
MEDICAL PRACTICE
Katharine Park
This chapter deals with medical practice in Western Europe, the institutions
and circumstances that shaped it, and their evolution during the period from
about  to . I have taken “practice” in its broadest sense, to refer to the
varied activities engaged in by medieval Europeans of all classes in order to
manage illness and to repair or maintain health. It includes approaches that
spanned what we would call religion, magic, and science – the boundaries
between those categories were less distinct in the Middle Ages – and included
activities as varied as domestic nursing, faith healing, and the founding and
administration of hospitals, as well as the work of the men and (occasionally)
women who practiced physic and surgery in accordance with the principles
of learned or text-based medical knowledge.
If medicine as a learned discipline was shaped primarily by the relationship between academic writers and their students and colleagues, historians
of medical practice focus rather on the relationship between healers and the
sick. The distinction is both important and fairly recent. Earlier historians
of medieval medicine tended to rely disproportionately on the perspective of
learned surgeons and, especially, physicians, as well as on the atypical example
of Paris. This resulted in a picture of medical practice that overemphasized
the importance of elite healers and attributed to them (and to university
culture in general) an exaggerated role in health care institutions and practices, prompting premature claims about the emergence of medicine as a
“profession” in the late Middle Ages. More recent historians have recast the
problem, focusing less on the power and authority of academically trained
doctors over their patients and other practitioners than on the “negotiation,”


Medical practice should not be confused with practical medicine, or practica, which was the part of
the learned discipline of medicine that dealt with diseases and their treatment. On the distinction
between practice and practica, see Geneviève Dumas and Faith Wallis, “Theory and Practice in the
Trial of Jean Domrémi, –,” Journal of the History of Medicine,  (), .
The best general account of the culture of learned medicine is Jole Agrimi and Chiara Crisciani,
Edocere Medicos: Medicina nei secoli XIII–XV (Naples: Guerini, ).

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Katharine Park
“exchange,” “contract,” or “encounter” between patients and healers. This
reformulation has two clear benefits. It allows the historians to move beyond
narrow (if important) questions of organizational structure to look at the
activities that actually constituted medical practice, and it foregrounds the
relative parity of the parties involved.
Indeed, for much of the period covered by this chapter, European society
lacked stringent licensing procedures, effective public regulation, and clear
disciplinary boundaries for medicine. Under these circumstances, anyone
could be a medical practitioner, provided he or she could attract clients –
a situation that gave patients a large degree of power and choice. This
situation began to change in the late Middle Ages, which saw the first effective
attempts to control and limit medical practice in some urban centers. This
should not be seen simply as an attempt by formally trained practitioners to
monopolize the business of healing, as the impetus for even this development
seems to have come at least as much from patients eager for some way to
identify those practitioners that deserved their commerce and their trust.
“Authority and trust are social products that are reconfigured differently in
every generation,” in the words of Michael R. McVaugh, and the history of
the medical profession and medical practice is as much the history of those
reconfigurations as of any collection of institutions or techniques.
This chapter presents an overview of this history insofar as it is currently known. The caveat is important, for much work remains to be done,
particularly in the form of local studies based on archival sources. Only
studies of this sort can provide an accurate sense of the dynamics that shaped
medieval health care and the enormous geographical and chronological variety of the institutions, laws, and practices that constituted it. Above all, these
studies reveal by their gaps and silences the challenges of understanding
and describing the health care offered and received by the vast majority of
medieval Europeans, who did not live in major cities and whose experiences





For example, Michael R. McVaugh, “Bedside Manners in the Middle Ages,” Bulletin of the History
of Medicine,  (), , , ; and Gianna Pomata, Contracting a Cure: Patients, Healers, and
the Law in Early Modern Bologna, trans. by the author, with the assistance of Rosemarie Foy and
Anna Taraboletti-Segre (Baltimore: Johns Hopkins University Press, ), especially chap. .
Michael R. McVaugh, Medicine before the Plague: Practitioners and Their Patients in the Crown of
Aragon, 1285–1345 (Cambridge: Cambridge University Press, ), especially chap.  and conclusion.
McVaugh, “Bedside Manners in the Middle Ages,” p. .
Useful overviews include Katharine Park, “Medicine and Society in Medieval Europe, –,”
in Medicine in Society, ed. Andrew Wear (Cambridge: Cambridge University Press, ), pp. –
; Vivian Nutton, “Medicine in Medieval Western Europe, –,” in The Western Medical
Tradition, 800 BC to AD 1800, ed. Lawrence I. Conrad et al. (Cambridge: Cambridge University
Press, ), chap. ; and Nancy G. Siraisi, Medieval and Early Renaissance Medicine: An Introduction
to Knowledge and Practice (Chicago: University of Chicago Press, ), especially chap. , and
literature cited therein.
For example, McVaugh, Medicine before the Plague, on Aragon; Pomata, Contracting a Cure, on
Bologna; Katharine Park, Doctors and Medicine in Early Renaissance Florence (Princeton, N.J.: Princeton University Press, ); and Joseph Shatzmiller, Jews, Medicine, and Medieval Society (Berkeley:
University of California Press, ), on Provence.
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and practices, largely divorced from literate culture, were never recorded in
documents and texts.
“BETWEEN DOCTORS AND HOLY SHRINES,” 1050–1200
There is little evidence for a sharp break between early-medieval patterns of
healing and those that dominated the eleventh and twelfth centuries, though
the increase in literacy and the rising production of written documents
means that we are much better informed about the latter than the former.
In particular, both periods saw the coexistence of religious, magical, and
naturalistic modes of healing, as is evident in the story of an English nun
from shortly after , when one of the canons of the Gilbertine order
compiled a list of the miracles performed by their late founder, Gilbert of
Sempringham. One of these miracles involved the nun Mabel of Stotfold,
who had injured her foot. According to the report, her fellow nuns “tried all
kinds of remedies, putting the foot both in traction and in plaster.” When she
eventually consulted a doctor (medicus), after two years of increasing pain,
he “stated that there was no alternative to amputating her foot, which was,
she said, as black as her veil.” Understandably apprehensive, Mabel instead
“requested that her measurements should be used for a candle intended for
Master Gilbert” – it was common practice to offer the saint a candle with a
wick as tall as the patient – “and when this had been made, she was taken
along with the candle into the church.” There the prioress “wrapped her foot
in the liturgical towel which had lain upon Master Gilbert’s breast when he
was about to die.” Shortly afterward, Gilbert appeared to her in a dream and
blessed her, and she woke completely healed.
It may seem counterintuitive to begin an account of medical practice
with a miraculous cure, but hagiographical documents – saints’ lives, lists
of miracles, and proceedings of canonization inquests – are among the best
sources for the history of health care in the eleventh and twelfth centuries.
The majority of saintly miracles in this period consisted of supernatural
cures, by holy people both living and (especially) dead, and the petitioners
to whom they were granted came from all walks of life. Many accounts
of such miracles, like that granted to Mabel of Stotfold, detail the varied
measures taken by the sick to heal themselves before they resorted to the


