Medieval medicine in Western Europe was composed of a mixture of existing ideas from antiquity, spiritual influences and what Claude Lévi-Strauss identifies as the "shamanistic complex" and "social consensus."[1] In this era, there was no tradition of scientific medicine, and observations went hand-in-hand with spiritual influences.
In the early Middle Ages, following the fall of the Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere.[2] Ideas about the origin and cure of disease were not, however, purely secular, but were also based on a world view in which factors such as destiny, sin, and astral influences played as great a part as any physical cause. The efficacy of cures was similarly bound in the beliefs of patient and doctor rather than empirical evidence, so that remedia physicalia (physical remedies) were often subordinate to spiritual intervention.
Influences
As Christianity grew in influence, a tension developed between the church and folk-medicine, since much in folk medicine was magical, or mystical, and had its basis in sources that were not compatible with Christian faith. Spells and incantations were used in conjunction with herbs and other remedies. Such spells had to be separated from the physical remedies, or replaced with Christian prayers or devotions. Similarly, the dependence upon the power of herbs or gems needed to be explained through Christianity.
The church taught that God sometimes sent illness as a punishment, and that in these cases, repentance could lead to a recovery. This led to the practice of penance and pilgrimage as a means of curing illness. In the Middle Ages, some people did not consider medicine a profession suitable for Christians, as disease was often considered God-sent. God was considered to be the "divine physician" who sent illness or healing depending on his will. However, many monastic orders, particularly the Benedictines, considered the care of the sick as their chief work of mercy.[citation needed]
Medieval European medicine became more developed during the Renaissance of the 12th century, when many medical texts both on ancient Greek medicine and on Islamic medicine were translated from the Arabic during the 12th century. The most influential among these texts was Avicenna's The Canon of Medicine, a medical encyclopedia written in circa 1030 which summarized the medicine of Greek, Indian and Muslim physicians up until that time. The Canon became an authoritative text in European medical education up until the early modern period. Other influential translated medical texts at the time included the Hippocratic Corpus attributed to Hippocrates, Alkindus' De Gradibus, the Liber pantegni of Haly Abbas and Isaac Israeli ben Solomon, Abulcasis' Al-Tasrif, and the writings of Galen.
The medieval system
Starting in the areas least affected by the disruption of the fall of the western empire, a unified theory of medicine began to develop, based largely on the writings of the Greek physicians on physiology, hygiene, dietetics, pathology, and pharmacology, and is credited with the discovery of how the spinal cord controls various muscles. From his dissections, he described the heart valves and determined the purpose of the bladder and kidneys.
Galen of Pergamum, also a Greek, was the most important physician of this period and is second only to Hippocrates in the medical history of antiquity. In view of his undisputed authority over medicine in the Middle Ages, his principal doctrines require some elaboration. Galen described the four classic symptoms of inflammation (redness, pain, heat, and swelling) and added much to the knowledge of infectious disease and pharmacology. His anatomic knowledge of humans was defective because it was based on dissection of pigs. Some of Galen's teachings tended to hold back medical progress. His theory, for example, that the blood carried the pneuma, or life spirit, which gave it its red colour, coupled with the erroneous notion that the blood passed through a porous wall between the ventricles of the heart, delayed the understanding of circulation and did much to discourage research in physiology. His most important work, however, was in the field of the form and function of muscles and the function of the areas of the spinal cord. He also excelled in diagnosis and prognosis. The importance of Galen's work cannot be overestimated, for through his writings knowledge of Greek medicine was subsequently transmitted to the Western world by the Arabs.
Anglo-Saxon translations of classical works like Dioscorides Herbal survive from the 10th Century, showing the persistence of elements of classical medical knowledge. Compendiums like Bald's Leechbook (circa 900), include citations from a variety of classical works alongside local folk remedies.
Although in the Byzantine Empire the organized practice of medicine never ceased (see Byzantine medicine), the revival of methodical medical instruction from standard texts in the west can be traced to the church-run Schola Medica Salernitana in Southern Italy in the Eleventh century. At Salerno medical texts from Byzantium and the Arab world (see Medicine in medieval Islam) were readily available, translated from the Greek and Arabic at the nearby monastic centre of Monte Cassino. The Salernitan masters gradually established a canon of writings, known as the ars medicinae (art of medicine) or articella (little art), which became the basis of European medical education for several centuries.
From the founding of the Universities of Paris (1150), Bologna (1158), Oxford, (1167), Montpelier (1181) and Padua (1222), the initial work of Salerno was extended across Europe, and by the Thirteenth century medical leadership had passed to these newer institutions. To qualify as a Doctor of Medicine took ten years including original Arts training, and so the numbers of such fully qualified physicians remained comparatively small.
During the Crusades European medicine began to be influenced by Islamic medicine. Much ink has been spilled on Usamah ibn Munqidhs supposed distaste of European medicine, but as anyone who reads the entire text of his autobiography will notice, his first-hand experience with European medicine is positive - he describes a European doctor successfully treating infected wounds with vinegar and recommends a treatment for scrofula demonstrated to him by an unnamed "Frank"[1].
