Where the Philosopher Finishes, the Physician Begins: Medicine and the Arts Course in Thirteenth-Century Oxford

DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. Whe e he Philosophe Finishes, he Physician Begins: Medicine and he A s Cou se in Thi een h-Cen u y Ox o d ROGER FRENCH (*) SUMMARY In oduc ion. 1.—Medicine in he A s cou se. 1.1.—De sensu e sensa o. 1.2.—On he di e ence be ween he soul and he spi i . 1.2.1.—The Accessus. 1.2.2.—Technical e ms. 1.2.3.—The glo ious Hippoc a es. 1.2.4.—Hea , spi i and pulse. 1.2.5.—B ain. 2.—Hea ing, eading and w i ing. 3.—Inco po a ion and eaching. 4.—The heo y o eaching. 5.—Conclusion. ABSTRACT In he hi een h cen u y he English uni e si ies we e di e en om o he s, pa icula ly hose in he sou h o Eu ope, in wo impo an ways: hey augh mo e na u al philosophy and less medicine. Bu he su i al o s uden s’ no es om he second hal o he cen u y shows ha in he o mal cou se o lec u es on na u al philosophy a en ion was paid o medicine inside he a s cou se. The p esen discussion examines he na u e o his medical ma e ial and he ins i u ional and in ellec ual ela ionship be ween medicine and philosophy. BIBLID [0211-9536(2000) 20; 75-106] Fecha de acep ación: 10 de mayo de 1999 (*) Lec u e in he His o y o Medicine. His o y and Philosophy Depa men , Uni e si y o Camb idge. F ee School Lane. CB2 3RH Camb idge. Uni ed Kingdom. 76 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. INTRODUCTION A is o le’s cycle o eaching a philosophy o na u e a he Lyceum seems o ha e begun wi h he Physics, which explained he gene al basis o na u al change, o mo ion. He hen wen on o explain how hose gene al p inciples came in o e ec in a se ies o ac ual si ua ions, om cosmology o he beha iou o ea hly elemen s and hei mix u es. He did no inish one wo k and hen p oceed o he nex , bu le each in an unpolished s a e so ha i could be modi ied in he u u e, possibly in he nex cycle o lec u es and a e mo e wo k by him and his colleagues. Mode n edi o s o en e e o he incomple e s a e o A is o le’s ex , and p obably he ne e came o a poin whe e he wan ed o p esen a polished e sion o he indi idual wo ks. In his cycle, a e he Physics, he o en e e s back and o wa ds o he o he physical wo ks o indica e how hey we e ela ed, and a leas once e e s o «ou o iginal unde aking» as he en e p ise o which hey we e all pa . A is o le’s la e edi o s saw his cohe ence and gene ally assembled collec ions o A is o le’s physical wo ks in a way ha led om gene al p inciples o si ua ions whe e o m p edomina ed o e ma e in one o he mos complex and mos impo an na u al ques ions, he na u e and ac ions o he soul. I was, o cou se, he human soul, and al hough De anima is no as big as he Physics, he wo ks associa ed wi h i , he Pa a na u alia, ex end he ange and impo ance o A is o le’s enqui y. A is o le ecognized ha he p ope s udy o mankind is man, and ha ing gi en an accoun o man’s body and soul, A is o le obse ed ha he na u al end-poin o a philosophy o na u e would be medicine. He did no each medicine a he Lyceum, because i was a p oduc i e and no a libe al a , bu he o en indica es whe e he physical basis o man’s na u e can become co up ed. Much o his was ecognized when he mas e s o he medie al uni e si ies began eaching om he physical wo ks. This is no he place o e ell he s o y o he in en ion o medie al na u al philosophy. I mus su ice o ecall ha he use o he physical wo ks was a i s con ined o Sale ni an medical men in he la e wel h cen u y and hen, mo e sys ema ically and o en om new and incomple e ansla ions, by he mas e s o he no he n uni e si ies. In he i s hal o he hi een h cen u y, while he physical wo ks we e banned in 77 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. Pa is (1), hey we e s udied in ensi ely in Ox o d, gene a ing exposi o y commen a ies by mas e s such as Adam o Buck ield. In he second hal o he hi een h cen u y, when he bans we e li ed in Pa is, he ea lie English in e es in he physical wo ks led o he p oduc ion o an «Ox o d» o «English» gloss, which became he common p ope y o a numbe o mas e s and hei s uden s: o hal a cen u y o so, i was he English way o eaching he physical wo ks. No es om lec u es we e w i en in he ample ma gins o he hi een h-cen u y ex book o na u al philosophy (2). Al hough medical acul ies came o be es ablished in he medie al English uni e si ies, hey we e nei he impo an no la ge. The numbe o s uden s passing h ough hem was miniscule in compa ison wi h acul ies u he sou h; and in con as oo wi h he uni e si ies o Spain and I aly, no e e yone hough ha uni e si y medicine was necessa y o desi able (3). Wha was impo an in English educa ion was ge ing he MA, o mo e p ecisely incep ing in he co po a ion o mas e s. E e y well-educa ed man was a mas e , ei he o he secula schools o o hose o he O de s o F ia s, and e e yone ag eed ha he physical wo ld was an A is o elian place. Such an educa ed man migh well wish o ex end his lea ning in o medicine. A uni e si y was no necessa y o his, and he did no necessa ily all in o (ou ) ca ego y o «doc o »: he migh gi e ad ice o a medical na u e o he g ea and he good as a p ela e. I is hus o in e es o no e ha s uden s hea ing s anda d (4) lec u es on he physical wo ks in Ox o d in he second hal o he (1) On he Pa isian bans, see DENIFLE, Hein ich (ed.). Cha ula ium Uni e si a is Pa isiensis, Pa is, 1889, ol. 1. (2) The co pus e us ius was he «olde » collec ion o A is o le’s physical wo ks, in use o he second hal o he hi een h cen u y. Recognized as a s age in he « ecep ion» o A is o le’s wo ks because o i s ex ual con en , i s unc ion as a ex book, pa ly demons a ed by i s anno a ions, has ha dly been ecognized. Fo he ecep ion o A is o elianism, see LACOMBE, Geo ge e al. A is o eles La inus, Roma, La Lib e ia dello S a o, 1939-1945, and i s Pa s Pos e io , Camb idge, Camb idge Uni e si y P ess, 1955. (3) See GETZ, Fay. Medicine in he English Middle Ages, P ince on, P ince on Uni e si y P ess, 1998, esp. chap. 1. (4) «S anda d» because he lec u es a e no he indi idual in e p e a ions o single mas e s, bu an ag eed appa a us, a he like he «o dina y gloss» on he Bible. 