University of Virginia Library

V. 10

MEDICAL FACILITIES

V.10.1

MEDICAL CARE AND THE WILL OF GOD

THE PHYSICIAN NOT A PRIMARY
MONASTIC OFFICIAL

The Rule of St. Benedict contains no clue as to whether a
monastery was to be provided with a permanent staff of
physicians,[369] and all later available sources disclose without
any shadow of doubt that the physician stood outside the
hierarchy of the monastery's regular administrative officers
(provost, dean, porter, cellarer, chamberlain, infirmarer,
etc.). The title carried no official status; but was granted to
monks, who by their special studies and devotion had
demonstrated unusual proficiency and knowledge in the
art of healing.

CASSIODORUS ON THE ART OF HEALING

Cassiodorus the Senator (ca. 480-ca. 575) in a chapter
"On Doctors" of his widely read Introduction to Divine
and Human Readings, written for the instruction of his
monks some time after 551,[370] refers to the brothers who
"look after the health of the human body" as men "who

[ILLUSTRATION]

410. PLAN OF ST. GALL. HOUSE OF THE PHYSICIANS

SHOWN FULL SIZE; 1:192

The Physicians' House shares a site with the
Medicinal Herb Garden in the northeast corner
of the monastery tract. The house belongs to a
sub-group of the guest and service buildings of
the Plan, of which the communal hall is
surrounded on only three sides by peripheral
rooms. Other variants of this smaller format are
the House of the Gardener (fig. 426), the House
for Cows and Cowherds (fig. 489), and the
House for Foaling Mares and their Keepers
(fig. 487).

The proximity of the physicians to their garden
reflects the contemporary state of pharmacy,
which lay largely in the realm of botanicals, as
the authorities of Dioscurides, Isidore, and
many others attest. The physicians' duties
included compounding and dispensing medicines;
their house is provided with a secure room
especially designated for storage of medication.

will receive their reward from Him by whom eternal rewards
may be paid for temporal acts."[371] He lists as standard
medical works to be studied for instruction in this specialized
craft: the book on herbs by Dioscurides; the Latin
translations of the works of Hippocrates and Galen (especially
the latter's Therapeutics, addressed to the philosopher
Glauco); an anonymous work compiled from various
authors; the book On Medicine by Caelius Aurelius;
Hippocrates' On Herbs and Cures as well as various other
medical treatises. He informs his readers that he had collected
copies of all of these works for future use, and that
these copies "are stored away in the recesses of our library"
(i.e., the library of the monastery of Vivarium, which he
had founded and for the monks of which the Institutiones
were written).[372]

Like the later medieval attitude toward medicine,
Cassiodorus' view about the efficacy of medical care is
tinted by the belief that the ultimate decision about sickness
and health are the concern of the Lord; and this ambivalence
between reliance on physical care and limitations
imposed upon it by divine predestination he expresses
clearly when admonishing the brothers: "Learn, therefore,
the properties of herbs and perform the compounding of
drugs punctiliously; but do not place your hope in herbs
and do not trust health to human council. For although the
art of medicine be found to be established by the Lord . . .
who without doubt grants life to men, makes them sound"

(et ideo discite quidem naturas herbarum commixtionesque
specierum solicita mente tractate; sed non ponatis in herbis
spem, non in humanis consiliis sospitatem. nam quamvis
medicina legatur a Domino constituta, ipse tamen sanos
efficit, qui vitam sine dubitatione concedit).[373]

STUDY & TRANSMISSION OF CLASSICAL MEDICINE

The Cassiodorian attitude had a profound effect on later
medieval thinking. It was responsible not only for the fact
that the science of medicine, despite its spiritual limitations
remained a highly respected avocation, but also for the
establishment of its study and transmission as a subject
worthy of being practiced in monastic schools of learning.

[ILLUSTRATION]

411. BARTHOLOMAEUS DE MONTAGNARO. CONSILIA MEDICA. 1434

A PHYSICIAN IN HIS CHAMBERS

MUNICH, BAYERISCHE STAATSBIBLIOTHEK, MS 25, FOL. lv

Montagnaro, a prominent Paduan physician, is portrayed as he inspects a flask of urine. The open books before him may be Theophilos
Unarines or the portions of Judaeus or Avicenna dealing with urine (McKinley, 1965, 13).

