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Doctors Have Always Gotten a Bad Rap

In their 2013 guide to help physicians curate their online personas, Kevin Pho, M.D., and Susan Gay tell the story of a doctor who, upon Googling herself, finds out that she shares her name with an optometrist accused of deliberately blinding patients. In the age of WebMD, Twitter, and online rankings, the challenges of managing both one’s reputation and the endless stream of misinformation permeating the web have generated new ways of talking about medicine and its practitioners. Skepticism of medical doctors, however, has been around since long before the profession was recognized as such.

The Elisha Whittelsey Collection, The Elisha Whittelsey Fund, 1959

The standardization of technical medical training in universities was a late development in the Middle Ages, in part because many academics considered the activities of wise women and barber surgeons to fall below the study of Aristotelian natural philosophy, astrology, and religious council. Even after universities across Western Europe began teaching hands-on medical procedures, they struggled to obligate patients, including aristocratic and royal patients, to rely exclusively on those with degrees. Well into the fifteenth century, it was inconceivable to mandate that English medical professionals be university-trained. This was because, first, the institutions that gave out these credentials in England, Oxford and Cambridge, were far removed from the most populated areas like London. Second, these urban communities were far too vast to be served by the handful of medical graduates.

The works of two major fourteenth-century authors demonstrate that the skepticism and ridicule with which doctors are often treated to this day existed even as the occupation of the medical professional was still being defined. In his “General Prologue” to the Canterbury Tales, for instance, Geoffrey Chaucer heavily satirizes his Physician, who knows little of the Bible, dresses extravagantly, and reaps financial rewards from the plague. A trained alchemist, he uses his claimed expertise in the scientific properties of gold to benefit from its economic value: “For gold in physic (medicine) is a cordial,/ Therefore he loved gold especially” (1.443-44). Like so many of Chaucer’s professional academics in the Canterbury Tales, the Physician abuses his qualifications in order to line his pockets.

William Langland’s B text of Piers Plowman anticipates the “General Prologue”’s criticism of the Physician. In the last passus, the personification Life seeks out a “phisik” to cure him of Old Age (B.20.169). The “Physician with a furred hood,” to whom Life gives gold “that gladdened his heart,” is similar to Chaucer’s Physician in that, in his greed, he takes advantage of Life’s illness. He plays a greater role in Langland’s allegorical theology when it becomes clear that his craft obscures the need for spiritual healing. The “glass helmet,” or placebo, that he offers Life is an ineffective diversion from the true purpose of Old Age: to direct Life toward virtue and cast out spiritual despair (B.20.172). Just as the Physician of the “General Prologue” has studied a long list of Greek, Arabic, and other medical sources, “but little of the Bible” (1.438), Langland’s “phisik” transgresses in that he displaces spiritual action with medical practice.

L0029312 Woman and doctor talking, Disease man
Credit: Wellcome Library, London. Wellcome Images
images@wellcome.ac.uk
http://wellcomeimages.org
Woman and doctor talking; text from accompanying treatise on scrolls – Woman and doctor hanging a nude woman upside down by her feet from a scaffold over a bucket for suffumigation – Disease man
Ink and Watercolour
1420? MS. 49
Wellcome Apocalypse
Published: –
Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 http://creativecommons.org/licenses/by/4.0/

Both Chaucer and Langland portray physicians who use the cachet of their expertise to exploit their patients. One of Langland’s earliest adaptors, however, demonstrates that not everyone took such a caustic view. The maker of Piers Plowman Z, takes care to specify that medical knowledge is valuable, and that at least some of its practitioners are worth consulting. In interpolated lines not present in any other version of Piers, Hunger says:

I defame not fysyk (medicine), for the science is true,
But incompetent scoundrels that cannot read a letter
Make themselves masters men for to heal.
But they are master murderers who slay men,
And no leches (doctors) but liars, Lord amend them!
In Ecclesiastes the clerk that can read
May see it there himself and then teach another:
‘Honor the doctor,’ he says, on account of the ‘need.’ (Z.7.260-267)

