1 Introduction: Moving From Practicality to Practice, an Investigation Into Applicability
The following chapters, building on the exploration of the practicality of recipes in Part 1, now investigate the question of applicability.1 While the preceding case studies showcased the practical nature of many of these recipes, including evidence for whether they could have been used, the degree to which this information was potentially relevant to the individuals with access to the texts was not considered. Although many recipes appear to have been practical, is there evidence suggesting that they were relevant to populations in this period? A recipeâs usability (i.e., its practicality) and utility (i.e., its applicability) should not be conflated. As discussed in Chapter 2, examples of individuals who sought to apply medical writings, such as Bishop Cynehard (though he was presumably somewhat unsuccessful in his use of the texts given his complaints about lacking some of the ingredients listed in the recipes), are few and far between.2 The second part of this book, therefore, asks: were these recipes applicable to individuals in early medieval Europe? Are there signs that they address health concerns that affected people during this period?
As noted in Chapter 1, the question of applicability may seem surprising since it is generally assumed that medical knowledge, due to its very nature, has direct relevance. This assumption must be questioned. The situation is more complex because, as Peregrine Horden has explained, medical knowledge may have been recorded, preserved, studied, and passed on for a multitude of reasons, and its use in the context of therapy represents just one of these reasons.3 Moreover, modern scholarship has highlighted that a variety of options were available in the âmedical marketplaceâ, but many of these approaches to healing did not necessarily involve medical writings, whether as teaching texts
The present chapter introduces this investigation of applicability, first outlining in greater detail why the medical textsâ relevance to populations in the Carolingian world deserves a deeper examination. This discussion delineates how the following chapters use the osteological record to re-evaluate the evidence presented by the recipe literature. I then address some of the challenges inherent in bringing together these two bodies of evidence and how they have helped to determine the foci of the case study-based chapters (Chapters 7â9). This introduction ends with an overview of the following chaptersâ analytical framework, including a review of the archaeological sites considered in the case studies.
2 Establishing the Framework of Part 2
2.1 Why Question the Relevance of Recipes?
Although the textual analyses of Part 1 identified the influence of sources beyond the classical canon, the continued significance of classical and late antique medical traditions in the Carolingian period, both as texts themselves and as sources for the recipes analysed in this book, cannot be downplayed.5 The impact of classical knowledge is important to consider since the âhealthscapeâ of Mediterranean Antiquity was not the same as that of early medieval Europe. Not only is it likely that diseases would have differed to some degree, but so, too, would individualsâ experiences of disease. As Faith Wallis affirms, experiences of health, wellness, and disease are culturally conditioned: âwhat human beingsâmedieval or modernâsee in the human body, or in the patterns of disease, is shaped not only by the possibilities and limitations of their experience, but by the structures and meanings that their culture bestows on this experienceâ.6
Despite the potentially stark differences that Mitchell describes, it is also important to recognise that changes to the external forces that shape an individualâs healthscape tend to accumulate gradually. Furthermore, this study contains a number of grey areas, such as the Italian peninsula, where the conditions experienced by classical authors may have been similar to those encountered by early medieval individuals. Consider, for example, the climate and living conditions experienced by a monk in St Gall, a courtier at Aachen, or a scribe in San Vincenzo al Volturno. Many of the external forces acting on the latter individual may have been fairly similar to those encountered by Pliny, Dioscorides, and Galen. The health experiences of physicians writing in Antiquity and of early medieval scribes compiling collections of recipes in the eighth and ninth centuries should therefore be viewed along a spectrum.
Finally, it might be expected that there are certain conditions that were as likely to afflict medieval monks as they were classical physicians, such as
2.2 Working With the Available Evidence
My approach to investigating the relationship between medical knowledge and practice has been shaped by the surviving evidence. While Mitchellâs work on medicine in the Crusades draws in part on the medical information recorded in surgical texts and chronicles, the early medieval written record is generally lacking such testimony. In later periods, medical treatments are discussed in a wider range of sources. Chroniclers, for example, often document conditions in camps, episodes of disease, and even some specific medical cases, ranging from trauma (such as injuries sustained while fighting, hunting, or horseback-riding) and infectious disease (including the famous case of Baldwin ivâs leprosy) to vitamin and mineral deficiencies (such as scurvy).8 Although these writings were not intended as case reports in the modern sense, medical professionals such as Mitchell can analyse their descriptions and assess the information they record. In some cases, chronicles and histories have provided pathognomonic details or have constructed a sufficiently clear overall picture of a condition for a modern medical diagnosis; this is, however, fairly rare, and the issue of retrospective diagnosis will be discussed below. Evidence from legal texts, such as penalties for malpractice, also provides insights into the types of procedures that were undertaken during this period. Comparable textual sources for the early medieval period, such as annals and law codes, tend to present less medical information, though as Chapter 9 demonstrates, they can still offer important evidence.
