The fact that so many—from military leaders to Emperors—sought to conquer Italy in the centuries following the deposition of the last western Roman Emperor in ad 476 bears witness to the strategic importance of Italy in the early Middle Ages, not to mention its cachet as the birthplace of the Roman Empire. No regime, however, whether Ostrogothic, Lombard, Byzantine or Carolingian, succeeded in conquering the entire peninsula.¹ The result was a complex social, ethnic and political patchwork, across which, nevertheless, people, manuscripts and goods continued to move. Northern Italy in particular connected—through Ravenna and its port at Classe—east and west, and south and north across the Alps.²

It is perhaps for this reason that the principal focus of scholarship by historians of medicine in early medieval northern Italy has been on the translation of Greek medical texts and manuscripts associated with the important medical centre of Ravenna in late antiquity (fifth to seventh centuries).³ However, despite several general surveys of herbal recipes and editions of individual manuscripts, smaller, miscellaneous Italian codices containing medical recipes have been less studied.⁴ Perhaps even more surprisingly, given the richness of the archives and similar studies for other regions, there is no systematic survey of either the charter evidence for the presence of physicians practising in northern Italy or attitudes to illness. Nor has there been any substantial comparative analysis for the provisions for coping with illness and accidents between the multiple legal codes in force in early medieval northern Italy. To date, the only major study of medicine and health in the legal material in early medieval Italy is Niederhellmann's comparative work on barbarian law codes in early medieval Europe.⁵

It is the legal evidence, therefore, that I shall use as a case study in this article, arguing that, far from excluding or marginalising the sick, law-makers and scribes sought to adapt and accommodate to the needs of the infirm wherever possible. Perhaps another explanation for the relative lack of attention for these types of sources, notwithstanding several decades of the dominance of the social history of medicine, is that they are termed ‘non-medical’ and problematic in their interpretation. It is certainly essential that all such sources need to be viewed in the context of their own genre expectations and aims, rather than simply being ‘mined’ for relevant ‘facts’. It is perhaps also time to reconsider the dichotomy between ‘medical’ and ‘non-medical’ texts. It is with this issue therefore that I begin, before establishing the baseline of contemporary views of health against which provisions for coping with accidents and illnesses in the legal material should be compared.

Medical Texts and Texts about Medicine

What is a medical text or manuscript? In many cases, for example the works of Hippocrates, Galen or their imitators, the answer would appear to be obvious: it is a text or manuscript about the causes of, and cures for, human illness. Into this category would fall Milan, Biblioteca Ambrosiana MS G108 inf., a ninth-century manuscript copied in Milan, apparently from a sixth-century Ravennate exemplar used in the teaching of medicine.⁶ The Pseudo-Apuleian Herbal, while being of botanical interest, was written with the primary aim of identifying and using plants to cure various ills.⁷ Most would probably also consider, in a classical and early medieval context at least, the work of a learned layman like Cornelius Celsus' De Medicina, to still be a medical text.⁸

However, is it the author or the reader who defines a text or manuscript? After all, medical texts could be used by earlier medieval readers within monasteries primarily for academic and even spiritual study on the wonder of God's creation rather than for practical medical purposes.⁹ Further, physical context can also play a role in how a text was viewed and used. Cesena, Biblioteca Comunale, MS Cod. Sin. XXI is a manuscript containing Isidore's Etymologies, and various ascetic works, some attributed to Augustine.¹⁰ It therefore would not normally be classified as a medical manuscript, either by modern scholars or early medieval librarians. However, in the second half of the ninth century, Rather of Verona scribbled in some verses of Quintus Serenus' medical poem into the margin of Isidore's section on medicine in his encyclopaedia.¹¹ This is a rare example of an early medieval reader visibly cross-referencing medical material and therefore manuscripts of Isidore's Etymologies should arguably be included in any discussion of medical codices.