78 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. hi een h cen u y we e gi en an in oduc ion o medicine in mo e de ail han he A is o elian ex s would seem o wa an (5). They we e eading hese lib i na u ales in he sequence sugges ed by he ea lie commen a o s, beginning wi h he Physics, bu he ca dinal poin was in De sensu e sensa o, one o he Pa a na u alia. I is he e ha A is o le a gues ha he na u al philosophe should acquain himsel wi h he i s p inciples o heal h and disease (bu no , o cou se, wi h he echniques o ea men ), because hese can occu only in li ing hings ( he subjec o his pa o he «o iginal unde aking») (6). This became codi ied as he apo hegm «whe e he philosophe inishes he physician begins»: quia ubi na u ales e minan ibi incipiun medici u dici u in lib o de sensu e sensa o, as he Ox o d mas e s said (7). I was an axiom ha had se ed he doc o s o he Middle Ages well. I was picked up by Isido e (8), and i was jus wha he doc o s a he ime o he new uni e si ies wan ed e e yone o hink. By basing he heo y o medicine i mly on he new philosophy o A is o le hey could s eng hen i immeasu ably, e en o he ex en o e en ually o e coming he adi ional suspicion o he g eedy and less han hones doc o . In ac an impo an pa o he backg ound o he s o y old in his chap e is he a emp by medical men o secu e a place in he inco po a ed See BURNETT, Cha les. The In oduc ion o A is o le’s Na u al Philosophy in G ea B i ain: A P elimina y Su ey o he Manusc ip E idence. In: A is o le in B i ain du ing he Middle Ages, Tu nhou , B epols [Rencon es de Philosophie Médié ale], 1995, pp. 21-50 and FRENCH, Roge . Teaching A is o le in he Medie al English Uni e si ies: De plan is and he Physical glossa o dina ia. Physis, 1997, 34, 225-296. (5) The MSS con aining he Ox o d gloss in an English hand used in his s udy a e: London, B i ish Lib a y, Royal 12 G II [hence o h II]; Royal 12 G III [hence o h III]; Royal 12 G V [hence o h V]; Ha ley 3487 [hence o h H 3487]. Du ham, Ca hed al, C III 17 [hence o h C III 17]. Va ican, U b. La ., 206 [hence o h UL 206]. Nü nbe g, Cen . V 59. Esco ial, F II 4. (6) De sensu e sensa o 436a. A is o le adds ha i was no uncommon o philosophe s o inish o hei books wi h a discussion o medicine and o doc o s o begin hei s wi h philosophical p inciples. (7) C III 17, . 382 . (8) GETZ, no e 3, p. 48. 79 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. uni e si y. The ise o he no he n uni e si ies as o mal g oupings o mas e s was app oxima ely coinciden wi h he ansla ion o he physical wo ks o A is o le in o La in. Al hough he Sale ni ans has been using some o hese wo ks o se e al decades, in he no h we seem o see his ansla ion and use as he business o philosophe s. In he p e ious cen u y, he medical man had been ecognized as some hing o an expe on he physical wo ld and i s mic ocosm, he human body, and he was o en called a physicus, because he s udied physica. Bu some o he men in ol ed in ansla ing he new A is o le hough ha hey alone knew wha eal na u al philosophy was and sco ned he ade o medicine. Al ed o Sha eshill, one o he i s ansla o s and commen a o s o he ex s in ques ion, conside ed himsel o be a philosophe , and snee ed a he doc o s as me cena y ea e s o diseases (9). The e was ample jus i ica ion in he educa ional di ision-o - he-sciences li e a u e o ega ding pu ely in ellec ual opics such as na u al philosophy as supe io o manual and p oduc i e a s such as medicine (10); and i mus ha e been pa ly because medicine was a oca ional subjec ha A is o le, he model philosophe o he new a s cou se, did no ex end he cou se a he Lyceum in o medicine. This a i ude owa ds doc o s canno ha e made i easie o hem o ha e secu ed a place o hei subjec in he no he n uni e si ies. Pe haps be o e he doc o s succeeded in es ablishing hei acul y a Ox o d he philosophe s ga e li le a en ion o me- dicine. An example is Adam o Buck ield, who commen ed on pe haps all o he physical wo ks o A is o le be o e he end o he 1240s; ha is, be o e he Ox o d medical acul y lou ished, be o e he philosophy s a u es, and while he physical wo ks we e s ill banned in Pa is. His commen a y on De di e en ia spi i us e anime does no men ion me- (9) See BARACH, Ca l Sigmund (ed.). Exce p a e lib o Al edi Anglici De mo u co dis i em Cos a-ben-Lucae de di e en ia animae e spi i us, Innsb uck, 1878, p. 94. (10) On he di ision o he sciences see, o example, GUNDISSALINUS. De di isione philosophiae. In: Clemens Baeumke ; Geo g F ied ich on He ling (eds.), Bei äge zu Geschich e de Philosophie des Mi elal e s, Müns e , 1906; and BUTTIMER, C. H. (ed.). Hugonis de Sanc o Vic o e Didascalicon, Washing on, De S udio Legendi, 1939. 