Secondly, while early medieval medical texts primarily focused on dietary and pharmaceutical treatments and avoided surgery (with bloodletting representing a significant exception), surgical writings feature prominently within the medical literature of the later Middle Ages. Again, Mitchellâs research on medicine in the Crusades offers a useful comparison: he writes that âsometimes the wording of a medical text uses practical examples that give the impression that it was written primarily to be used to treat the injured and at other
In addition to using the textual record, Mitchellâs work on medicine in the Crusades integrates archaeological evidence. His analyses of written sources, skeletal remains, and the results from excavations of hospitals, latrines, and other sites that may produce information regarding health and medicine provide a more comprehensive picture, demonstrating the importance of bringing together complementary types of evidence. Consider, for example, the evidence for surgical interventions. While some surgeries only concern soft tissue, others affect the skeleton and would therefore leave indications of surgical intervention, such as cutmarks, in an individualâs remains. Skeletal evidence and surgical tools found in excavations can then be compared to surgical texts to assess whether particular treatments were put into practice. While this combined approach works for the central and later Middle Ages, the relative lack of early medieval Latin surgical writings combined with the absence of medical equipment, such as surgical tools or pharmacy jars, among the material remains found in early medieval excavations makes this type of comparison impossible for the Carolingian period.10
Yet, although early medieval written sources and material finds, when compared to both earlier and later periods, provide more limited evidence for
So, what can a skeleton tell us? Bones and teeth react to various stresses and age-related processes, including infection, injury, surgery, and repeated use, and, in some cases, these changes leave indicators on the skeleton. An evaluation of an individualâs remains can also reveal information regarding their health and living conditions at various stages of their life: teeth, formed in infancy and childhood, provide information about an individualâs early years whereas bones, which continue to remodel throughout life, can shed light on the final decades of an individualâs life.13 Palaeopathological reports from excavations with early medieval remains can therefore offer insights into the applicability of the medical knowledge in circulation: does the osteological record preserve evidence of the conditions described in the texts? Would the recipes under analysis have been sought by individuals in early medieval Europe?
While the osteological evidence provides a wealth of information, there are, as explained below, a number of challenges that must be considered when studying the skeletal record alongside written sources. Many of these challenges, however, are not insurmountable obstacles and instead have helped to shape the parameters of this bookâs approach. In the following section, I shall address some of the intrinsic issues with archaeological research and theoretical challenges related to the integration of skeletal evidence.
3
3.1 Intrinsic Issues With Archaeological Evidence
At the most basic level, it is important to recognise that the underlying organisation of archaeological research affects its work in various ways, including influencing (or determining) where an excavation will occur, its scope, and its duration. In academic research archaeology, excavation size and timing may be dictated by funding, resources, and the seasonal limitations of fieldwork scheduled around academic calendars. Emergency or rescue archaeology that occurs as a result of construction and development may be more constrained by the requirements and urgency of the project in question. In recent decades, the number of emergency excavations (especially of cemeteries) has grown, a by-product of roadworks, land development, and the redevelopment of urban spaces.15 While this has greatly increased the number of excavated cemetery sites, these projects are, necessarily, carried out under major financial and time pressures, limiting their size, duration, and, in terms of analysing skeletal material, level of detail.16 Although the constraints felt in research archaeology, such as limited funding or fieldwork seasons, may stem from different origins, they often produce similar results. These fundamental restrictions, combined with the potential physical constraints caused by existing structures above ground, often result in only partial excavations of larger sites. This is especially important to bear in mind with excavations of cemeteries, as it makes it difficult to know the extent to which the excavated sample is representative of the site as a whole.17
While the inherent nature of rescue archaeology determines where the excavations occur, research archaeology has more latitude in site selectionâat least in theory. These types of excavations, however, have often concentrated on elite sites, such as religious institutions, royal settlements, or urban centres, based on the research interests of the investigators, the research interests of
It must also be remembered that the geographic distribution of excavations is not evenly spread across western Europe, and certain areas are better represented than others. This is particularly noticeable in northern Italy, where large numbers of Lombard necropoli have been excavated due to the regional interest in Lombard migration and settlement.21 Some of these sites continued to be used in the generations following the Carolingian conquest of Lombard
Moreover, many of the recent, well-documented northern Italian excavations under consideration have published analyses of skeletal remains, something essential to this investigation and that is often lacking in older archaeological reports due to funerary archaeologyâs traditional focus on the study of burial contexts and grave goods rather than the osteological material itself.22 While it is important to recognise that skeletal remains are not always available to study (perhaps a result of cremationâa practice that continued in the Rhineland into the eighth and, in some cases, even the ninth centuriesâor later disturbances of the burial site),23 there has been a significant increase in research on osteological evidence in recent decades, coinciding with the development of new techniques and methodologies, such as stable isotope analysis, that are producing alternative approaches to studying the skeletal record.24 The growing number of publications from excavations across the Carolingian world that not only examine burials but also address their skeletal remains has made this studyâs dual approach possible.