In this passage, the Z maker is more concerned with the intellectual hierarchy generated by medical knowledge than he is with “fysyk” itself. He criticizes those without what he deems sufficient education, he applies the logic that the misuse of medicine can be fatal in order to encourage the exclusion of the untrained, and he adds to this sense of hierarchy by immediately asserting that “the clerk that can read” should mediate the Bible for his less educated audience. This passage indicates that understanding not just of the medical material, but also of the ethical implications underpinning it, must be mediated by a professional. The Z maker’s frustration is akin to that of many of today’s physicians when their patients diagnose themselves using pharmaceutical commercials and online forums. In the case of Piers Plowman Z, this tension is amplified by the integral nature of bodily and spiritual healing in medieval culture.

Erica Machulak
PhD in English
University of Notre Dame
Founder of Hikma Strategies

References and Further Reading

Chaucer, Geoffrey. The Riverside Chaucer. Edited by Benson, L.D. and Robinson, F.N. 3rd ed. Boston, MA: Houghton Mifflin Co, 1987.

Chen, Pauline W. “Doctors and Their Online Reputation.” New York Times, March 21, 2013. https://well.blogs.nytimes.com/2013/03/21/doctors-and-their-online-reputation/.

Dumas, Geneviève, and Faith Wallis. “Theory and Practice in the Trial of Jean Domrémi, 1423–1427.” Journal of the History of Medicine and Allied Sciences 54, no. 1 (January 1, 1999): 55–87.

Fuller, Karrie. “The Craft of the ‘Z-Maker’: Reading the Z Text’s Unique Lines in Context.” Yearbook of Langland Studies 27 (2013): 15–43.

Getz, Faye. Medicine in the English Middle Ages. Princeton, NJ: Princeton University Press, 1998.

Kerby-Fulton, Kathryn. “Confronting the Scribe-Poet Binary: The Z Text, Writing Office Redaction, and the Oxford Reading Circles.” In New Directions in Medieval Manuscript Studies and Reading Practices Essays in Honor of Derek Pearsall, edited by Sarah Baechle, John J. Thompson, and Kathryn Kerby-Fulton, 489–513. Notre Dame, IN: University of Notre Dame Press, 2014.

Langland, William. Piers Plowman: The B Version: Will’s Visions of Piers Plowman, Do-Well, Do-Better and Do-Best. Edited by George Kane and E. Talbot Donaldson. London: Athlone Press, 1975.

McVaugh, Michael. Medicine before the Plague: Practitioners and Their Patients in the Crown of Aragon, 1285-1345. Cambridge History of Medicine. Cambridge, UK; New York: Cambridge University Press, 1993.

Pho, Kevin, and Susan Gay. Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. Phoenix, MD: Greenbranch Publishing, 2013.

Rawcliffe, Carole. Medicine & Society in Later Medieval England. Stroud, England: Alan Sutton Pub., 1995.

Rawcliffe, Carole. Urban Bodies: Communal Health in Late Medieval English Towns and Cities. Woodbridge, Suffolk: The Boydell Press, 2013.

Rigg, A.G., and Brewer, Charlotte, eds. Piers Plowman: The Z Version. Studies and Texts 59. Toronto: Pontifical Institute of Mediaeval Studies, 1983.

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Broken Water Law? Put Some Icelandic on It

Last week, a small newspaper in Storm Lake, Iowa won the 2017 Pulitzer Prize in Editorial Writing for the editor, Art Cullen. Cullen’s campaign against agricultural run-off into the Raccoon River was praised as “editorials fuelled by tenacious reporting, impressive expertise and engaging writing that successfully challenged powerful corporate agricultural interests in Iowa.”[1] Unfortunately, last month the judge dismissed the Des Moines Water Works’s legal suit against Sac, Buena Vista, and Calhoun Counties because agricultural drainage doesn’t count as “point source” pollution covered under section 301 of the federal Clean Water Act (1972).[2] The utility has no legal recourse for the damage of nitrate pollution to the drinking water source for 500,000 Iowa residents.