80 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. dicine as a opic (11). He does no ake he oppo uni y o enla ging on a numbe o opics deal wi h by la e eache s: he skills o he «mos glo ious» Hippoc a es, and he di e ences o opinion be ween he philosophe s and physicians on he opics o he numbe o en icles o he hea , he o igin o he eins, a e ies and ne es, and he unc ion o he en icles o he b ain. These came o be e y common opics in he uni e si ies, bu pe haps only a e he medical men had secu ed hei subjec he e and he mode o eaching had shi ed om commen a y o dispu ed ques ion (12). The pu pose o Adam’s commen a y was qui e di e en , namely, o expound he s uc u e o he ex so ha he eade and Adam’s s uden audience could unde s and i s mo phology and i s au ho ’s in en ions in all o i s pa s. S ic ly, he was an exposi o a he han a commen a o in he ull sense, o a commen a o would ha e—a e his exposi ion—illumina ed obscu i ies and esol ed p oblems such as hose a ising om a compa ison wi h o he au ho s and o he subjec s. The ch onology o hese changes is impo an . In summa y, Adam o Buck ield was commen ing on he physical wo ks in and pe haps be o e he 1240s, when A is o le was s ill banned in Pa is, and while a commission se up by Pope G ego y IX in 1239 o excise he o ensi e pa s o A is o le was s ill si ing. T adi ionally, Roge Bacon began o each na u al philosophy in Pa is in he mid 1240s and by 1252 he English na ion in Pa is was in a posi ion o speci y De anima as a necessa y pa o he cu iculum. The uni e si y soon ollowed wi h a comple e lis o he lib i na u ales. The «olde collec ion» o he physical wo ks, he co pus e us ius, a ose—appa en ly be o e he p omulga ion o hese s a u es— o p o ide he ele an ex s (13). I may ha e a isen in Ox o d: one o he oldes exempla s was w i en (and anno a ed) in an English hand and wen y peciae o i we e comple e by 1250 and pa s o i may be a decade olde (14). (11) See FRENCH, Edmund. Adam o Buck ield and he Ea ly Uni e si ies, Ph.D. Disse a ion, Uni e si y o London, 1998, pp. 131-143. (12) See CALLUS, Daniel A. In oduc ion o A is o elian Lea ning o Ox o d. P oceedings o he B i ish Academy, 1943, 29, 229-281. (13) See DENIFLE, no e 1 and LACOMBE e al., no e 2. (14) UL 206: see LACOMBE e al., no e 2. 81 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. 1. MEDICINE IN THE ARTS COURSE 1.1. De sensu e sensa o Thus, when we mee e e ences o medicine in lec u es o bachelo s hoping o become Ox o d mas e s, we a e looking ( ha is, wi hin he Ox o d gloss) a a discipline ha had no ye e ec i ely inco po a ed i sel in he uni e si y. No English-educa ed medical man is known om he hi een h cen u y and he e was no deg ee-gi ing acul y o medi- cine be o e he ou een h (15). The na u al-philosophy lec u e was no looking o e a acul y wall a wha he medical eache s we e doing bu a medical w i ings gene ally. Bu in wha he said we can see some o he ma e ials and echniques wi h which i would ha e been possible o de end and de elop ins i u ional medicine. Le us look i s a De sensu e sensa o. I is gene ally in con as o he medical man ha he eache o na u al philosophy calls himsel a na u alis. A na u alis conside s (as A is o le had said) he i s p inciples o heal h and disease, whe eas a p ac ical medicus does no (16). No all medical men we e o cou se simply p ac ical, bu whe e hey s udied p inciples, he p inciples we e seconda y o «p oximal» (17). E en when medical men hough abou he e y p inciples o li e and dea h, hey we e di e en p inciples (18). The na u alis o cou se ealized ha me- dicine had i s heo e ical, specula i e, side (19); bu he di e ences be ween and he ela ionship o he wo disciplines was one o subal e na ion. This oo was an A is o elian doc ine and explains how he p inciples o (15) GETZ, no e 3, p. 17. (16) H 3487, . 216 : «[de medicina] ides quidam medici u p ac ici incipiun ad p ac icam medicine e non conside an p ima p incipia sani a is e eg i udinis de quibus amen conside a na u alis». Also II, . 382 ; III, . 245 ; C III 17, . 363 . (17) III, . 245 : «[de medicina] ides ad p oxima p incipia que sun de consilio medici, e non conside an p ima p incipia sani a is e eg i udinis de quibus an um conside a na u alis». Also II, . 382 . (18) Esco ial, F II 4, . 181 : «[p ima] ides que sun eadem cum p imis p incipiis i e e mo is lice p incipia de quibus habe medicus conside a e non sin eadem qua e e ce e a». H 3487, . 216 . (19) CIII 17, . 363 . 82 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. a subal e na ed scien ia a e aken om he discipline o which i is subal e na ed. The doc o s, p obably om A icenna, we e much conce ned wi h he impossibili y o ques ioning, wi hin medicine, axioms impo ed om na u al philosophy: i was w ong e en o y. Wha is p o ed in a subal e na ing discipline mus be accep ed in a subal e na ed discipli- ne (20). Subal e na ion was an in ellec ual jus i ica ion o ins i u ional dis inc ions. The conso ium o eaching mas e s was a guild o eache s. Like o he guilds, his was ecognised in law, p o ided ha i plied a eal ade. Being ecognized, i was aken as he only legi ima e au ho i y on he ade i p ac ised. Whe e ha ade was selling knowledge, he philosophe s and la e he medical men p onounced hei own cu icula and au ho i ies. The medical acul y became almos a guild wi hin he b oade conso ium o mas e s, and in I aly a leas e en specialis s such as ana omis s had guild-like au onomy. A man could mo e om being a p o essional eache o philosophy o one o medicine and hem pe haps o ana omy. In doing so he changed his mode o exp ession, his ancien au ho i ies and his p o essional conclusions. Medie al philosophe -physician dispu es we e e en s ha bea he mu ual bounds o subal e na ed disciplines, no ailed sea ches o a physical u h. Wi hin medie al na u al philosophy i sel , he sequence o A is o le’s lib i na u ales was seen pa ly as a conca ena ed subal e na ion. E en he non-A is o elian De di e en ia spi i us e anime was said—by Adam o Buck ield— o be subal e na ed o De anima. Mo eo e , i was he las in ha b anch o subal e na ion, a «comple i e» wo k because i deal wi h all spi i , he common agen o all ac ions o he soul (21). E en mo e (20) Nü nbe g, Cen V 59, . 