3.2
3.2.1 Retrospective Diagnosis
Retrospective diagnosis, the identification of âan individual case of illness or a disease in history by a modern name or diagnostic categoryâ, can be highly problematic for a wide variety of reasons.25 In particular, there are extensive debates regarding the potential utility of retrospective diagnosis (what is gained from applying a modern medical diagnosis to a past disease experience?), its accuracy (if modern medicine sometimes makes errors in diagnosis, what is the likelihood of correctly diagnosing individuals in the past?), appropriateness from an intellectual standpoint (can a modern diagnosis be applied given the cultural and environmental differences between the diagnosing physician and diagnosed individual?), and potential ethical problems (have the individuals in question given consent?). The following section will review the debates involving retrospective diagnosis, the responses to these issues, and how this study fits into the discussion.
In many cases, retrospective diagnoses have been pursued by physicians interested in the health of a famous individual. Studies of this kind, sometimes labelled âanachronistic diagnosesâ, are often criticised for their modern medical approach to a historical question combined with their less rigorous study of the appropriate historical evidence.26 Axel Karenberg, a physician-turned-historian, explains that retrospective diagnosis âruns the risk of restricting the understanding of history to a biologic processâ; this is particularly true if the cases are not adequately contextualised within their historical period.27 Osamu Muramoto expands on these concerns, noting that retrospective diagnoses rarely address âthe possibility that different diseases might have existed in historical time, or [that] the same disease might have been described through different illness experiences that are bound by a particular historical time and placeâ.28 This raises the question, is retrospective diagnosis useful? And does applying a modern medical label on a past disease experience make sense? Andrew Cunningham takes a hard-line against retrospective diagnosis, arguing that it is neither legitimate nor possible to diagnose diseases from
In addressing the ontological challenge presented by making a diagnosis in the past, Muramoto uses the example of tuberculosis, or rather a Mycobacterium tuberculosis infection. Many retrospective diagnoses are interested in asking âwhether Disease X which we recognise as tuberculosis today is the same and identical disease as âphthisisâ, âconsumptionâ, or whatever they called [it] in historical timeâ.32 This, he argues, is not an appropriate way to investigate a past disease because it does not account for changing environmental, biological, and cultural differences. Instead, he suggests framing the investigation by questioning the ontology of a disease, its persistence and existence through time: âconsider modern tuberculosis representing Disease X, while historical tuberculosis Disease X1. Diseases X and X1 may be related to each other, but they are not identical, or may be clinically similar but may be different entities with different aetiology and pathophysiologyâ.33 Accepting both the difference and similarity or relatability between Diseases X and X1 is crucial to the present study. Continuing with the tuberculosis example, although in a modern medical setting tuberculosis is understood to be caused by Mycobacterium tuberculosis, historical tuberculosis (âconsumptionâ, âphthisisâ, etc.) may have been caused by other pathogens (such as Mycobacterium bovis) that produced a similar result.
Given the underlying questions of this book, thinking about a range of related or similar diseases is more fitting: when considering the potential applicability of medical remedies, I am interested in the symptoms that diseases
Although retrospective diagnosis continues to be debated, this type of non-specific, conservative approach is generally accepted by many historians of medicine. Faith Wallis, for example, writes, âit can sometimes be useful for the purposes of historical analysis to try to determine what modern disease category might match a medieval description; indeed, it can actually enhance our understanding of what the medieval writer is attempting to conveyâ.34 This fits with what the following chapters aim to do: by thinking about the âdisease categoriesâ suggested by the texts with respect to the osteological evidence, it is possible to re-evaluate whether the texts might have been applicableâthat is, whether they record treatments for conditions (or rather the symptoms of conditions) that, based on skeletal remains, individuals experienced in this period.
