Friday, November 9, 2012

A Medieval Doctor and His Career

Taddeo Alderotti was something of a rock star among 13th century physicians.  A brilliant teacher and a skilled medical practitioner, Taddeo was also well versed in philosophy.  He held that medicine derived its principles from (and was there a subdivision of) natural science, and thus natural science and logic were a necessary foundation for the study of medicine.

Much in demand for his medical skills, Taddeo demonstrated another formidable skill as well:  the art of making money.  It was this latter talent that earned him a mention by Dante, who in his Paradiso 12:82-85, put these words into the mouth of Saint Bonaventura, speaking of Saint Dominic: 

Non per lo mondo, per cui mo s'affanna di retro ad Ostiense ed a Taddeo,     ma per amor della verace manna
 in picciol tempo gran dottor si feo...

Not for the world, for whose sake they labor now, following the man from Ostia and Taddeo, but for love of the true manna,
in short time he became a great teacher...
(trans. Robert M. Durling)

 (The Ostian in the quote above is Enrico di Susa, a very successful scholar of canon law who became Cardinal-Bishop of Ostia and Velletri in 1262.)

Taddeo taught students who became the next generation of rock star doctors, and he treated patients ranging from a blacksmith to the pope, with stops in between at Florentine noblemen, a Venetian doge, a natural son of Emperor Frederick the Second, and a bishop who was himself an eminent physician, thus making Taddeo a physician's physician.  He treated men and women, old and young, all over Italy, both in person and as a consultant to their own physicians.  (Most of them did have in common a certain amount of wealth, for Taddeo did not come cheap.)  He wrote health regimens and consilia, detailing his recommendations for living a healthy life.

Two well-known anecdotes about Taddeo may give a little of the flavor of his time, and possibly also of the man.  One pertains to his teaching, the other to his medical practice.

First, there was the time that Taddeo cautioned his students against eating petronciani (eggplant, probably) on the grounds that it would cause madness.  One of his students disagreed, and, to prove his point, ingested eggplant and returned to class to announce that he was not at all mad.  And then he raised his garments and mooned Taddeo.  So - whose point did he prove, exactly?  (I think the usual conclusion here is that such behavior was not standard in a 13th century medical school classroom.)

And secondly, a chronicler reports that Taddeo had been called in on a difficult case, that of a nobleman who was seriously ill.  Taddeo believed that his patient was on the mend, so over the protests of his assistants, who were less sure of the outcome, he went home to get a good night's sleep.  When he returned the next morning, the patient was at death's door, and distraught family members were making wild threats, such as - horror of horrors - withholding the fee.  Taddeo looked around the sickroom, spotted an open window, and rounded on them:  had he not told everyone present that the windows had to be kept closed?  Therefore, the unfortunate change in the patient's condition was no fault of his.

Taddeo was largely responsible for taking medical education out of dusty translations of ancient texts and into the sickroom, teaching at the patient's bedside. He believed in taking a patient's medical history.  He advocated a scholastic and dialectical approach to medical teaching, and his methods to a large extent shaped medical education at Bologna, a curriculum which was in its infancy at the time he arrived there.

He got wildly excited about the medicinal benefits of distilled alcohol, including its use as an antiseptic, which to the modern mind seems like good sense indeed.  However, if you were his patient and you were suffering from epilepsy, his prescription might have been a concoction of burned human bones, wine, and peony juice, along with pills which included the gallbladder of a beaver and bear's testicles.  If that didn't appeal, you could try an alternative:  the liver of a wolf, burned and powdered asses' hooves, and the blood of a tortoise.  Bear in mind, he lived in a time when physicians believed in the evil eye (especially among elderly women, whose humors were considered to be cold and dry), and when people believed that the glance of a menstruating woman could cloud a mirror. 