The Book of Saint Gilbert, ed. and trans. Raymonde Foreville and Gillian Keir (Oxford: Clarendon
Press, ), p. .
On saintly healing in this period, see Ronald C. Finucane, Miracles and Pilgrims: Popular Beliefs
in Medieval England (London: J. M. Dent, ), chaps.  and ; Pierre-André Sigal, L’homme
et le miracle dans la France médiévale (XI e –XII e siècle) (Paris: Edition du Cerf, ), especially
chap. ; Constanze Rendtel, Hochmittelalterliche Mirakelberichte als Quelle zur Sozial- und Mentalitätsgeschichte und zur Geschichte der Heiligenverehrung (Inaugural-Dissertation, Freie Universität Berlin, ) (Düsseldorf: [n.p.], ); and Thomas Head, Hagiography and the Cult of the
Saints: The Diocese of Orléans, 800–1200 (Cambridge: Cambridge University Press, ), especially
pp. –.
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Katharine Park
inconveniences of a pilgrimage and the extreme measures of a supernatural
cure. Thus the miracle books offer arguably the most comprehensive picture
of the attitudes toward disease and healing of medieval Christians – and
even, on occasion, members of the Jewish minority  – as well as the types
of medical practice available to them.
As Mabel’s story indicates, although medieval Christians made a clear mental distinction between natural and supernatural healing, few saw the two as
incompatible or opposed. Rather, both formed part of a single world of health
care, in which patients and their families moved back and forth between secular and saintly healers: “between doctors and holy shrines,” as the account
of another of Gilbert’s miracles specified. Although the monastic apologists
who drew up the miracle lists sometimes disparaged the efforts of the former
to the glory of the latter, most laypeople and members of religious orders
saw doctors and saints as collaborators (sometimes literally) in the work of
healing. Thus, when a doctor found himself unable to extract an arrowhead
from the cheekbone of a patient in the mid-eleventh century, Saint Faith
shifted the point so that the human practitioner could remove it with ease.
Writing on the early Middle Ages, Peter Brown has emphasized the plurality of healing practices and the choice of therapeutic systems available to the
sick. He notes that no one system had final authority; rather, “social and cultural criteria” dictated which illnesses might be taken to particular kinds of
healers. (In the eleventh and twelfth centuries, the illnesses taken to saints’
shrines were for the most part chronic conditions that failed to respond to
domestic or secular medical care, such as lameness, paralysis, blindness, and
the like.) Brown divided his healers into two main groups: the saints, whose
power to heal was invested in them personally by God and who required the
sick to enter into a quasi-feudal relationship of dependence, and what he
called the “diffuse resources of the neighborhood.” These included family
members, cunning men and women, and occasionally parish priests. Their
authority stemmed not from any special relationship with the divine but
from their learned ability to mobilize the powers invested by God in the
environment – plants and animals, springs, the heavens – using natural
remedies, often catalyzed by prayers, incantations, and charms.







For Jewish recourse to Christian shrines, see Shatzmiller, Jews, Medicine, and Medieval Society,
pp. –.
Foreville and Keir, Book of Saint Gilbert, p. .
The Book of Sainte Foy, trans. Pamela Sheingorn (Philadelphia: University of Pennsylvania Press,
), pp. –. On the relations between supernatural and naturalistic healing, see Stephen R.
Ell, “The Two Medicines: Some Ecclesiastical Concepts of Disease and the Physician in the High
Middle Ages,” Janus,  (), –.
Peter Brown, The Cult of the Saints (Chicago: University of Chicago Press, ), pp. – (quotation at p. ).
Sigal, L’homme et le miracle dans la France médiévale, pp. –.
Brown, Cult of the Saints, pp. – (quotation at p. ).
We know these remedies only indirectly, through written sources, most of them monastic, or through
archaeological excavations. See, for example, Lea Olsan, “Latin Charms of Medieval England: Verbal
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Much more rarely, depending on location, the healing resources of the
neighborhood might include those described in Latin texts as medici, or doctors. Unlike the villagers described earlier, most doctors trained by apprenticeship and practiced medicine for a fee and as a regular occupation. In the
late eleventh and twelfth centuries, such men – outside southern Italy, there
are few references in this period to medicae, or female doctors – gravitated
to the relatively few population centers able to support their practices. They
appear with some regularity in miracle lists, as I have already mentioned,
where they are recorded as treating mainly townspeople and the well-todo; the most successful found posts as court doctors in the employ of high
nobles, kings, and queens. Villagers and the poor had infrequent access to
their services; Mabel of Stotfold was treated by her fellow nuns for two years
before she consulted the doctor who wished to amputate her foot. Historians
know relatively little about medici in this early period and the degree to which
they cultivated specialized skills, though the existence of a vocabulary that
distinguished between different types of doctors – physicians, surgeons, barbers, herbalists, bleeders, leeches – suggests that some kind of differentiation
was already in progress. The miracle accounts report them as performing
a variety of surgical procedures (lancing abscesses, amputating members,
extracting teeth, cutting for stone, and so forth), as well as administering
what one miracle collection refers to as “potions, pills, decoctions, plasters,
and oils.” There is no sign of licensing in the eleventh and twelfth centuries; practitioners built up a clientele through local reputation and word
of mouth.
A final group of medici included monks, nuns, and other dependents of
monastic institutions. This group (together with court doctors the only ones
to work in a predominantly literate environment) is the best documented of