Returning to Muramotoâs in-depth examination of retrospective diagnosis, he also takes issue with one of the standard approaches to the question âhow do we know what disease a person had?â Many opponents of retrospective diagnosis point out that modern researchers can never know the full medical ârealityâ of an individual in the past since historical evidence, whether textual, art historical, or archaeological, does not represent medical data, or at least not the type of medical data recorded today for the purpose of diagnosis. Yet, fundamentally, âmedical diagnosis is a process of hypothesis-making and hypothesis-adjustmentâ as well as âa probabilistic judgment under uncertainty rather than an apodictic judgement under certaintyâ.35 If modern diagnoses are not given with complete certainty, then retrospective diagnoses should not be held to a higher, impossible standard. Additionally, Muramoto explains that âa clinician is not a natural scientist whose task is to uncover a hidden state of affairs of nature; she is only applying natural sciences to more pragmatic
Muramoto tackles one further epistemological point: the methodologies involved in diagnosis. Modern medicine can diagnose conditions from a number of different approaches: âby clinical signs and symptoms (clinical diagnosis); by laboratory tests (laboratory diagnosis); by genetic tests (genetic diagnosis); by identifying aetiology (aetiological diagnosis); [and] by pathological examination (pathological diagnosis)â.38 Although the study of skeletal remains makes possible the examination of pathologies and even some medical tests, many of the above methods are not available when making diagnoses in the past, adding a further degree of uncertainty. An assessment of the evidence should therefore take these methodological limitations into account, framing the possible diagnosis cautiously, such as âX and Y symptoms or markers are consistent with Z diseaseâ.39 Mitchell similarly advocates a cautious approach to the identification of past disease and suggests using phrases such as âpossible example ofâ, âis compatible withâ, âa probable example ofâ, or âvery likely to representâ Disease X.40
Finally, with this theoretical framework in mind, the question of medical ethics must be addressed. Since this book examines general trends and patterns in the palaeopathological data regarding a selection of conditions, many of the ethical concerns related to retrospective diagnosis pose less of an issue. First, the selected conditions, such as joint disease and oral pathologies, are not diseases that could damage someoneâs reputation posthumously (i.e., reveal information that someone would want to conceal), and secondly, given
3.2.2 The Osteological Paradox
In 1992, James Wood, George Milner, Henry Harpending, and Kenneth Weiss presented the osteological paradox, a series of conceptual challenges that have had a significant impact on the study of palaeopathology.42 While elements of their landmark report have been debated and revised, the points they originally outlined remain essential to consider when analysing the skeletal record in relation to health and disease in the past.43 They identified three major problems: demographic nonstationarity (populations are not stationary but in a constant state of flux), selective mortality (a skeletal sample is inherently biased because it only represents the dead and only represents them at their age of death), and hidden heterogeneity in risks (an individualâs âunderlying frailty or susceptibility to disease and deathâ is unknown).44 The combination of these problems results in the paradox that skeletal remains with evidence of pathologies may actually represent the healthier individuals of the population. To clarify, those individuals with signs of âdisease Xâ lived long enough with disease X for signs of its presence to be recorded in their bones. Individuals from the same burial group without indicators of disease X may have also suffered from disease X but died before it could be recorded in their skeleton. Consequently, individuals who appear healthy based on an assessment of their skeletal remains may actually have been frailer than those with evidence of disease.
While the osteological paradox remains an important collection of concepts with which to engage given the integration of skeletal evidence in the
3.2.3 Selection of Conditions
Palaeopathological evidence for disease, injury, and treatment is grounded in what can be seen on an individualâs remains. That not all medical conditions leave marks on the skeleton restricts the comparison of textual and skeletal evidence to conditions that have the potential to be recorded in teeth and bones. As a result, there are many medical issues that, though they are mentioned by medical texts, cannot be investigated with this approach, including conditions affecting soft tissues (such as stomachaches, liver and spleen pain, and eye problems), external areas (such as hair loss and skin diseases), and mental health. There are, of course, some exceptions. A limited number of conditions affecting soft tissues may be revealed through palaeopathological analysis, but they are often challenging to identify and can go unnoticed fairly easily.45 In the case of cardiovascular disease, for example, abnormal, enlarged blood vessels may leave an impression of their expansion in certain areas of the skeleton, especially around the heart.46 Mummified remains present another exception because soft tissues may be preserved and analysed; the archaeological material under consideration, however, does not contain remains preserved in this
Similarly, some conditions that may at first appear to be unable to leave any skeletal indicators, such as head pain or vision changes, could, in fact, be related to pathologies observable in skeletal remains. For example, an osteoma, a type of benign tumour that can be found in the skull and frontal sinus, could explain these two symptoms, head pain and vision changes.48 A criterion in selecting the conditions to investigate in Part 2 has therefore been the likelihood of a probable correspondence between, on the one hand, a pain or problem described in the texts and, on the other hand, evidence that can be seen on skeletal remains. In the case of an osteoma, it would be impossible to compare these two bodies of evidence given all the possible causes of head pain and vision changes. In contrast, an issue such as tooth pain, loose teeth, and related descriptions can be more meaningfully compared to dental remains from early medieval individuals.
