Medieval and Early Renaissance Medicine: An Introduction to Knowledge and Practice.

A synthetic survey of medical learning and practice in Europe between the twelfth and the end of the fifteenth century, this splendid study is an indispensable, lucid, state-of-the-art introduction to a subject that lies close to the center of any consideration of Renaissance society and culture. Enlivened by a number of well chosen images, it illuminates not only contemporary assumptions about the functioning of the body and intellectual systems of disease and therapeutics but also the institutional and social structures within which those assumptions and systems were transmitted and put into practice. Siraisi has included chapters on the textual tradition of medical writing, practice and practitioners, medical education, anatomy and physiology, disease and treatment (including a fine discussion of pharmacology), and surgeons and surgery. She has drawn not only on her own vast knowledge of academic medical writing and on a number of recent local studies by medical historians working from archival sources, but also (though to a lesser degree) on texts that illuminate more popular attitudes toward disease and healing: chronicles, letter collections, and--in many ways most interesting of all--canonization proceedings. The result comes as close to a total history of high medieval and early Renaissance medicine as is possible given the present state of research.

The picture Siraisi paints for us is of a body of knowledge and practice remarkable for its diversity. Officially documented and recognized healers ranged from military surgeons to female saints to university professors to itinerant empirics. Each kind of healer had its place and its own clientele, defined in terms of class (rich or poor, urban or rural), context (private or institutional), technique (medication and diet, surgical operation, or prayer and incantation), and condition (chronic or acute, internal or external, hernia or cataract). These groups often overlapped, giving rise to the cooperative arrangements and fierce rivalries that did so much to shape medical rhetoric and organization.

As Siraisi repeatedly emphasizes, there was very little to distinguish one kind of healer from another in terms of effectiveness, with the possible exception of surgeons, who seem to have treated with considerable success traumatic injuries such as wounds and broken and dislocated bones. As a result, the choices made by doctors and patients reflected, even more than they do today, a set of cultural negotiations shaped by widely shared assumptions (and generally lower expectations) concerning health and disease.

These general assumptions and expectations seem to have changed little over the period covered by Siraisi's book, a fact that lends her treatment unity and coherence. That is not to say that the high Middle Ages and early Renaissance did not witness important changes: this is the period that saw not only the creation of a sophisticated and highly theorized body of, first, Latin and then vernacular medical learning based on Greek and Arabic sources, but also the emergence of the university medical faculty, the specialized medical hospital, and state-sanctioned guilds of doctors--institutions that still shape the teaching and practice of medicine today. But the techniques employed and general agreement on what they could and could not achieve remained remarkably stable, even in the face of dramatic challenges such as the pandemic of plague that dominated European demography and epidemiology in the centuries after 1348.

Siraisi's account is rich and convincing, though my own work on non-textual healing traditions, which could be highly localized, leads me to wonder if the coherence of her treatment is somewhat overdrawn. Although she fully acknowledges and describes the range of healers active in this period, she tends to emphasize the Latin and its strongly derivative vernacular version of what she calls "literate medicine." Yet even in fourteenth- and fifteenth-century Florence, one of the wealthiest, most literate and urbanized areas of western Europe, fewer than half of the licensed medical practitioners (and almost none of the surgeons) lived in households that owned any books at all. It may be that their practice did in fact reflect the norms and assumptions in the works of their more literary colleagues, but without more specialized study, it is still too early to tell.

That caveat aside--and it is a caveat that reflects only the current state of research--Siraisi has produced a remarkable book, one that is extraordinary for its richness and its range as well as its readability. She has included a good index and three extremely useful bibliographies: a complete one of works cited (in itself an excellent guide to the field), an abbreviated one of suggestions for further reading, and an (alas! so short) one of medieval medical works in English translation. This is a study that can and should be read by anyone, from amateur to undergraduate to published scholar, with even a passing interest in the medicine of Renaissance Europe.

WELLESLEY COLLEGE