Water is different from most other legally protected resources because of its mobility and mutability. It doesn’t respect political boundaries despite legal statutes; water cannot be separated out from the physical world we inhabit – not even our own bodies. Stacy Alaimo emphasizes the ineluctable character of material agencies, “the often unpredictable and always interconnected actions of environmental systems, toxic substances, and biological bodies,” that cannot be ignored no matter how hard we try to control our environments. Ursula Heise, analyzing systems rather than agentic intra-action, argues that “what is crucial for ecological awareness and environmental ethics is arguably not so much a sense of place as a sense of planet—a sense of how political, economic, technological, social, cultural, and ecological networks shape daily routines.”[3] In other words, the local environment experienced by an individual cannot be separated from the multifarious aspects of global networks, nor can the global be understood without the local experience of limited primary interaction. We need a system that recognizes the physical and social interconnectivity of water as a part of our bodies, our basic rights, our livelihoods, and our common good.

Since our modern legal system is ill-equipped to deal with these challenges, I suggest an alternative model from the medieval period when people were more cognizant of their dependence on nature. Jónsbók represents an integration of the pre-existing Icelandic legal codes – primarily known to us from the Grágás law codes – and the Norwegian law code, Nyere Landslov (1271-74).[4] The Grágás law codes developed from an oral tradition whereby one-third of the legal code was recited each year at the annual Alþingi, or national legislative meeting where legal claims were resolved. The Jónsbók laws were written down in 1117 by unanimous consent (as the story goes) and two early fragmentary copies survive: Konungsbok (Copenhagen, Royal Library, GKS 1157 fol, c. 1260) and Staðarhólsbók (Reykjavik, Árni Magnússon Institute, AM 334 fol, c. 1280). A later manuscript – Reykjavik, Árni Magnússon Institute, AM 351 fol, fol. 1ra-64rb – provides the best manuscript witness since it includes the complete text of Jónsbók along with the 1294, 1305, and 1314 amendments.[5]

The most significant difference between the medieval Icelandic law code and modern U.S. water laws is in the rights and significance given to in-stream use of water, particularly fishing rights. To understand the U.S. system of water law one must first understand the 100th meridian division and how the landscape and precipitation patterns influenced the historical development of the law. Essentially, riparianism in the Eastern states functions through “the sharing of a watercourse by all of the landowners bordering it, regardless of whether a user had ever put water to work previously.”[6] West of the 100th meridian, precipitation is significantly less due in part to the impact of the Rocky Mountains on rainfall patterns.[7] Prior appropriation – qui prior est in tempore potior est in jure as the California Supreme Court wrote in the seminal case Irwin v. Phillips (1855) – holds that whoever is first to use the water has the first right to the water regardless of land ownership. Over time states began to protect certain uses or adapt riparian principles into the prior appropriation system, but although “[a] states constitutions or statutes declared water to public, … nearly all water was appropriated for private gain.”[8] Neither the riparian nor the prior appropriation systems originally included in-stream usage.

Jónsbók VII,56 creates a community obligation when it delineates the process for reclaiming one’s rights when in-stream rights have been compromised. Blocking the stream and passage of fish triggers the community obligation:

Each man may place nets in his part of the stream, but in such a way that the fish are able to swim up into every part of the stream. God’s gifts [i.e., fish] are to go to the mountain as well as to the shore, if they want to go. If, however, a man blocks the stream, then those men who own the stream higher up are to issue a five days’ notice summons from the assembly to the one who blocked the river to come and remove the blockage. If he refuses to move the blockage, then they are to ask for help to remove it. Each householder who refuses to go with him is fined an ounce-unit to the king. Those who illegally blocked the stream are to pay a mark to each man who lives higher up and who lost the right to fish because of the obstruction in the stream.[9]