Despite the various limitations outlined above, many conditions can be studied through palaeopathological analyses of human remains. Primary research areas include joint diseases, infectious diseases, metabolic diseases, trauma, disorders of growth and development, dental diseases, and certain cancers.49 Taking the methodological challenges into account and using my knowledge of the recipe literature, the following chapters focus on three of these categories: dental diseases (Chapter 7), joint diseases (Chapter 8), and surgery and trauma (Chapter 9).
3.2.4 Absence of Evidence as Evidence of Absence?
One additional theoretical challenge to consider is the potential absence of osteological evidence for conditions recorded in the texts. If symptoms relating to âDisease Xâ are described in the recipes but unidentified in skeletal remains, does this indicate that the texts were, at least with respect to this disease, irrelevant to early medieval populations? While such a case could suggest that the
4 Outlining the Analytical Approach to Chapters 7â9
4.1 Overview of Sites
The osteological evidence consulted in the following chapters comes from excavations of early medieval sites found across the Carolingian world, and, like the manuscript evidence, represents communities from both the Frankish heartlands as well as more peripheral areas. In total, Chapters 7â9 have considered reports on skeletal material from twenty-one different sites located within the Carolingian Empire and one on the very southern edge, San Vincenzo al Volturno (see the map). The selected sites are located in present-day Germany, the Netherlands, France, Switzerland, and Italy and include excavations from Acqui Terme, Biel, Bolgare, Cairate, Campione dâItalia, Caravate, Cherbourg, Cremona, Desenzano, Kirchheim am Ries, Lorsch, Maastricht, Neresheim, Nusplingen, Ovaro, Quingentole, Rivoli, San Cassiano, Schretzheim, Seckenheim, and Tolmezzo. References are also made to skeletal evidence from contemporary sites in the British Isles (Chapters 8 and 9) as well as to excavations of early Frankish burials (Chapter 9) for comparative purposes. Paralleling the manuscript review of Chapter 2, it is important to comment on the representativity of these sites, especially in relation to their chronological range and geographical distribution.
In many cases, the dates of a siteâs occupation and/or the use of a burial area are only known with relative precision based on stratigraphic evidence or material remains. Occasionally, more exact dating methods, such as radiocarbon dating, are used on osteological remains, providing a date typically within the range of two to three generations. Many of the dates for early medieval skeletal assemblages must therefore be interpreted as approximate rather than absolute. Rarely, however, the existence of complementary documentary
The duration with which a site was used also deserves mention since many sites were active over a relatively long period of time, often spanning several centuries, and may have been used for multiple purposes over this period (settlement, cemetery, quarry, disposal area, etc.), complicating the establishment of a firm chronology.51 As a result, although the sites involved in this study were in use during the Carolingian period, many pre- and/or post-date it, too. This chronological breadth means that some of the skeletal material consulted in the following case studies does not align perfectly with the chronologically narrower textual record. Yet, as noted above, the external and internal factors affecting health and disease, such as the environment and culture, tend to change gradually, thereby allowing for some flexibility with respect to dating. Cemeteries that contain remains pre- or post-dating the Carolingian period by a few generations should, in the majority of cases, still be comparable and relevant to this study. Consider, for example, the cemetery areas of the Abbey of Lorsch. Although they may contain burials spanning the entire period in which the monastery was active (i.e., up to the sixteenth century), radiocarbon dating has provided definite evidence of Carolingian burials within the so-called Mönchsfriedhof, the cemetery that is thought to have contained the monks.52 Additional archaeological evidence, including the cemetery areaâs size and uniformity, suggests that many of the un-dated individuals also lived during the Carolingian period (or at least within a few generations of it) rather than the later Middle Ages. The Lorsch skeletal material, moreover, represents a particularly interesting reference point given its connections with medical texts in the late eighth and ninth centuries: surviving library catalogues indicate that its library housed several medical manuscripts during this period and its scriptorium produced the Lorscher Arzneibuch in c. 800.53 As this codex
Lorsch, situated in the Rhineland, represents a site at the heart of the Frankish Empire. Likewise, excavations from sites in the Netherlands, southern Germany, and Switzerland come from core territories within the Carolingian world. On the other hand, some of the skeletal material considered in Part 2 was excavated on the fringes of Carolingian Francia, such as the burials from Cherbourg. As discussed above, there is also a strong focus on sites from northern Italy. Given Charlemagneâs conquest of the Lombard Kingdom in 774, I have consulted palaeopathological reports from sites in northern Italy which have evidence of continued use during this period. Crucially, these sites not only overlap with the period of Carolingian control of northern Italy but, like Lorsch, they present a particularly relevant sample to study since several of the core manuscripts involved in this study were produced in northern Italian writing centres. The movement of many codices to communities in the Alps and beyond, such as St Gall, Reichenau, and Fulda, speaks to the interconnectedness of these sites and a shared intellectual culture, thus indicating the importance of considering skeletal remains from both sides of the Alps. Finally, I have also included evidence from San Vincenzo al Volturno, a site just on the edge of the Carolingian Empire at its greatest extent, given the known links between this important ecclesiastical centre and others further north.