[ILLUSTRATION]

412. KIRKSTALL ABBEY, WEST RIDING, YORKSHIRE, ENGLAND. INFIRMARY PLAN

[redrawn after Hope and Bilson, 1907]

In its original form the infirmary hall of Kirkstall may have been very like the castle hall of Leicester, a reconstruction of which is shown in
figure 339. Pre-Norman monastic infirmaries of England were probably built entirely in timber. Under the influence of Norman church
construction, not only were the walls built in stone, but even the free-standing inner posts came to be replaced by masonry arcades. At Kirkstall
this change was made in the 14th century, in adjustment to a trend that in other places such as Canterbury (I, 70, fig. 52.A) had begun as early
as mid-11th century.

In many monasteries, consequently, the study and propagation
of these skills was held in high esteem. The oldest
catalogue of the library of the Abbey of St. Gall lists no
fewer than six medical treatises.[374] The Abbots Grimoald
(841-872) and Hartmut (872-883) increased these holdings
by each bequeathing to the monastic library one medical
book.[375] Among the actually surviving medical treatises of
St. Gall, written in the ninth century, there are extracts
from the works of Hippocrates and Galen (Cod. 44), a book
on cures through herbs and animal extracts (Cod. 217), a
large collection of medical prescriptions (Cod. 751), a
heavily used list of pharmaceutical prescriptions (Cod. 759),
as well as a collection of smaller medical treatises written
by the hand of an Irish monk.[376] Abbot Grimoald (841-872)
can be singled out as one who apparently took a special
interest in the art of healing, since it is to him that Walahfrid
Strabo dedicated his famous poem, Hortulus, in which the
virtues of medicinal herbs are extolled.[377] Other monks of
St. Gall reputed to have been physicians of great distinction
were Iso and Notker II, surnamed Medicus. Iso is
praised by Ekkehart IV for his skill at making salves and is
reported to have healed blind men, lepers and paralytics
with his ointments.[378] The same author proclaims Notker II
the most famous of all.[379] Frequently performing unbelievable
wonders of healing, he was known far and wide in the
country as one of the greatest monastic urologists.[380] The
names of other monks skilled in this science are listed in the
Necrologium of St. Gall.[381]

V.10.2

HOUSE OF THE PHYSICIANS

Besides the Monks' Infirmary and the sick ward in the
Novitiate,[382] the Plan provides for three other medical installations:
the House of the Physicians, the Medicinal
Herb Garden, and the House for Bloodletting, all of which
are situated in the northeast corner of the monastery next
to the Monks' Infirmary. The House of the Physicians (fig.
410) forms the center of the group. It is separated from the
House for Bloodletting by a wall or fence and has no direct
connection with the Infirmary. The house is small and
almost square in shape (37½ feet by 42½ feet). Its principal
room is designated as "the hall of the physicians" (domus

[ILLUSTRATION]

PLAN OF ST. GALL. HOUSE OF THE PHYSICIANS. AUTHORS' INTERPRETATION

413.A

413.B

GROUND PLAN AND TRANSVERSE SECTION

Our reconstruction of the House of the Physicians is only one choice of several possible alternatives. Despite the inclusion of corner fireplaces
in the physicians' private aisle and the aisle for the critically ill—a feature which elsewhere has called for masonry walls—the exterior walls of
this house could have been entirely of timber (a possibility we have demonstrated in reconstructing the Gardener's House, figs. 427.A-F, where
similar conditions obtain). On the other hand, these walls could also have been built all in masonry, as is shown in the House for Distinguished
Guests (figs. 397.A-F). Above is a third alternative: the entrance wall is timber, all the others are masonry.

medicorum) and is furnished with the customary open fireplace
with louver overhead. The western aisle of the house
is used as a "bedroom for the critically ill" (cubiculum ualde
Infirmorum); the eastern aisle serves as the "dwelling of the
chief physician" (mansio medici ipsius), while the lean-to in
the rear of the house is a "repository for drugs and medicaments"
(armarium pigmentorum). Both the bedroom for the
sick and the physician's quarters are provided with corner
fireplaces and their own privies.

Measuring only 37½ feet by 42½ feet the House of the
Physicians is one of the smaller guest and service buildings.
Its sick room, nevertheless, was large enough to accommodate
eight beds. We should imagine the interior of this
building to have looked very much like the thirteenth
century Hospital of St. Mary's in Chichester, (fig. 343),[383]
except, of course, that the Physicians' House on the Plan
is considerably smaller and its aisles were probably separated
from the common hall in the center by wall partitions
between the posts. Another building, somewhat smaller
than St. Mary's Hospital although still twice the length of
the House of the Physicians, was the Infirmary of the
Abbey of Kirkstall, dating from around 1220 (fig. 412),
whose roof was originally held up by two rows of wooden

[ILLUSTRATION]

PLAN OF ST. GALL. HOUSE OF THE PHYSICIANS. AUTHORS' INTERPRETATION

413.C
In the center: a window admitting light to the room where the pharmaceutical
drugs are stored. To either side: the privies of the physicians and the critically
ill.

