World medicine in the middle ages (V – XVII cent. A. D.)
Lecture Plan
1. Introduction to the Medieval Medicine.
2. The Byzantine Medicine.
3. Medicine in Arab Caliphates.
4. Medicine in Medieval Europe.
5. Renaissance Medicine.
Introduction
Medicine during the medieval era was multi-faceted, relying on the skills of several classes of practitioners. The ill and aged were treated by university trained physicians, monks, or folk healers, depending on the patient’s socio-economic class. Though medical practices and procedures in the middle ages are generally considered obsolete and relying on herbal remedies, prayer, spells and incantations, there were also surgeries performed and cures perfected that are similar to modern procedures.
The first medical university was founded in the tenth century in Salarno, Italy where Greek manuscripts written by such physicians as Hippocrates were studied. Medieval physicians followed the Greek belief that the body was made up of four humors: sanguine (blood), choler, phlegm and melancholia. They believed that the primary cause of illness was an imbalance of the humors, each of which were given qualities of heat and moistness. Sanguine was hot and moist, choler was hot and dry, phlegm, cold and moist, melancholy, cold and dry. They worked to diagnose which humor was at fault then balanced out or purged the humor with herbal remedies and often by bloodletting or by the administration of laxatives.
The physicians also believed, in what became known as the Doctrine of Signatures, that the color of flowers and other properties of plants indicated their usefulness in treating particular diseases. For example, plants which bore yellow flowers, such as dandelion and fennel, were linked to the liver’s yellow bile and were recommended to treat jaundice.
This belief, however, did not stop the monks, who were the most literate of the general population, from applying what they had learned by making copies of the ancient medical texts. Each monastery had an infirmary where treatment was available with herbal remedies, based on those prescribed by Hippocrates and others, made from plants cultivated in their gardens. The earliest hospitals were established by monasteries and were primarily refuges for the old and disabled and traveling pilgrims.
More practical medicine for the masses, usually performed by women, relied on folk remedies passed down by elders. Herbal remedies were only one of the resources available. Healing wells, stones, and charms played a part as well, often in combination. Pagan cures, incantations and spells were also practiced. These were forbidden by the church, and as a result, over time many archaic spells were given a Christian flavor. Instead of invoking the pagan gods, the Christian God and patron saints were called upon.
Thus, on one side there were the university trained physicians, all men, who were based in towns and cities and served the wealthy. On the other side there were the folk healers, usually women, in the rural areas. In the middle were healers in the religious orders, who incorporated both aspects of healing into their practices. All used many of the same plant remedies but operated in distinctly separate socio-economic groups and with great distrust and/or contempt for each other. The situation was amplified over the centuries resulting in religious persecution and witch hunting which ultimately led to the execution of thousands of folk healers who were so skilled that they were thought to have a pact with the devil.
Medieval Medical Practitioners
Physicians were scholars who studied at universities. In order to be declared a physician, a student had to prove himself able to recite, lecture and debate the contents of his studies.
Surgeons belonged to the working class and did the jobs that were considered beneath physicians, such as bloodletting and pulling teeth. Most surgeries were performed by the barber/surgeon. The most common operations were for hernias, gallstones and cesarean section.
During the early medieval centuries it was the monks who copied out manuscripts of the works of Hipocrates and other Greek or Latin medical writers. There is evidence that they practiced the medical knowledge they obtained as scribes. Each monastery had an infirmary for its ailing and aged members. Medical aid would also be provided to the poor, travelers and pilgrims who visited. Some monks gained such a reputation for being skilled healers that they were sought out by lay patients. In some cases the care of such outsiders gave rise to hospitals apart from the monks’ infirmaries.
Leeches were lay practitioners whose training was more practical than theoretical. Practicing without proper education, they relied more on informal observation and folk medicine. They may have been apprenticed to a barber-surgeon or physician at some point.
Dentatores were the dentists of the medieval era and were so expensive that usually only the very rich could afford their services. They removed decay, which was believed to be caused by worms, and filled teeth with ground bone. Gold was used for filling cavities by the fifteenth century. They repaired loose teeth with metal bindings and made dentures from ox and other animal bones.
