Download PDF | Peter Murray Jones - The Medicine of the Friars in Medieval England (Health and Healing in the Middle Ages, 5) (Middle English Edition)-York Medieval Press (2024).
327 Pages
Preface
This book began with transcription of a fragmentary text found in a manuscript in Cambridge, Gonville & Caius College, MS 98/50. The text turned out to be part of the Tabula medicine, which plays such a large role in the story of friars’ medicine in England. The transcribed fragment of Latin text featured names of medical figures who were not the usual suspects as medical authorities, that is doctors with an university background. Some clues suggested they might be English friars, but it was only when Neil Ker’s Medieval Manuscripts in British Libraries helped me to identify the fragment as a part of the Tabula medicine that this could be confirmed. The Tabula medicine had attracted no attention from historians of English medicine, and English friars had been hitherto given no role to play as medical practitioners or authors. My friend and colleague Linda Ehrsam Voigts was working on the fifteenth-century Cambridge and London physician Roger Marchall and found this fragment written in his hand in a manuscript he later gave to Gonville Hall. She shared her transcription with me, and such generosity has been a constant refrain in writing this book.
Despite Covid lockdowns and restrictions this book is largely based on manuscripts seen in person in libraries, supplemented with digital facsimiles where available. I am glad to have the opportunity to thank the staff of beleaguered libraries, especially those responsible for the manuscripts of the Bodleian Library, the British Library, Cambridge University Library and the Wellcome Library. The college libraries too, Corpus Christi, Gonville & Caius, Jesus, King’s, Peterhouse, St John’s, Trinity Colleges in Cambridge and Corpus Christi, Merton and New Colleges in Oxford, have all been of great help, gratefully acknowledged here. ‘The Library of the Department of History and Philosophy of Science in Cambridge has supplied me with books, and news of books. I would like to thank the staff of these libraries for their personal assistance, as well as acknowledge their generosity in allowing me access to their manuscripts, and to quote from them.
In finding my way into the history of English friars, I have been lucky enough to have had the encouragement and guidance of Michael Robson, the leading historian of Franciscanism and English friars in general. He has guided my way into the historical sources as well as allowing me to benefit from information drawn from his database of English Franciscans. I had no idea, when I began the project, that Michael lived in Cambridge. It has made a huge difference that he has been able to give me informal tutorials on mendicant history. I am deeply grateful for this generosity and kindness.
I have greatly benefited from the opportunity to give talks on friars and medicine at various academic meetings. These included, in the earliest stages of the project, the International Medieval Congress at Kalamazoo (in a session honouring Linda E. Voigts), the Early Science and Medicine seminar at the Department of History and Philosophy of Science in Cambridge, the Medieval Questions Seminar at King’s College, Cambridge, the Medieval Church and Culture Seminar at the Faculty of History in Oxford, the History of the Book Seminar at Corpus Christi College, Cambridge and the Angelical Conjunctions Conference at McGill University. I am very grateful to have been invited to present my research, and to the audiences for valuable discussion and suggestions. I am grateful to King’s College, Cambridge, where I served as Librarian for thirty-six years, for supporting my research financially and in many other ways. My friends and colleagues at King’s, in the Fellowship and among the staff and students, have been (often unknowingly) a great source of intellectual stimulus.
I am very grateful to have been invited by the organisers to join the ‘After the Plague Health and History in Medieval Cambridge’ project at the Department of Archaeology at Cambridge (2017-21), and for the opportunity to learn from all the scientific researchers involved. This gave timely insight into the health and lifestyles of the Cambridge Augustinians. The Augustinian friars once occupied a large plot in central Cambridge exactly where the New Museums site of the University is now. Affiliation to the Department of History and Philosophy of Science means that I have been lucky enough to spend a lot of time over many years visiting a building standing on the plot where the friars lived, worshipped, gardened and buried their dead.
Many individuals have helped me with this book, and I express my since thanks here: John Arnold, Leah Astbury, Debby Banham, Richard Beadle, Winston Black, Julia Boffey, Elma Brenner, Bill Burgwinkle, Mary Carruthers, Philippa Carter, Craig Cessford, Mattia Cipriani, Peter Clarke, James Clements, Chiara Crisciani, Andrew Cunningham, Michael Cusato, Luke Demaitre, Jenna Dittmar, Jack Dixon, Jo Edge, Tony Edwards, Larry Eldredge, Klaus-Dietrich Fischer, Mary Fissell, James Freeman, Faye Marie Getz, Monica H. Green, Timothy Griffin, Aslihan Gtirbtizel, Jack Hartnell, John Henderson, Alpo Honkapohja, Philippa Hoskin, Sarah Inskip, Lori Jones, Lauren Kassell, Sebestien Kroupa, Sachiko Kusukawa, Tig Lang, Elaine Leong, Scott Mandelbrote, Silvia Marchiori, Daniel Margécsy, Iona McCleery, Michael McVaugh, Patricia McGuire, Piers Mitchell, Angela Montford, Laurence Moulinier-Brogi, Ann Eljenholm Nichols, Marilyn Nicoud, Laura Nuvoloni, Eyal Poleg, Robert Ralley, Kari Anne Rand, Silvia de Renzi, John Robb, Miri Rubin, Fernando Salmon, Lucy Sandler, Carolin Schmitz, Kathryn Smith, Lesley Smith, Sarah Star, Torgny Svenberg, Tillmann Taape, Irma Taavitsainen, M. Teresa Tavormina, Rodney Thomson, Anke Timmermann, Chris Tuckley, Maaike van der Lugt, Iolanda Ventura, Faith Wallis, Tianyi Wang, Teresa Webber, Richard Wragg, Joseph Ziegler and Patrick Zutshi. If I have omitted anyone, I apologise sincerely.
My thanks here cannot do proper justice to the kindness and help these friends and colleagues have given. I am especially grateful to those who have read part or the whole of the book in its various stages of evolution. Seb Falk, Laure Miolo, Nicolette Zeeman, Jennifer Rampling and Michael Robson have nobly read and commented on various chapters, to my great benefit. William Caverlee has weeded out a great number of stylistic faults in reading the whole book, the work of a real writer and friend. Lea T. Olsan has also read the entire work and our conversations about the book as it developed have been inspirational, and I hope did not slow up her own research too much. None of the persons mentioned above should be held responsible for the remaining faults of the book.
Peregrine Horden and Sara Ritchey, as editors of the series Health and Healing in the Middle Ages, have encouraged and advised me from the start, as has the series adviser, Linda E. Voigts. They have tactfully urged me onward when the pace flagged and have supplied me with many helpful suggestions. Peter Biller, as General Editor of York Medieval Press, has provided invaluable stimulus and assistance from our earliest meetings in York onwards. I benefited tremendously from improvements to the book suggested by an anonymous reader. Caroline Palmer and Laura Bennetts on behalf of the Boydell Press have supplied vital guidance on publication, have been very understanding about delays, and brought me to the finishing line. Demi Wormgoor has been the highly efficient production editor for the book. John Dawson has provided the comprehensive index.
Introduction
An ointment for wounds, sores, burns and dead flesh. Take [ingredients and manufacture follow] ... with this Brother William Holme healed the wounded and rotting testicles of a knight in the Queen’s household, and it is called Punchardon’s remedy since he gave Holme 100 shillings for it.’
This successful remedy abstracted from a text compiled by Franciscans in England between 1416 and 1425 was credited to Brother William Holme. He sold the ointment for a very high price to a desperate knight of the Punchardon family, who gave the remedy its name. This gives us a dramatic insight into Holme’s lucrative surgical practice at court c. 1400. The ointment is found under the heading Ma/um mortuum (a kind of scabbing of flesh on the body’s extremities) in a remedy book the Franciscans put together five hundred years ago for the use of their brethren, and subsequently for other readers to profit from, friars or not. It serves to introduce us to the twin themes of this book, the practice and medical writing of English friars.