413.D
Our assumption that the gable walls were half-timbered is purely conjectural.
They could of course as well have been built in masonry.

413.E
Locating the fireplaces in the outer corners of the aisles keeps the chimney
stacks at a safe distance from the inflammable roof.

413.F
Two trusses, in addition to the gable walls, would have been entirely sufficient
to carry the roof of this relatively small building.

NORTH, SOUTH AND WEST ELEVATIONS AND LONGITUDINAL SECTION

SCALE 1/16 INCH = 1 FOOT [1:192]

posts which were later replaced by masonry arcades.[384] The
House of the Physicians on the Plan is the Carolingian
prototype for this type of building.

It is one of only a few buildings on the Plan in which the
main room with the open fireplace is directly accessible
from the outside.[385] We have reconstructed this side of the
house as a straight timber-framed gable wall (fig. 413A-F),
with infillings of daubed wattlework, reaching to the
ridge of the roof. Because of the presence of corner
fireplaces in the physician's bedroom and in the room for
the critically ill, we have rendered the walls against which
these fireplaces were built in masonry. The architectural
privacy of both the physicians and their critical patients—
attainable only by wall partitions and ceilings separating
their quarters from the common source of light and air in
the center room—created, of course, a need for supplementary
fenestration in the walls of these rooms.

The isolated location of the House of the Physicians and
its rigid separation from all other buildings have given rise
to the opinion that it served primarily as an isolation ward
for patients with communicable diseases.[386] It appears to me
more plausible to assume that it was the place where the
monastery's serfs and workmen were taken when their condition
became critical, since laymen could not be admitted
to the Monks' Infirmary. The monks had their own ward
for persons stricken with acute illness, and this could also
have been used as a separation ward for monks afflicted
with communicable diseases.

The physicians were obviously not only in charge of the
patients who were bedded in the Physician's House, but
also attended to the sick in the adjacent Infirmary of the
Monks and took care of the treatments administered in the
House for Bloodletting. That they were not always from
the ranks of the regular monks may be gathered from Abbot
Adalhard's Directives for the Abbey of Corbie, where two
physicians (medici duo) are listed as laymen.[387] Hildemar, in
his commentary on the Rule, lists as instruments indispensable
to the physician: the bloodletting tools (fleuthomus),
the book of herbs (herbarius liber), the medicaments and
tools required for their preparation (pigmentum ferramenta
quibus incidit), and "all such other similar things with the
aid of which the physician performs his craft of healing"
(et reliqua his similia, quibus medicamen medicus operatur).[388]

V.10.3

MEDICINAL HERB GARDEN

The medicinal herb garden (herbularius) lies in the northeastern
corner of the monastery site, immediately east of
the House of the Physicians. It is a small intimate garden,
37½ × 27½ feet (fig. 414). Like the Monks' Vegetable Garden,
it is surrounded by a wall or a fence, but the arrangement
of the planting beds differs. In the Vegetable Garden
the planting beds are separated from the walls by a peripheral
walk, so that each bed can be cultivated from all four
sides. In the medicinal herb garden a row of planting beds
clings to each wall. This seemingly insignificant rearrangement
of beds in relation to the wall is, according to Wolfgang
Sörrensen, the first step away from the "utility garden"
(Nutzgarten) to the "pleasure garden" (Ziergarten).[389] It
would, nevertheless, be wrong to classify the herb garden
on the Plan of St. Gall as a "Ziergarten." The primary
function of its plants is a practical one: they furnish the
physician with the pharmaceutical products needed for his
cures. As in the Monks' Vegetable Garden, each planting
bed is reserved for the cultivation of a single species. There
are sixteen in all:

                               

1.	lilium	lily (lilium candidum L.)
2.	rosas	garden rose (rosa gallica L.)
3.	fasiolo	climbing bean (dolichos melanophtalmus L.)
4.	sata regia	pepperwort (satareia hortensis L.)
5.	costo	costmary (tanacetum blasamita L.)
6.	fena greca	greek hay (trigonella foenum graecum L.)
7.	rosmarino	rosemary (rosmarinus officinalis L.)
8.	menta	mint (mentha piperita L.)
9.	saluia	sage (salvia officinalis L.)
10.	ruta	rue (ruta graveolens L.)
11.	gladiola	iris (iris germanica L.)
12.	pulegium	pennyroyal (mentha pulegium L.)
13.	sisimbria	water cress (mentha aquatica L.)
14.	cumino	cumin (cuminum cyminum L.)
15.	lubestico	lovage (levisticum officinale L.)
16.	feniculum	fennel (anethum foeniculum L.)[390]