221 : «sicu illud quod p oba um es in scien a subal e nan e debe supponi in scien ia subal e na a». Gen ile da Foligno (d.1348) adop s om A icenna almos a mo al doc ine ha he medical man should no y o p o e he axioms he bo owed om philosophy: «medicus debe illa c ede e e non p oba e and e go medicus debe c ede e sua p incipia e non debe a iocina i de eis, ides p oba i e p ocede e». See P imus A i. canon. A icenne medico um p incipis canonum libe una cum lucidissima Gen ilis Fulg. exposi ione, Venice, hei s o Oc a ian Sco , 1520, . 9 . (21) «Ideo simul de e mina de anima e e iam de di e en ia spi i us ad animam, e quia sua scien ia comple u in hac di e en ia ideo ab illo sicu a comple ico 83 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. p ope ly, he Pa a na u alia ook hei p inciples om De anima (22). Thus De sensu e sensa o was a book subal e na us om De anima, and a he same ime subal e nans o medicine. The connexion be ween he wo disciplines, he poin a which philosophical axioms we e deli e ed o medicine, was he Isagoge o Johanni ius. This was he i s wo k in he medie al ex book o medicine, he A icella, and a he ime o he Ox o d lec u es, he only one con aining any heo y o medicine. I is a e y sho diges o he p inciples o G eek medicine, so compac ha he Sale ni ans and o he s may ha e sea ched ou bigge wo ks, o A is o le, Galen and e en A icenna, o he pu pose o explaining i . In indica ing o his s uden s (who we e no ye philosophe s) ha medicine was subal e na ed o philosophy, he mas e was also showing hem many o he undamen als o medicine: necessa ily so, o hese we e he unassailable philosophical axioms ha he medical man should no ques ion. No hing was mo e undamen al o he pe ipa e ic wo ld pic u e han he ou elemen s and he ou elemen a y quali ies, sha ed in pai s be ween he elemen s. I was in e ac ion be ween he quali ies ha p oduced he mixed bodies and ac ions o he e es ial wo ld, he business o he medical man. B oadly speaking, he mix u e o he quali ies p oduced a complexio, and e en he cause-and-e ec ac ion o he celes ial bodies on ea h was a «complexioning». «Complexion» was also a medical e m, wi h he same gene al meaning—a speci ic mix o quali ies. Tempe amen um was a ela ed e m and bo h could apply ei he o he solids o he body (composed ul ima ely o he elemen s) o o he humou s (cha ac e ized p incipally by hei elemen a y quali ies). The undamen al ac o G eek heo y was ha heal h was a balance o quali ies, whe eas disease was an unbalanced s a e. denomina u is e libe , e es ul imus in e lib os subal e na os lib o de anima». See FRENCH, no e 11, p. 131. Because mo e han one discipline could be subal e na ed o a single p eceding discipline, he classi ica ion could be a b anching one. Adam exp esses his in his in oduc o y accessus o De di e en ia spi i us e anime by means o he impo an ques ion, «To wha pa o philosophy does i belong?» (22) Esco ial, F II 4, . 181 : «[consequens es ] scilice in hoc lib o e in quibusdam sequen ibus lib o de anima subal e na is aliquo modo». And «[subiacea u ] ides supponan u in hoc lib o e in elinquis sequen ibus sicu de e mina a in supe io i scien ia». Also III, . 245 ; II, . 382 . 90 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. A abic ansli e a ion unnecessa y (35). Bu «a e y», a e ia, i sel was a echnical e m and needed explaining in he common gloss, pa icula ly since he windpipe was called he «ha sh a e y» and ca ied ai a he han spi i (36). «A e y» was also a echnical medical e m ha a oided he olde and clumsy «pulsa ile ein» used, o example, by Adam o Buck ield w i ing in a philosophical a he han medical way (37). One exempla o he gloss has an unusually la ge pos il explaining wha is mean by «a e y» as a echnical medical e m (i includes he «a e y o he oice» o he wise known as he «ha sh a e y», ou achea) (38). Ano he obscu i y conce ned he ne es. The common gloss poin s ou ha Cos a did no men ion he ne es se ing he sense o ouch, because ouch is a sense o he whole body and no jus o a single sense o gan. No did he men ion he ne es o he sense o smell, pe haps (35) «Spi i us es quoddam co pus sub ile quod in humano co po e o i u ex co de e e u in assu iane , ides in enis pulsus ad i i icandum co pus; ope a u que i am e aneli um a que pulsum». See FRENCH, no e 11, p. 290. The gloss: II, . 359 : «[pulsum] e es pulsus secundum medicos mo us co dis e a e ia um ad in igidacionem calo is inna i e ad expulsionem umo um supe luo um u pos ea habebi u ». Also V, . 222 and C III 17, . 381 . (36) C III 17, . 381 : «I em no a quod pulsus es mo us co dis e a e ia um ac us secundum ele acionem e dep essionem ad in igidandum inna um calo em. I em no a quod a e ia es co pus o undum oblongum ad ins a cannalis a co de incipiens pe o um co pus di usum ae em ocalem e spi i um con inens». (37) This is explici in one exempla whe e a agmen o Adam’s commen a y is used as a supplemen o componen o he Ox o d gloss: «No a quod in co po e humano sun duo gene a ena um scilice ene non pulsa iles in quibus de e u sanguis pe o um co pus e ie[is e?] ocan u communi e ene e ene pulsa iles in quibus de e u spi i us i alis pe o um co pus e is e ocan u communi e a e ie. e in hoc lib o ocan u ene pulsus». C III 17, . 381 . (38) C III 17, . 381 : «No a quod es sun spi i us secundum medicos unus qui o i u in co de e ex endi u in enas pulsa iles e is e dici u spi i us i alis. alius es spi i us na u alis qui o i u in epa e e ex endi u ad enas non pulsa iles. e ius es spi i us animalis qui o i u in ce eb o e ex endi u pe conca i a es ne o um de duobus au em scilice i ali e animali in endi in hoc lib o. I em no a quod pulsus es mo us co dis e a e ia um ac us secundum ele acionem e dep essionem ad in igidandum inna um calo em. I em no a quod a e ia es co pus o undum oblongum ad ins a cannalis a co de incipiens pe o um co pus di usum ae em ocalem e spi i um con inens. Spi i us es quoddam co pus e c.». 