4.2 The Spectrum of Specificity
Returning to the texts, it is essential to outline a central feature of my assessment of the recipes in the light of the osteological record. As mentioned in Chapter 2, recipes vary enormously in their specificity: an antidote may claim to treat over fifty different conditions, while a simple may intend to heal a single ailment. This variety is important to bear in mind when considering the question of applicability as there is a difference between, on the one hand, a reference to tooth pain in a very general antidote and, on the other hand, a highly targeted remedy for toothache. In the former, tooth pain is one of many conditions that the antidote intends to treat, whereas it is the primary focus of the latter. These examples represent the two ends of the spectrum of
In the following chapters, I shall classify recipes as belonging to one of three levels of specificity: a) non-specific, b) semi-specific, and c) highly specific.55 Generally, antidotes and other recipes that claim to treat a large variety of seemingly unrelated conditions, ranging from snake bites to fevers to stomach pains to gout, fall into the non-specific group; recipes that target a range of similar conditions are considered semi-specific; and recipes that intend to treat a single condition have been classified as highly specific. While the difference between these levels of specificity is subjective, their divisions become easier to see when mapped onto the recipe literature. Consider, for example, recipes that target joint pain: when joint pain is listed as one of a host of different conditions, the recipe is classified as non-specific, but when it is found alongside a more limited number of other symptoms, such as dislocations and fractures, the recipe is considered semi-specific (all of the conditions the recipe intends to treat involve pain management). In contrast, a remedy that only targets joint pain, whether general arthritic pains or a named joint area, falls under the highly specific category. Given the particularly focused nature of highly specific treatments, the following case studies tend to concentrate on this category of recipes in relation to the skeletal evidence.
Having reviewed the significance of the question of applicability and outlined my approach to re-evaluating the recipe literature, it is now possible to turn to the first case study, an investigation into the applicability of early medieval treatments for dental problems.
Wallis, Medieval Medicine, 110â11; âEpistula 114â, in Die Briefe des heiligen Bonifatius und Lullus, ed. Tangl, 247: sed tamen [p]igmenta ultramarina, quae in eis scripta conperimus, ignota nobis sunt et difficilia adipiscendum.
Horden, âPrefatory Noteâ, 1â6.
Flint, âThe Early Medieval âMedicusââ, 127â45; Skinner, Health and Medicine in Early Medieval Southern Italy, see especially Chapter 5 (pp. 79â107); Clare Pilsworth, âCould you just sign this for me John? Doctors, charters and occupational identity in early medieval northern and central Italyâ, Early Medieval Europe 17, no. 4 (2009): 363â88,
Again, see the discussion of this topic in Chapters 1 and 2.
Wallis, Medieval Medicine, xxv-xxvii.
Mitchell, Medicine in the Crusades, 1.
Piers D. Mitchell, âAn Evaluation of the Leprosy of King Baldwin iv of Jerusalem in the Context of the Medieval Worldâ, in The Leper King and His Heirs: Baldwin iv and the Crusader Kingdom of Jerusalem, ed. Bernard Hamilton (Cambridge: Cambridge University Press, 2000), 245â58; Mitchell, Medicine in the Crusades, 185â6, 188â90.
Mitchell, Medicine in the Crusades, 138.