Herbalists (Folk Healers). Practitioners of popular healing varied widely from place to place within Europe. In some areas the healers were mostly women; in other they were predominantly men. In some places the secrets of healing were passed only from woman to woman or from men to men, but in other regions the gender alternated with each transmission. In some places healers were thought to possess inherited skills and if an attempt was made to pass these skills to people without these inherited gifts, they would be ineffectual.
Midwives were taught their duties by other midwives or were introduced into the craft by fathers or husbands who were medical men. Midwives were usually apprenticed to older more experienced midwives. The only requirement for becoming a candidate for midwifery was a statement from the parish priest attesting to the applicant’s good character.
Medieval nurses were women who attended to the more basic needs of the ill in hospitals. Many joined monastic orders, but there were secular nursing orders as well, especially during the Plague. As the disease spread women from all socio-economic groups came forward to care for the sick. Noble-born women who became nurses of the poor or sick, were considered “nursing saints.”
Byzantine Medicine
In Byzantine times (from about 400 AD to 1453 AD) medicine shows but little originality. The work handed down to us are all compilations, but as they frequently contain excerpts from lost works they are of some historical value.
Byzantine medicine drew largely on Ancient Greek and Roman knowledge. However, Medicine was also one of the few sciences in which the Byzantines improved on their Greco-Roman predecessors. As a result, Byzantine Medicine had a significant influence on Islamic medicine and the Western rebirth of Medicine during the Renaissance.
Byzantine physicians often compiled and standardized medical knowledge into textbooks. These books tended to be elaborately decorated with many fine illustrations, highlighting the particular ailment. The Medical Compendium in Seven Books, written by the leading physician Paul of Aegina, is of particular importance. The compendium was written in the late seventh century and remained in use as a standard textbook for 800 years.
Late antiquity witnessed a revolution in the medical scene and many sources mention hospitals in passing (although their own history in the Military sense can be drawn back to Imperial Rome and beyond). Constantinople doubtless was the center of such activities in the Middle Ages, owing to its geographical position, wealth and accumulated knowledge.
Hospitals
An important contribution of Byzantium is arguably the fact that it was the first Empire in which dedicated medical establishments – usually set up by individual Churches or the State, which parallel modern Hospitals in many way, flourished. Although similar establishments existed in Ancient Greece and Rome, they differed in that they were usually either institutions for Military use, or places were citizens went to die in a more peaceful way. Medical Institutions of this sort were common in Imperial Cities such as Constantinople and later Thessaloniki.
The first hospital was built by Basil of Caesarea in the late fourth century, and although these Institutions flourished, it was only throughout the 8th and 9th Centuries that they began to appear in Provincial Towns as well as Cities, (although Justinian’s subsidization of private physicians to work publicly for six months of the year can be seen as the real breakthrough point). Byzantine Medicine was entirely based around Hospitals or walk-in dispensaries which formed part of the Hospital complex, there was a dedicated hierarchy including the Chief Physician (archiatroi), professional nurses (hypourgoi) and the orderlies (hyperetai).
Doctors themselves were well trained and most likely attended the University of Constantinople as Medicine had become a truly scholarly subject by the period of Byzantium (despite the prominence of the great physicians of antiquity, its status as a Science was greatly improved through its application in formal education (particularly in the University of Constantinople). This rigidity through professionalism (similar to the professionalism exhibited in the Byzantine Civil Service) bears many hallmarks of today’s modern Hospitals, and comparisons are nearly always made by modern Scholars studying this particular field. Thus, we know that in the twelfth century, Constantinople had two well organized hospitals staffed by medical specialists (including women doctors), with special wards for various types of diseases and systematic methods of treatment.
Christianity always played a key role in the building and maintaining of Hospitals, as it did with most other areas of the Empire. Many Hospitals were built and maintained by Bishops in their respective prefectures. Hospitals were nearly always built near or around Churches and great importance was laid on the idea of healing through salvation – When medicine failed doctors would always ask their patients to pray, after the Iconoclastic problems had been resolved, this usually involved symbols of saints such as Saints Cosmas and Damien, who were killed by Diocletian in 303, and were the patron saints of medicine and doctors.