91 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. because he b ain i sel was eckoned he ins umen o smell (39). Indeed, he gloss ackles he long-s anding con usion o he wo d ne us i sel . This wo d was used in La in o any h eadlike s uc u e in he body, ma ched by neu on in he G eek. When he Alexand ians disco e ed mo o and senso y ne es, hey used neu on in a echnical sense, and in La in ne us ca ied bo h meanings, dis inguished by con ex . Bu he pic u e was con used because A is o le, who had no knowledge o he ne ous sys em, desc ibed sinewy h eads in he hea . These appea ed in La in as ne i, and could be used as e idence by hose who a gued ha A is o le did know abou ne es and said ha hey o igina ed in he hea . The La in ansla ion o he A abic pa aph ase o Galen’s De usu pa ium also has ne i in he hea , which seemed o con i m he pseudo- A is o elian iew. The common gloss enla ges on Cos a’s dis inc ion be ween ha d ( ha is, sinewy) and so ne es, which i says a e hollow and ca y animal spi i om he b ain; and i con i es o lessen he o ce o he con adic ion wi h A is o le, who in he new ansla ions could be seen as saying ha he e we e no ne es in he b ain (40). 1.2.3. The Glo ious Hippoc a es The common gloss d aws a en ion o he di e en opinions o he medical men in a numbe o a eas. P obably no hing could be aken o g an ed abou he s uden ’s p e ious knowledge o medicine, o e en (39) II, . 361 : «[accidi ] non ide u mencionem de ne is ansmissis ad ins umen um ac us quia ac us non ige in una pa e co po is de e mina a sed ubique; nec ad ins umen um ol ac us, quia am p incipium es ce eb o quam si ce eb um el aliqua eius pa s, dubi a i posse um dici quod angi pe hoc quod dici sex um descendi ad ex a ides ad quedam in e io a e o e ce eb um es in media um ins umen um sensus odo a us el adminus eius ins umen um immedia ius es adhe ens ce eb o quam alicuius al e ius». Also C III 17, . 383 . (40) C III 17, . 383 : «No a quod dua sun gene a ne o um. sun enim quidam ne i solidi qui sun solidissima pa s co po is ... e ille sun ad sus amen um co po is non minis an es sensum e mo um ... alii sun ne i conca am in quibus de e un u spi i us animales a ce eb o ... Nec con adici huic quod [A is o eles dici ] in de [animali]bus quod in ce eb o non es ne us quia ibi loqui u de ne o p op ie dic o qui solidus e non conca us». 92 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. he wo d «su ge y» had o be explained (41). We can examine a numbe o opics in John’s La in ex in u n. The i s is he epu a ion o Hippoc a es, he Fa he o Medicine. Then he e is a g oup o opics cen ed on he na u e o he spi i s and he ac ions o he soul. The Ox o d eache could o en d aw om con empo a y medical men de ails no a ailable in he ex he is glossing, ha o Cos a ben Luca. Whe e Cos a e e s o « he mos glo ious Hippoc a es» i is p obably simply an hono i ic o he single Fa he o Medicine, amously econciled wi h Pla o by Galen. John o Alexand ia, he ea ly medie al commen a o on Galen’s De sec is, also called Hippoc a es «glo ious». Bu o he Ox o d eache he e m ecalled a p ecise loca ion in a Hippoc a ic ex . This was he P ognos ics, whe e he au ho , belie ed o be Hippoc a es himsel , e e s o he «glo y» o be acqui ed om he good use o echniques o p ognos ica ion: Hippoc a es was glo ious o he Ox o d expounde o he common gloss because he p ognos ica ed (42). Me- die al doc o s we e highly ali e o he mechanisms o gene a ing a good image o hemsel es, and he ees ha ollowed, and i seemed as hough he glo y ha Hippoc a es men ioned could be achie ed by hem. The image o he physician aising he u ine lask o ca ch he ligh in o de o p ognos ica e is almos a adema k o he medie al physician, and was a display o indica e o he onlooke s ha he physician could ell he pas , p esen and u u e s a e o he pa ien . The P ognos ics was an impo an componen o he medie al medical ex book, he A icella, and some o i s echniques we e codi ied, along wi h o he sca e ed ema ks in G eek medical w i ings, by he Byzan ine Theophilus in his ac on p ognos ica ing om u ines. This oo was pa o he A icella, and so again i seems likely ha his collec ion o sho wo ks was known o he philosophy eache . (41) Cos a uses «su ge y» in place o «ana omy» when desc ibing Galen’s De Usu Pa ium: «... ex lib o quoque galieni quem eci de conco dia qua umdam sen en ia um glo iosissimi ypoc a is a que pla onis e ex lib o eiusdem galieni quem in ope e ci u gie e in u ili a e memb o um». See FRENCH, no e 11, p. 289. The gloss explains «su ge y» in he simples e ms: «[in ope e cy u gie] Si u gia es a s cu andi ulne a e acciden ales lesiones enien es ab ex a». V, . 221 . (42) II, . 358 : «[ipoc a is] glo iosissimi quia in e omnes loquen es de medicina p ognos ica laudis debe u ypoc a i». Also V, . 221 ; H 3487, . 202 and C III 17, . 381 . 93 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. 