Healing in a Christian Oral Tradition,” Oral Tradition,  (), – (on oral formulas); Audrey
Meaney, “Women, Witchcraft, and Magic in Anglo-Saxon England,” in Superstition and Magic in
Anglo-Saxon England, ed. Donald Scragg (Manchester: Manchester Centre for Anglo-Saxon Studies,
), especially pp. – (on excavated objects); and in general Karen Louise Jolly, “Magic, Miracle,
and Popular Practice in the Early Medieval West: Anglo-Saxon England,” in Religion, Science, and
Magic: In Concert and in Conflict, ed. Jacob Neusner, Ernest S. Frerichs, and Paul Virgil McCracken
Flesher (New York: Oxford University Press, ), pp. –.
Rendtel, Hochmittelalterliche Mirakelberichte als Quelle zur Sozial- und Mentalitätsgeschichte und zur
Geschichte der Heiligenverehrung, p. . On the situation in southern Italy, see Monica H. Green,
Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynecology (Oxford:
Oxford University Press, ), chap. .
See, for example, Edward J. Kealey, Medieval Medicus: A Social History of Anglo-Norman Medicine
(Baltimore: Johns Hopkins University Press, ), chap. , on physicians in the court of Henry I.
Jole Agrimi and Chiara Crisciani, Medicina del corpo e medicina dell’anima: Note sul sapere del medico
fino all’inizio del secolo XIII (Milan: Episteme, ), p.  n. ; Kealey, Medieval Medicus, p. ;
and Danielle Jacquart, Le milieu médical en France du XII e au XV e siècle (Geneva: Droz, ),
p. .
Miracles of St. Thomas of Canterbury (late twelfth century), cited in Benedicta Ward, Miracles and
the Medieval Mind: Theory, Record, and Event, rev. ed. (Philadelphia: University of Pennsylvania
Press, ), p.  n. .
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Katharine Park
any group of healers in this period. Medicine was taught as a book discipline in monastic and cathedral schools, as part of general learned culture.
Important centers of this kind of learning in the eleventh and twelfth centuries included schools at Reims and Chartres in northern France and the
abbeys of Monte Cassino in central Italy and Bury St. Edmunds in England.
The library catalogues of these and other monasteries included a range of
Greek medical texts in Latin translation. A smaller number of priests and
members of religious orders had more specialized training, through reading
and (occasionally) apprenticeship, which allowed them to treat a range of
patients: fellow monks and nuns, laypeople who came to the monasteries in
search of treatment, and sometimes high-status clients as well. Some of these
religious, like the French abbot Fulbert of Chartres or the German abbess
Hildegard of Bingen, limited themselves to dispensing occasional medical
advice and medicines to their correspondents (and presumably also to members of their communities), whereas others had more advanced training, in
several schools or with several masters, which gave them lucrative skills and
sometimes prestigious positions as court physicians. For example, Baldwin,
who studied at Chartres and later became abbot of Bury St. Edmunds, was
medical adviser to both Edward the Confessor and William the Conqueror.
Everything we know about the work of such monk-practitioners suggests that
it was largely naturalistic, based on principles and information derived from
Greek and Roman texts, though often combined with spiritual guidance and
advice.
Monasteries also served as local medical centers, dispensing medicines,
medical knowledge, and medical services to the broader community. Some
abbeys had extensive herb gardens and engaged in the exchange of medicinal
plants and seeds, and monastic herbals and antidotaries contain evidence of





Well-documented discussions include Anne F. Dawtry, “The Modus Medendi and the Benedictine Order in Anglo-Norman England,” in The Church and Healing, ed. W. J. Sheils (Oxford:
Blackwell, ), pp. –; Johannes Duft, Notker der Arzt: Klostermedizin und Mönchsarzt im
frühmittelalterlichen St. Gallen (St. Gall: Ostschweiz, ); and David N. Bell, “The English Cistercians and the Practice of Medicine,” Cı̂teaux; Commentarii Cistercienses,  (), –. Loren
C. MacKinney, Early Medieval Medicine, with Special Reference to France and Chartres (Baltimore:
Johns Hopkins University Press, ), is still useful; see especially chap. .
See, for example, Rodney M. Thomson, “The Library of Bury St. Edmunds Abbey in the Eleventh
and Twelfth Centuries,” Speculum,  (), –; and Herbert Bloch, Monte Cassino in the
Middle Ages,  vols. (Cambridge, Mass.: Harvard University Press, ), vol. , pp. –.
Fulbert of Chartres, The Letters and Poems of Fulbert of Chartres, ed. and trans. Frederick Behrends
(Oxford: Clarendon Press, ), nos. , , and ; and MacKinney, Early Medieval Medicine,
pp. –. Hildegard also wrote her own medical treatises and engaged in miraculous healing; see
Florence Eliza Glaze, “Medical Writer: ‘Behold the Human Creature’,” in Voice of the Living Light:
Hildegard of Bingen and Her World, ed. Barbara Newman (Berkeley: University of California Press,
), pp. –.
Dawtry, “Modus Medendi and the Benedictine Order in Anglo-Norman England,” pp. –, .
On the spiritual services often combined with clerical medical practice, see Faye Marie Getz,
Medicine in the English Middle Ages (Princeton, N.J.: Princeton University Press, ), pp. –,
–. For an example of spiritual advice in medical language, see Fulbert of Chartres, Letters and
Poems, pp. –.
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direct botanical observations. In addition to their own often impressively
structured infirmaries, some had hospitals or clinics for laypeople, as is clear
from one final miracle attributed to Gilbert of Sempringham. A doctor
(medicus) from Castle Donnington had long suffered from tertian fever. At
length, despairing of curing himself, he went to the local hospital, “to search
among the powerful herbs and roots that were kept there for a means of
restoring his health.” Instead, the warden of the hospital gave him water in
which Gilbert’s staff had been washed, which cured him on the spot.
Accounts of this sort underscore the fluid and pluralistic nature of
eleventh- and twelfth-century medical practice, where supernatural and naturalistic forms of healing coexisted easily with incantations and charms.
In the absence of exclusionary ideas as to what constituted acceptable and
effective healing practice, the authority of healers – saintly and secular –
depended on their reputations, and ultimately on the satisfaction of their
patients, who exercised to the limit their freedom of choice.
URBANIZATION AND THE TRANSFORMATION
OF MEDICAL PRACTICE, 1200–1350
Later-medieval health care retained many of the characteristics described
previously, particularly in rural areas. Beginning in the thirteenth century,
however, demographic, economic, social, and political changes transformed
medical practice in the towns and cities that had sprung up along trade
routes and around important administrative centers. Urbanization generated
an unprecedented market for medical services, both because city inhabitants
were numerous and relatively wealthy and because the dense concentration
of people in medieval towns, living in crowded and often unsanitary conditions, supported a host of infectious illnesses. At the same time, the rise of a
commercial economy, based on the sale of goods and services, created a template for the commercialization of medical practice, and the centralization
of political authority and the increasing ambitions of both secular and ecclesiastical governments set the stage for early forms of licensing and control.
The effect of urbanization was to support a larger, more diverse, and more
specialized community of medical practitioners. This change is visible even in