Christianity also played a key role in propagating the idea of charity, medicine was made, according to Gary Ferngren, accessible to all and… simple. This idea, combined with the vast resources Byzantine physicians had at their disposal was one of the first times in History that a state has actively sought to expend resources on a public healthcare system.
Christian and Muslim reservoirs of learning
After the fall of Rome, learning was no longer held in high esteem, experiment was discouraged, and originality became a dangerous asset. During the early Middle Ages medicine passed into the widely diverse hands of the Christian Church and Arab scholars.
Translators and saints
It is sometimes stated that the early Christian Church had an adverse effect upon medical progress. Disease was regarded as a punishment for sin, and such chastening demanded only prayer and repentance. Moreover, the human body was held sacred and dissection was forbidden. But the infinite care and nursing bestowed upon the sick under Christian auspices must outweigh any intolerance shown toward medicine in the earlydays.
Perhaps the greatest service rendered to medicine by the church was the preservation and transcription of the classical Greek medical manuscripts. These were translated into Latin inmany medieval monasteries, and the Nestorian Christians (an Eastern church) established a school of translators to render the Greek texts into Arabic. This famous school, and also a great hospital, were located at Jundi Shāhpūr in southwest Persia, where the chief physician was Jurjīs ibn Bukhtīshū, the first of a dynasty of translators and physicians that lasted for six generations. A later translator of great renown was Ḥunaynibn Isḥāq, or Johannitus (born AD 809), whose translations weresaid to be worth their weight in gold.
About this time there appeared a number of saints whose names were associated with miraculous cures. Among the earliest of these were twin brothers, Cosmas and Damian, who suffered martyrdom (c. AD 303) and who became the patron saints of medicine. Other saints were invoked as powerful healers of certain diseases, such as St. Vitus for chorea (or St. Vitus’ dance) and St. Anthony for erysipelas (or St. Anthony’s fire). The cult of these saints was widespread in medieval times, and a later cult, that of St. Roch for plague, was widespread during the plague-ridden years of the 14th century.
Arabian medicine
A second reservoir of medical learning during those times was the great Muslim empire, which extended from Persia to Spain.Although it is customary to speak of Arabian medicine in describing this period, not all of the physicians were Arabs or natives of Arabia. Nor, indeed, were they all Muslims: some were Jews, some Christians, and they were drawn from all partsof the empire. One of the earliest figures was Rhazes, a Persianborn in the last half of the 9th century near modern Tehrān, who wrote a voluminous treatise on medicine, Kitāb al-hāḳī (“Comprehensive Book”), but whose most famous work, De variolis et morbillis (A Treatise on the Smallpox and Measles), distinguishes between these two diseases and gives a clear description of both.
Of later date was Avicenna (980–1037), also a Persian, who hasbeen called the prince of physicians and whose tomb at Hamadan has become a place of pilgrimage. He could repeat the Qurʾān before he was 10 years old and at the age of 18 became court physician. His principal medical work, al-Qānūn fīaṭ–ṭibb (The Canon of Medicine ), became a classic and was used at many medical schools—at Montpellier, Fr., as late as 1650—and reputedly is still used in the East.
The greatest contribution of Arabian medicine was in chemistry and in the knowledge and preparation of medicines. The chemists of that time were alchemists, and their pursuit was mainly a search for the philosopher’s stone, which supposedly would turn common metals into gold. In the course of their experiments, however, numerous substances were named and characterized, and some were found to have medicinal value. Many drugs now in use are of Arab origin, as are such processes as distillation and sublimation.
At that period, and indeed throughout most historical times, surgery was considered inferior to medicine, and surgeons were held in low regard. The renowned Spanish surgeon Abū al-Qāsim (Albucasis), however, did much to raise the status of surgery in Córdoba, an important centre of commerce and culture with a hospital and medical school equal to those of Cairo and Baghdad. A careful and conservative practitioner, hewrote the first illustrated surgical text, which held wide influence in Europe for centuries.