Unlike earlier passages which limited recompense to the damages done (to land and animals) and a trespassing fee, persons who block the passage of fish in the river are required “to come and remove the blockage” upon notice by the local assembly. If the offender refuses to remove it, the burden passes to the community at large. Jb. VII,56, therefore, creates a community obligation to correct the damage to the free movement of fish within the river, presumably because it affects all the householders in the assembly regardless of whether they utilize their fishing rights. The damages owed are extended not just to the individual who lost the right to fish but to the king and to “each man who lives higher up” due to the obstruction. In this way, community obligation for the shared right for in-stream supersedes the diversion or obstruction needs of individual users while explicitly recognizing the necessity of river passage for fish populations. The fishing rights section of Jónsbók makes clear that while primary water rights conflict occurs at the immediate interpersonal level, the ripples of such actions impact other riparian owners, local householders, district assemblies, and the super-national treasury, as well as impacting the ability of fish populations to survive human intervention.

Medieval Icelandic code of water rights represents a more ethical and holistic perspective on water rights. Jónsbók-style limitations on water removals and blockages that impede fish migration and movement might have served as a restraining force on the proliferation of dams, water treatment facilities, and industrial waste discharge on the waters of the U.S. by requiring proponents to more thoroughly take into consideration not just other human users, but also the impact on nonhuman organisms, i.e. the flora and fauna that developed within and alongside the riparian biomes.[10] While the Clean Water Act (1972) has attempted to redress the problem of longterm environmental damage due to human actions, it is fighting an uphill battle against long-established rights where individual (mostly corporate) extraction rights are privileged over in-stream usage, the local community’s needs, the larger public good, and environmental concerns. We would be better served by a legal code that recognizes the intersections of needs and rights and Jónsbók provides us with a foundation to build on.[11]

Mae Kilker
University of Notre Dame

[1] Staff & Agencies, “Tiny, Family-Run Iowa Newspaper Wins Pulitzer for Taking on Agriculture Companies,” The Guardian, April 10, 2017, sec. US news, https://www.theguardian.com/us-news/2017/apr/11/tiny-family-run-iowa-newspaper-wins-pulitzer-for-taking-on-agriculture-companies.

[2] Donnelle Eller, “With Water Works’ Lawsuit Dismissed, Water Quality Is the Legislature’s Problem,” Des Moines Register, sec. Money, accessed April 15, 2017, http://www.desmoinesregister.com/story/money/agriculture/2017/03/17/judge-dismisses-water-works-nitrates-lawsuit/99327928/.

[3] Ursula Heise, Sense of Place and Sense of Planet: The Environmental Imagination of the Global, (Oxford, UK: Oxford University Press, 2008), 55.

[4] Jana K. Schulman, Jónsbók: The Laws of Later Iceland, (Saarbrücken, Germany: AQ-Verlag, 2010), xv.

[5] Schulman, Jónsbók, xxii-xxiii. The amendments, in manuscript order, are King Erikr’s Amendments (1294/1295), King Hakon’s Amendments (1305), King Hakon’s Amendments (1314), and King Hakon’s Amendments (1308), which latter pertain only to Norwegian law. It excludes only three sections: royal women’s inheritance, the earl’s oath, and the presiding judge’s oath. Schulman terms the three omitted sections “unnecessary” in the new legal context of the late 14th century.

[6] “A Universal Sense of Necessity and Propriety” in History of Water Rights, n.p.

[7] Excluding, of course, portions of the Pacific Northwest where the biome is a temperate rainforest.

[8] “A Universal Sense of Necessity and Propriety” in History of Water Rights, n.p.

[9] Schulman, Jónsbók, VII.56 (263).

[10] For more on the co-evolution of human culture and nonhuman species within specific geophysical boundaries, see Wendy Wheeler, “‘Tongues I’ll Hang on Every Tree’: Biosemiotics and the Book of Nature,” in Cambridge Companion to Literature and the Environment, ed. Louise Westling. Cambridge, UK: Cambridge University Press, 2014, 121-35.

[11] I’ll be presenting more on water law issues and the approach codified in Jónsbók at the ASLE biennial conference in Detroit (June 20-24).