Herbal recipes were a cornerstone of pre-modern western medicine, but two recipes jotted into a spare folio of an eighth-century northern Italian psalter would usually only attract the attention of scholars specialising in herbal recipes.¹² Further, one of the recipes could be seen as an early version of chicken soup rather than a plant-based remedy, since the main ingredients are a large chicken (‘pullum grassu’), lard, bone marrow, radishes, oil and honey.¹³ It is, however, clearly labelled as a physic potion (‘potio ad physicos’): that is, a concoction for general health and well-being or what might be called now a tonic for ‘building up your strength’. In contrast, however, a recipe for candied nuts, nestled among more commonplace herbal recipes, does not seem to have had a specific medical use. This culinary recipe was copied into Karlsruhe, Bayerische Staatsbibliothek, MS Perg. Aug. 172, dating from the ninth century and was probably produced in southern Germany (fol. 77r).¹⁴ However, in the early Middle Ages, as in other time periods, medicine and diet could be synonymous, although it has to be said that candied nuts do not figure in the advice of dietetic authors such as the early sixth-century doctor and diplomat Anthimus!¹⁵

For the early Middle Ages, however, even if the broadest definition of a medical text or manuscript is used, the reality is that most of our evidence about health, illness and medicine in the early Middle Ages in western Europe comes from non-medical sources. That is, texts not primarily written with the aim to enlighten or educate on the subject of health or medicine. Nevertheless, classical ideas of the body, health and illness permeate early medieval texts from many different genres. For example, the diffusion of the Hippocratic theory of the four humours, systematised by Galen, and how it affects health, extends well beyond medical texts and/or advice for the wealthy. In a model letter for the appointment of the comes archiatrorum, chief doctor, during the rule of the Ostrogoths in the first half of the sixth century in northern and central Italy, its author, the Roman senator Cassiodorus, states that it ‘the health of men is too obscure, based upon a mixture consisting of opposing humours: when whatsoever of those should have grown it immediately leads the body to illness’.¹⁶ It might be expected that a powerful, educated man such as Cassiodorus, active in Ravenna in the period when medical texts were being translated from Greek into Latin, and commentaries composed, would have at the very least a basic understanding of the humoral system. Indeed, in his later Institutiones, he lists several medical works as an essential part of the library at the monastery of Vivarium in Calabria which he founded, although there is debate as to precisely which volumes he was referring to.¹⁷

However, ideas about the humoral system even seep into penitentials—handbooks for priests and bishops when handing out penances for their sinful flock. In a late ninth-century manuscript copied in northern Italy, it is stated that a woman who is menstruating should not ‘be prevented from entering the church or taking communion, because [periods] result from a superfluity of nature for which she is not responsible’.¹⁸ Imbalance of the humours could be caused by many things: the environment (particularly bad air), the passions, inappropriate diet, too little or too much exercise, and so on. Bishop Epiphanius of Pavia's biographer Ennodius in the sixth century describes in precise detail the catarrh which tore though the prelate's body, causing (along with the allegedly harmful ministrations of doctors), Epiphanius' death.¹⁹ The ninth-century writer Agnellus of Ravenna frequently comments to his audience about his own poor health, whether it be headaches or general sickness of the body.²⁰ Paul the Deacon writing at the end of the eighth century about a plague in northern Italy in the sixth century remarked that ‘there appear in the groins of men … a swelling of the glands, after the manner of a nut or date, presently followed by an unbearable fever’.²¹

Equating such descriptions with modern definitions of plague, however, are problematic, and therefore increasingly archaeological evidence is being turned to for a snapshot of the actual physical health of the population.²² Unlike many written sources, archaeological evidence does include some evidence of individuals of differing social status, although higher status burials dominate. However, the relationship between status or role in life and grave goods in death is a complex one and once the use of burial goods wanes, identifying different strata of society becomes even more difficult. Further, archaeological evidence is by its very nature, like written evidence, incomplete, and is also restricted to those diseases or health indicators that are apparent in bones or teeth.²³ As far as disease is concerned, evidence of mass burials at a cemetery may point to a rapid epidemic but also to a massacre.²⁴ Equally, though, several burials in an identical stratum may also indicate an infectious disease progressively ravaging a population.²⁵

Further, as Irina Metzler has argued for the high Middle Ages, a distinction needs to be made between physical impairment and a socially disabling condition.²⁶ One does not always follow the other, and Sally Crawford has shown in the Anglo-Saxon burial evidence that physical impairment can be associated with wealth as well as with relative poverty.²⁷ Conversely, archaeological evidence for the survival of those with serious physical impairment which would have required care by others does not necessarily equate with the impaired individual being cared about or being a valued member of the community.²⁸ The degree to which an individual could play a social and economic role in their communities also depends on the precise nature of the impairment together with their social status. For example, in a family where every member had to undertake physical labour to feed and clothe themselves, the loss of the use of one or more limbs could be devastating. In a wealthy family, however, a child with limited mobility might be sent to a monastery. Here the child could, for example, undertake a vital role as a scribe or teacher to oblates.