Taddeo's Life

We have wildly divergent birthdates given for Taddeo.  I've seen dates as early as 1206 and as late as 1223, which means that when he died in 1295 (that one we do know), he was somewhere between 72 and 89.  He was a Florentine, probably from a family of modest means - it's said that as a child he sold church candles. 

He was teaching at the university in Bologna by the early 1260s.  Since in 1260 he would have been at least 37 and possibly as old as 54, this suggests that he may have begun his medical training later than most.

We'll take a closer look at both his teaching and his practice in a moment, but first I'll tell you what little we know about his life. 

He never lost his connection to his native Florence, although he spent his entire career based in Bologna and died there.  His wife, Adela, came from a Florentine family; they were wed in 1274 (when he was somewhere between 51 and 68).  They had a daughter, Mina, born around 1280, who married into the prominent Pulci family in Florence, bringing with her a sumptuous dowry of 1000 gold florins.  Taddeo also had a natural son, Taddeolo, who he legitimated in 1290.

It appears that he may have suffered some incapacitation in the last couple of years of his life, during which time he quarreled bitterly with one of his students (see Students, below).  He may have grown "manipulative and suspicious" in those years, as historian Nancy Siraisi surmises based on his numerous wills and the secrecy with which he surrounded his final will.

That will left large charitable bequests to the inform, sick, and aged poor, as well as a legacy to every hospital in Bologna.  His library of medical and philosophical books he left to the Franciscans and the Servites, and his body was laid to rest in the Franciscan church.

Taddeo's Students

We know the names of six of Taddeo's students, because each of them made a name for himself in his own right.  Here, as a sampling, I give you brief descriptions of the careers of two of these men, both of whom were noted for their contributions to anatomy.  A third student, Dino del Garbo, will merit a separate blog post for some of the odd and mysterious twists and turns his life took.

Bartolomeo da Varignana, the well-to-do son of a physician, did some forensic work for the city of Bologna, including (with four other physicians) conducting an autopsy to shed light on the suspicious death of a nobleman in 1302 - one of the first forensic dissections of the middle ages.  Caught up in the politics of his time, Bartolomeo, a White Guelf, was banned from Bologna in 1311 and joined Emperor Henry VII in his Italian travels.  Upon Henry's sudden death in 1313, Bartolomeo defended Henry's confessor against charges that the emperor had been slain by a poisoned host.

Mondino de'Luzzi, 1275-1326, was the son of an apothecary.  His family was Florentine but moved to Bologna while Mondino was a small child.  Mondino was a major figure in the history of anatomy, and may have performed dissections with his own hands, instead of looking on and directing his assistants, as had been the practice.  Known as "the restorer of anatomy," he played a major role in reintroducing the practice of public dissection.

Taddeo's Teaching Career

Taddeo's teaching at Bologna was so successful that he and his students were granted the same privileges afforded Bologna's elite, the students of law.  Although he was not a citizen of Bologna, the city granted him tax exemption and allowed him to purchase property.  One account states that he was even granted citizenship in 1289.  There is considerable evidence that his teaching colleagues respected him and valued him as a colleague, and chose him on various occasions to serve as arbitrator of their disagreements or guarantor of their agreements. 

Although the city of Bologna valued his teaching, it also liked having him practice medicine there; he may have been part of a team of forensic physicians called on when legal proceedings required a professional evaluation of a wound or the determination of cause of death.  Both Perugia and Venice vied with Bologna for his services, but unsuccessfully.  (He did agree to go to Perugia for a huge salary, but once there demanded even more.  Perugia's rulers refused, so he returned to Bologna.)  Bologna paid him well, his students paid him even better, and he had the freedom to travel to distant places at his pleasure, there to collect still more substantial fees.

Taddeo's Patients

In addition to the patients he saw in person, Taddeo offered his advice via letter to many other Italian physicians.  He traveled, when the price was right, to other cities to see patients in person.  As I mentioned above, he treated a wide range of people, but I'd like to take a closer look at two of his patients:  Pope Honorius IV, and Corso Donati.