The Medicine of the Friars in Medieval England aims first and foremost to recuperate the contribution, almost entirely overlooked, made by English friars to medicine between the thirteenth and sixteenth centuries. It will show that members of the four orders of friars practised medicine and wrote or compiled books about medicine. As medical practitioners, the friars sometimes took payment for their remedies, just as other kinds of practitioners did, but they also supplied medical services to their brothers, and provided charitable relief to lay people — who might also be recipients of their spiritual services, that is preaching, religious instruction and confession. At the highest level of society, some friars were retained by royalty, nobles or bishops as both healers and confessors. But the patients of the friars might also be much humbler lay folk.
In attending the sick or the dying in their homes, or within an infirmary or hospital setting, friars could offer both bodily and spiritual healing. There could of course be tension between these two healing roles, and between the friar as mass-priest or administrator of sacraments, and the friar as medical practitioner. But this book will argue that despite constitutions and regulations governing the friars that attempted to keep these roles distinct, and even posited an opposition between them, the evidence suggests that friars negotiated these boundaries with more ease than other religious or secular healers. This relative ease in moving between bodily and spiritual healing was sometimes the object of fierce criticism from priests and laymen and played a part in anti-fraternal agitation in England, but the self-identification of friars as ‘the poor of Christ’ and as imitators of Christ’s (or St Francis’s) role as healer of the sick worked powerfully to sustain the friar in his role as medicus.
Many friars learned some practical medicine before they took the habit, and from early days the orders of friars encouraged those who had studied medicine at university (as well as students of philosophy, law or theology) to join them. The Dominican Jordan of Saxony made attracting such students central to the mission of the nascent order in England. ‘The relative backwardness in English universities of the Faculty of Medicine meant that most students of medicine who became friars were educated in France or Italy instead. Some medical friars reached the highest ranks in their orders. Crescentius da Iesi, Franciscan minister general from 1244 to 1247, had studied and practised medicine before entering the order in his middle age.
There were other less well documented and local ways of acquiring medical knowledge in the friaries. Where there was one friar with medical knowledge or skills, there were others who might be taught as pupils within the friary. The friaries, as they grew and benefited from lay patronage of their houses, built infirmaries, just as the Benedictine and other monastic orders had done before them. The infirmarer of a friary would have been expected to manage the care of the sick friar (and perhaps lay patients too) or supervise recovery after regular bloodletting.’ Despite the catastrophic scattering or destruction of the libraries of the friars at the dissolution of the late 1530s, there is sufficient evidence from surviving catalogues to show that some friaries at least had medical books. These would have served as reservoirs of medical knowledge for those friars who used them. But this argument for medical knowledge amongst the friars is necessarily based more on supposition rather than hard evidence.
The compelling evidence for both medical practice and medical learning among the friars in England comes from surviving medieval manuscripts. Here, the friars left traces of their activities as practitioners as well as taking on the role of author or compiler of texts on medicine. This evidence is necessarily piecemeal. It is found mainly in the large collections of medical manuscripts at the British Library, the Bodleian Library, Cambridge University Library, Oxford and Cambridge colleges, the Wellcome Library in London and the Hunterian collection at Glasgow University Library, but there are also some individual manuscripts elsewhere with traces of the friars. Only in recent years has this evidence in manuscript collections begun to emerge, though of course there have been clues in earlier catalogues and bibliographies waiting to be followed up.
The only English friar who wrote on medicine whose works attracted serious scholarly attention in the early twentieth century was Roger Bacon, who joined the Franciscans in 1257. The pioneering work of John Henry Bridges and Andrew G. Little on editions of Bacon’s writings on medical and related subjects has still not been replaced, or perhaps even properly valued. This book will follow in the footsteps of Faye M. Getz, the first modern scholar to appreciate the significance of Bacon's writings on medicine and the prolongation of life, in a specifically English context. So influential was Bacon that there was an efflorescence of English writings on his characteristic themes on the errors of scholastic medicine and the contributions that alchemy, astrology and experiential knowledge should make to health. Most of these writings were attributed in manuscripts (wrongly) to Bacon’s authorship.
Another author-compiler, the Dominican Henry Daniel, has emerged only very recently to take the place he deserves in consequence of his massive (and digressive) work on diagnosis, the Liber uricrisiarum, and his equally idiosyncratic Herbal, both written in the 1370s in English.* A team of scholars attached to the University of Toronto and led by E. Ruth Harvey and M. Teresa Tavormina has done most to give Daniel his rightful place as a medical author. Bacon and Daniel are the two big ‘names’ amongst friars who wrote on medicine, but this book will look also at less well-known figures. A very significant role in this book goes to the Tabula medicine, a work on sicknesses and their remedies compiled by a collective of English Franciscans in 1416-25.
‘That work is an anthology of treatments, many of them identified with named English friars, who tested them in practice, and it also yields the most detailed information we have about friars who treated named English patients. ‘The writings of Bacon and Daniel, and a compilation like the Tabula medicine, show that the friars did not write on medical themes within the constraints of the university medical curriculum, whose characteristic genres were expository treatises, commentaries and questions. Bacon led by example in devising new forms of medical writing, polemical and evangelical, and he was fiercely critical of logic-chopping and disputation as indulgences of the scholastic physician. This book will devote attention to the impact on English medical writing of the distinctive methods of study and intellectual organisation developed by friars, and to the affinity between methods of addressing an audience developed for their core mission of preaching, teaching and confessing, and those used in their contributions to medicine.
The Medicine of the Friars in Medieval England will not just be an act of recuperation of roles later lost to view, then, but will also examine the ways in which the friars departed from established patterns of medical practice and writing. These patterns have been relatively well-studied by historians who have focussed variously on university-trained physicians or master surgeons or barbers, apothecaries or midwives. As we will see, friars practised in these same areas of expertise, and wrote about them too, but often in ways affected by their roles as both religious and healers, and the opportunities opened to them by their mission to the laity.
‘The only monographic study so far published on friars and medicine is by Angela Montford. Her work focuses on the convents of the Franciscans and Dominicans in Bologna, and it shows the centrality of health matters in those institutions. This study takes in the design of conventual buildings, including: the infirmary; the office of infirmarer; the importance of health and strength to the ministry of the friars; and diet, medicine and surgery as practised on the friars. The book is built on detailed archival research on two account books from the fourteenth century for the Dominicans, and an eighteenth-century transcription of accounts since lost for the Franciscans. What Montford found in these accounts has been calibrated with the prescriptive rules and regulations of both orders, most particularly the Chapter acta of the Dominicans. The book deals with change as well as continuity. Montford argues that the practice of medicine by friars in their convents, in the hands of the frater medicus, was in decline by the fourteenth century in Italy. She also acknowledges that this development was not necessarily so marked outside Italy, and that her book does not address what happened in the later fourteenth and fifteenth centuries.* There is no evidence surviving for English friaries, which could sustain a comparable investigation to that of Montford for Bologna, although this book will bear out her general conclusions about the centrality of health and disease to friars in England. Where this book differs will be in arguing that practising and writing about medicine by English friars survived the supposed decline of the frater medicus.
An important article, also by Angela Montford, addresses unique visual evidence for the connection of Dominican friars to the teaching of practical medicine in Paris, 1255-70. This evidence is found in Philadelphia, University of Pennsylvania, Kislak Center for Special Collections, MS LJS 24. The manuscript was made in Paris, probably for a Dominican friar there, and the contents are texts associated with teaching of the Ars medicine, a corpus of medical texts which attracted scholastic commentary. Crucially, the manuscript also contains a series of twelve historiated initials showing a Dominican teaching a class, but also engaged in activities like judging urine, taking the pulse and supervising the administration of foods or medicines. Given that these images mark the beginning of separate medical teaching texts, the images should not be taken as evidence that Dominican friars practised medicine, but rather that they were somehow involved in teaching or studying texts to do with urine, pulse and foods or medicines.* Their involvement in medical teaching or study is not, however, supported by documentary evidence for the University of Paris at this time. What evidence there is connecting friars to university medicine relates to Bologna rather than to Paris.
