University of Virginia Library

V.10.4

HOUSE FOR BLOODLETTING

DESCRIPTION OF HOUSE

The House for Bloodletting (fig. 416) lies west of the
Physicians' House and consists of a large rectangular space
35 feet by 45 feet. It is furnished with a central fireplace
with the customary louver and contains, besides this traditional
heating device, four additional corner fireplaces
as well, doubtless in consideration of the weakened condition
of the monks after being bled. The wall space between
these fireplaces is taken up by six benches and tables
(mensae) on which the monks were bled and purged.

The primary function of this separate house, as Leclercq
has correctly pointed out, is to relieve the Monks' Infirmary
of the many people who were to receive the incision of the
lancet as a cure for a vast variety of ailments, real and
imaginary.[396]

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185

MONASTIC VIEWS ON BLEEDING

The Rule of St. Benedict is silent on the subject of
bleeding,[397] and there is no certainty as to what point in
history bleeding became a regular practice in monastic life.
A description in Bede's Ecclesiastical History of a case of
unsuccessful bloodletting causing intensive swelling and
nearly leading to the death of a nun, suggests that bleeding
was a fully adopted form of medical treatment in the
monasteries of England at the time of Theodore of Tarsus
(669-690). The same story also reveals that when something
went wrong with the operation this was likely to be
attributed not to the use of infectious tools or other forms
of medical malpractice, but to the fact that the operation
was performed at the wrong time: "You have acted
foolishly and ignorantly to bleed her on the fourth day of
the moon," Bede records Bishop Wilfrid of Hexham to
have exclaimed. "I remember how Archibishop Theodore
of blessed memory used to say that it was very dangerous
to bleed a patient when the moon is waxing and the Ocean
tide flowing. And what can I do for the girl if she is at the
point of death?"[398] A book, De minutione sanguis, wrongly
attributed by tradition to the Venerable Bede, recommends
that the blood be let between March 25 and May 26, on the
assumption that this was the season "during which the
blood develops in the human organism" (quia tunc sanguis
augmentum habet). After this period, the operation was to be
undertaken only with a due regard for the qualities of
the seasons and phases of the moon (sed postea observandae
sunt qualitates temporum et cursus lunae).[399]

The first synod of Aachen (816) abolished the custom
according to which large segments of the community were
bled at a fixed date, and ruled that individuals be bled
according to need. It reaffirms the right of those who are
exposed to this treatment to receive a fortifying diet of food
and drink, including at least by implication the otherwise
forbidden meats (Ut certum fleutomiae tempus non obseruent,
sed unicuique secundum quod necessitas expostulat concedatur
et specialis in cibo et potu tunc consolatio prebeatur).[400]

The food for the monks who were bled was doubtlessly
prepared in the kitchen of the Infirmary, which lies directly
to the west of the House for Bloodletting. The number and
length of the tables in this house would permit the simultaneous
feeding of a maximum of thirty-two monks, if we
count 2½ feet as the normal sitting space required by each
monk, as we did in calculating the seating capacity of the
Monk's Refectory.[401] The number of monks to be bled on
a single day could not exceed this figure; and if as many as
thirty-two were bled in a single day, this operation could
not have been extended to others, until the first group to be
treated had gone through the entire cycle of convalescence,
which involved several days of special treatment and care.

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MEDIEVAL PORTRAYALS OF BLEEDING

A marginal illustration in the Luttrell Psalter (fig. 417)
furnishes us with a realistic picture of the performance of
this ubiquitous craft. It shows a physician standing and
bleeding a patient from the right arm. The patient is seated
on a stool and holds a bowl in his left hand to catch the
blood. He keeps his right arm steady by propping it on a
staff or pole while the physician places his left foot on that
of the patient. This appears to have been a standard position
for this kind of operation. It occurs again, almost
feature by feature, in the representation of a similar scene
in the Grimani Breviary (fig. 418).[402] In both cases the blood
is taken from the anticubital vein, in the crook of the elbow,
a preferred place for bloodtaking even today, since here one
of the principal veins comes close to the surface and exposes
itself in a relatively fixed position. The staff or pole, apart
from steadying the patient in a general sense, adds muscular
control to the operation, as it enables the patient to
increase or diminish the flow of blood by locking his fist
around the pole or conversely by relaxing his grip.

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187

PHLEBOTOMY: A MEDIEVAL PANACEA

Phlebotomy was a medical omnium-gatherum used for
curing a bewildering variety of ailments.[403] The Regimen
sanitatis salernitanum, a widely read treatise on medicine,
written at the end of the eleventh century for Robert, Duke
of Normandy, the eldest son of William the Conqueror,
probably by John of Milan, head of the faculty of the School
of Medicine of Salerno at that time,[404] defines its beneficial
effects as follows:

The physician points out that the "superabundance of
spirit" (spiritus uberius) that escapes with the blood is
quickly replenished through the drinking of wine, while
the weakness of the body sustained by bleeding is gradually
repaired by the intake of food.