Pope Honorius IV, born Giacomo Savelli, held the papacy for only two years.  Born in 1210 in Rome, he died in 1287.  Even at the point where he became pope, gout had incapacitated him, and he was unable to stand or to walk.  In fact, when he said mass he was unable to elevate the host without the help of a mechanical device to lift his hands.  Thus, when Taddeo was called to come to Rome and treat the ailing pope during what proved to be his final illness, no one would necessarily have expected a miraculous cure; the pope's health had been too poor for too long.  Taddeo went, and he commanded the princely sum of 100 ducats a day for his services.  My source says he eventually walked away with 10,000 ducats, a huge amount of money, so he must have been in attendance on the pope for 100 days.  Although Taddeo was probably not the only physician summoned, it was a signal honor to be called.

Honorius IV

Corso Donati, the turbulent Florentine nobleman who was distantly related to Dante by marriage, apparently was both friend and patron to Taddeo, who wrote a health regimen especially for him.  It incorporated much of the same sorts of advice Taddeo proffered to others in his many written consilia, but was specifically tailored to Corso's needs.  The regimen was probably prepared for Corso during one of his tenures as podest√† (a city's chief magistrate, hired from outside the city for a short term, typically a half year).  Corso held that position more than once, and also served as Capitano (another high city office, similarly filled from outside the city in the interest of avoiding bias).  Corso served in one or the other of those offices in 1283, 1284, 1285, 1288, and 1293.  Historians suggest the latest of those dates as the likeliest for the creation of this remarkable book of health advice.  Corso in 1293 would have been in his low forties; he suffered from gout. 

And what did Taddeo advise Corso to do?  Well, among other things, he was advised to wear fine clothing, because the soul rejoices in it; to drink a "subtle and fragrant" white wine; to surround himself with pleasant aromas; to look at beautiful things; to remember pleasant experiences; and to strive for a cheerful disposition.  He also offered general hygiene advice:  stretch in the morning after waking, clean face and teeth, comb hair, walk 1000 steps after eating.

He offered dietary advice as well.  His usual included avoiding bread hot from the oven, and also avoiding cheese, some (if not all) fruit, and fish taken from still water.  Diet should consist of poultry and veal, with moderate amounts of herbs and vegetables.  He generally favored dry cooking methods (though in Corso's case he did advise soup), and he even prescribed specific mixtures of spices.

(Corso may have been less pleased at being told to avoid overeating and overindulgence in sexual intercourse during the summer, practices which Taddeo apparently thought Corso likely to engage in.)

Taddeo on Distillation

And last but not least, we should take a look at Taddeo's extraordinary devotion to the art of distillation.  He wrote a treatise on distillation of wine, a process that had been known since the 12th century but which Taddeo was the first to use medicinally.  And he used it a lot.

A 17th century distillation manual

Here's Taddeo on distillation:
Its glory is inestimable; it is the parent and lord of all medicines, and its effects are marvelous against all cold affections.
 Aqua vitae had endless uses, according to Taddeo.  It could prevent grey hairs and restore youth.  You could drink it, apply it topically, or sniff it.  It could be used to treat eye problems, toothache, facial tics, certain headaches, bronchitis, sciatica, dysentery, quartan fever, gout, and sterility of cold origin.  Not to mention cancer and fistula, plus it has the ability to expel poisons.  Here's his recipe against melancholy and sadness:
A half spoonful (of aqua vitae) every morning, taken on an empty stomach, together with a small dipper of fragrant wine, makes a man glad, merry, and happy, and strengthens all the animal virtues against all thick and turbid spirits.

 One might wonder just how big a spoon he was talking about, and how big a dipper, but hey - it could work.  And on that note, we'll leave Taddeo Alderotti, rock star doctor of the 13th century.

Images in this post are in the public domain, either by virtue of being sufficiently old or of having been placed there by the copyright holder.

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