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Working in the Archives – Manuscript Research at the Khizana al-Hasaniyya, Rabat

One of the major manuscript collections in Morocco is currently the property of His Majesty, King Mohammad VI. The Khizana al-Hasaniyya or the Bibliothèque Royale as it is known, is housed in the royal palace in Rabat and directly attached to the royal residences. The Researcher Annex where most guests of the library work, is detached from the palace yet located within the palatial environs.

Due to the personal nature and physical location of this library, it is necessary for the aspiring researcher to observe security protocol and to put their best professional foot forward. Like many things in Morocco, the rules will not be explained in detail but everyone will act as though you know them. When in doubt, ask questions.

Basic Details

The Khizana al-Hasaniyya is part of the Qasr al-Malik or Palais Royale in Rabat and consists of the main manuscript library attached to the royal residences and the Researcher Annex. The Researcher Annex is opened from 9am-4pm Monday – Friday. Most work is done in the Researcher Annex, a new building completed sometime after 2014 and staffed with computers for manuscript consultation. Be advised that electronic devices such as phones, tablets, and laptops are forbidden in the Researcher Annex, and all bags must be stored in the small cupboard in the corner of the Researcher Annex.

At the time of the visit, the Khizana al-Hasaniyya manuscript library was open only to those researchers with specific codicological research though it is possible for one of the librarians to give you a tour of the Khizana. The manuscripts they have on display are stunning, from early Qur’ans to musicology texts to a copy of Ibn Khaldun’s al-Muqaddima copied by one of his students and annotated in the margins by Ibn Khaldun himself.

Researcher cards can be obtained by contacting the director of the Khizania al-Hasaniyya, Dr. Ahmed Chouqui Binebine (a.binebine@gmail.com), and requesting a meeting with him to discuss your research. Dr. Binebine speaks Darija (Moroccan dialect of Arabic), Fusha (Modern Standard Arabic or MSA) and French; if you do not speak these languages, it is best to arrange your meeting with the help of another scholar with current researcher privileges; that way, they can advocate on your behalf while translating as needed.

If you arrive in Morocco and you don’t have someone in country who can pull strings for you at the Hasaniyya, contact Dr. James Miller, the director of MACECE in Rabat.  He is used to helping Americans make connections with Moroccans and may know someone who can help.

Bring your passport and a copy of the passport face page and the page with your date of entry to Morocco or your Carte de Séjour, your research clearance and/or Lettre D’Attestation, and two passport sized photographs to your meeting. Unlike the BRNM, there is no fee associated with this card. It is unclear as to whether or not researcher cards are valid for a specific amount of time or if this time can be negotiated.

For the record, I was able to gain a researcher card valid for three months. This card is an index sized paper card written in Arabic and stamped with the official seal; you will need it for subsequent visits to the library.

During your meeting, you can also request a copy of the General Index for the Khizana al-Hasaniyya along with other catalogs relevant to your research.  This is invaluable as copies of the General Index are quite hard to come by in the United States (Emory and the Metropolitan Museum of Art have copies of the General Index).

The General Index of Manuscripts for the Khizana al-Hasaniyya. All entries are in Arabic.

While the General Index just lists the manuscripts alphabetically and with little information about the manuscript, the more in-depth catalogs, such as the catalogs on Ash’arite manuscripts and those concerned with Islamic law, are much more detailed.  You can request copies of these subject-specific indexes from Dr. Binebine.

Additional manuscript catalogs; text in Arabic.

Dr. Binebine and other librarians at the Khizana may also give you additional texts, such as their publications on codicology. Dr. Binebine’s 2015 book, Histoire des bibliotheques au Maroc, is worth having for any medievalist or manuscript specialist.

The dress code is business wear, with many Moroccan researchers wearing traditional Moroccan clothes such as djellabas. Looking like you have a valid reason to go to the royal palace will help convince the guards and employees that you are not some random tourist hoping to see the king.

For those spending the day or at least the lunch hour at the Khizana al-Hasaniyya, there is a small arcade opposite the soccer field near the Researcher Annex where you can get a pizza (15 MAD) and fresh orange juice (10MAD) as well as a sandwich on occasion or snacks from the nearby hanout (kiosk). It is best to be discreet about drinking water in the Researcher Annex just to avoid any problems.