FROM PHYSICIAN TO BARBER

There is no reason to presume that in the early Middle
Ages bloodletting was performed by persons other than
trained physicians. Alcuin and Walahfrid Strabo refer to
the practice as being performed by medici.[406] But in the later
Middle Ages physicians considered this operation to be
beneath their dignity and conceded it to "barbers" and
"professional bleeders" (rasatores et sanguinatores).[407] In the
twelfth century this change must have been well under way.
A hint of the social milieu from which such secular bleeders
may have emerged and how and where they may have
received their training is found in the Chronicle of the
Abbey of St. Trond, where it is said of one of the monastery's
serfs, a recalcitrant oppidanus (inhabitant of a city)
named Arnulf, that in return for the terms of a tenement
granted to him by the abbey, he was not only to assist the
monks whenever they were bled, but in addition to provide
for the abbot's saddle and spurs, repair the abbey's window,
and perform other minor services, such as keeping all of
the monastery's locks in working condition.[408]

RELIEF FROM DREARINESS OF DAILY ROUTINE

Dom D. Knowles attributes the phenomenal spread of
the practice of bloodletting in monastic life to the "general
feeling of physical malaise" brought about by an unbalanced
diet and the sedentary life of the monks, calling for
some violent form of relief.[409] One of the attractive features
of its practice was that it gave relief from the dreariness of
the daily routine and was associated with a fortifying regime
of food, allowed in compensation for the loss of blood. This
gave to the occasion a touch of recreative pleasure, which
monastic discipline found it difficult to repress.

RULES TO BE FOLLOWED IN THE PRACTICE
OF BLEEDING

A detailed account of special rules to be followed in the
practice of bleeding will be found in Ulric's Antiquiores
consuetudines (d. 1093) of the Monastery of Cluny[410] and the
chapter "Permission for Being Bled" in the Monastic
Constitutions of Lanfranc.[411] From a review of these, and a
variety of other sources,[412] the routine of the monk who subjected
himself to bloodletting went as follows:

After having obtained formal permission to be bled
(licentia minuendi) by petition to the chapter, the brother
left the church at the end of the principal mass and went to
the dormitory to exchange his vestments of the day (diurnales)
for his clothing of the night (nocturnales) which he
retained for the three days of rest that followed his operation.
The operation was initiated with a brief prayer which
began with the verse Deus in adjutorium meum intende. (In
the Benedictine monastery this prayer was preceded by an
inclination of the body called ante et retro.) The incision
was made in the morning, save for the time of Lent, when
it was done after vespers. The patients were issued bandages
of linen (fasciae, ligaturae, ligamenta brachiorum, bendae,
arcedo) with which to wrap their arms. Some consuetudinaries
recommend that before being bled a monk should
pass by the kitchen to have his arm warmed.

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During recovery the patients were not held to their
regular duties in the choir, but had leave to rise later than
the others and to recite only a part of the divine office.
Moreover, they were at liberty to take walks in the monastery's
vineyards and meadows. Their diet, as already
mentioned, made allowance not only for the ordinarily forbidden
meats, but also for greater abundance. During the
periods when the rest of the community ate only one meal,
the frater minuendus ate two; on all other occasions, three:
the mixtum, the prandium and the coena.

It is obvious that in view of all these special privileges,
bloodletting acquired an attraction that in the minds of
some of the more conservative members of the community
bordered on dissipation; and the monastic consuetudinaries,
indeed, abound with admonitions aimed at curtailing
the spread of merriment, if not of outright breaches of
discipline, with which this activity tended to be associated.
A main concern of those who were in charge of monastic
discipline was to prevent the seynies from coinciding with
important religious festivities; others felt it necessary to
restrict the repetition of the privilege to certain cycles. The
monastery of St. Augustine in Canterbury allowed the
monks to be bled in intervals of seven weeks; at Ely the
interval was six; in other monasteries it was only five or
four times per year that a monk could be bled.

The reconstruction of the House for Bloodletting poses
problems of a special kind. Safety of construction, in the
presence of so many corner fireplaces, requires that its
walls be built in masonry. The house is not inhabited by
any permanent residents and serves one purpose only:
bleeding and recovering from this treatment. There is no
need for the designation of any internal boundaries between
the primary function of the building and such subsidiary
functions as sleeping or stabling animals which in the plans
of other buildings led to the delineation of aisles and leanto's;
and this is the reason, in our opinion, why the drafting
architect showed it as a unitary all-purpose space. Yet the
size of the building argues against the assumption that it
was surmounted by a roof that spanned the entire width of
the house in a single span. For the nave of a church a roof
span of 35 feet would be normal practice in this period, but
in a simple service structure it would be an anomaly. We
have introduced in our reconstruction of the House for
Bloodletting two inner ranges of roof-supporting posts
whose presence cannot be proven from the simple analysis
of the plan of this building.[413]