In contrast, excavations at a number of later medieval sites, such as the monastic hospital of Skriðuklaustur, have uncovered a variety of medical tools, including lancets and scalpels: Steinunn Kristjánsdóttir, âThe Tip of the Iceberg: The Material of Skriðuklaustur Monastery and Hospitalâ, Norwegian Archaeological Review 43, no. 1 (2010): 44â62,
Charlotte A. Roberts, Human Remains in Archaeology: A Handbook, rev. ed. (York: Council for British Archaeology, 2012), 6; Piers D. Mitchell, âRetrospective Diagnosis and the Use of Historical Texts for Investigating Disease in the Pastâ, International Journal of Paleopathology 1, no. 2 (2011): 81â8,
Mitchell, Medicine in the Crusades, 10; Fleming, âBones for Historiansâ, 29â48; Fleming, âWriting Biographyâ, 606â14.
Donald J. Ortner, âWhat Skeletons Tell Us: The Story of Human Paleopathologyâ, Virchows Archiv 459 (2011): 247â54,
This review of challenges focuses on those specific to my use of the osteological evidence, such as the location of excavations. For more information on the physical challenges of studying human remains, such as the impact of disposal and decay on skeletal material or the effect of excavation and conservation on its preservation, see Roberts, Human Remains in Archaeology.
John Pearce, âBeyond the Grave: Excavating the Dead in the Late Roman Provincesâ, in Field Methods and Post-Excavation Techniques in Late Antique Archaeology, ed. Luke Lavan and Michael Mulryan (Leiden: Brill, 2015), 441â82, at p. 445.
Pearce, âBeyond the Graveâ, 445, 461.
Ibid, 444.
Ibid, 445â8.
As noted in Chapter 2, the level of medical practice available within and beyond monastic centres continues to be debated. See, for example, Glaze, âThe Perforated Wallâ, 13â14, 69â79; Horden, âWhatâs Wrong with Early Medieval Medicine?â, 8, 10â13, and 16; Nutton, âEarly Medieval Medicine and Natural Scienceâ, 326; Park, âMedicine and Societyâ, 65â6.
Claus Kropp, Anne-Karin Kirsch, Wilfried Rosendahl, Jörg Orschiedt, and Lukas Fischer, Begraben und Vergessen? Knochen erzählen Geschichte: Anthropologische Ausstellung im Schaudepot Zehntscheune des unesco Welterbe Kloster Lorsch (Bad Homburg v. d. Höhe: Verwaltung der Staatlichen Schlösser und Gärten, 2017). My thanks, too, to members of the scientific board of Lorsch, including Claus Kropp and Hermann Schefers, for sharing their insights into the cemeteries and discussing unpublished data from the excavations.
Alexandra ChavarrÃa and Maurizio Marinato, âFrammentazione e complessità nelle pratiche funerarie altomedievali in Italia settentrionaleâ, in vii Congresso Nazionale di Archeologia Medievale. Palazzo Turrisi. Lecce, 9â12 settembre 2015, ed. Paul Arthur and Marco Leo Imperiale, vol. 2 (Florence: AllâInsegna del Giglio, 2015), 61â8.
Roberts, Human Remains in Archaeology, 11, 40.
Willem A. van Es and Willem J. H. Verwers, Excavations at Dorestad 4: The Settlement on the River Bank Area (Amersfoort: Cultural Heritage Agency of the Netherlands, 2015), 227: âin Groningen and further eastwards [cremation] continues until after 800â. For more on early Frankish burial practices, see the work of Guy Halsall, such as Guy Halsall, Cemeteries and Society in Merovingian Gaul: Selected Studies in History and Archaeology, 1992â2009 (Leiden: Brill, 2010) and Guy Halsall, Settlement and Social Organization: The Merovingian Region of Metz (Cambridge: Cambridge University Press, 1995).
Fleming, âWriting Biographyâ, 611â13. On stable isotope analysis, see, for example, Susanne Hakenbeck, âPotentials and Limitations of Isotope Analysis in Early Medieval Archaeologyâ, European Journal of Post-Classical Archaeologies 3 (2013): 95â111. On the relevance of stable isotope analysis to specific questions of past population health, such as dietary practices or age of weaning, see Sam Leggett and Tom Lambert, âFood and Power in Early Medieval England: A Lack of (Isotopic) Enrichmentâ, Anglo-Saxon England 49 (2020): 155â96,
Axel Karenberg, âRetrospective Diagnosis: Use and Abuse in Medical Historiographyâ, Prague Medical Report 110, no. 2 (2009): 140â5, at p. 140.
Osamu Muramoto, âRetrospective Diagnosis of a Famous Historical Figure: Ontological, Epistemic, and Ethical Considerationsâ, Philosophy, Ethics, and Humanities in Medicine 9 (2014),
Karenberg, âRetrospective Diagnosisâ, 144â5.
