Siena 665sickness and disease In a medieval Christian
context in the East and the West, sickness was a conse-
quence of original sin, but sometimes had the ambiva-
lent status of a metaphor of punishment for SINor even
HERESY. Physical suffering, on the other hand, was com-
pared with the redemptive suffering of Christ. MEDICINE
involved palliative care for the body and the SOULas vic-
tims were being prepared to meet their maker. LEPROSY
was closely linked with carnal sin, and the horrifying
and implacable Black Death of 1348 was sometimes cast
as punishment for sin. Medicine had few treatments for
disease beyond occasionally alleviating the symptoms,
still often blaming much on an imbalance of humors.
This imbalance meant a rupture of the equilibrium of the
complexion, the mixture of the primary qualities of hot,
cold, dry, and wet, proper to a part of the body or to the
whole of it.
The causes of most diseases were not understood at
all through most of the Middle Ages. When remedies
were effective, success was more attributable to chance
than to any understanding of causes. Ancient classical
Greek ideas became better known by the 15th century,
but they were only partially helpful. The effects of certain
drugs were known and were employed by skillful physi-
cians and local folk practitioners to ease pain. Midwives
had considerable skill in assisting in childbirth, and
physicians and surgeons intervened to perform cesarean
deliveries. Skin and intestinal diseases were almost uni-
versal; fever caused by many kinds of infection was com-
mon, since personal hygiene was primitive. Smallpox,
malaria, typhoid, tuberculosis, measles, meningitis, and
other infectious diseases regularly reached epidemic pro-
portions. Cancer and diabetes doubtlessly were present
but were masked by other problems. Mental illness and
INSANITYwere recognized and sometimes received pro-
tective care. Malnutrition and parasitic invasions lowered
resistance to disease, when they did not themselves kill.
The Arab–Islamic medical tradition understood better
and earlier the ideas of classical medicine but was only
marginally more successful in combating and treating
disease.
See alsoCONTRACEPTION AND ABORTION; HOSPITALS;
IBNSINA, ABUALI AL-HUSAYN; MAIMONIDES, MOSES; PARA-
SITES; PSELLOS, MICHAEL; TROTA.
Further reading:Saul Nathaniel Brody, The Disease of
the Soul: Leprosy in Medieval Literature(Ithaca, N.Y.: Cor-
nell University Press, 1974); Sheila Campbell, Bert Hall,
and David Klausner, eds., Health, Disease, and Healing in
Medieval Culture(New York: St. Martin’s Press, 1992);
Luis García-Ballester, ed., Practical Medicine from Salerno
to the Black Death (Cambridge: Cambridge University
Press, 1994); J. N. Hays, The Burdens of Disease: Epidemics
and Human Response in Western History(New Brunswick,
N.J.: Rutgers University Press, 1998); Donald R. Hopkins,
Princes and Peasants: Smallpox in History (Chicago:
University of Chicago Press, 1983); Vivian Nutton,
“Medicine in Medieval Western Europe, 1000–1500,” in
The Western Medical Tradition, 800 B.C. to A.D. 1800,ed.
Lawrence I. Conrad et al. (Cambridge: Cambridge Uni-
versity Press, 1995), 139–205, 500–502.sieges and fortifications SeeCASTLES AND FORTIFICA-
TIONS; WARFARE.Siena Medieval Siena was a city in TUSCANYset on the
intersection of three hills about 1,000 feet above sea level.
In the Middle Ages, it was part of the kingdom of ITA LY
and part of the HOLYROMANEMPIRE. It was on a major
PILGRIMAGE route to ROME, the Via Francigena or Via
Romea. In the 12th century it became a COMMUNEand
tried to protect its independence from the emperor, the
pope, and other nearby cities, such as its great rival FLO-
RENCE. Siena soon constructed a contado,or rural juris-
diction, beyond the limits of its diocese. In this contadoit
imposed its own LAWand taxation and obtained the sub-
mission of the rural lords, towns, and peasant communi-
ties. By the 14th century, Sienese territory included
southern Tuscany and the Maremma and coast near the
Mediterranean Sea.
In the 13th century, Siena’s trading activities and par-
ticularly papal banking prospered. Sienese companies
were among the largest in Europe, and its family compa-
nies conducted business with ROME, the FAIRSof Cham-
pagne, PARIS,LONDON, and elsewhere. Despite its papal
banking connections, it led the Ghibelline cities that
opposed Guelf Florence and the PAPACY. With the aid of
German mercenaries sent by MANFRED in 1260, it
inflicted a major defeat on Florence in 1260 at the Battle
of Montaperti but was unable to take any long-term
advantage of its temporary dominance of Tuscany. The
Tuscan GUELFSregrouped and forced a Guelf regime on
the city which became the regime of the Nine, which
lasted until 1355. Around 1300 all of the Sienese banking
companies failed and were usually replaced by new Flo-
rentine firms. The Sienese families and MERCHANTSwho
had run the companies managed to preserve much of
their wealth but retreated to business and politics within
the Sienese state. Without the water resources of its rival
Florence, Siena did not develop much of a lucrative cloth
industry: Its economy instead became even more closely
tied to its rich agricultural region.FOURTEENTH CENTURY AND LATER
In the early 14th century, the town’s population reached
about 50,000. During the second half of the 14th century,
internal politics was characterized by almost constant
conflict and included several barely suppressed magnate
rebellions, especially after the Black Death killed as much
as one-third of its population. The city was hugely bur-
dened by mercenary bands demanding bribes in return
for the safety of both the countryside and the city itself.