Linda E. Voigts, “Anglo-Saxon Plant Remedies and the Anglo-Saxons,” Isis,  (), –,
especially pp. –. See also Audrey Meaney, “The Practice of Medicine in England about the
Year ,” Social History of Medicine  (), –.
Foreville and Keir, Book of Saint Gilbert, p. ; Latin on p. . On monastic infirmaries, see Bell,
“English Cistercians and the Practice of Medicine,” pp. –; and Dieter Jetter, Das europäische
Hospital: von der Spätantike bis 1800 (Cologne: DuMont, ), pp. –; and the literature cited
therein.
On the health conditions in medieval cities, see Ynez V. O’Neill, “Diseases in the Middle Ages,”
in The Cambridge World History of Human Disease, ed. Kenneth F. Kiple (Cambridge: Cambridge
University Press, ), pp. –.
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the arena of saintly healing, where the rising population enlarged the pool of
supplicants to any given saint. This facilitated the appearance of specialized
cults, such as those of St. John (for epilepsy) or St. Maur (for gout). At the
same time, the appearance of conditional vows – I’ll fulfill my vow if and only
if you heal me – expressed a new sense of a contractual, even commercial,
relationship between saint and petitioner. The faithful no longer offered
their entire person to the saint but substituted more specific and limited
commitments, in the form of objects, charitable works, and, increasingly,
monetary offerings; one witness at the canonization inquest of St. Nicholas
of Tolentino () testified that he had promised the saint “as much money
as he would give to a doctor who cured him [of the same complaint].” As
this last remark suggests, religious and secular systems of healing retained a
strong relationship to one another; subject to the same market forces, they
evolved in roughly parallel, though increasingly autonomous, ways.
It is virtually impossible to establish absolute numbers for secular medical practitioners in this period. In addition to virtually insurmountable
problems of documentation (particularly acute for female healers), the
continuing indeterminacy of the definition of medical practitioner means
that any attempt to fix the group’s boundaries must be largely arbitrary.
But it is clear that the thirteenth and early fourteenth centuries saw a large
and steady rise in the number of practitioners relative to the earlier period.
At the same time, the proportion of priests and other religious involved in
medical practice dropped dramatically, at least partly in response to a series
of church decrees limiting the study and practice of medicine by clergy in
major orders.
The growth in the number of medical practitioners coincided with
their increasing diversification. By the early fourteenth century, official
sources clearly distinguished between physicians (who treated internal illnesses through diet and medication), surgeons, apothecaries, and barbers
(who bled people and provided other minor surgical services). Italy even






See Park, “Medicine and Society in Medieval Europe,” pp. –.
André Vauchez, Sainthood in the Later Middle Ages, trans. Jean Birrell (Cambridge: Cambridge
University Press, ; orig. ), pp. –. See also Sigal, L’homme et le miracle dans la France
médiévale, pp. –.
Cited in Vauchez, Sainthood in the Later Middle Ages, p.  n. .
See, for example, Monica H. Green, “Documenting Medieval Women’s Medical Practice,” in
Practical Medicine from Salerno to the Black Death, ed. Luis Garcı́a-Ballester et al. (Cambridge:
Cambridge University Press, ), pp. –.
Darrel W. Amundsen, “Medieval Canon Law on Medical and Surgical Practice by the Clergy,”
Bulletin of the History of Medicine,  (), –; and André Goddu, “The Effect of Canonical
Prohibitions on the Faculty of Medicine at the University of Paris in the Middle Ages,” Medizinhistorisches Journal,  (), –, especially pp. –.
The literature on the relationships between these groups of practitioners is voluminous, for the
period before . See, for example, Cornelius O’Boyle, “Surgical Texts and Social Contexts:
Physicians and Surgeons in Paris, c. –,” in Garcı́a-Ballester et al., Practical Medicine from
Salerno to the Black Death, pp. –; Danielle Jacquart, “Medical Practice in Paris in the First
Half of the Fourteenth Century,” in Garcı́a-Ballester et al., Practical Medicine from Salerno to the
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saw the appearance of surgical subspecialties, like those mastered by Maria
Gallicia, licensed in Naples in  to treat “wounds, swellings, hernias, and
conditions of the uterus.” These changes suggest the development of more
complicated and specialized techniques, (re)learned from newly available
Greek and Arabic surgical texts or elaborated in the course of apprenticeship
and practice, and transmitted through original Latin surgical textbooks by
contemporary authors.
Indeed, the thirteenth and early fourteenth centuries saw a general expansion of text-based practice, which was no longer largely confined to clerics (of
whom fewer and fewer studied and practiced medicine) but also included lay
physicians and eventually surgeons. This development coincided with the
appearance of academic training for medical practitioners alongside private
study and apprenticeship, first in southern Italy (in the late eleventh or early
twelfth century) and then (in the years around ) at the universities in
Bologna, Paris, and Montpellier. With their increasingly formalized curricula
and teaching methods, university medical faculties institutionalized the idea
of medicine as a body of text-based knowledge, embracing both theory and
practice, as opposed to a set of empirically acquired skills. At the same time,
they supplied clear credentials for one who had acquired such knowledge,
in the form of a university degree. Surgery could also be studied at the university – this was particularly the case in Italy – but the typical holder of
a medical degree was the physician ( physicus), whose knowledge of healing
was underpinned and buttressed by an extensive education in the theoretical
principles that underlay the body’s anatomy and physiology, the nature of
disease, and the physical order of the universe itself.
This period also saw the first attempts at formal licensing of particular
groups of healers. Given the diversity of healers and their training, there could



Black Death, pp. –; and Jacquart, Milieu médical en France du XII e au XV e siècle, pp. –.
The situation in other areas is discussed in Getz, Medicine in the English Middle Ages, chap. ; and
McVaugh, Medicine before the Plague, pp. –.
Raffaele Calvanico, Fonti per la storia della medicina e della chirurgia per il regno di Napoli nel
periodo angioino (a. 1273–1410) (Naples: L’Arte Tipografica, ), passim (quotation at p. ).
See in general Katharine Park, “Eyes, Bones, and Hernias: Surgical Specialists in Fourteenth- and
Fifteenth-Century Italy,” in Medicine from the Black Death to the French Disease, ed. Jon Arrizabalaga
(London: Ashgate, ), pp. –.
Siraisi, Medieval and Early Renaissance Medicine, chap. ; and the following essays on literate
surgery in Garcı́a-Ballester et al., Practical Medicine from Salerno to the Black Death: Jole Agrimi
and Chiara Crisciani, “The Science and Practice of Medicine in the Thirteenth Century According
to Guglielmo da Saliceto, Italian Surgeon,” pp. –; Nancy G. Siraisi, “How to Write a Latin
Book on Surgery: Organizing Principles and Authorial Devices in Guglielmo da Saliceto and Dino
Del Garbo,” pp. –; Pedro Gil-Sotres, “Derivation and Revulsion: The Theory and Practice of
Medieval Phlebotomy,” pp. –; and Michael R. McVaugh, “Royal Surgeons and the Value of
Medical Learning: The Crown of Aragon, –,” pp. –.
The literature on the rise of university education in medicine is vast; for an introduction, with
appropriate references, see Siraisi, Medieval and Early Renaissance Medicine, chap. . The academic
culture of physica is brilliantly analyzed in Agrimi and Crisciani, Edocere Medicos. On the development of a textual tradition in surgery, see Michael R. McVaugh, The Rational Surgery of the Middle
Ages (Florence: SISMEL/Edizioni del Galluzzo, ).
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be no single standard for medical qualification, which varied dramatically
depending on the geographical region and the type of practice involved. In
some areas (for example, England), licenses might be granted by local bishops,
whereas in others (Spain and southern Italy) this was a matter for royal and
municipal authorities and contingent on either proven competence or a
medical degree. In some university towns (most notably Paris), the faculty
of medicine itself claimed this privilege, which in many northern Italian
cities belonged to whatever craft guild incorporated medical practitioners –
in the case of Florence, for example, the Guild of Doctors, Apothecaries,
and Grocers (which will be discussed further). With the possible exception
of Paris and some Italian cities, however, there is little evidence that the
pressure for licensing came largely or exclusively from medical practitioners.
Rather, it was the work of patients and the public, who came increasingly to
accept the knowledge claims of formally (though not necessarily university)
educated doctors and as a result began to look for ways to distinguish those
worthy of their trust. This new willingness to submit to the authority of
trained doctors also appears in the increasing public reliance on medical
experts in situations where lay testimony previously would have sufficed: in
legal judgments concerning impotence or cause of death, for example; in the
official identification of lepers; and in canonization processes, where doctors
were called on to certify the natural impossibility of miraculous cures.
Despite the increasing number of licensed medical practitioners in this
period, it is important not to overstate their importance. Until recently,
historians of medicine have tended to overestimate the degree to which
university-educated physicians and, to a lesser degree, formally trained and
licensed general surgeons dominated the health care of medieval Europeans,
often referring to them as lying at the “center,” in opposition to a host of
other “marginal” practitioners, and conferring on them an authority that
they did not yet possess. This model fits poorly with the realities of medieval
health care, where the extraordinary variety of practitioners, as well as the
many customs and regulations that governed them, make it difficult to speak
meaningfully of either margins or center. It is important to remember that
only a small minority of thirteenth- and fourteenth-century Europeans lived
in cities, where they might have had access to physicians and formally trained