By the Thirteenth Century many European towns were demanding that physicians have several years of study or training before they could practice. Surgery had a lower status than pure medicine, beginning as a craft tradition until Roger Frugardi of Parma composed his treatise on Surgery around about 1180. A stream of Italian works of greater scope over the next hundred years, spread later into the rest of Europe. Between 1350 and 1365 Theodoric Borgognoni produced a systematic four volume treatise on surgery, the Cyrurgia, which promoted important innovations as well as early forms of antiseptic practice in the treatment of injury, and surgical anaesthesia using a mixture of opiates and herbs.
The great crisis in European medicine came with the Black Death epidemic in the 14th century. Prevailing medical theories focused on religious rather than scientific explanations.
Theories of medicine
The underlying principle of medieval medicine was the theory of humours. This was derived from the ancient medical works, and dominated all western medicine up until the 19th century. The theory stated that within every individual there were four humours, or principal fluids - black bile, yellow bile, phlegm, and blood, these were produced by various organs in the body, and they had to be in balance for a person to remain healthy. Too much phlegm in the body, for example, caused lung problems; and the body tried to cough up the phlegm to restore a balance. The balance of humours in humans could be achieved by diet, medicines, and by blood-letting, using leeches. The four humours were also associated with the four seasons, black bile-autumn, yellow bile-summer, phlegm-winter and blood-spring.
HUMOUR TEMPER ORGAN NATURE ELEMENTBlack bile Melancholic Spleen Cold Dry Earth
Phlegm Phlegmatic Lungs Cold Wet Water
Blood Sanguine Head Warm Wet Air
Yellow bile Choleric Gall Bladder Warm Dry Fire
The astrological signs of the zodiac were also thought to be associated with certain humours. Even now, some still use words "choleric", "sanguine", "phlegmatic" and "melancholy" to describe personalities.
The use of herbs dovetailed naturally with this system, the success of herbal remedies being ascribed to their action upon the humours within the body. The use of herbs also drew upon the medieval Christian doctrine of signatures which stated that God had provided some form of alleviation for every ill, and that these things, be they animal, vegetable or mineral, carried a mark or a signature upon them that gave an indication of their usefulness. For example, the seeds of skullcap (used as a headache remedy) can appear to look like miniature skulls; and the white spotted leaves of Lungwort (used for tuberculosis) bear a similarity to the lungs of a diseased patient. A large number of such resemblances are believed to exist.
Most monasteries developed herb gardens for use in the production of herbal cures, and these remained a part of folk medicine, as well as being used by some professional physicians. Books of herbal remedies were produced, one of the most famous being the Welsh, Red Book of Hergest, dating from around 1400.
The hospital system
In the Medieval period the term hospital encompassed hostels for travellers, dispensaries for poor relief, clinics and surgeries for the injured, and homes for the blind, lame, elderly, and mentally ill. Monastic hospitals developed many treatments, both therapeutic and spiritual.
During the thirteenth century an immense number of hospitals were built. The Italian cities were the leaders of the movement. Milan had no fewer than a dozen hospitals and Florence before the end of the Fourteenth century had some thirty hospitals. Some of these were very beautiful buildings. At Milan a portion of the general hospital was designed by Bramante and another part of it by Michelangelo. The Hospital of Sienna, built in honor of St. Catherine, has been famous ever since. Everywhere throughout Europe this hospital movement spread. Virchow, the great German pathologist, in an article on hospitals, showed that every city of Germany of five thousand inhabitants had its hospital. He traced all of this hospital movement to Pope Innocent III, and though he was least papistically inclined, Virchow did not hesitate to give extremely high praise to this pontiff for all that he had accomplished for the benefit of children and suffering mankind.[3]
Hospitals began to appear in great numbers in France and England. Following the French Norman invasion into England, the explosion of French ideals led most Medieval monasteries to develop a hospitium or hospice for pilgrims. This hospitium eventually developed into what we now understand as a hospital, with various monks and lay helpers providing the medical care for sick pilgrims and victims of the numerous plagues and chronic diseases that afflicted Medieval Western Europe. Benjamin Gordon supports the theory that the hospital – as we know it - is a French invention, but that it was originally developed for isolating lepers and plague victims, and only later undergoing modification to serve the pilgrim.[4]
Owing to a well-preserved 12th century account of the monk Eadmer of the Canterbury cathedral, there is an excellent account of Bishop Lanfranc’s aim to establish and maintain examples of these early hospitals:
But I must not conclude my work by omitting what he did for the poor outside the walls of the city Canterbury. In brief, he constructed a decent and ample house of stone…for different needs and conveniences. He divided the main building into two, appointing one part for men oppressed by various kinds of infirmities and the other for women in a bad state of health. He also made arrangements for their clothing and daily food, appointing ministers and guardians to take all measures so that nothing should be lacking for them.[5]
Later developments
High medieval surgeons like Mondino de Liuzzi pioneered anatomy in European universities and conducted systematic human dissections. Unlike pagan rome, high medieval Europe did not have a complete ban on human dissection. However, Galenic influence was still so prevalent that Mondino and his contemporaries attempted to fit their human findings into Galenic anatomy.
During the period of the Renaissance from the mid 1450s onward, there were many advances in medical practice. The Italian Girolamo Fracastoro, 1478 - 1553, was the first to propose that epidemic diseases might be caused by objects outside the body that could be transmitted by direct or indirect contact. He also discovered new treatments for diseases such as syphilis.