In order to understand how illness and impairment were managed and negotiated in the community, therefore, written sources, not least the legal evidence, still play a crucial role. As a result of the messy political history of northern Italy after ad 476, from the second half of the sixth century onwards, which legal code you were subject to largely depended on whether you identified yourself (or were identified) as Roman, Lombard, Alemannic or Frankish.²⁹ Before that date—even under the Ostrogoth Theodoric—Roman law was in force.³⁰ These various Roman and ‘barbarian’ codes continued to be revised by subsequent rulers, and were supplemented, after the Carolingian invasion of northern/central Italy in 773–4, by Frankish capitularies (in theory at least applicable to all living in Carolingian controlled areas).³¹ Only by including discussion of all of these codes, not to mention the penitential codes which were just as much a part of the cultural and religious landscape as secular law, can the full potential of the legal material be realised.

It has been argued, however, that legal codes reflect the aspirations and ideal of rulers as much as the actual practice of law, and we often have no way of knowing which laws were still in force (and enforced) and which just quietly lapsed without ever being removed from the legal codes.³² This is of course equally pertinent for the penitential codes. However, the manuscript tradition for Rothari's seventh-century Lombard law code, for example, is fairly contemporary, and an insight into what rulers felt they should be legislating about or what they believed their subjects were concerned about, whether or not it was ever enforced, is still valuable.³³ Further, law codes (and penitentials) arguably still trace the basic contours and features of early medieval society. For example, secular medici feature more heavily in Mediterranean ‘barbarian’ law codes than in their more northerly counterparts, a distinction that is supported by contemporary charter evidence.³⁴

Perhaps partly due to their focus on the everyday elements of rural or urban life, such as the sale of a piece of land or house, or donations for the souls of deceased family members, the temptation has been to see charters as a more ‘true’ or at least more accurate picture of early medieval life than the edicts of law codes, despite the fact that both are in fact highly codified.³⁵ Charters are structured using formulae, set phrases into which individual details of a transaction or agreement are woven. Further, it must be remembered that charters or placita represent the ‘official’ version of a transaction or judgement. However, as in the case study below, when several charters can be compared, any deviations from the norm can be significant.

Managing Illness in Early Medieval Northern Italy

Influenced by anthropological theories, some early medieval historians have come to view health and illness principally in terms of social inclusion and exclusion. Raymond Van Dam, focusing on the work of Gregory of Tours, writes that: In Merovingian Gaul people's attitudes towards diseases were as intimately concerned with community and individual values as with physical sickness and disability; and a better translation of these attitudes would instead be in terms of social exclusion and reintegration … . People who became ill were often seen as outside the community, as people excluded, disgraced, confined, or humiliated. For these social illnesses men needed ‘social cures’ and hence the therapy of healing also involved a process of reintegration and acceptance by the community.³⁶

However, I shall demonstrate that while this model may apply to many hagiographical writings, it is considerably less relevant for early medieval Italian legal sources, which have received scant attention from historians on the issue of health other than in relation to specific illnesses or conditions such as leprosy or rabies. Further, with the exception of specific conditions such as leprosy, rarely is illness attributed to sin in the legal evidence. Illness, in the legal codes, is primarily represented as a legitimate reason for not doing what normally would be expected of someone, legally or socially speaking. This is true of all the complex web of legal codes and edicts—Roman, Ostrogothic, Lombard and Carolingian—in force in early medieval northern Italy. By including provisions in cases of illness, I shall argue, however, rather than this signalling exclusion, that the legal compilers are ‘normalising’ illness and integrating the sick into society rather than excluding them or placing them on the edge of social interaction. In other words, the compilers were using at least a partially socially-orientated model of illness or disability.³⁷ They represent rulers and administrators as assessing the ability of someone to participate in routine social acts, such as carrying out their job, and making adjustments accordingly.