1.2.4. Hea , Spi i and Pulse A second a ea ela ing o bo h philosophy and medicine was conce ned wi h he en icles o he hea , impo an in he p oduc ion o spi i . I came o be a opic o much dispu e in he Middle Ages why A is o le had said ha he hea had h ee chambe s and Galen had said wo. Cos a, w i ing «wi h he g ea es b e i y», does no men ion he A is o elian posi ion. He speaks ins ead o he p aisewo hy philosophe s and medical men who we e expe ienced in su ge y in he li ing body and who hough ha he hea con ained wo en icles. He also used he e m «su ge y» o he dissec ions and i isec ions ha Galen used in On he Use o he Pa s, so o him he e m may ha e mean some hing close o «dissec ion». I so, hen he may be echoing he old s o y o he Alexand ians He ophilus and E asis a us i isec ing condemned c iminals, especially since he emphasizes he wo ds «in he bodies o he li ing», which would be edundan in connexion wi h «su ge y» in ou sense (43). The Ox o d gloss, in con as , gi es he loca ions (44) o he A is o elian iew and explains how Cos a, by igno ing him, con adic s A is o le. I also gi es he esolu ion o he p oblem ( ha he medical men ake he middle and le en icle as a single ca i y) o e ed by Al ed o Sha eshill in his De mo u co dis (45). Books wi h his i le (43) «E quidem ex laudabilibus medico um a que philosopho um de his qui in co po ibus i en ium usi sun ope e ci u gie pu a e un quod in co de sun duo en iculi el conca i a es, una scilice in dex a pa e eius e alia in sinis a, e in his duobus en iculis con ine u sanguis e spi i us; sed in dex o en iculo plus es de sanguine quam de spi i u; in sinis o e o plus spi i us quam sanguinis». See FRENCH, no e 11, p. 290. (44) In De sompno e igilia and he animal books. (45) II, . 358 : «[duo en iculi] a is o eles in lib o de sompno e igilia in ine p ius doce quod iii alami sun in co de, simili e in ine p imi de animalibus dici quod iii sun en iculi in co de e i a au o is e con adici u a is o ele, qua con a i a e in e medicos e a is o elem eci a al edus in lib o de mo u co dis e de e mina docens quoniam sun iii secundum a is o elem e quoniam sun ii secundum medicos qui medium alamum e sinis um epu an p o eodem». (H 3487, . 203 ). This gloss also appea s in Pa is, Biblio hèque na ionale, la . 12953, . 276 , which adds ha he physician is a philosophe conce ned wi h sensibles: «No a quod medicus qui sensibilis philosophus poni spi i um esse medium in e co pus e animam in animalibus». (Al ed’s ex da es om abou 1200). 94 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. became almos a gen e o li e a u e in he Middle Ages p ecisely because hey deal wi h he impo an p oblem ha we a e conside ing he e, he loca ion and na u e o he soul and spi i s. Al ed’s became s a u o y in some uni e si ies (46). Second, he i al spi i , gene a ed in one o he wo en icles o he hea , was acco ding o Cos a ca ied in he « eins o he pulse» o he body o p oduce li e, b ea h and he pulse. The Ox o d gloss poin s ou ha «pulse» has an impo an medical meaning, o he doc o s unde s and by i a mo ion o he hea and a e ies ha cools he inna e hea and e acua es smoky was es (47). Cos a’s ex is mo e medical han he gloss: he says ha he con ac ion and expansion o he hea p oduced he «pulse o he whole body» and ha he pulse indica ed he s a e o he hea and i s own pa icula su e ings, in lic ed ei he om neighbou ing pa s o om i s own na u e (48). Diagnosis om he pulse was a medical a he han philosophical a ai and Cos a is e lec ing his medical sou ces. Philosophe s had o know ha he pulse was p ognos ic (49), bu he gloss does no go in o he echnical de ails, obse ing ha some aspec s o he pulse we e impo an only « o he medical men» (50). Fo he philosophe , in con as , he pulse «is no hing (46) See CALLUS, no e 12, p. 238. Al ed’s ex was adop ed by mid-cen u y o he las pa o he scien ia na u alis in e io . (47) II, . 358 : «[pulsum] e es pulsus secundum medicos mo us co dis e a e ia um ad in igidacionem calo is inna i e ad expulsionem umo um supe luo um u pos ea habebi u ». Also V, . 222 . (48) «Co enim colliga u a que ex endi u , e pe ex ensionem eius a que collec ionem i pulsus o ius co po is, e ideo pulsus indica esse co dis, ides eius passiones p op ias am equales, quam inequales a que di e sas que iun causa di e si impedimen i eiusdem co dis quod accidi ei a seme ipso, el a quibusdam memb is sibi icinis». See FRENCH, no e 11, p. 290. (49) II, . 359 : «[inequalies a que] pulsus os endi passiones». (50) C III 17, . 381 : «[pulsus indica ] ides spi i us aciens pulsum scilice medicis». C III 17, . 381 : «[seme ipso] e huius pulsus indica medicis que sic innui ...». Since he Ox o d gloss men ions he P ognos ics, i s au ho (s) would ha e been amilia wi h he A icella, ano he p ognos ic ex o which was ha on he pulse, bea ing he name Phila e us. 95 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. mo e han he ele a ion and dep ession o he pulsa ile ein» (51), which eaches he whole body (52). 1.2.5. B ain The Ox o d gloss epo s ex ensi ely on wha happens in he pa o Cos a’s ex ha desc ibes how he i al spi i , gene a ed in he hea and ansmi ed o he a e ies, is con e ed a he b ain in o animal spi i and en e s he en icles. The ques ion was one o he en icles o he b ain and which powe s o he soul we e exe cised in hem. While Adam o Buck ield cha ac e is ically con ines himsel o he ci a ion o lemma a and he subdi ision o ex be ween hem, he Ox o d gloss e e s o he opinions o he medical men mo e on his opic han on all he o he s pu oge he . Cos a’s ex says ha he b ain is double, i s pa s being an e io and pos e io . The an e io pa con ains wo en icles joined by a cen al common space. The pos e io pa o he b ain con ains a single en icle, also communica ing o he common middle space. Con olling access o he en icles by he spi i is a wo m-like body which mo es, opening and closing he en ances o he en icles (53). Galen had a gued ha he ea o he b ain is ha d and he e o e sui able o memo y and he ini ia ion o mo ion, and he so an e io ma e o he b ain was app op ia e o he ecep ion o he (51) II, . 359 : «[ o ius co po is] ... unde pulsus nichil aliud es quam ele acio e dep essio ene pulsa ilis». Also C III 17, . 381 ; H 3487, . 202 ; V, . 