However we do know that Dominicans like John of St Giles and Giles of Santarem did study medicine, and were present in Paris as early as the 1220s and 1230s, although they may not have been taught medicine in Paris or carried out teaching themselves.° Unfortunately, a thirteenth-century commentary on the Viaticum of Constantine, a Salernitan text of practical medicine often accompanying the Ars medicine corpus, cannot be shown conclusively to be the work of Giles of Santarem.’ John of St Giles and Giles of Santarem both left Paris for Dominican convents elsewhere, and, as we shall see in Chapter 1, John was summoned back to England to serve as both medicus and counsellor to Bishop Robert Grosseteste. The Dominicans were never involved with study or teaching of medicine at the English universities. ‘The implication of the Paris medical manuscript with its fine historiated initials remains in many respects mysterious, lacking as it does other contextual evidence which might prove Dominican involvement with scholastic medicine.
There have been other modern studies which have drawn attention to the contributions made by friars to different branches of natural philosophical and medical learning in the Middle Ages. Essays in the volume I francescani e le scienze by Agostino Paravicini Bagliani, Iolanda Ventura, Michela Pereira, Chiara Crisciani, Cecilia Panti and Jeremiah Hackett, among others, represent some of the excellent work done in this area.* The thirteenthcentury Franciscan authors who are the subjects of this essay volume include Englishmen, pre-eminently Roger Bacon, but also Robert Grosseteste (the lector of the Franciscans in Oxford), Bartholomaeus Anglicus and Adam Marsh — all of these figures we will meet too in this book.’ The great encyclopedias compiled by friars in the thirteenth century, which summarise natural philosophical and medical learning within a cosmological framework, have in recent years become the focus of intensive research.
'” The compilers of these encyclopedic works include Vincent de Beauvais, Speculum naturale, Bartholomaeus Anglicus, De proprietatibus rerum; and Thomas de Cantimpré, Liber de natura rerum. The last two of these are the subject of modern editions in progress.'' Moving beyond the big names amongst the friars, Laurence Moulinier-Brogi has identified some anonymous but significant medical writings by friars, testifying to their interest in astrology as well as therapeutics.” The attention of The Medicine of the Friars in Medieval England will not so much be directed at friars as well-travelled members of international orders and as philosophers but instead will concentrate on friars at the intersection between medical learning (in its widest sense, including astrology, alchemy and magic) and medical practice in England.
The orders of friars in England
Four orders of friars —- Dominicans, Franciscans, Carmelites and Augustinians — came to England in the thirteenth century, and still flourished in the sixteenth century. The two largest orders arrived in England in the 1220s. The Dominicans and Franciscans both made expansion to England an early priority after their foundation. The Dominicans (Order of Preachers) arrived in England in 1221 under the protection of the powerful bishop of Winchester, Peter des Roches, who took them to Canterbury and introduced them to Archbishop Stephen Langton. They pushed on to London and Oxford, spreading rapidly to cathedral cities and market towns. The second minister general of the Order, Jordan of Saxony, preached in Oxford, and hoped to find there a rich pool of recruits among masters and students. The Franciscans (Order of Friars Minor) arrived in 1224 in a small party including Agnello of Pisa, who was to become the first minister provincial. They too were received at Canterbury as guests and within six months had set up friaries in London, Oxford and Northampton. Like the Dominicans, they favoured towns rather than rural settings, and rapidly adopted the same strategy of recruiting learned men from the universities.
‘Two further orders arrived in the 1240s. The Carmelites (Order of Our Lady of Mount Carmel) and the Augustinians (Order of the Hermits of St Augustine) differed from the first two orders, insofar as their first settlements in England were in rural locations. Nevertheless both Carmelites and Augustinians soon developed houses in English towns, and became learned preaching orders like the Dominicans and Franciscans. As time went on, these newer orders benefited in their turn from royal patronage. John of Gaunt, for example, was a great supporter of the Carmelites, employing them as confessors. He was the patron of Nicholas of Lynn OC, whose medical calendar became widespread in England (see Chapter 4 below). In the fourteenth and fifteenth centuries, each of these four orders of friars was well established and continued to flourish, despite the heavy casualties among friars inflicted by the plague from 1349 onwards. There were, in fact, still other English orders of friars, though their success was confined to the thirteenth century. The Friars of the Sack and the Pied Friars were not so successful as the other four orders at making themselves permanent features of the English scene. The Second Council of Lyons of 1274 effectively doomed them to disappearance when it forbade them from recruiting new members to their orders."
‘The coming of the friars to England was opportune in the context of the movement of church reform set in motion by the Fourth Lateran Council of 1215. The canons promulgated by this Council were far from being original, as they were for the most part the culmination of trends already in motion at the Third Lateran Council of 1179, or even before then. But these canons of 1215 explain how the English friars were first called to action within their national church. Canon 10 ordered the appointment of preachers and penitentiaries to assist in the discharge of the episcopal functions of preaching and penance.
The formation of the Dominican and Franciscan orders followed soon after the Lateran Council, and these two orders became the chosen instruments of the pope, cardinals and bishops, to fulfil the requirements of Canon 10. ‘This applied also to Canon 21 of the same Council, which ordained that every Christian person, of either sex, who had attained the age of reason, must confess their sins to their own priest at least once each year. If anyone, for just causes, should desire to confess their sins to a priest other than their own, they must first apply for and obtain permission from their own priest, for otherwise that other priest will not be able to loose or bind (in the sacrament of penance). This permission was in effect delegated not (as the Canon suggests) to the parish priest but to the presiding bishop, for it was the bishops who allowed and encouraged friars who were priests to act as penitentiaries.
‘The decrees of the Fourth Lateran Council were promulgated in England by the bishops and abbots who were in attendance, and (for the province of Canterbury) by the Council of Oxford which took place in 1222. Thereafter it was the bishops who took the lead through their diocesan synods and visitations. Although the Council took place before the Dominican and Franciscan orders came into being, the bishops were quick to see the opportunity afforded by the new orders in fulfilling the Council’s aims.’* Robert Grosseteste, bishop of Lincoln, wrote in 1236 to Elias, minister general of the Franciscans requesting his help:
...because my diocese is much larger and more populous than any other in the kingdom of England, and I therefore need more, and more effective, help in preaching God’s word, hearing confessions, and imposing penances, and because there are no assistants I know of for these and similar responsibilities so effective as your friars’
Grosseteste asked for two to four friars to help him with this. In fact, Grosseteste is echoing here the language of Canon 10 of the Lateran Council, and he made similar requests of the Dominicans. During the thirteenth century, most English bishops followed Grosseteste’s lead in deploying the friars as preachers and confessors to put into practice the programme of 1215. ‘The friars themselves needed instruction in these tasks, and many of the most influential guides to preaching and confessing were the work of Dominicans and Franciscans. ‘The use of the friars by bishops in these roles met opposition from parish clergy who disliked the competition and from some bishops who found that they could not subject the friars to the same sort of control that they could parish clergy or monks.
These tensions were meant to be resolved by the papal bull Swper Cathedram (1300), which allowed the friars full right to preach in their own churches and in public places at certain times, and also in parish churches by invitation. Friars were to choose suitable brothers to be confessors and present them, through the provincial prior, to the bishop for approval. This compromise established the rules of engagement for friars as preachers and confessors, until the dissolution of the friaries in 1536-8, although it did not prevent localised disputes about their rights and responsibilities over this long span of time. As we have seen, the Augustinian friars and the Carmelites — both of whose constitutions were modelled on the Dominicans — began to spread to English towns from the mid-thirteenth century onwards. All four orders had a ministry of preaching and confession.
By the reign of Henry III, the requirement of the Fourth Lateran Council of 1215 that every Christian confess his or her sins and be absolved at least once a year was enforced as policy by synods and bishops of the English church. Like other European monarchs, English kings made sure they received special treatment that set them apart from normal folk, bychampioning the royal chapel as their parish and requesting papal privileges that allowed them to choose their confessor freely.’° The role of confessor in the royal, noble or episcopal household was now much better defined than chaplaincy had been. From the reign of Henry III onwards, friars established themselves as the preferred confessors of kings and queens, and, by imitation, of the higher nobility and episcopate too.
For almost one hundred and fifty years, the king’s confessor was a Dominican friar; the queen’s confessor tended to be a Franciscan. Later, in the fourteenth century, the Carmelites too were chosen as royal confessors. ‘These royal confessors were primarily spiritual advisors, but also could be employed as counsellors in secular affairs, and as envoys and diplomats, not just to the pope and to other courts, but to broker deals with disaffected nobles or recalcitrant clergy within the kingdom. We can see because of the exceptional survival of his letters that the Oxford-based Franciscan Adam Marsh (Chapter 1 below) could find himself counselling the queen, Simon de Montfort, Boniface archbishop of Canterbury and many others, even when he was not acting as their confessor, strictly speaking.