I use the word ‘represent’ deliberately as it has long been recognised that legal codes were not just a practical tool of government and order, but were also a key arena in which rulers could—and did, as we shall see—present themselves as protectors of the poor or sick, defenders of freedom, and so on.³⁸ I make no judgements, therefore, as to the degree to which the statutes I discuss were actually applied, assuming that legal codes were read and understood by contemporaries as now on a number of different levels. Even as idealised, rhetorically charged regal statements they are still relevant to any discussion of health and illness since they were, for the most part, relatively widely copied, apparently almost exclusively in northern Italy, where they had the greatest relevance.³⁹

In the eighth century, the Lombard king Luitprand decreed that: If the schultheis [Lombard legal official] before whom the case is brought is ill or is known to be in another district on his own business, he shall be awaited until he returns or until he convalesces from his illness. And when he has returned or recovered from his illness, if he delays to do justice within the established four days, the schultheis himself, as has just been said, shall pay six solidi as composition to him who brought the case and a like six solidi to his judge.⁴⁰

An early ninth-century Italian capitulary issued by the Carolingian Emperor Charlemagne (and his grandson, Bernard, king of Italy from ad 810), discusses baptism and illness: ‘None shall be baptised except at the statutory times, [Easter and Pentecost] unless due to illness’.⁴¹ Lothar, another grandson of Charlemagne's, and co-emperor with his father Louis the Pious from 815, legislates for orphans and the poor who cannot afford scribe's fees for the drawing up of documents.⁴² He states that the scribes must do it free of charge. In cases where someone is ‘required to make a journey or has a grave infirmity’ he refers them to a statute of his father's, Louis the Pious, which deals with the making of wills in various circumstances.⁴³

Another capitulary, again issued by Lothar for Italy in 822–3, states that scribes/clerks (cancellarii) should: come to sick men and according to the law draft a will, to be strengthened by witnesses. It should immediately be written up in a charter and shown to the bishop, counts, judges and other citizens … in order to be truly recognised [as legitimate].⁴⁴

It has been recognised that there was often a mismatch between the provisions of the legal codes and legal practice as evidenced in charters and judgements.⁴⁵ In this case, however, an actual legal transaction does appear to echo provisions already made in the legal codes. Some 80 years after the legal provisions discussed above, a certain Petrus, ‘called Spoletino’, a sculdassius (legal official) in the Carolingian administration, is doing something very similar to that envisaged by Lothar, in order that his last testament would be carried out according to his wishes.⁴⁶ Extremely unusually, the charter, dated 898, explicitly states that Petrus had the document drawn up while he was ‘lying in bed, ill’, (‘in egritudine lectulo iacente’) and that he had already made a will.⁴⁷ What is unusual here is not that it was stated that Petrus was ill, but that it is couched in very specific rather than generic terms. Further, it also echoes the language found in the Lombard king Liutprand's own eighth-century provisions on illness.⁴⁸ It was written in Niviano, 27 kilometres south-east of Piacenza.⁴⁹ Petrus is one of the few local officials in the Carolingian Empire whose career can be traced in the surviving charter evidence. He and his family appear in 26 transactions over the course of the last two decades of the ninth century.⁵⁰ He and his wife, Ragimberga, both lived according to Roman law, but their daughter, Adalberga, made an advantageous match with a Frank called Eto.⁵¹ This particular charter makes provision for the distribution of Petrus' moveable goods after his death. They are to be divided into three equal parts: one for his wife, one for his daughter and the final portion for priests and the poor.⁵²

Compared to the other transactions in which Petrus or his family participated, this charter is unusual in a number of ways and I argue that this is due to the fact of his illness. First, the combination of witnesses is quite different to that in the other ‘family’ charters.⁵³ It is the only one witnessed by a gastald (official) and iudex (judge).⁵⁴ Alongside these, in local terms, relatively high-powered (and in the judge's case, literate) witnesses, however, are more humble witnesses.⁵⁵ Two of these in the latter group are possibly the sons of witnesses to two of Petrus' charters some 20 years previously. One of the witnesses to Petrus' final charter, whose name we cannot any longer read, is listed as the son of a certain Adrevertus.⁵⁶ An ‘Adrevertus’ is a witness to a charter, dated 882, where a priest sells some sections of vineyards to Petrus' wife, Ragimberga.⁵⁷ In the second case, ‘Martinonus son of Ilderadus’ is also a witness to Petrus' final charter. Petrus and Ragimberga make a sale to an Ilderadus in 892.⁵⁸ Further, the scribe (his name is now missing from the charter) writes in a hand that has some unusual characteristics compared with other documents copied in the region.⁵⁹ It does, however, have some affinity with the script of the iudex Donumdeus, suggesting that the scribe was brought with the judge to draw up the charter.