222 . (52) II: «[ o ius co po is] ides ad omnes pa es co po is quia pe co dis collec ionem ans e un u spi i us enas eplen es e ele an es e pe co dis ex ensionem e ocan u is i spi i us e pe con[sequens] [dep i]mun u ene unde pulsus nichil aliud es quam ele acio e dep essio ene pulsa ilis». Also C III 17, . 222 ; H 3487, . 202 ; V, . 222 . (53) «Ce eb um e o di idi u , in duas di isiones qua um una es an e io , que es maio , e al e a pos e io . E in illa an e io i duo sun en iculi haben es in oi um ad commune spa ium, quod es in medio ce eb i. In pos e io i, e o habe u unus en iculis aciens i e ad sup adic um spacium quod es commune u isque en iculis qui sun in an e io i ce eb o ... E in ipso ansi u ides in oi u pe quem adi spi i us, habe u quoddam pi acium, ides quedam pa icula de co po e ce eb i, similis e mi, que ele a u e deponi u , in ipso i ine e». See FRENCH, no e 11, p. 292. 96 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. senses, bu he said no hing abou a «wo m». The e is an echo o Galen’s scheme in he gene al loca ion o he men al acul ies in Cos a’s ex , bu i is no clea whe e he de ails o he unc ions o he en icles— all medical a he han philosophical—come om. No is i clea how he philosophe s came o di e om he physicians, because o A is o le he powe s o he soul we e exe cised in he hea and he b ain se ed mainly o cool he hea . Cos a’s ex desc ibes how he i al spi i , sen by he pulse om he e e below he b ain in o one o he an e io en icles, he e becomes s ill mo e sub le, is u he pu ged, and is con e ed in o animal spi i . As such i is i o ecei e he powe s o he soul. Explaining ha «pulse» he e means «pulsa ile ein» (54), he Ox o d gloss adds ha he spi i is e ined by means o he in ellec i e powe o he soul, bu ha he physicians belie e ha i is by means only o he cogi a i e acul y (55). Whe e Cos a says ha he e ining o he spi i makes i i o « ecei e» he powe s o he soul, he gloss explains ha he medical men hold ha wha is ecei ed a e he acul ies o in ellec , cogi a ion and o esigh , whe eas he na u al philosophe s (na u ales) belie e ha i is he sensi i e acul y (56). The gloss also makes clea ha he loca ion o he acul ies wi hin he en icles by he mo ion o he spi i is also a medical business. A leas in he case o memo y his is also mo e o less wha Cos a’s ex says, o i desc ibes how memo y is possible only when he en ance o he ea en icle is opened by he mo ion o he wo m. The gloss epo s he medical opinion ha memo y lou ishes in he ea en icle in he double sense ha i s o es images o hings seen, and enables hese o be ecalled a will (57). Following his gloss, he Ox o d eache (54) II, . 360 : «[pulsus] ene pulsa iles de e en es spi i um i alem sub ilem». Also C III 17, . 382 ; V, . 223 ; H 3487, . 203 . (55) II, . 360 : «[ibi sub ilio ] scilice median e i u e in ellec i a secundum medicos secundum au em a e oys median e i u e cogi a i a e dis ing i am an um». Also H 3487, . 203 ; C III 17, . 382 ; V, . 223 . (56) II, . 360 : «[ ecipiendum] secundum medicos in ellec i am e cogi a i am e p o- iden am secundum au em na u ales sensi i am». Also V, . 223 ; H 3487, . 203 . (57) «[spacio quod] sicud quod secundum medicos pos e io i cellula ige memo a i a quia secundum ipsos species omnium e um p eaccep a um depingun u in hac 97 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. ad ised his s uden s ha he physicians placed he powe o eason in he «middle» en icle, ha is, he common space sha ed by all h ee. The physicians said his because eason was los i his en icle was damaged (58). In sho , Cos a ook much o his ma e ial om medical sou ces, some o i classical (which he ci es) and appa en ly some mo e con empo a y, which con ained he doc ine o he b ain en icles. In asse ing ha his is a medical doc ine he Ox o d na u ales who pu oge he o augh om he common gloss seem o wan o dis ance he doc ine om philosophy. They a e no doing so by e e ence o he a he s o medicine, howe e , bu o a con empo a y g oup o men. The ph ase secundum medicos, used a su p ising numbe o imes, is a look a ano he discipline, bu no mo e: i does no p oceed o he dispu ed ques ions ha we e cha ac e is ic o he la e Middle Ages, and which we e pe haps a ea u e o he inco po a ed acul ies (59). 2. HEARING, READING AND WRITING The glosses also h ow ligh on he eaching p ocess. They a e he esul o he s uden hea ing lec u es (as Hen y o Rainham says in London, B i ish Lib a y, MS Royal 12 G II) and a e no , o example, cellula ad quas i ecu sus cum i eminiscen ia de p e e[ i is]». II, . 360 and C III 17, . 382 . (58) II, . 360 : «[spacium] pe hoc innui cellulam mediam in [qua] secundum medicos ige acio quia illa lesa debili a u acio». [Also H 3487, . 203 ] The a gumen abou damage o he en icles and hei unc ion can be aced back o Nemesius, Bishop o Emesus, a con empo a y o S Augus ine and who may ha e had a sou ce in Poseidonius o Byzan ium. Nemesius’ On he Na u e o Man was ansla ed by Al anus in Mon ecassino and was compa a i ely widely known. See D’ALVERNY, Ma ie-Thé èse. T ansla ions and T ansla o s. In: Robe L. Benson; Giles Cons able (eds.), Renaissance and Renewal in he Twel h Cen u y, Camb idge, Mass., Ha a d Uni e si y P ess, 1982. (59) Some no able loca ions o he ph ase secundum medicos a e: II, . 358 ( he mo ion o he hea and a e ies); 358 ( he medical e sion o he doc ine o h ee ca diac ca i ies); 360 ( he loca ion o easoning in he b ain); 360 ( he loca ion o he in ellec i e powe ); 360 ( he loca ion o memo y). 