Sometimes friars were called on to preach crusades on behalf of pope and king, and to help to solicit contributions, voluntary or forced. This access to power, and the relaxation of the mendicant rule that of necessity accompanied such a role, provoked envy and criticism (see Chapter 6). But although anti-mendicant feelings reached a crescendo in the sermons preached by Richard Fitzralph, archbishop of Armagh in London in 1356-7, the challenge to religious orthodoxy, and to the structure of the late medieval church itself, posed by Lollardy, provided the next generation of friars with an opportunity to prove their loyalty to the crown and to preach and write against the heretics. Mendicants were at the forefront of the campaign to enforce doctrinal orthodoxy and church discipline, and to censor vernacular theology, marshalled by the Constitutions of Archbishop Arundel published in 1409.
My focus in this book will be on England, and English friars, though at different times the province of England within the four orders did not coincide with the territorial boundaries of the English kingdom. I will not be dealing with Scottish, Welsh or Irish developments however. Although England constituted a separate and insular province in terms of mendicant organisation, it would be a mistake to imagine that England was backward or isolated in respect of the continental provinces of the orders of the friars. Because the friars were international orders reporting ultimately to their ministers general, general councils and to the papacy itself, there were close links between English friars and those in other provinces, promoted by a /ingua franca of Latin, and a steady traffic of men and books across the English Channel. The importance of the studia generalia of the friars as places of study in theology, especially for Englishmen of the universities of Paris, Oxford and Cambridge, contributed significantly to the flow of friars into and out of the country.
All four orders of friars in England underwent significant changes over the centuries in their relation to wider society in towns and cities. An early stage in which the friars were establishing themselves in houses granted to them by lay and clerical patrons gave way from the late thirteenth century onwards to ambitious campaigns of building and extending the urban footprint of the friary. The friaries came to resemble monasteries in their employment of cloister, infirmary, chapter house, library, refectory, gardens and other ancillary buildings within a walled precinct.'? In university towns like Oxford and Cambridge the four friaries came to dominate the built environment before colleges began to gain ground in the fifteenth century.
In other market towns, the friaries experienced less in the way of competition, and their dominance of the urban landscape was unchecked. Although they closely resembled monastic houses, the friaries were much more central to urban space, and the walls of the friaries were far more porous than those of the monasteries. Townsfolk came into the friary to hear sermons, and to worship at side-altars; after death, they could be be buried in the chancel of the church and commemorated post-mortem by the saying of masses. Friars encouraged the development of confraternities of lay men and women linked to local friaries, and alreadyestablished gilds of merchants and craftsmen found friaries to be useful hosts and spiritual advocates.
The four orders developed strong links with their lay patrons through their activities as confessors and preachers, and, accordingly, were often remembered as a community or as named individuals in the wills of lay people. Much of the income of friaries by the fifteenth century came from renting out properties inside or outside the friary precinct to lay people rather than from pursuing alms as mendicants. Although the pace of building work slowed in the fifteenth century, there was no decline in the numbers of friars in England until the very last years before the dissolution when the writing was on the wall for monasteries and friaries."*
These developments were seen by some as imperilling the original and evangelical mission of the friars. In 1482, observant Franciscans, who rejected what they saw as the lax attitude to vows of poverty of their conventual brethren, and insisted on a stricter rule, won the support of Edward IV and established their headquarters at the royal palace of Greenwich. By 1517, there were observant houses in Canterbury, Greenwich, Southampton, Richmond, Newcastle and Newark, and the papacy acknowledged the Observants as a separate English Franciscan province of six houses. But by contrast with other countries in continental Europe, stricter observance was a late development in England and only affected the Franciscans.”
Religion and medicine
‘The contributions of friars to medicine in England needs to be situated within a broader appreciation of the relation of religion to medicine in the late Middle Ages. That relation can be, and often has been, characterised as a dichotomy in which clerics looked after healing the soul or salvation (sa/us anime), while secular physicians or other medical practitioners looked after healing the body (salus corporis). But a compelling case has been made that the connection of religion and medicine should be characterised instead as an overlap or entanglement, in which theology and medicine, those who care for soul and body, spiritual and medical attitudes to disease, cannot be separated neatly but are involved in complex interactions.” The Medicine of the Friars in Medieval England will argue strongly for the case for overlap and entanglement rather than dichotomy. Not least this is because we will find friars, who were also priests, acting as medical practitioners on their own brethren and on lay people.” There is a striking example of just this entanglement of priestly activity with physic in the instance of Giles of Santarém (d. 1265), Portuguese Dominican and former physician, whose manifold activities (and healing miracles) have been treated in exemplary fashion in the work of Ilona McCleery.” This book will show that English friars, like Giles of Santarém, practised medicine and wrote about it, although none of them so far as I can tell were ever credited like him with healing miracles. Alongside their medical activities, they served as confessors and chaplains in households, administering the sacraments and giving last rites, as well as carrying out their designated mission of preaching and teaching lay folk. There is no evidence that this involvement with healing the body, as well as saving the soul, caused individual friars hesitation or doubt about the appropriateness of their medical activities.
The entanglement or intersection of religion and medicine in the case of the friars was not without its tensions however. There were, at least on the surface, institutional inhibitions on the friars’ involvement in medical learning and practice. These inhibitions arose from the provisions of canon law and from the constitutions and regulations of the orders of friars themselves. Canon 18 of the Fourth Lateran Council of 1215 provided that no cleric could proclaim a sentence of death, execute such a sentence, or be present when a death sentence was carried out, and that any instances that required this action must be given over to a layman. ‘This was to ensure that clerics would have no part in the shedding of blood and thus compromise their ability to participate in and administer sacraments. The same canon prohibited subdeacons, deacons and priests from surgical practices which involved burning and cutting.” This would appear to rule out the practice of surgery by friars in major orders, and an overwhelming majority of friars were priests. But the great Italian surgeon Teodorico Borgognoni (d.1298) was a Dominican (and a bishop). The inhibitions never seem, in the English case, to have been enforced to inflict penalties on individual friars or to put certain kinds of medical practice and remedies out of bounds (even surgery, practice on women patients, the use of charms, or the creation of miraculous elixirs, as we shall see in Chapters 1, 2 and 4).
Various Councils of the Church and papal bulls attempted to forward the study of theology at the University of Paris by forbidding some clerics from pursuing the study of secular law and medicine. The complicated and often misunderstood story of these provisions has been surveyed by Darrel Amundsen.” The last word on medical education for clerics was that of Pope Boniface VII, who in 1298 promulgated the Liber Sextus, designed to supplement the Decretales of Gregory IX. This permitted the departure of religious from their houses for study of law or medicine if permission was first obtained from their prelates with the consent of a majority of members in their religious house. What little evidence we have suggests that English friars may have studied medicine in Paris, Montpellier or Bologna, before or perhaps even after taking the habit, but that they did not leave their friaries to study medicine in England. There were, in any case, no canon law provisions which forbade the practice of medicine (as opposed to surgery) by friars.
We are severely limited in our knowledge of how the orders of friars in England might have viewed the study or practice of medicine in respect of good discipline within or outside the friary. This is a consequence of the almost total disappearance of documentary evidence for the provincial or regional levels of decision making. We are left with what was recorded at general or provincial chapters of the orders. Angela Montford has summarised Dominican Chapter acta on medicine and medical practice.** These show that the Dominicans were concerned about fratres medici travelling outside the friary to treat sick laypeople. Other areas of concern were the making or selling of oleum benedictum (Limoges 1266),*’ alchemy or magical arts (Narbonne 1272), touching the flesh of women with bare hands (Montpellier 1278), payments for medical services going to the friar rather than the friary of (Rouen 1320), and, most frequent of all, that medical practice not licensed by the prior of a convent or the prior provincial (Paris 1343). There has been no similar analysis of these acta for other orders of friars, but it is highly likely that these concerns were shared. We will see that the English Dominican Geoffrey Launde in 1398 received a licence to practice medicine from the master general of his order, and the Franciscan Eryk de Vedica was licensed to practice by the prior of the London Greyfriars (Chapter 1, pp. 52, 62). Other friar practitioners in England were no doubt licensed too, though records have disappeared. We will also find in later chapters of this book evidence that practice on women patients, the use of healing rituals or charms, the use of astrology and alchemy, all found exponents among English friars.
