. The image of premodern medicine is skewed to the extent that our evidence is scriptural rather than material and discursive or demonstrative rather than factual. It remains difficult to do justice to the varied group of men and women who catered to the health needs of most people and who were far less marginal throughout the Middle Ages than their modern counterparts. They ranged from herbalists to bath attendants and from midwives to miracle workers, but in France their protagonist, as the successor to the Roman medicus, was the mège (metge, metgesse) or mire (miresse). Together with popular medicine in general, this figure was eclipsed, more completely than the analogous læce, or “leech,” in England, by the learned physician or doctor and his Latin writings.
The sources from the first two-thirds of the medieval millennium are meager, yet they reveal some persistent characteristics of French medical practice. A disproportionate prominence of royal patients, the influence of imported healers and Mediterranean traditions, and a preference for palliative therapy over more aggressive intervention: all these features are personified by the physician who attend to Theuderic I of Austrasia, the son of Clovis. Anthinus, a Byzantine exile sent to Metz by the Ostrogothic king Theodoric, left prescriptions that are nutritional rather than medicinal. When native practitioners first became literate, they drew on classical traditions not only through Gallo-Roman schools, as at Marseille or Autun, but also through monastic infirmaries. By the 10th century, as we learn from a personal appeal by Charles the Simple and a heralded visit by Bishop Adalbero of Verdun, the oracle and mecca for health seekers was the center of Salerno, where cures as well as care revolved around a “regimen,” or dietary governance. The propagation of Salernitan wisdom, even across the Channel, was aided by emanations from Chartres and by such individuals as the monk Baudouin, French physician to Edward the Confessor.
Until close to 1100, the majority of acute and chronic ailments that demanded more intense attention seem to have been treated by monks, faith healers, good Samaritans, and part-time practitioners. A rising demand for more specifically trained and dedicated “professionals” is reflected in the 12th-century complaint by the Welsh visitor Giraldus Cambrensis that the wandering monks of Cîteaux and Clairvaux treated the populace “not with fresh drugs, selected syrups, or medicines compounded according to the art, but only with collected and assorted herbs of the fields, as if this would seem to be something unusual.” A contemporary, the satirist Guiot de Provins, clearly differentiated unschooled practitioners, the medicus and the apothecary, from the physician who had been academically trained at Salerno or Montpellier and who commanded a higher honorarium.
A literate instruction in health care was virtually inaccessible to anyone outside the clergy. Members of this class, however, faced ethical problems when they wished to apply their schooling, particularly to lucrative transactions, surgical treatments, and such unseemly activities as gynecol-ogy or even diagnosis by uroscopy. The practice of medicine by clerks was initially proscribed at church councils on French soil (at Clermont in 1130 and at Tours in 1163) and formally prohibited in 1219, but, paradoxically, it remained more prevalent—and far more physicians held prebends or church benefices—in France than elsewhere until the 15th century. As further ironies, even here the secularization of medicine was the result less of ecclesiastical restrictions than of incorporation in the universities, and it did not preclude the special deference that academically trained physicians showed to clerical prerogatives in their refusal to treat the critically ill before they had gone to confession.
As the professionalization of medicine evolved in the university, it accentuated the social ranking of practitioners on the basis of literacy. The teaching of the art became paramount, and the title of “doctor” appeared more coveted than those referring to healing. Nevertheless, the exercise of the art remained the object of school statutes that required experience as an integral part of training, of many scholastic writings devoted to diagnostic techniques and therapeutic procedures, and of the professors’ careers and communal actions outside academe. Once they had gained control of instruction, the incorporated physicians aimed for the regulation of all practice by means of licensing. An avowed concern with the public welfare as well as a drive for control, if not for monopoly, culminated at Paris between 1332 and 1352 in a bitter campaign of the faculty against two dozen unlicensed practitioners. On account of their Latin book learning and their practice with oral advice rather than with manual intervention, doctors deemed themselves above surgeons, unlike in Italy; the distance was more pronounced in Paris than at Montpellier.
Even within the craft of surgery, there was a stratification based as much on education as on activities. In his Livre des métiers, the prévôt of Paris under Louis IX, Étienne Boileau, distinguished between the barbier-clerc, or surgeon-barber, “of the long robe” and the lowlier barbier-laic, or barber-surgeon, “of the short robe.” The former, who seemed as much at ease in the royal court as downtown, claimed greater respectability on account of their knowledge of medical theory; their ambitions gained momentum after 1295, when Lanfranc of Milan introduced academic surgery to Lyon and to Paris; and they were recognized as a faculty by King John in 1356. Most illustrious among these master surgeons were Henri de Mondeville and Gui de Chauliac, distinguished by their books no less than by their care of kings and popes. A larger group was that of the barber-surgeons, whose chief customers were merchants, sailors, and other travelers; from 1311 on, they were allowed, after examination by four sworn masters, to provide such health-related services as cupping and bloodletting; incorporated in Paris since 1361, in 1372 they received from King Charles V permission to extend their activities to the treatment of “boils, tumors, and open wounds if these are not mortal.”
Documented practitioners, whatever their educational level, were naturally concentrated at noble courts and in urban centers. Their services, less often as providers of care to the community than as expert witnesses at trials, examiners of alleged lepers, and inspectors of health conditions, were engaged by municipalities mainly from the 15th century on, later than in Italy. Such services may not have received generous compensation, and bourgeois patients were perhaps not the most profitable ones. While doctors to notables could accumulate considerable fortunes, urban practitioners appear to have been of modest average means. One may be surprised to learn that in Paris the majority of them paid low taxes, and in Toulouse one-half were characterized as “poor devils.”
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