Shatzmiller, Jews, Medicine, and Medieval Society, p. ; McVaugh, Medicine before the Plague,
pp. –, –; and Luis Garcı́a-Ballester, Michael R. McVaugh, and Agustı́n Rubio-Vela,
“Medical Licensing and Learning in Fourteenth-Century Valencia,” Transactions of the American
Philosophical Society, , no.  (), –.
O’Boyle, “Surgical Texts and Social Contexts,” pp. –; Jacquart, “Medical Practice in Paris in
the First Half of the Fourteenth Century,” pp. –; and Park, Doctors and Medicine in Early
Renaissance Florence, chap. .
McVaugh, Medicine before the Plague, chaps.  and .
See, e.g., McVaugh, Medicine before the Plague, chap. ; Shatzmiller, Jews, Medicine, and Medieval
Society, pp. –; and Joseph Ziegler, “Practitioners and Saints: Medical Men in Canonization
Processes in the Thirteenth to Fifteenth Centuries,” Social History of Medicine,  (), –.
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surgeons; country dwellers (and city dwellers of limited means) mostly made
do with the healing skills of family members and neighbors – some of whom
were known for their special abilities in this area. Furthermore, many regional
authorities licensed not only physicians and general surgeons but empirically
trained (or self-trained) surgeons skilled in the treatment of a single condition, such as cataracts, fractures, or hernias, and sometimes herbalists as
well. In many cities, including some with well-defined licensing procedures,
there is little evidence that prohibitions against unlicensed practice were
consistently and effectively enforced – although prosecutions for unlicensed
practice did become more common in the first decades of the fourteenth
century. In general, however, the marketplace for medical services remained
relatively open and uncontrolled.
The nature and limits of medical authority in this period are clearly visible
in the contracts that increasingly governed the relationship between patient
and doctor. One typical agreement was drawn up in Genoa in :
I, Roger de Bruch of Bergamo, promise and agree with you, Bosso the wool
carder, to return you to health and to make you improve from the illness
that you have in your person, that is in your hand, foot, and mouth, in good
faith, with the help of God, within the next month and a half, in such a
way that you will be able to feed yourself with your hand and cut bread and
wear shoes and walk and speak much better than you do now. I shall take
care of all the expenses that will be necessary for this; and at that time, you
shall pay me seven Genoese lire. . . . If I do not keep my promises to you,
you will not have to give me anything. And I, the aforementioned Bosso,
promise to you, Rogerio, to pay you seven Genoese lire within three days
after my recovery and improvement.
Such contracts (oral or written) seem to have shaped a significant portion of
medical care by full-time, formally trained practitioners, and examples have
been published from all parts of Western Europe – though their currency
and the chronology of their spread, especially outside of the Mediterranean
area, have yet to be explored. The majority governed individual bouts of
illness, though agreements also survive in which an individual or institution
contracted for the services of a medical practitioner as needed over a particular
period of time. Like the agreement just mentioned, they involved mutual
promises by practitioners and patients – the former to cure his client, and
the latter to follow the doctor’s directions and to pay in the event of a
cure. (This practice had clear echoes in the conditional vow that increasingly
accompanied the petition for saintly healing, as described earlier.) Some



See McVaugh, Medicine before the Plague, pp. –, –.
Cited in Pomata, Contracting a Cure, p. .
Ibid., chap. ; see especially references to published contracts on pp. – n. . For other examples, with discussion, see Shatzmiller, Jews, Medicine, and Medieval Society, pp. –; McVaugh,
Medicine before the Plague, pp. –; and Getz, Medicine in the English Middle Ages, p. .
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Katharine Park
contracts further specified an initial payment at the beginning of treatment
and installments at clearly indicated points along the way.
One of the most striking aspects of these contracts, as Gianna Pomata has
recently argued, is that illness, improvement, and cure were defined from
the point of view of the patient, in negotiation with his or her doctor, rather
than according to some general standard established by medical practitioners,
either individually or as a group. This clearly reflects the differences between
modern professional practice and medical care in the late Middle Ages, when
malpractice was conceived as breach of contract rather than as negligent
behavior that violated standards for treatment upon which physicians and
surgeons generally agreed. Thus, even when medical experts were called in to
adjudicate a legal disagreement concerning a course of treatment, they did so
only by establishing whether the practitioner and patient had met the terms
specified in the contract rather than whether the doctor’s conduct (and the
patient’s health) met professionally established norms.
The overall picture of health care in this period, then, is one of profound
change, from a world of ill-defined and wholly unregulated practices and
practitioners to an order that acknowledged, at least in theory, that particular
types of healing required particular skills. There was a difference between
competent and incompetent healers, and patients needed a way of distinguishing between them (before, rather than after, the fact), even if they
thereby had to forfeit some freedom of choice. Here again, the issue came
down to the doctor’s authority and the patient’s trust; clients were willing to
give up a degree of autonomy – though many insisted on the safety of a contract – if they were convinced that they were putting their welfare in capable
hands. Yet the novel authority claimed by medical practitioners was fragile
and required continual reinforcement, as is clear not only from contemporary treatises on medical conduct, which advised physicians on matters
ranging from manners to extracting payment, but also from continued
conflicts concerning who might practice, in what way, and on whom.
These issues were particularly urgent when it came to two groups of
practitioners, women and Jews, whose claim to authority over patients (normatively, Christian male patients) raised obvious problems in the juridical
and ideological context of medieval Christian Europe. Both groups had long
been involved in medical practices of various sorts. Women treated a range
of patients, both male and female, in a range of domestic and commercial



