "Long Tradition" (n. 14), pp. 355, 356-57; and E. A. Hammond, "Incomes of Medieval English Doctors," J. Hist. Med., 1960, 15: 154-69, esp. pp. 155-56. On the other hand, Sigerist's assessment of Mondeville's sardonic comments was, typically, nonjudgmental: see Henry E. Sigerist, "Sidelights on the Practice of Medieval Surgeons," Proceedings of the Annual Congress on Medical Education, Hospitals, and Licensure, February 1953, pp. 18-19, reprinted in Marti-Ibañez, Henry E. Sigerist (n. 1), pp. 141-45.
78. For example, Rawcliffe, "Profits" (n. 43), p. 62; García-Ballester, "Medical Ethics" (n. 43), pp. 51-52; Welborn, "Long Tradition" (n. 14), pp. 355, 356-57; and E. A. Hammond, "Incomes of Medieval English Doctors," J. Hist. Med., 1960, 15: 154-69, esp. pp. 155-56. On the other hand, Sigerist's assessment of Mondeville's sardonic comments was, typically, nonjudgmental: see Henry E. Sigerist, "Sidelights on the Practice of Medieval Surgeons," Proceedings of the Annual Congress on Medical Education, Hospitals, and Licensure, February 1953, pp. 18-19, reprinted in Marti-Ibañez, Henry E. Sigerist (n. 1), pp. 141-45.
79. "Perfectus cyrurgicus est plus quam perfectus medicus et . . . ad ipsum plura requiruntur, scilicet operatio manualis": Mondeville, Chirurgia (n. 14), 1890, 40: 657; Nicaise, Chirurgie (n. 14), p. 91.
80. "Perfectus cyrurgicus est plus quam perfectus medicus et . . . ad ipsum plura requiruntur, scilicet operatio manualis": Mondeville, Chirurgia (n. 14), 1890, 40: 657; Nicaise, Chirurgie (n. 14), p. 91.
81. Mondeville, Chirurgia (n. 14), 1890, 40: 694; Nicaise, Chirurgie (n. 14), p. 147.
82. Mondeville, Chirurgia (n. 14), 1890, 40: 694; Nicaise, Chirurgie (n. 14), p. 147.
83. L. R. Lind, Studies in Pre-Vesalian Anatomy: Biography, Translations, Documents, Memoirs of the American Philosophical Society, vol. 104 (Philadelphia: American Philosophical Society, 1975), p. 151. See also Roger French, "The Medical Ethics of Gabriele de Zerbi," in Wear, Geyer-Kordesch, and French, Doctors and Ethics (n. 5), pp. 72-97.
84. L. R. Lind, Studies in Pre-Vesalian Anatomy: Biography, Translations, Documents, Memoirs of the American Philosophical Society, vol. 104 (Philadelphia: American Philosophical Society, 1975), p. 151. See also Roger French, "The Medical Ethics of Gabriele de Zerbi," in Wear, Geyer-Kordesch, and French, Doctors and Ethics (n. 5), pp. 72-97.
85. This is not simply a rhetorical possibility. See Andrew Cunningham and Perry Williams, eds., The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 1992) - in particular, the editors' introduction, which gives a general survey of the rise of laboratory medicine (pp. 1-13), and the chapter by John Harley Warner, "The Fall and Rise of Professional Mystery: Epistemology, Authority, and the Emergence of Laboratory Medicine in Nineteenth-Century America," which deals with the emergence of laboratory medicine in nineteenth-century America as shaped, precisely, by its distinctively American context (pp. 110-41).
86. This is not simply a rhetorical possibility. See Andrew Cunningham and Perry Williams, eds., The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 1992) - in particular, the editors' introduction, which gives a general survey of the rise of laboratory medicine (pp. 1-13), and the chapter by John Harley Warner, "The Fall and Rise of Professional Mystery: Epistemology, Authority, and the Emergence of Laboratory Medicine in Nineteenth-Century America," which deals with the emergence of laboratory medicine in nineteenth-century America as shaped, precisely, by its distinctively American context (pp. 110-41).
87. Sigerist, "Bedside Manners" (n. 1), p. 132.