Medical practice in England by clerics did not originate with friars.” Faricius, abbot of Abingdon (d.1117), was an Italian who may have acquired medical learning there or in England. He served as physician to King Henry I and his wife Matilda, and to other noble families, and was rewarded with royal patronage for himself and his abbey.” No fewer than four monks of St Albans (including Warin, abbot 1185-95) all entered the monastery on the same day and had all studied at the medical school of Salerno.*° An even more remarkable case is that of Nicholas of Farnham, royal physician and bishop of Durham (d. 1257). He studied both theology and medicine in Paris, and was afterwards professor of medicine in Bologna, but was by 1228 referred to as physician to King Henry III. By 1237, he was also confessor to both the king and the queen, an appointment made on the advice of the papal legate to England, Otto. He was valued also as a counsellor and administrator both before and after he took over the key northern bishopric of Durham in 1241.*7 He anticipated the combination of secular and spiritual guidance that became characteristic of the friars.
Nor were the orders of friars the first religious to engage with the health issues facing town populations in England. The order of Augustinian canons, whose first house in England was founded in 1105, had a mission in hospitals and among the urban poor. There were soon houses in most English towns.” A solitary custumal survives for the Augustinian Priory of Barnwell, near Cambridge. The almoner was urged to make frequent visits to ‘old men and those who are decrepit, lame and blind, or are confined to their beds’.*? Many English hospitals, though not part of the order, adapted the Augustinian rule as a guide to their communal life.** Some Augustinian canons also anticipated the friars in a preoccupation with natural philosophy and medicine. Alexander Neckam, author of the encyclopedic commentary on Ecclesiastes, De naturis rerum, had studied medicine and other subjects in Paris before joining the Augustinian canons and becoming abbot of Cirencester in 1213. The first two books of De naturis rerum and his other writings display his knowledge of medicine.* Very few catalogues and lists of Augustinian canons libraries survive, but the largest such catalogue, that of Leicester Abbey from the late fifteenth century, contains an extraordinarily wide-ranging collection of medical books.*°
‘The friars were not then the first or only English religious to display an interest in practising medicine and writing about medical matters. Their vocation raises a more general problem about the compatibility of secular and religious attitudes to sickness and health. This problem has been explored at length by Joseph Ziegler in his book Medicine and Religion, c. 1300: The Case of Arnau de Vilanova (Oxford, 1998). Ziegler discusses several mendicant authors whose religious writings show considerable knowledge of medicine, for instance the Dominican Giovanni di San Gimignano (d. c. 1332) and the Franciscan Servasanto da Faenza (d. c. 1300). The central figure in his book is Arnau de Vilanova, who was a scholastic physician, also a theologian, and a close associate of the Franciscans. As Ziegler writes,
Arnau’s medical texts themselves are devoid of any allusions to a moralistic interpretation of disease as the consequence of sin, and rely solely on a natural explanation. Diseases in Arnau’s medical writings are neither the results of a direct divine intervention nor of the flawed moral behaviour of
a patient.*”
‘There is much shared ground here between Arnau and the friars writing on medicine mentioned by Ziegler. In contrast to this naturalistic account of disease shared by Arnau and the two friars, we must consider what Ziegler calls the ‘clerical attitude to disease and medicine’, conveniently represented by the weighty Summa predicantium, an alphabetically ordered handbook for preachers, compiled in the first half of the fourteenth century by the English Dominican John Bromyard. Bromyard argues that disease is first and foremost a moral phenomenon with accidental physical manifestations, leaving no place for the physician but only for reflections on sin and submission to God’s providential order. This is directly at odds with the view of disease and medicine taken by Arnau and even by Bromyard’s brother Dominican Giovanni di San Gimignano.** But this apparent clash of perspectives in writings on illness and medicine does not signify irreconcilable viewpoints. We find both perspectives are present in the unique chronicle of the coming of Franciscans to England, Tractatus de adventu fratrum minorum in Angliam, a text written about 1258-9 by Brother Thomas (sometimes called of Eccleston). He speaks of Franciscans going to shrines for healing and being punished for pride by illness, but he also displays a good knowledge of practical medical texts himself, and talks about treatments, medical and surgical, given to the brethren.*”
Ziegler also explores the use of medical analogies in religious writings of the thirteenth and fourteenth centuries. As he puts it:
Similes which portray the relationship between God and his ministers and the believer in terms of the relationship between a physician and his patient form the medical model...According to this model, Christ, priests, confessors, and preachers appear as physicians, the sinners appear as patients, and the soul is represented by the body, and every stage in the curing process, from diagnosis through prognosis to therapy, represents a stage in the process of spiritual cure.”
This medical model was not, of course, new in the thirteenth century,*! but it was applied more systematically in works by Giovanni di San Gimignano and Servasanto da Faenza (in his Antidotarium animarum (Antidotary for souls)) than ever before. From writings like theirs, designed to provide materials for friars’ preaching, medical analogies proliferated in sermons. The Fasciculus morum was compiled by a Franciscan to do the same thing for English preachers. Although its use of the medical model is less systematic and comprehensive than those of the Italians, it does compare Christ’s passion to an act of bloodletting, for example.” The most extravagant use of the medical model in English sources is the Livre de Seyntz Medicines (Book of sacred medicines), a penitential work compiled by Henry of Grosmont, duke of Lancaster in 1354, which made use of the Fasciculus morum and the Dominican work of spiritual and physical counsel, La Somme le roi. This work on holy medicines by Duke Henry shows the extent to which the medical model had already been absorbed in aristocratic circles, and was soon to be reproduced in many other devotional works aimed at the laity. Carole Rawclifte’s Medicine & Society in Later Medieval England concludes with examples which bear out this observation.“ The authors of all these religious works drew on medical authorities for their characterisation of diseases and remedies, but usually indirectly, often relying for example on the encyclopedic work of the English Franciscan Bartholomaeus Anglicus, De proprietatibus rerum (On the properties of things). A good understanding of the procedures of medical diagnosis, the nature and difference of illnesses, and of medical and surgical treatment, is assumed on the part of the preacher and of his audience, if the medical model is to work as a preaching device.
‘The analogy between the stages of illness and medical treatments, on the one hand, and sin and the administration of penance, on the other, was exploited in both religious and medical writing.* The confessor played the same role in diagnosing sin and prescribing penance as did the medical practitioner in relation to illness and treatment. The analogy came readily to writers of sermons in England, whether friars or other preachers. But it was also exploited by medical writers, most notably by the English surgeon John Arderne. He compared the surgeon's role explicitly to that of the confessor, giving prominence to the need to tell the patient stories that will encourage him or her to bear present pain in the hope of future relief.*° Counsel directed at lay readers, both religious and medical, was not just a matter of oral preaching or telling stories to patients. Friars were heavily involved with two complementary areas of advice to lay people in written form, spiritual guidance and bodily regimen and diet. Roger Bacon's edition of pseudo-Aristotle, Secretum secretorum of the 1270s, which took the form of advice from the philosopher Aristotle to Alexander the Great, combined advice on conduct with medical regimen in the same text. This conduct of princes genre found a ready readership among aspirational lay folk more generally. Such was the case with the Dominican La Somme le roi, already mentioned, and with its various spin-offs in translations or adaptations in Middle English. Moral or spiritual guidance was a necessary partner to advice on regimen and diet, as the aim was to encourage spiritual and bodily control on the part of the individual in their daily life. This topic will be explored in Chapter 5.