Pomata, Contracting a Cure, pp. –.
McVaugh, Medicine before the Plague, pp. –. For specific cases of this sort, see Pomata, Contracting a Cure, pp. –,  n. , – n. ; and Madeline Pelner Cosman, “Medieval Medical
Malpractice: The Dicta and the Dockets,” Bulletin of the New York Academy of Medicine,  (),
–.
McVaugh, “Bedside Manners in the Middle Ages”; Luis Garcı́a-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 Doctors and Ethics: The Earlier Historical
Setting of Professional Ethics, ed. Andrew Wear et al. (Amsterdam: Rodopi, ), pp. –.
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settings, though their practice was often informal, and the very low levels of
female literacy in this period meant that few learned or worked from written texts. Jewish practitioners, in contrast, had a more highly developed
textual tradition. Their numbers varied geographically, but in areas with
well-established Jewish populations – Spain, Germany, Provence, and parts
of Italy – they were well represented, even at the highest levels of formal
practice. Despite their importance (and their differences) as practitioners,
however, both women and Jews found themselves subject to increasing limitations and restrictions, as well as intermittent prosecution for unlicensed
practice. (The best-known case is that of Jacqueline Félicie, convicted in
Paris in  together with two men and three other women, one of them a
Jew.) Although clearly part of the attempts of better-established practitioners to restrict competition, such cases also spoke to the more general issue of
medical authority.
Indeed, women and Jews seem to have had difficulty establishing and
maintaining the authority commanded, at least in theory, by their Christian
male counterparts. Both groups were barred in principle from earning university degrees, the gold standard of medical competence, though this had
changed for Jews by the early fifteenth century. In addition, each was viewed
as generally suspect, whether because of moral and intellectual weakness (in
the case of women) or because of implacable hostility to Christians (in the
case of Jews). Stereotypes of this sort buttressed official attempts – on the
whole unsuccessful – to prevent Jews from treating Christian patients and
to limit women to female clients.
The scarcity of women in the ranks of licensed full-time practitioners,
especially physicians, was overdetermined – by their lack of formal education
and their family responsibilities as well as by legal restrictions. But the peculiar





See in general Monica H. Green, “Women’s Medical Practice and Health Care in Medieval Europe,”
Signs,  (), –; Green, “Documenting Medieval Women’s Medical Practice”; Green,
Making Women’s Medicine Masculine, passim, especially chap. ; Katharine Park, “Medicine and
Magic: The Healing Arts,” in Gender and Society in Renaissance Italy, ed. Judith C. Brown and
Robert C. Davis (London: Longman, ), pp. –, especially pp. –; McVaugh, Medicine
before the Plague, pp. –; Montserrat Cabré, “Women or Healers? Household Practices and the
Categories of Healthcare in Late Medieval Iberia,” Bulletin of the History of Medicine,  (),
–; and Carole Rawcliffe, Medicine and Society in Later Medieval England (New York: Sutton,
), chap. .
Shatzmiller, Jews, Medicine, and Medieval Society; McVaugh, Medicine before the Plague, passim;
and Jacquart, Milieu médical en France du XII e au XV e siècle, pp. –.
On the case of Jacqueline Félicie, see Monserrat Cabre and Fernando Salmon, “Poder académico
versus autoridad femenina; la Facultad de Medicina de Parı́s contra Jacoba Félicié (),” Dynamis,
 (), –; Pearl Kibre, “The Faculty of Medicine at Paris, Charlatanism and Unlicensed
Medical Practice in the Later Middle Ages,” Bulletin of the History of Medicine,  (), –. On
the licensing of women and Jews in general, see Shatzmiller, Jews, Medicine, and Medieval Society,
pp. –; McVaugh, Medicine before the Plague, pp. –, ; and Green, “Women’s Medical
Practice and Health Care in Medieval Europe,” pp. –.
McVaugh, Medicine before the Plague, pp. –; Rawcliffe, Medicine and Society in Later Medieval
England, pp. –; and Shatzmiller, Jews, Medicine, and Medieval Society, pp. –.
Calvanico, Fonti per la storia della medicina e della chirurgia per il regno di Napoli nel periodo angioino,
p. .
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legal difficulties faced by Jews in the course of medical practice suggest
that generalized prejudice could compromise the authority of women and
religious minorities, and the trust of their patients, in more subtle ways. In
particular, Jewish doctors were disproportionately targeted in malpractice
suits and prosecuted for prescribing poisons or supplying poisons to clients.
This was not only because such activities conformed to obvious stereotypes
but also because, as McVaugh hypothesizes, Jewish doctors were less able to
control their relationships with Christian patients, so that litigious patients
“were in effect expressing the reservations and fears they felt when submitting
themselves to treatment by a Jew.”
THE ELABORATION OF MEDICAL INSTITUTIONS,
1350–1500
In the period after , medical practice continued to develop along the
lines described in the previous section, as the continuing rise in prestige
and currency of text-based medicine created an expanding market for medical services, together with public acknowledgment that safe and effective
practice required a well-defined set of skills. These changes had important
institutional implications. For one thing, potential patients felt an increasing need to be able to determine who possessed those skills and who did
not, which spoke to the need for licensing procedures and other institutional
markers of competence. For another, as communities and individuals became
increasingly convinced of the public benefits of medical care and medical
expertise, they elaborated institutions to increase access to both. At the same
time, practitioners themselves began to organize in order to take advantage
of the social and economic opportunities offered by this new situation. The
result was a flowering of institutions devoted to the ordering and provision
of medical care.
In this section, I will focus on two principal kinds of medical institutions elaborated in the fourteenth and fifteenth centuries: those concerned
with regulating practice and defending the interests of practitioners, notably
guilds and colleges of doctors, and those concerned with mobilizing medical
expertise for the benefit of the larger community, notably hospitals for the
sick poor and other institutions relating to charity and public health. Neither
form of institution was new in the period after ; both had roots that went
back a century or more. But they acquired a more clearly medical character
beginning in the late thirteenth century – as the nature of medical practice
itself acquired clearer definition – and accelerating into the fourteenth and
fifteenth.