Getting There

The Qasr al-Mālik is a massive compound located at the end of the Avenue Mohammed V in downtown Rabat and is guarded around the clock. For your first visit, you will need to present your passport and tell the guard that you have an appointment with the director of the Khizana; the guard will then phone to confirm your visit. For subsequent visits, saying that you are a researcher (chercheur/chercheuse) at the library and presenting your researcher card is enough to get in, though it never hurts to have your passport and your Lettre D’Attestation in case someone asks for it.

Unlike European palaces, the Qasr al-Mālik is more akin to a city within a city, making it difficult for the first time visitor to get to where they are going. For the person going alone, it is best to take a petit taxi to the main gate, Bab Soufara, and then have the cab driver continue through the gate and take you directly to the Khizana.

NB: Make sure the driver takes you to the right spot; simply asking for the Khizana al-Hasaniyya might bring you to the Researcher Annex or it might bring you to the Khizana itself. The same is true when it comes to asking for directions inside the compound. If the cab driver wants to leave you at the gate, it is a 10-15 minute walk to the Researcher Annex from Bab Soufara.

Conducting Research

As previously mentioned, the physical manuscripts are largely off-limits to most researchers, meaning that the majority of manuscript work is now done digitally. To request a copy of the manuscript, you will need to fill out a small request form at the desk in the Researcher Annex and give it to the librarian sitting there; they will then call up the digital copies of the manuscript and load them on one of the computers lining the walls. When the files are ready, the librarian will call you over to the computer.

To request digital copies of the manuscripts, you will need to write directly to the director of the Khizana, Dr. Binebeine, and state what it is you want and why you need it. Do not email Dr. Binebine but present a printed and signed copy of your letter to the librarian at the Researcher Annex and ask them to give it to Dr. Binebine. The librarian will then convey your request and, if it is approved, a digital copy of the manuscript will be given to you within 24-48 hours.

Prior to 2013, digital copies were presented to researchers on CD but as of March 2017, a colleague was able to load the files directly onto a USB stick.

NB: One might be limited to the number of folia they are allowed to request per manuscript. Some have reported that they were only able to request 10 folia of a manuscript, while others said they were able to get 40-50 folia. As such, plan your requests and research accordingly.

Language

The Khizana al-Hasaniyya runs on Arabic, especially Darija. The various manuscript indexes, from the General Index to the more thematic indexes of manuscripts, are in Arabic, along with the manuscript request forms. Researchers should have a solid command of the Arabic script and decent penmanship in order to correctly write out their requests.

Spoken French can get one by in a pinch, especially if one’s vocabulary related to manuscripts is not as strong in Darija or Fusha (MSA) as it is in French. For those researchers who are Caucasian or black, the staff may speak to you in somewhat broken French, assuming that you either come from France (if white) or one of the francophone African countries (if black).

The computers in the Researcher Annex all run Microsoft OS and are in French, not English. The screens are touch screens, meaning that you can pinch and zoom in on the images, as well as swipe back and forth. However, most of the other researchers in the Annex use the mouse so it’s probably best to follow their lead.

When it comes to writing a manuscript request letter, the letter must be in Arabic (MSA) or French. If you are unsure about the protocol or language within the letter, ask the librarian in the Researcher Annex if they have a copy of a request on file for you to use.

Misc.

The Royal Palace is a trip for a medievalist not in the least because it is a functioning palace on the scale of medieval administrative cities.  Those who live on the palace grounds and who work there inherited the position from their family members, many of whom may have been part of the royal slave retinues just under two hundred years ago.  To see the Royal Palace in Rabat gives one a good appreciation for the scale of medieval administrative cities like Baghdad, Samarra, Qayrawan, Cairo, Fez, and Marrakech and for the way in which such palaces were cities in their own right.

For additional resources on the Hasaniyya as well as other manuscript libraries in Morocco, see J. Hendrickson and S. Adil, “A Guide to Arabic Manuscript Libraries in Morocco: Further Developments,” (2013)