A charming contemporary description of a garden of this
type is Walahfrid Strabo's Hortulus, written around 845 in

[ILLUSTRATION]

PLAN OF ST. GALL. MEDICINAL HERB GARDEN

414. PLAN OF ST. GALL. MEDICINAL HERB GARDEN

414.X

414.Y

PLOT PLAN

SHOWING RELATIONSHIP OF HEALTH & MEDICAL FACILITIES

The plot plan suggests two traffic patterns within the Infirmary areas. Moving
north, monks and serfs needing medical attention could leave the Church after
services and report to whichever medical facility they were assigned. The
Monks' Infirmary was available only to regular monks; the House for
Bloodletting was probably used by both monks and serfs. The critically ill were
lodged with the physicians; probably serfs or other laymen with minor infirmities
were treated where they lodged.

Moving southward on the site, the physicians might make daily rounds:
conducting or overseeing bloodletting; at the bath and kitchen for the ill
recommending therapy and special diet, supplies for which might be sent for
from the small stock of luxuries afforded the Abbot in his own nearby kitchen;
thence reporting directly to the Abbot himself (as was their charge and his own)
concerning the ill, recommending further treatment for some, or swifter cures for
suspected malingerers. At mid-point in this course the physicians could stop in
the Chapel and Cloister for the Ill to advise recuperating brothers.

It would be an oversight to regard these economies of movement and communication
as happy accidents; on the contrary, a high degree of skill and
consciousness in such matters helped the Benedictines eventually to influence
the affairs of Carolingian Europe, and gave the Plan of St. Gall its unique
stature as an architectural plan.

The herbs to be cultivated in this small garden are selected for their medicinal properties. Their renascence each spring under the care of man,
after the plants had either died altogether or only back to their roots during winter, has been described by Walahfrid Strabo in an account of
great poetic beauty (Hortulus) as a recurring manifestation of the forces of life imparted to nature by Divine creation.

The physicians cared directly for the critically ill and for those to be bled; their chief duties in addition were making medicines, and prescribing
courses of treatment that might be administered by others. From the nearby garden they could pluck fresh the plants needed to compound the
poultices, purges, infusions, and simples that were the main concerns of pharmacy in the 9th century.

[ILLUSTRATION]

415. MEDICINAL HERB GARDEN. PERSPECTIVE VIEW FROM THE NORTHEAST (INTERPRETATION)

Inde noti conquitur flabris solisque calore
Areola et lignis, ne diffluat, obsita quadris
Altius a plano modicum resupina levatur.
Tota minutatim rastris contunditur uncis,
Et pinguis fermenta fimi super insinuantur.
Seminibus quaedam tentamus holuscula, quaedam
Stirpibus antiquis priscae revocare iuventae.
Denique vernali interdum conspergitur imbre
Parva seges, tenuesque fovet praeblanda vicissim
Luna comas. . . .
Then my small patch was warmed by winds from the south
And the sun's heat. That it should not be washed away,
We faced it with planks and raised it in oblong beds
A little above the level ground. With a rake
I broke the soil up bit by bit, and then
Worked in from on top the leaven of rich manure.
Some plants we grow from seed, some from old stocks
We try to bring back to the youth they knew before.
Then come the showers of Spring, from time to time
Watering our tiny crop, and in its turn
The gentle moon caresses the delicate leaves.

WALAHFRID STRABO, HORTLUS, verse 46-55

Payne and Blunt, eds., 1966, 28-29

the monastery of Reichenau.[391] The poet relates how in the
early spring he rushes into this garden, weeds out the nettles,
and covers the soil with manure which he carries out in
baskets. As soon as the soil is permeated with the fermenting
action of this substance and fanned by the warm winds
from the south, he turns it over with the spade, and
frames the planting beds with boards to prevent the humus
from sliding off onto the walks. Then he sets out his seedlings
and in the following weeks observes with empathy
the miracle of nature's rejuvenation in the growth of plants
whose shape and physical characteristics he describes with
a sharpness of visual definition that reminds one of the
much later plant and water studies of Albrecht Dürer.

