The Black Death

The situation of medicine was not helped by the stern determination of the medieval churchman to keep the physician in his place. What Professor Gurlt described as ‘that fatal exaggeration which enthroned theology not merely as mother but as Queen of all the sciences’,^{124} ensured that the doctor would play a secondary  role. In the sick room it was the priest who took the lead and the doctor who humbly offered his services once the praying was over. Before he even treated a patient the doctor was supposed to establish whether he had first confessed; if he had not, then medicine would have to wait its turn. Sometimes the doctor would manage to assert himself but, in general, the more eminent the invalid, the more likely it was that he would find himself thrust into the back row behind a bevy of churchmen and courtiers. When the disease worked quickly a doctor might not even be admitted to his patient’s bedside until death was imminent or had actually occurred.

But the Church, by the stranglehold which it had on every field of education, ensured that the invalid would have gained little even if the doctor had been given a freer hand. All medical teaching at the universities was on lines laid down by the Church and consisted mainly of the reading of outmoded texts with a brief and usually misleading ‘interpretation’ by the professor. Surgery was the poor relation of an anyhow impoverished science. In 1300, Boniface VIII published a Bull forbidding the mutilation of corpses. His object was to check the excesses of relic hunters but, incidentally, he dealt a crippling blow to would-be anatomists. Soon afterwards the Medical Faculty of Paris formally declared itself an opponent of surgery. At Montpellier, supposed to be among the most enlightened of the medical schools, there was one practical anatomy lesson every two years. This long and eagerly awaited occasion consisted merely of the opening of an abdomen and a cursory exposition of its contents. It was not till the end of the fifteenth century that Sixtus IV authorized the practice of dissection and even then specific authority had to be obtained on each occasion.

Given such handicaps it would have been miraculous if the medical profession had met the Black Death with anything much more useful than awe-struck despair. Their efforts were as futile as their approach was fatalistic. Not only were they well aware that they could do little or nothing to help but they considered it self-evident that an uncharitable Deity had never intended that they should. ‘The plague’, wrote Gui de Chauliac, one of their most distinguished and, incidentally, successful practitioners, was ‘shameful for the physicians, who could give no help at all, especially as, out of fear of infection, they hesitated to visit the sick. Even if they did they achieved nothing, and earned no fees, for all those who caught the plague died, except for a few towards the end of the epidemic who escaped after the buboes had ripened.’^{125} A doctor not prepared to visit the sick must, of course, labour under a singular disadvantage but de Chauliac was certainly right in his contention that, from the point of view of the infected, it made little difference. Nothing in the medical literature which survives suggests that the treatment of the doctors, though it may sometimes have eased a patient’s sufferings, can have been directly responsible for a single cure.

The views and activities of the doctors are reasonably well known through the plague tractates which they left behind them. Sudhoff’s Archives^{126} already reproduce well over two hundred and eighty of these. Many relate to other phases of the great pandemic but seventy-seven were written before 1400 and at least twenty before 1353. The majority of the most important studies relating to the Black Death have been analysed by Dr Anna Campbell in her invaluable work, The Black Death and Menof Learning.^{127} The preamble to the Report of the Faculty of Medicine at Paris demonstrates admirably the vague, hopeless search for arcane solutions which appeared again and again in the tractates: ‘Upon seeing effects whose cause is concealed even from the most highly trained of intellects, the mortal mind must ask itself, especially as there is in it an innate desire for appreciation of the good and of the true, for what reason everything seeks good and desires knowledge…’