McVaugh, Medicine before the Plague, p. . See also Jacquart, Milieu médical en France du XII e au
XV e siècle, p. ; and Park, Doctors and Medicine in Early Renaissance Florence, p. .
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The late-medieval corporations of medical practitioners, whether guilds,
companies, colleges, or faculties, had two separate sets of functions. They
provided (at least in theory) a framework for licensing and regulating medical practice and for helping practitioners resolve disputes in a formal and
dignified manner. In this way, they buttressed the authority (and earnings) of
their membership. At the same time, they served as fraternal organizations,
providing mutual aid, solidarity, and protection, thereby promoting (again
in theory) a sense of group identity. In practice, however, it proved difficult
to reconcile these two different goals, given the enormous diversity of urban
healers, which included not only physicians, master surgeons, surgical specialists, apothecaries, and barbers but a disparate range of informally trained
healers. Any corporation that embraced all these groups could claim a relatively comprehensive monopoly and control of medical practice, as well as
the wealth and influence that went with a large membership. By the same
token, however, it possessed very little in the way of group identity and solidarity since its well-educated physicians and wealthy apothecaries had very
little in common with its lower ranks. Conversely, organizations of more
narrowly defined groups of practitioners (companies of barbers, guilds of
apothecaries, colleges of physicians, and so forth) were more homogeneous,
but their claim to monopolize and control medical practice was limited, and
they inevitably squandered their resources and energies in turf battles with
each other.
Fourteenth- and fifteenth-century Europe offers examples of both the
inclusive and the exclusive models, as well as a spectrum of intermediate
forms. The exclusive model tended to characterize cities with strong university medical faculties, such as Bologna or Paris, where the academic (or
academically trained) physicians’ strong sense of distinctiveness seems to
have acted to dissolve any sense that medical practitioners were a group with
shared economic or political interests. In Paris, the medical faculty found
itself in a long-term tug-of-war with separate companies of surgeons, barbers,
and apothecaries, and seems to have been uniquely successful in this arena.
In other cities, members of the college of physicians, although wealthy and
socially prominent, were usually too few to exert effective control over other
practitioners, despite their claims to intellectual authority.
In towns without universities, however, medical guilds tended to conform
to some version of the inclusive model, of which the Florentine Guild of


On Paris, see O’Boyle, “Surgical Texts and Social Contexts”; Jacquart, “Medical Practice in Paris
in the First Half of the Fourteenth Century”; and Goddu, “Effect of Canonical Prohibitions on
the Faculty of Medicine at the University of Paris in the Middle Ages.” On Bologna, see Nancy
G. Siraisi, Taddeo Alderotti and His Pupils: Two Generations of Italian Medical Learning (Princeton,
N.J.: Princeton University Press, ), pp. –.
For example, on the small size of Italian colleges of physicians, see Richard Palmer, “Physicians
and the State in Post-Medieval Italy,” in The Town and State Physician in Europe from the Middle
Ages to the Enlightenment, ed. Andrew W. Russell (Wolfenbüttel: Herzog August Bibliothek, ),
pp. –.
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Katharine Park
Doctors, Apothecaries, and Grocers was a particularly dramatic example.
Not only did this guild incorporate spice merchants and other sellers of
dry goods, but the “doctors” (medici) of its title referred to a vast range of
medical practitioners, from physicians with international reputations down
to a woman of modest means who identified herself as a “ringworm doctor”
and a shoemaker who couched cataracts on the side. The Florentine Guild
enjoyed a reasonably effective monopoly among full-time practitioners, but
its statutes demonstrate inevitable problems in enforcing a sense of group
identity and solidarity among medical practitioners, leading to the founding of a subcorporation of university-educated physicians (the College of
Doctors) in .
In addition to bodies developed to license and regulate medical practitioners, the cities of the late Middle Ages produced a variety of institutions
that drew on the expertise of practitioners who met the emergent criteria
for medical competence and that aimed to broaden access to the particular
forms of health care that they provided. These institutions were intended
to meet the special needs of the urban population, which included growing numbers of the poor. Beginning in the early thirteenth century, for
example, Italian communes began to employ salaried municipal doctors to
ensure that quality health care was both available and affordable. The practice varied from city to city. Smaller towns usually wished only to ensure
the presence of one competent practitioner, whereas larger ones might subsidize a whole stable; Venice employed thirty-one physicians and surgeons in
. Whereas smaller communes tended to employ physicians – presumably on the grounds that they could treat a wider variety of illnesses – large
cities, already well supplied with physicians, might hire only surgeons with
highly specialized skills, such as treating wounds resulting from judicially
prescribed torture and amputation. Some cities required their municipal
doctors simply to remain in residence, engaging in regular private practice,
whereas others insisted that they treat the poor gratis or in accordance with
a sliding scale of fees. In addition to providing doctors with ongoing positions, public authorities employed them as occasional consultants – on the
nature of particularly serious epidemics, for example, or to offer evidence
in judicial proceedings. When the Savoyard Pierre Gerbais was accused of
poisoning in , seven doctors and a barber testified at his trial. As this
example suggests, the public employment and consultation of doctors soon





Park, Doctors and Medicine in Early Renaissance Florence, especially pp. –.
Ibid., pp. –, –.
Vivian Nutton, “Continuity or Rediscovery? The City Physician in Classical Antiquity and Mediaeval Italy,” in Russell, Town and State Physician in Europe from the Middle Ages to the Enlightenment,
especially pp. –.
For example, Florence. See Park, Doctors and Medicine in Early Renaissance Florence, pp. –.
Jacquart, Milieu médical en France du XII e au XV e siècle, p. . Italian examples are in Katharine
Park, “The Criminal and the Saintly Body: Autopsy and Dissection in Renaissance Italy,” The
Renaissance Quarterly,  (), –.
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Medical Practice
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
spread from Italy to other parts of Europe. Over the course of the late
Middle Ages, therefore, doctors supplemented their contracts with private
individuals by contracts with institutions, which increasingly included not
only public authorities but hospitals as well.
Hospitals had existed in Europe since late antiquity, often associated with
monasteries and cathedrals. The eleventh and twelfth centuries had seen an
explosion of new foundations, often started by laypeople, at least partly in
response to the increasing incidence of leprosy. But these early hospitals
were not properly medical institutions; for the most part small, rural houses,
they catered to a miscellany of the needy – pilgrims, travelers, and the old, as
well as the sick and the disabled. Even those devoted to the care of lepers
almost never employed staff identified as doctors. This situation changed in
the thirteenth century, with the appearance of large institutions, sometimes
with several hundred beds, founded to serve the growing urban population.
Some of these hospitals hired formally trained doctors to visit the sick on
a regular basis, as at two of the larger thirteenth-century foundations, St.
Leonard at York and the Hôtel-Dieu at Paris. The best-organized and bestdocumented institutions of this sort were in Italy, which saw the emergence
of large specialized hospitals devoted to treating the acutely ill in addition to
providing a range of other medical services to the city poor. Florence seems to
have had the largest number of such institutions; by , it boasted four large
hospitals for the sick, including the hospital of Santa Maria Nuova, which
employed ten physicians and surgeons, as well as a staff of pharmacists.
As their names suggest, late-medieval hospitals were in the first instance
religious institutions, established as Christian charities and concerned at least
as much with the spiritual as with the physical needs of their dependents; in
, the Florentine hospital of San Matteo employed four priests, but only
two doctors, to serve its forty-five patients. But these hospitals nonetheless
reflected an order in which religious and natural healing had become defined