Muramoto, âRetrospective Diagnosis of a Famous Historical Figureâ.
Andrew Cunningham, âIdentifying Disease in the Past: Cutting the Gordian Knotâ, Asclepio 54, no. 1 (2002): 13â34,
Cunningham, âIdentifying Disease in the Pastâ, 16.
Muramoto, âRetrospective Diagnosis of a Famous Historical Figureâ; Mitchell, âImproving the Use of Historical Written Sourcesâ, 88â95.
Muramoto, âRetrospective Diagnosis of a Famous Historical Figureâ.
Ibid.
Wallis, Medieval Medicine, xxvii.
Muramoto, âRetrospective Diagnosis of a Famous Historical Figureâ.
Ibid.
This take on diagnosis also aligns more closely to the early medieval focus on prognostication. See Wallis, âSigns and Sensesâ, 265â78.
Muramoto, âRetrospective Diagnosis of a Famous Historical Figureâ.
Ibid.
Mitchell, âImproving the Use of Historical Written Sourcesâ, 89.
Richard Hodges, John Mitchell, and Lucy Watson, âThe discovery of Abbot Talaricusâ (817â3 October 823) tomb at San Vincenzo al Volturnoâ, Antiquity 71 (1997): 453â6,
James W. Wood, George R. Milner, Henry C. Harpending, and Kenneth M. Weiss, âThe Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samplesâ, Current Anthropology 33, no. 4 (1992), 343â70.
Consider, for example, the twelve pages of responses to the original article (Wood, Milner, Harpending, and Weiss, âThe Osteological Paradoxâ, 358â70) and later responses such as Mark Nathan Cohen, James W. Wood, and George R. Milner, âThe Osteological Paradox Reconsideredâ, Current Anthropology 35, no. 5 (1994): 629â37; Sharon N. DeWitte and Christopher M. Stojanowski, âThe Osteological Paradox 20 Years Later: Past Perspectives, Future Directionsâ, Journal of Archaeological Research 23 (2015): 397â450,
Wood, Milner, Harpending, and Weiss, âThe Osteological Paradoxâ, 344â5.
Tony Waldron, Palaeopathology (Cambridge: Cambridge University Press, 2009), 224â35.
Waldron, Palaeopathology, 224.
Michael R. Zimmerman, âThe Analysis and Interpretation of Mummified Remainsâ, in A Companion to Paleopathology, ed. Anne L. Grauer (Chichester: Wiley-Blackwell, 2012), 152â69; Waldron, Palaeopathology, 221â3.
Waldron, Palaeopathology, 170â2.
Arthur C. Aufderheide and Conrado RodrÃguez-MartÃn, The Cambridge Encyclopedia of Human Paleopathology (Cambridge: Cambridge University Press, 1998); Anne L. Grauer, ed., A Companion to Paleopathology (Chichester: Wiley-Blackwell, 2012); Waldron, Palaeopathology.
Hodges, Mitchell, and Watson, âThe discovery of Abbot Talaricusâ, 453â6.
Pearce, âBeyond the Graveâ, 467.
Kropp, Kirsch, Rosendahl, Orschiedt, and Fischer, Begraben und Vergessen?, 38â9 and personal communications with members of the scientific board of Lorsch, including Claus Kropp and Hermann Schefers. See Figures 8â14 for a selection of images of skeletal remains from the Mönchsfriedhof.
Bamberg, Staatsbibliothek, Msc. Med. 1; Das Lorscher Arzneibuch, ed. and trans. Stoll; Bernhard Bischoff, Die Abtei Lorsch im Spiegel ihrer Handschriften, 2nd ed. (Lorsch: Laurissa, 1989); Keil and Schnitzer, eds., Das Lorscher Arzneibuch und die frühmittelalterliche Medizin; Adelheid Platte and Karlheinz Platte, eds., Das Lorscher Arzneibuch: Klostermedizin in der Karolingerzeit (Lorsch: Laurissa, 1990); Klaus-Dietrich Fischer, âDas Lorscher Arzneibuch im Widerstreit der Meinungenâ, Medizinhistorisches Journal 45, no. 2 (2010): 165â88.
Note: the recipe books of the Lorscher Arzneibuch do not form part of the present studyâs textual sample since they have received extensive scholarly attention in recent decades. On the Lorscher Arzneibuch, see the references in the preceding note.
In the tables of Chapters 7â9, these categories are generally abbreviated as: NSp, SSp, and HSp, respectively.