98 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. he esul o copying an exempla (which would pu he same glosses in he same posi ion o he olio). They a e also « ai copy» w i en up om no es, p esumably aken down in an abb e ia ed o m on wax o «schedules» a he lec u e. Each s uden would ake sligh ly di e en no es and expand hem sligh ly di e en ly. Some s uden s w o e consis en ly longe glosses (such as hose o Du ham Ca hed al, MS C III 17) han o he s (such as hose o London B i ish Lib a y, MS Royal 12 G II). The sho e glosses omi some ma e ial (and a e no me ely mo e concise). Fu he wo k migh show ha he e a e consis en kinds o ma e ial omi ed, and would pe haps indica e i he omission was magis e ial o by he s uden . The e a e signs o changes made du ing he au al and manual p ocesses o w i ing lec u e no es: some imes a e b is changed o one wi h a closely ela ed meaning; o en he o de o wo ds is changed. Blank olios may mean ha he lec u es we e no gi en o he s uden missed hem. Occasionally a space is le , as i he s uden hoped o e u n and supply a wo d he had missed. 3. INCORPORATION AND TEACHING This e u ns us o he ques ion o inco po a ion. Wha he mas e s in Pa is called hei conso ium was a o mal g ouping o eache s, ecognized by he empo al powe s wi h he p i ileges o a guild (60). The mas e s could d aw up s a u es, elec o ice s, including a p oc o o ep esen hem, and use a common seal. As a guild o eache s hey decided wha was augh and how; as medical eache s hey decided who he g ea au ho i ies we e, and in sho , decided wha medicine was. The e we e, o cou se, powe ul in luences in hese ques ions om Sale no and he sou he n uni e si ies, whe e medicine had been augh alongside he a s, bu as guild knowledge medicine in Pa is—and, we guess, in Ox o d— was sel -de ining. This has an impo an bea ing on he ela ionships be ween medi- cine, a s and class oom echnique. By he middle o he hi een h (60) On guilds see BLACK, An ony. Guilds and Ci il Socie y in Eu opean Poli ical Though om he Twel h Cen u y o he P esen , London, Me huen, 1984. 99 Medicine and he A s Cou se in Thi een h-Cen u y Ox o d DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. cen u y, he mas e s o a s had decided wha an a s cou se was o consis o . A a compa a i ely ea ly da e in Ox o d, i was clea ha he na u al philosophy o he a s cou se was o be an examina ion o he A is o elian physical wo ks in app oxima ely he sequence ha hey had had in he Lyceum and a he hands o he schola s o Alexand ia and Byzan ium. They may ha e hough he same in Pa is, bu hey could no each i because o he bans o 1210 and 1215. Bu by he 1250s, A is o elian philosophy was he main componen o he la e a s cou se, he necessa y eading o bachelo s hoping o become mas e s. I was, hen, na u al philosophy ha quali ied a man o join he mas e ’s conso ium and become a mas e himsel ( o become a eache he also had o sa is y he bishop’s chancello ) (61). Now, wha e e he in e nal me i s o A is o le’s philosophy, i is clea ha wi hin he inco po a ed uni e si y i s main unc ion was o p o ide a body o knowledge on which a candida e could be examined. This was he poin o he mas e s ag eeing on wha a philosophy cou se should be. This was an ag eemen no only abou which books we e o be he basis o he cou se, bu abou wha lec u es we e o be gi en. In Ox o d, indeed, he e was an ag eed commen a y, deli e ed by di e en eache s o di e en s uden s bu essen ially he same in all cases (62). So no all medie al educa ion was a ques ion o a mas e adding his pe sonal in e p e a ion o a ex supplied in some o he pa o he eaching p ocess. Indeed, his happens mos isibly in he la e majo commen a ies o g ea mas e s, such as hose o Aquinas in philosophy and Gen ile da Foligno in medicine. These commen a ies con ain ea u es o he dispu a ion and pe sonal esolu ion o p oblems: i Gen ile canno ind a known opinion o disag ee wi h, he has o pu one in he mou h o an in e locu o , gene ally a s uden - igu e (63). The ea lie exposi ions (61) On mas e s’ e ision guides o hese examina ions see LAFLEUR, Claude. Qua e in oduc ions à la philosophie au XIIIe siècle, Mon éal, Ins i u d’é udes médié ales, Pa is, Lib ai ie philosophique J. V in, 1988. (62) The uni o mi y o he gloss is ema kable in he case o De plan is, De di e en ia spi i us e anime and he Me eo ologica. (63) See, o example, his commen a y on he hi d book o he Canon, . 274 : «Sed u dices si is que i ab o e s omachi non i pe communi a em ...». This pa o he commen a y is in wo olumes: (i) Te ius can. A ic. cum amplissima Gen ilis 106 ROGER FRENCH DYNAMIS. Ac a Hisp. Med. Sci. His . Illus. 2000, 20, 75-106. The medie al s uden , ha ing inished his cou se in na u al philosophy, was le in no doub abou he s anding o medicine. I may ha e been subal e na ed o philosophy, bu i wen u he , beginning whe e he philosophe inished. Maybe he saw a ound him «physicians o cul u e and e inemen » who wan ed o ake medicine u he as a highe discipline in i s own acul y. In his quo a ion om A is o le hey had a powe ul jus i ica ion in a wo ld whe e all educa ed men we e A is o elians. By «di e se p o inces» and «con e minous» A is o le seems o sugges ha he philosophe and physician sha ed a bounda y and had hei being on ei he side o i : i is sugges ed abo e ha he medie al p ac ice o inco po a ion p o ided ins i u ional o m o his dis inc ion, inally ealised when he physicians we e able o se up hei own acul y in he uni e si ies. I is clea om he ea ly yea s o he ou een h cen u y ha he doc o s had succeeded in ans o ming hemsel es om me cena y ea e s o disease o high scholas ic philosophical wa io s. This chap e sugges s wha he philosophy s uden migh come o know o medicine a a ime when he doc o s we e a emp ing o each he highes o m o ins i u ionaliza ion; wha migh p epa e him o p oceed ins i u ionally o medicine o (especially in England) o p ac ising i on he basis o his own eading (as a gen leman o cul u e and e inemen ); and wha s a egies could be ound in he A is o elian co pus o p o essionally ambi ious doc o s.