Nutton, “Continuity or Rediscovery?”; Shatzmiller, Jews, Medicine, and Medieval Society, pp. –;
and McVaugh, Medicine before the Plague, chap. .
See, for example, Kealey, Medieval Medicus, chaps.  and ; Carole Rawcliffe, Leprosy in Medieval
England (Woodbridge: Boydell Press, ); and Luke Demaitre, Leprosy in Premodern Medicine:
A Malady of the Whole Body (Baltimore: Johns Hopkins University Press, ).
See in general Miri Rubin, “Development and Change in English Hospitals, –,” in The
Hospital in History, ed. Lindsay Grandshaw and Roy Porter (London: Routledge, ), p. . Recent
overviews of this topic include Peregrine Horden, “A Discipline of Relevance: The Historiography
of the Later Medieval Hospital,” Social History of Medicine,  (), –, with copious references,
and Jetter, Das europäische Hospital.
Nutton, “Medicine in Medieval Western Europe,” p. .
John Henderson, The Renaissance Hospital: Healing the Body and Healing the Soul (New Haven,
Conn.: Yale University Press, ); Katharine Park, “Healing the Poor: Hospitals and Medical Assistance in Renaissance Florence,” in Medicine and Charity before the Welfare State, ed.
Jonathan Barry and Colin Jones (London: Routledge, ), pp. –; and Katharine Park and John
Henderson, “‘The First Hospital among Christians’: The Ospedale di Santa Maria Nuova in Early
Sixteenth-Century Florence,” Medical History,  (), –, which includes a translation of the
hospital’s early-sixteenth-century statutes.
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Katharine Park
as complementary but autonomous. The staff of earlier medieval hospitals
had engaged in both. Asked for “herbs and roots” to cure a tertian fever, the
warden of the twelfth-century hospital of Castle Donnington dispensed holy
water instead. By the end of the fifteenth century, however, priests had one
well-defined set of functions and doctors another, and medical personnel
rarely prescribed religious cures; a notebook of remedies “tried and tested in
the hospital of Santa Maria Nuova,” compiled in  by a hospital doctor,
contained hundreds of medical recipes using natural ingredients, and only a
smattering of prayers and charms.
One final index of the growing complementarity of the realms of medical
and religious healing was the appearance in the late fifteenth century of
a new form of hospital. The plague hospital, or lazaretto, was motivated
exclusively by concerns relating to medicine and public health. Plague had
appeared in medieval Europe in the winter of – and returned in the
form of periodic epidemics over the next three hundred years, generating
enormous public concern. At first, local governments confined themselves
to traditional preventive measures, principally prohibitions against dirt and
odors. Over time, however, the authorities became increasingly convinced of
the contagious nature of plague – in line with contemporary medical theory –
and began to emphasize techniques for isolating the sick. As was the case
with other medical institutions, the Italian cities were in the vanguard; by the
end of the fifteenth century, they had begun to experiment with quarantine
procedures and to establish special isolation hospitals, which, although they
offered confessors for the dying, cannot be considered religious institutions
at all. Indeed, concerns about contagion increasingly set public health
authorities at odds with the church. Whereas religious authorities responded
to epidemics of plague with calls for religious processions, public preaching,
and church attendance, public health officials tried to ban assemblies of all
sorts. Preaching in Venice during the epidemic of , one friar called the
civic authorities to task:
Gentlemen, you are closing the churches for fear of the plague, and you are
wise to do so. But if God wishes, it will not suffice to close the churches. It
will need a remedy for the causes of the plague, which are the horrendous
sins committed, the schools of sodomy, the infinite usury contracts made
at Rialto, and throughout the sale of justice and the favoring of the rich
against the poor.



Florence, Biblioteca Nazionale, MS. Magl. XV, , fol. r–r. See Henderson, Renaissance
Hospital, chap. .
See Carlo M. Cipolla, Public Health and the Medical Profession in the Renaissance (Cambridge:
Cambridge University Press, ), chap. ; Ann Gayton Carmichael, Plague and the Poor in Renaissance Florence (Cambridge: Cambridge University Press, ), chap. ; Ann Gayton Carmichael,
“Contagion Theory and Contagion Practice in Fifteenth-Century Milan,” Renaissance Quarterly,
 (), –; and Richard Palmer, “The Church, Leprosy, and Plague,” in Sheils, Church and
Healing, pp. –.
Marin Sanudo, Diarii, as cited in Palmer, “Church, Leprosy, and Plague,” p.  (translation slightly
edited); see in general pp. –.
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Medical Practice
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It would be wrong, however, to overemphasize the split between religious
and naturalistic healing. In , as in , most Europeans (including most
doctors) continued to subscribe to an ontology that accepted illness as having
both spiritual and natural causes, and spiritual and natural cures; after all,
God had created the natural world and used it to accomplish his purposes,
such as punishing the wicked. People still engaged in charity, performed acts
of penance, used religious charms, and went on pilgrimages when medical
remedies had failed. But even the humble turned first to medical practitioners rather than the heavens. In the first place, medical practitioners lay closer
at hand, at least in cities; not only had the period seen an enormous expansion in the number of doctors, but institutions such as hospitals rendered
their services more accessible to the poor. Even more important, a public
consensus had emerged that a relatively well-defined corpus of activities constituted medical practice – just as there was a relatively well-defined corpus
of medical practitioners – and that those activities were the proper first line
of defense against disease. This process, which some historians refer to as
“medicalization,” should not be confused with the emergence of medicine
as a profession in any recognizable modern sense. Medical practice and medical practitioners were still too varied to qualify as such, and although the
emergence of medicine as a learned discipline had created a generally shared
set of assumptions and procedures, practitioners overall continued to lack
standardized training and a sense of group identity. Furthermore, the contractual relationship between patient and practitioner meant that payment
of the doctor depended ultimately on the patient’s satisfaction rather than
on adherence to a set of professional standards and norms. By the end of
the Middle Ages, Europeans had granted considerable public authority to
their medical practitioners: as forensic experts, interpreters of the natural
order, and consultants on issues relating to public health. But they reserved
to themselves the power to judge the effectiveness of their own doctors’ care.

McVaugh, Medicine before the Plague, p. ; and Shatzmiller, Jews, Medicine, and Medieval Society,
chap. .
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