This book will not be considering the wider issue of the impact of medicine and natural philosophy on the theological outlook of the friars or on biblical exegesis. These are very important and still under-investigated topics. English friars seem to have gone further than others when it came to incorporating insights drawn from secular texts into their reading of scripture, and into the theology taught in their own schools and in the universities. These secular texts included medicine, as has been shown by a close analysis of the surviving works of the thirteenth-century English Franciscan, Nicholas of Ockham, by Joseph Ziegler.’ The theological disputations found in continental quodlibetal literature also reflect the influence of medical ideas.** The pioneering researches of Beryl Smalley, especially on works of biblical exegesis by English friars, have still to be followed up properly, though Danielle Jacquart has recently highlighted the significance of medicine in this field.*” The work of Maaike Van der Lugt, particularly in her book Le ver, le demon et la vierge, has shown what may be done to elucidate the role of medicine by focussing on the topic of generation as it played out in theological arguments from the 1230s onwards. She demonstrates that Dominican and Franciscan theologians chose to incorporate explanatory ideas drawn from Aristotle and Galen on the topic of generation according to their theological priorities. Franciscans tended to favour a Galenic approach to embryology in discussing the virgin birth of Christ, because it espoused an active maternal role in generation and fitted best with their particular reverence for the virgin Mary. Aristotelian denial of an active role to the maternal seed in generation was favoured more by Dominican theologians, who were more interested in emphasising an instantaneous formation of Christ’s human nature at conception.*° Individual theologians in all orders of friars might nevertheless take positions on these questions, which differed from others of their own brethren, and Van der Lugt’s discussion of these debates shows how deeply the friars entered into naturalist theories of human generation, while always prioritising theology.*! In contrast with their different handling of medical issues in theological discussions, I will be arguing that the four orders of friars in England shared a similar outlook in writing about practical medicine (see Chapters 3 and 4).
Friars and the medical economy
The historiography of medical practice in England during the Middle Ages has tended to obscure the work of the friars. Historians have evaluated medical practice in England in terms of functional categories like physicians, surgeons, apothecaries, barbers, midwives and empirics. This is how we find them identified in the valuable biographical listings in Talbot and Hammond, Medical Practitioners in Medieval England (1965). Most of the records of these practitioners are extracted from legal or administrative documents — property transactions, wills, lawsuits, exchequer or chancellery records. Many of the entries only record the existence of individuals identified as medicus or leech, where the occupational category remains unresolved. ‘These biographical entries contain the names of very few friars who practised medicine. ‘This is not surprising as friars are very seldom mentioned in property transactions or lawsuits, the most common secular records.** When individual friars do appear, it is most often in ecclesiastical records, typically in ordination lists or licences to preach or confess, or sometimes in university records. From the perspective of such ecclesiastical records, medical considerations are irrelevant. Friars are thus likely to be systematically under-represented in these biographical resources. So of course are other sorts of medical practitioner — midwives, itinerant specialists like tooth-drawers, herniotomists or eye-doctors, wise women and herbalists, who are below the radar of institutional or legal records.
‘This is a prosopographical point then, about the counting of heads when it comes to record-keeping in medieval England. The nature of the sources makes a considerable difference. But apart from prosopography, there is a further issue about the relationship of medical practitioners to their patients. When medical practitioners in medieval England are envisaged as options open to a patient in search of help, they are usually presented in terms of a hierarchy of resort. Usually, physicians are at the top of the hierarchy, as the most expensive and long-educated kind of practitioner, then come surgeons, apothecaries, and, below in the social scale, barbers and other specialists (usually classed as empirics), and women practitioners.‘ Note that this hierarchy of resort has no space for friars or religious, nor is it clear how they would fit in with this essentially occupational approach to describing medical practitioners. But attaching occupational labels to practitioners, while it makes sense of documentary categories, is also problematic when it comes to considering how medical practice worked. The practitioners we know best are those who were writers or compilers. The manuscripts they produced tell us a lot about how they practised, but also about their relations to their patients. In every case of English practitioners of the fourteenth and fifteenth century who wrote (John Arderne, Thomas Fayreford, John Crophill, Richard Trewythian, Nicholas Neesbett, John Clerk, John Argentein), we see the insufficiency of the occupational labels.** In the cases of Crophill and Trewythian, their primary activities were not medical at all (bailiff; money-lender and astrologer); in the cases of the others, their interests and activities spread too wide to be confined to a simple label. And, as we shall see, the friars who practised medicine do not fit into the occupational boxes any better. What we know about the practice of medicine in late medieval England suggests a much more fluid picture, with no well-defined boundaries on practice or authorities to enforce them. Even the attempt by physicians and surgeons in the 1420s to draw up regulations for a supervised hierarchy of medical practice, with officers drawn from those judged to have fulfilled the professional requirements for physicians and elite surgeons, rapidly fell apart even in the city of London, when faced with the opposition of the Grocers and the Barbers companies and lack of interest on the part of city authorities in enforcement.*°
Medical practitioners of all kinds can be imagined as options available to patients looking for help within a form of medical marketplace — and this has been a popular way of looking at things among early modern historians of England. But a major drawback to this approach is that a medical marketplace presupposes patients acting as consumers making choices about prices and availability of medical care in their locality. This model is a better fit for early modern England or for the sophisticated city-states of late medieval Italy than it is even for England’s largest city, London. David Gentilcore has argued that in southern Italy patients did not have ready access to a variety of practitioners, nor were the practitioners identified by occupational labels. In these respects, most of late medieval England must have been more like southern Italy.*” Rob Ralley has made the point that what he calls medical economies, not wholly dependent on competition, capture the relations of healers and patients in late medieval England better than does the medical marketplace. This alternative model allows space for charity when healing is offered free of charge, and for an exchange of services between healer and patient, rather than confining medical transactions to straightforward monetary purchase. Medical economies also allow a role for institutions like hospitals and monastic infirmaries, which sometimes offered medical care to the sick poor or inmates who were professing religious. Since friars were generally — but not always — unpaid for their medical services, they are more easily accommodated within the medical economy model than in a medical marketplace model.**
In the case of Franciscans, St Francis’s care for lepers and other sick poor could inspire emulation on the part of his followers. Charitable care for the sick in imitation of Christ and St Francis was undoubtedly embraced by some friars as an avocation, a means of drawing nearer to God, particularly if they had done some training in the sciences of healing before they took the habit. In a manuscript in an Italian library written at the end of the thirteenth century, apparently by a religious, the writer refers to himself as ‘I, a sinner, but by the grace of God, a member of a religious order.’ His medical book is written for the use of other religious so that they may give treatment to the poor for nothing, since they are abandoned by the ordinary physicians and surgeons. But when it comes to rich patients the manuscript supposes that religious healers are to take fees. This applied to any religious order, not just the Franciscans. The writer of this manuscript refers to a certain frater ‘R. de Boemonte’, a Dominican friar, ‘who for a long time studied medicine.’ Such medical study would have been forbidden to Dominicans once professed, so ‘R. de Boemonte’ no doubt had studied medicine before he took the habit. We will see in Chapter 1 that Dominicans as well as Franciscans with medical expertise did in fact practise charitable healing of the poor.
Besides charitable care of the sick poor, the constitutions of the mendicant order required friars to look after members of their own order, particularly when they were outside the friary.© Friar on friar medical care was one aspect of the rule that friars should always travel in pairs. A travelling socius should look after his sick brother as well as offer spiritual counsel and support. While this kind of care is not instantiated in documentary records, it has left its trace on the first chronicle of the Franciscans in England by brother Thomas in 1257/8, which has many passages dealing with the illnesses of the brethren.“ Letters help to fill out the picture sketched by the chronicle of Brother Thomas. The letters of the English Franciscan Adam Marsh (d.1259), first Franciscan lector in Oxford in 1242/3, friend and adviser of Robert Grosseteste, bishop of Lincoln, make up the most detailed and revealing English letter collection before the Paston letters in the fifteenth century. Adam recommends experienced healers in the Franciscan order who may be called on to give help to their sick brethren and to eminent clerics and courtiers. We will come back to Adam Marsh’s letters in Chapter 1.