Nine of the sixteen plants listed in the herb garden on
the Plan were also grown in Walahfrid Strabo's garden. All
of these plants, as botanists stress, could be raised in the
warm climate of the island monastery of Reichenau,[392] and
all of them, with the exception of pumpkin and melon, had
medicinal value. In the cultivation of these gardens and the
medical uses to which they were put, the monks leaned
heavily on the classical tradition. But they did not expand
just the traditional medical use of plants and herbs; the
benefits they brought to the art of cooking may have surpassed
the contributions their gardens made to medicine.[393]
From the monasteries the use of herbs spread to the nobles
and the peasants, and thus, eventually, herbs became an
integral part of every kitchen garden.[394]

Recipe quotation after Mitteilungen der antiquarischen Gesellschaft,
Zürich, XII, No 6; Bikel, 1914, 99-100.

[ILLUSTRATION]

416. PLAN OF ST. GALL. HOUSE FOR BLOODLETTING

In the Middle Ages bleeding was used to remedy almost every known disease, to such excess that public opinion eventually turned against the
procedure. It is, even today, used as a cure for a small number of pathological conditions where other means fail—but nowhere, now, to the
extent of justifying the construction of special houses for bleeding. The Plan of St. Gall reveals with unique precision the appearance of this
extinct species of house in the 9th century.

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]

[ILLUSTRATION]

PLAN OF ST. GALL. HOUSE FOR BLOODLETTING

The vulnerable condition in which patients found
themselves through the process of bleeding
required that the House for Bloodletting be well
heated. This was accomplished by installation of
four corner fireplaces, in addition to the traditional
open fireplace in the center of the building. Safety
from fire hazards would require that the walls of
the House for Bloodletting be built in masonry.

416.X.2 TRANSVERSE SECTION LOOKING EASTWARD

Without doubt Carolingian builders could have
covered a house 35 feet wide with a single span
(the nave of the Church after all had a span of 40
feet) but in most medieval buildings such a span
would have had additional support in two rows of
free-standing inner posts, if more than 25 feet
wide. For this reason in our reconstruction we have
introduced four additional inner posts carrying
roof plates, which in the longitudinal direction of
the building are slightly cantilevered to support the
rafters of the hips of the roof.

416.X.1 PLAN AT GROUND LEVEL

AUTHORS' INTERPRETATION

[ILLUSTRATION]

416.X.3 LONGITUDINAL SECTION, LOOKING SOUTHWARD

416.X.5 ELEVATION LOOKING NORTHWARD

416.X.4 ELEVATION LOOKING SOUTHWARD

416.X.6 ELEVATION LOOKING WESTWARD

Caring for the ill was a primary Christian, and therefore also an important monastic occupation, and included study and transmission of
teachings of the great physicians of classical times. Yet monastic tradition also made it clear that the "ultimate decision about sickness and
health" was "the concern of the Lord," not of man (see above, p. 176), which may explain why the physician, although his arts were often
performed by monks, was not a member of the monastery's regular staff of administrative officers.

Among monastic foundations, the separate House for Bloodletting is, we believe, unique to the Plan of St. Gall, attesting the high curative and
prophylactic value attached to this procedure, and demonstrating the perspicuity of the designers of the Plan, who separated this medical facility
from the infirmary. This made sense because of the large number of monks to be bled, and their convalescent state for a few days afterward. If
the full monastic complement of 130 at St. Gall were to be bled at six-week intervals (1,170 bleedings in a year) as was customary at Ely (cf.
p. 188 below), the Infirmary alone could hardly have served both those with longer-term or contagious illnesses requiring lengthy recuperation
or isolation, and those merely recovering from bleeding.

[ILLUSTRATION]

417. LUTTRELL PSALTER (1340). LONDON, BRITISH MUSEUM, ADD. MS 42130, FOL. 61

[By courtesy of the Trustees of the British Museum]

A physician bleeds a patient under the interested gaze of a large kingfisher. The iconography of this bird is ancient and complex; with its
ability to hurl itself into the water and then arise after having apparently drowned, it captured the Christian imagination to become a symbol
for the resurrected Christ. Perhaps its association with the act of bleeding symbolizes the hope of the patient for restored health.

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.

[ILLUSTRATION]

418. GRIMANI BREVIARY (1490-1510). ILLUMINATION FOR THE MONTH OF SEPTEMBER

VENICE, BIBLIOTECA DI SAN MARCO, FOL. 10

The breviary affords a painfully realistic view of a physician bleeding a patient. The Grimani Breviary, of uncertain authorship, provenance,
and even date, is one of the finest and most profusely illuminated manuscripts of its class; its 110 illuminations depict labors of the months and
numerous other scenes from daily life, religious festivals, feasts of the saints. The illuminations are from many different hands, mostly Flemish,
a few perhaps French; the style suggests a date nearer the start of the 16th century.

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.

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.

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]

[ILLUSTRATION]

SITE PLAN