Avignon in southeastern France stands as one of Europe’s most historically significant cities, commonly remembered as the seat of the Catholic papacy during the 14th century and for its famous bridge immortalized in song. It was a time of conflict and unstable conditions in Italy while the French King Philip IV was exerting pressure on the newly elected French pope, Clement V, to relocate to France. Clement eventually chose to settle near Avignon, which was then a territory under French influence and offered the popes a more secure and stable location from where to govern the church than Rome. The pope moved in 1309, transforming this modest city into the center of Western Christendom, and staying there during the so-called “Babylonian Captivity”, which lasted until 1377. During that period, the popes attracted not only theologians and diplomats but also physicians, who came to serve the pontiffs and their vast retinue.
The medieval medical practice at that time combined Galenic humoral theory with Islamic medical knowledge transmitted through Spain and Italy. The city’s physicians widely performed bloodletting, prescribed herbal remedies, and consulted astrological charts to determine the best times for treatment. The papal court maintained its own medical staff, and its court physicians were among the most educated practitioners of their time, often having studied at the prestigious medical schools of Montpellier or Salerno.
In 1348, bubonic plague struck the city with catastrophic consequences, as Avignon was a major center of commerce and pilgrimage and therefore especially vulnerable to the pandemic. It is believed to have been spread by merchants, sailors, pilgrims, fleas, and rats from Genovese ships who docked at Marseilles. The plague killed thousands of residents within months, overwhelming the city’s burial capacity. Bodies were thrown into the Rhône River or buried in mass graves when consecrated ground ran out. Pope Clement remained in the papal palace, surrounded by fires that his physician, Guy de Chauliac, believed would purify the air of the miasmatic vapors thought to cause the disease. Despite contracting the plague himself and suffering from bubonic swellings, de Chauliac survived and documented his observations in his masterwork Chirurgia Magna (Great Surgery), which he finished in 1363, and in which he described a variety of surgical procedures, bloodletting, cauterization, drugs, anesthetics, wounds, fractures, and ulcers. While referring to the works of Hippocrates and Galen, he paid much attention to the extensive writings of Avicenna, which were later translated into English and several other European languages.
De Chauliac deserves particular attention as one of medieval medicine’s most important figures. His clinical descriptions of the plague’s two forms—the pneumonic variety that killed within days and the bubonic form that gave victims a slim chance of survival—remain valuable historical records. De Chauliac’s willingness to continue treating patients during the epidemic, despite the obvious mortal danger, exemplified the highest ideals of medical practice.
During the Black Death, Jews across Europe were often scapegoated and massacred. Claims that they poisoned wells were false but widely believed. However, in Avignon, the Jewish community was spared thanks to the intervention of Pope Clement VI, who protected them from popular violence.
The Black Death prompted medical authorities in Avignon to implement rudimentary quarantine procedures, restrict travel, and attempt to improve urban sanitation. While these measures were based on the miasma theory of disease transmission, they represent important steps toward organized public health responses to epidemics. The city established hospitals and charitable institutions to care for the sick and poor. The Hôtel-Dieu, a hospital founded in the 13th century, provided medical care and served as a refuge for pilgrims and travelers. Like other medieval institutions, it was typically run by religious orders, reflecting the medieval understanding of illness as having both physical and spiritual dimensions.
The city’s apothecaries dispensed remedies derived from the region’s medicinal plants. Herbs such as lavender, rosemary, and thyme featured prominently in pharmaceutical preparations. The surrounding countryside provided ingredients for complex mixtures of dozens of ingredients believed to counteract poisons and diseases. In 1791, as Avignon transitioned out of papal rule, its medical institutions evolved, and the University of Avignon, founded by Pope Boniface VIII in 1303, developed advanced medical education among its offerings. Today, the Centre Hospitalier d’Avignon provides contemporary healthcare to the region.
Today, visitors to Avignon walk through streets where medieval physicians once hurried to attend plague victims, papal doctors prescribed remedies according to humoral theory, and the foundations of public health were tentatively laid. The magnificent Palais des Papes still stands as a monument to the remarkable growth of our ability to manage diseases once thought untreatable and universally fatal.
Further reading
George Dunea, Healthcare for the popes, Hektoen International, Spring 2008. https://hekint.org/2018/04/17/healthcare-for-the-popes/