The health of the friars
‘The picture we get of the health of English friars in Brother Thomas’s chronicle and in the letters of Adam Marsh suggests that friars were often liable to illness, and that their superiors were preoccupied with keeping them healthy despite the rigours of their vocation. Apart from this anecdotal evidence, we do now have archaeological research on burials in friaries that throws interesting light on the health status of friars. One of the most recent and far-reaching investigations of this kind focusses on friars and their contemporaries in Cambridge. All the main mendicant orders were represented by substantial friaries in the town, because of its attraction as a centre of teaching and study. But only in the case of the Augustinians, who occupied a site near the south boundary of the city (now part of the New Museums site of the University), did the opportunity arise to undertake an archaeological investigation covering most of the original site of their cloister, where there were seventy burials identified as dating to between the thirteenth and sixteenth centuries.
An Augustinian friary had been established in Cambridge between 1277 and 1289 and continued until the dissolution in 1538. By 1297, there were thirty-six friars in residence, and by 1326/8 their number had risen to seventy. As well as functioning as a normal friary, it was also a national and international study house, a studium generale for the Augustinian order, with young friars coming to study for a few years. As well as the friars buried there with permission from 1290, the Augustinians also acquired the right to bury individuals who were not members of the order in 1302. In 2016-17, the Cambridge Archaeological Unit excavated part of the site, revealing two groups of burials. ‘The earlier group of thirty-two burials, dating from the late thirteenth to mid-fourteenth centuries, come from a cemetery located to the south of the friary church. The individuals buried there were mainly male adults who were clothed when buried. The presence of distinctive belt buckles argues for their being friars. Burials dating to between the late fourteenth and mid-sixteenth centuries were made under the floors of the friary chapter house or in the cloister walkway. In that area were found the remains of Augustinian friars and some of their lay patrons. Other archaeological work in Cambridge allowed the remains found at the Augustinian friary to be compared with those of other groups associated with the cemeteries of the Hospital of St John and various parishes outside and inside the city.** The ‘After the Plague’ project was able to bring to bear multidisciplinary bioarchaeological approaches, including social osteology (effects of activity and lifestyle evidence in the human skeleton); palaeopathology (revealing infectious, congenital and metabolic illnesses, and trauma); ancient DNA of skeletons and pathogens; isotopic investigations of diet and geographic origins; and studies of differences in bone architecture (caused by stress or diet).
Compared to contemporary burials of townspeople in the Hospital of St John and other parish sites in and around Cambridge, the friars were taller and their health status better in general. Because Cambridge was a studium generale for the Augustinians, it is likely that many temporary denizens of the friary had come to Cambridge from other places in England and Europe to study in the schools. Yet the isotope evidence suggests that almost all the Augustinians buried in the friary were of East Anglian origin. Burials on the site were differentiated archaeologically, as friars appear to have been buried clothed and wearing a belt with buckle (as noted at excavation), whilst lay people were typically buried wrapped in a shroud (with no belt buckle). The townspeople buried in the friary likely represent some of the more prosperous members of Cambridge society, as typically a donation was required for burial within the friary. Their diet and general health seem to have been more like that of the friars than that of the other Cambridge groups.
Comparable excavations at the site of the Augustinian friary in Hull between 1994 and 1999 resulted in the detailed investigation of some 70% of the main cloister area (including the church, and the east and west ranges). This was not only the most extensive investigation of any of this order’s houses, but also one of the larger excavations of any mendicant house in the UK. As in Cambridge, human remains of friars and lay patrons (nearly 40% of all burials) were found on site in the nave and chancel of the church, and in the cloister, dating from 1316 to 1539. A minimum of 192 individuals were buried there, a much larger number than those so far found in Cambridge. One difference from the burials at the Cambridge Augustinians is a cluster of six burials at Hull showing evidence of probable or possible treponematosis, whether caused by endemic or venereal syphilitic infections, or the disease of yaws. Two of these people probably originated outside England. Hull, like Cambridge, was a place where there was considerable international traffic in travellers, although in the case of Hull this was owing to its trading connexion to the ports of the Baltic Sea, rather than to its attraction as a study centre.”
In other respects, the investigations at Hull yield similar information about the diet and health status of the friars to those at Cambridge. The Hull friars enjoyed a rich diet including beef, veal and mutton (despite proscription of meat and fasting) and in particular enjoyed very high levels of consumption of eels and freshwater fish. The incidence of chronic conditions signifying a compromised nutritional status in childhood, like cribra orbitalia (pitting in the bone on the roofs of the orbits of the skull, suggestive of anaemia), and lesions caused when tooth enamel was being formed, or signs of inflammatory infections of the lower limbs, found for instance in the Hospital of St John’s in Cambridge, was not as high among the Augustinian friars of Hull and Cambridge. On the other hand, the older Hull Augustinians did show a high incidence of degenerative joint disease (DJD) and osteoarthritis. As high as 48% of the sample at Hull were affected by DJD, and 15% by osteoarthritis.°’ Gout, probably brought on by a rich diet, seems to have affected the Cambridge Augustinians in the fourteenth and fifteenth centuries. The rate of hallux valgus (long-standing lateral subluxation of the big toe, causing bunions) among the friars was almost twice as high as the next highest group of burials in Cambridge, those in the Hospital of St John. There was also a strong correlation between hallux valgus and fractures caused by falling. One friar had a coccyx fracture from falling backwards as well as ha//ux valgus. Surprisingly, fashionable footwear among the friars, specifically pointed shoes with lengthy tips, seems to have caused both hallux valgus and incidental fractures, particularly amongst those who died at an advanced age.® An equally surprising finding is that friars were more liable to survivable traumatic fractures than others.” The overall impression is that the illnesses of friars in the fourteenth and fifteenth centuries were those of comparative affluence, measured in terms of nutrition and longer life expectancy, than the general population of Cambridge.
The most surprising contrast between the health of the friars and that of those buried in other Cambridge cemeteries is that the friars had nearly double the infection rate of parasites spread by poor hygiene, compared with the general population. Prevalence of roundworm and whipworm found in burials of the Augustinian friars was 58%, and in the All Saints by the Castle parishioners just 32%. This last rate of prevalence is broadly in line with those in late medieval burial sites in England. Both these figures represent a minimum prevalence, as it is likely that the actual number of infections was higher due to destruction of eggs in the burial sediment by fungi and insects. The explanation of the difference between the Augustinians and the others most likely lies in sanitary practice, though this is necessarily speculative. The Augustinians might have manured the crops in their friary gardens with the faeces from their own latrine block, and if the townspeople did not, then this might have caused disproportionate reinfection in the Augustinians. Similarly, if the Augustinians purchased manure from the town to fertilise their gardens that contained human faeces or pig faeces (pigs can be infected by roundworm), then this might have led to higher infection rates when they ate the crops from their gardens. Medical texts available in medieval Cambridge show that educated healers of the time were aware of intestinal worms of different shapes and sizes and knew of medicines that they felt were helpful in treatment.”
Many epidemic diseases must have affected the Augustinian friaries, but the archaeological evidence is restricted to plague. The plague bacillus Yersinia pestis was found in one burial in an early cemetery on the Cambridge site, quite possible a victim of the first great outbreak of 1348-50. Three other plague victims were buried in the friary chapter house at some time between c. 1450, when the chapter house was altered, and the dissolution in 1538. All these burials were conducted as ceremoniously as non-plague burials, unlike the six lay victims found in a mass burial nearby at St Bene’t’s Church.” This suggests that, as far as can be judged, deaths from epidemic disease were not treated any differently from any others.
The arc described by this book will move from the evidence for medical practice by English friars, to their writings on medicine, to how friars were seen in their role as confessors and healers, and finally to the legacy of their writings for English medical culture after the dissolution of the friaries in the 1530s. Chapter 1, ‘Friars practising medicine’, begins with the most famous English friar practitioner of the Middle Ages, the surgeon William Appleton. New evidence for his medical and surgical practice is found in remedies attributed to him in the 7adula medicine, a collective work on practical medicine by English Franciscans, dated to 1416-25. The Tabula medicine is also our principal source for knowledge of other late medieval friars and their patients. Pushing back earlier, there is evidence for medical practice at court and among the English nobility and higher clergy by friars of the thirteenth century. Two English Dominicans who were both confessors and healers to their patients are studied in some detail, as their prescriptions survive. As late as 1477, we find a very unusual legal case from London when a Franciscan Eryk de Vedica, and his convent superior, try to recover fees owing to them for medical treatment of a lady, whose husband refused to pay. There is also surviving evidence scattered in manuscripts for other individual friars practising medicine, and some of this is for friars from the Carmelite and Augustinian orders.