Can we imagine, therefore, a sick- or death-bed scene where the great and the good together with the sons of friends, or local landowners, are summoned? In this case, it can be argued that the ritual of drawing up the charter formed part of the process of visiting or even saying goodbye to the sick or dying man.⁶⁰ We do not know exactly when Petrus died but he is not involved in any more surviving charters. Far from Petrus being ill or dying with just immediate family around him, it would appear from this charter that the sickbed is crowded with an extended network of friends and colleagues as his death would have an economic and social impact on the local community as well as on his family. The fact that prestigious witnesses were present presumably also was an added guarantee that the charter would be upheld as valid after Petrus' death. Illness did not exclude Petrus from legal or social transactions. It only altered the circumstances in which they were made. Further, the legal codes and capitularies, rather than simply being regal ‘wish lists’, appear to have provided the framework for the necessary arrangements to be made.

Certainly, the compilers of laws, edicts and capitularies, whether they be Roman, Ostrogothic or Lombard, were very much alive to the potential for fraud in provisions for the sick and dying such as those utilised by Petrus, not least from supposedly grieving relatives. An edict of the Ostrogothic king Theodoric in the early sixth century outlines what should happen if someone is unable to sign their own will because they are either ‘ignorant of letters’ (illiterate) or ‘close to death’.⁶¹ In these cases, eight witnesses are required whose faith cannot be doubted.⁶² Two centuries later, the Lombard kings Luitprand and Aistulf are similarly concerned that the wishes of ill or dying individuals should be both expressed and then fully carried out after their death. In the first year of his reign (713) Luitprand states that: if a Lombard, suffering from human infirmity, is ill, even though he is confined to his bed he has the right, while he lives and is able to speak rationally, to make decisions on behalf of his soul or to dispose of his property in whatever manner and to whatever extent is pleasing to him. And that which he decides shall remain firmly in effect.⁶³

In 721, Liutprand clarifies that although, in legal terms, the age of maturity is 19 for disposing of property: If any illness befalls him [the man] before he is eighteen and he realizes that he is in danger of dying then, acting in piety with concern for his soul, he shall have the right to provide as he wishes concerning his property to the benefit of some sacred place or hospital (xenodochium). That which he disposes for the sake of his soul ought to remain valid.⁶⁴

The ‘remaining valid’ aspect of both the above clauses was obviously still problematic, since in 755 Aistulf states that: We know that many unscrupulous men have acted contrary to the wishes of their dead relatives who, for the well-being of their souls, distributed their property to sacred places and gave outright liberty together with some property to their dependents. Acting with cleverness, the heirs remove [the freed slaves] from their huts and replace them in servitude, so that they lose their liberty as well as their property. Therefore we decree, in order to correct this evil practice, that the desire and command of the dead be carried out: if any Lombard, whether in sickness or in health, arranged by charter that holy places shall have his property and that the household servants by whom that property is served are to be free in order that they may make a return [i.e. pay rent] to those holy places, these things shall be observed to all time by a man's heirs as was established.⁶⁵

Aistulf adds that when a man dies suddenly, if his wishes were for a slave to be freed upon his death, this should be carried out, even if the formal procedure for the granting of freedom had not been done before his or her master's death.⁶⁶ Whether or not this was a frequent problem is not clear. Aistulf certainly uses this opportunity to present himself as a pious and merciful ruler: Because of our compassion … it seems to us to be a good thing that slaves be given their freedom from servitude since our Redeemer himself deigned to become a slave in order that He might make us free.⁶⁷

Another problem legislators considered was what should happen when someone ‘either because of age or other infirmity, despairs of ever having children and therefore transfers his property to someone else’ but who then goes on to make a miraculous recovery and beget an heir.⁶⁸ In these cases, the Lombard king Rothari decrees ‘the gift which was made before the children were born, is broken and the one or more legitimate sons who were born afterwards shall be the heirs of the father in all things’.⁶⁹ According to this edict, daughters and illegitimate children are also entitled to their share.⁷⁰