Chapter 2, ‘William Holme, medicus’, makes a case study of a Franciscan of the late fourteenth century, whose medical practice is the best attested in the Tabula medicine. We know more about his patients, the illnesses they suffered, and the range of remedies used by Holme to treat them, than we do for other friars. But the chapter also shows the connexion, or rather lack of it, between medical practice and medical writing. William Holme compiled a Tractatus de medicinis, incomplete and known to survive only in one manuscript by a Franciscan amanuensis, which was probably intended as a useful medical guide for friars in Holme’s own convent. He is best known as a compiler for another text, his De simplicibus medicinis, which is a digest of twelve ‘doctors of medicine’ on simple medicines, arranged alphabetically under illness headings and then by the simples employed against each illness. Paradoxically, perhaps, it turns out that there is not much to link William Holme as medical practitioner with William Holme as medical author.
Chapter 3, “Writing medicine differently’, moves the argument onwards from the individual case of William Holme to more general considerations about the kinds of medical writing associated with English friars. The principal argument here is that friars did not write the same kinds of medical treatises as university physicians and surgeons. The friars’ writings were more akin to their religious writings, for example, sermons or moralising encyclopedias, than to scholastic forms of medicine. Perhaps the friars picked up the anti-scholastic bias so marked in the medical works of Roger Bacon. Collaboration on largescale projects to construct biblical concordances, tables of contents and indexes was also characteristic of friars’ compilation practice, as was a preference for alphabetical order to give rapid access to information. The Tabula medicine and the Liber uricrisiarum of the Dominican Henry Daniel both reflect the friars’ creativity in devising new ways of representing practical medical knowledge. Finally, the English friars were at the forefront of translating medical knowledge from Latin into English, advancing this movement as a charitable mission to lay householders.
Chapter 4, “The Medical Culture of Friars’ looks at the content rather than the form of friars’ medicine. The kinds of medical knowledge that particularly enthused English friars followed a programme first established by Roger Bacon in his writings addressed to Pope Clement in the 1260s. ‘The friars did not abandon the tenets of humoural medicine, or the use of degrees of hot, cold, wet and dry in ranking medicaments, any more than Bacon did. But they showed themselves as enthusiasts for three elements in the Baconian programme in particular. These were medicinal alchemy, scientia experimentalis with its commitment to knowledge vouched for by experience, and philosophical calendars and astrology. In each of these areas, English friars were innovators in adapting these sciences for application to practical medicine. There is one other area of medical knowledge of special interest to friars but not an original part of the Baconian programme. This is a focus on matters to do with women’s medicine and human generation. These are given a high profile in the Tabula medicine and in Henry Daniel’s Liber uricrisiarum, testifying to the friars’ involvement in the intimate details of their patients’ lives.
Chapter 5, ‘Souls and Bodies’, explores the two domains in which friars counselled laymen and other clergy, whether as religious or secular advisers. The Lateran Council of 1215 wished the two domains to be kept strictly separate, but this proved impossible. When it came to the care of souls, cura animarum, the friars as preachers and teachers were keen to explore the role of bodily complexion in its influence over the virtues and vices. In counselling the penitent layman, the friar was aware of the importance of diagnosing sin and prescribing penances to restore spiritual health. In works of spiritual counsel directed at lay readers, friars outlined a regimen for the soul. Conversely, friars were also much involved in giving their lay patients advice on maintaining bodily health, in the form of the regimen sanitatis (rule of health). These regimina often formed part of larger works like encyclopedias and the Tabula medicine handbook. A theoretical overlap between the domains of the soul and of the body was to be found in the significance of complexion for both, and in the embedding of ‘accidents of the soul’ among the six non-natural factors, which it is the task of the healer and his patient to control.
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Chapter 6, ‘Creeping into Homes’, introduces a different perspective, that of the critics and opponents of the friars in England. There had been attempts even in the early days to roll back the growing power of the mendicant orders, seen as interfering in the proper relationship of the parishioner to their priest or bishop. In the fourteenth century, criticism often took the form of literary attacks on the hypocrisy and self-serving manoeuvres of the orders of friars, as they became an established, and increasingly wealthy, part of the ecclesiastical landscape. Geoffrey Chaucer cast a jaundiced eye on friars in several of the Canterbury Tales. At the crudest level, such attacks might take the form of popular songs about the sexual adventures of friars with the ladies they counselled. At an infinitely more sophisticated level, Piers Plowman, by William Langland, explored the case of the friar ‘sick with envy’, using an allegorical language of medical diagnosis to depict his ailment in extraordinary detail. The friar as failed healer and corrupted confessor is central to Langland’s description of the deadly weaknesses of the English Church of his day at the climax of his great poem. By contrast, the fifteenth-century imitations of Piers Plowman are satires picking up some of the themes of the hostile dismissal of four orders of English friars by the Lollards.
Chapter 7, “The Legacy of Friars’ Medicine’, turns to the fate of medical writings by the friars in the century or so after the dissolution of the English friaries. English academic physicians soon saw the practical value of a text like the Tabula medicine, adapting it for use as a source of remedies. Practitioners like Thomas Fayreford and the English royal physician John Argentein or Argentine modelled their own handbooks on it. Similarly, the writings of Henry Daniel OP were used and annotated by the academics, and a number of sixteenth-century manuscripts testify to this. Roger Bacon OFM continued to be taken seriously as a philosopher with influence over contemporary practice of astrology, alchemy and scientia experimentalis, while his popular reputation developed as a necromancer whose tricks often failed. The coming of print gave a new lease of life to friars’ medicine, whether in the form of new editions of the De proprietatibus rerum of Bartholomaeus Anglicus, or in the sixteenthcentury medical bestseller, This is the myrour or glasse of helthe, which was based on a plague treatise by the mid-fifteenth-century Dominican Thomas Moulton or Multon. The astrological medical practitioner Simon Forman, working at the end of the sixteenth century, unknowingly adopted the Tabula medicine as the basis of his own medical manuscript handbook. His extensive medical practice, revealed in his voluminous case notes, was an extension of what he had learned from the Tabula medicine. In these ways, the friars’ medicine was far from disappearing even long after the orders of English friars themselves had been disbanded.
This Introduction began by suggesting that the active participation of English medieval friars as medical practitioners and as authors or compilers of texts on medicine has been overlooked. The purpose of the book is to recover what we can learn about these activities, taking place over three centuries from the 1220s onwards, and to restore the friars to their rightful place in the history of health and healing over this period. The story does not end abruptly in the 1530s, however, despite the dissolution of the friaries.
The orders of friars disappeared in England from the 1530s for centuries, but the influence of their medical writings and attitudes to healing did not. In particular, the attention paid by authors like Roger Bacon OFM and Henry Daniel OP to astrology, alchemy and to the collection of experimenta, kept their influence alive. The anonymous Franciscan Tabula medicine also continued to exert influence long after the origin of that compilation with the friars had been forgotten. More generally, the writings of the friars on medical subjects, sometimes in the form of remedy books, survived in manuscript as well as in print, and such manuscripts were treasured and used by later practitioners. These surviving manuscripts are also the principal source of this book.
All the chapters of the book consider the entanglement of medicine and religion from various points of view. The state of health of the friars themselves was critically important to their active role as religious, their ability to perform the evangelical and pastoral tasks prescribed by their constitutions and solicited by popes and bishops. The first responsibility of friars as healers was to look after their own brethren. Reaching out beyond that to lay people the friars found themselves acting as both confessors and healers. If the councils and canons of the church set out the need to keep the two roles distinct and stressed the priority of care of the soul over curing of the body, in practice at the bedside of the sick or at the deathbed friars found themselves slipping from one role to the other.
This seems to have caused less friction in practice than might have been expected, and regimens of healing and guides to right living authored by the friars had significant areas of overlap. Critics of the friars might have argued that mendicants found it in their own interest to ‘creep into homes’ to solicit alms and legacies, but many lay people were happy to pay for the services of friars, whether as healers or confessors. Chapter 1 begins with a vivid example of payment to a friar for a remedy.
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