Another great doctor of Córdoba, born in the 12th century, just as the sun of Arabian culture was setting, was the Jewish philosopher Maimonides. Banished from the city because he would not become a Muslim, he eventually went to Cairo, where the law was more lenient and where he acquired a reputation so high that he became physician to Saladin, the Saracen leader. (He was the original of El Hakim in Sir Walter Scott’s Talisman.) A few of his works, written in Hebrew, were eventually translated into Latin and printed.
Medieval and Renaissance Europe
Salerno and the medical schools
At about the same time that Arabian medicine flourished, thefirst organized medical school in Europe was established at Salerno, in southern Italy. Although the school of Salerno produced no brilliant genius and no startling discovery, it was the outstanding medical institution of its time and the parent of the great medieval schools soon to be founded at Montpellier and Paris, in France, and at Bologna and Padua, in Italy. Salerno drew scholars from near and far. Remarkably liberal in some of its views, Salerno admitted women as medical students. The school owed much to the enlightened Holy Roman emperor Frederick II, who decreed in 1221 that no one should practice medicine until he had been publicly approved by the masters of Salerno.
Great hospitals were established during the Middle Ages by religious foundations, and infirmaries were attached to abbeys, monasteries, priories, and convents. Doctors and nurses in these institutions were members of religious orders and combined spiritual with physical healing.
The spread of new learning
Among the teachers of medicine in the medieval universities there were many who clung to the past, but there were not a few who determined to explore new lines of thought. The new learning of the Renaissance, born in Italy, grew and expanded slowly. Two great 13th-century scholars who influenced medicine were Roger Bacon, an active observer and tireless experimenter, and Albertus Magnus, a distinguished philosopher and scientific writer.
About this time Mondino dei Liucci taught at Bologna. Prohibitions against human dissection were slowly lifting, and Mondino performed his own dissections rather than following the customary procedure of entrusting the task to a menial. Although he perpetuated the errors of Galen, his Anothomia, published in 1316, was the first practical manual of anatomy. Foremost among the surgeons of the day was Guy de Chauliac, a physician to three popes at Avignon. His Chirurgia magna (“Great Surgery”), based on observation and experience, had aprofound influence upon the progress of surgery.
The Renaissance in the 14th, 15th, and 16th centuries was much more than just a reviving of interest in Greek and Romanculture; it was rather a change of outlook, an eagerness for discovery, a desire to escape from the limitations of tradition and to explore new fields of thought and action. In medicine, it was perhaps natural that anatomy and physiology, the knowledge of the human body and its workings, should be the first aspects of medical learning to receive attention from those who realized the need for reform.
It was in 1543 that Andreas Vesalius, a young Belgian professor of anatomy at the University of Padua, published De humani corporis fabrica (“On the Structure of the Human Body”). Based on his own dissections, this seminal work corrected many of Galen’s errors. By his scientific observationsand methods, Vesalius showed that Galen could no longer be regarded as the final authority. His work at Padua was continued by Gabriel Fallopius and, later, by Hieronymus Fabricius ab Aquapendente; it was his work on the valves in the veins, De venarum ostiolis (1603), that suggested to his pupil William Harvey his revolutionary theory of the circulationof the blood, one of the great medical discoveries.
Surgery profited from the new outlook in anatomy, and the great reformer Ambroise Paré dominated the field in the 16th century. Paré was surgeon to four kings of France, and he has deservedly been called the father of modern surgery. In his autobiography, written after he had retired from 30 years of service as an army surgeon, Paré described how he had abolished the painful practice of cautery to stop bleeding and used ligatures and dressings instead. His favourite expression,“I dressed him; God healed him,” is characteristic of this humane and careful doctor.
In Britain during this period surgery, which was performed by barber-surgeons, was becoming regulated and organized underroyal charters. Companies were thus formed that eventually became the royal colleges of surgeons in Scotland and England. Physicians and surgeons united in a joint organizationin Glasgow, and a college of physicians was founded in London.
The 16th-century medical scene was enlivened by the enigmatic physician and alchemist who called himself Paracelsus. Born in Switzerland, he traveled extensively throughout Europe, gaining medical skills and practicing and teaching as he went. In the tradition of Hippocrates, Paracelsusstressed the power of nature to heal; but unlike Hippocrates hebelieved also in the power of supernatural forces, and he violently attacked the medical treatments of his day. Eager forreform, he allowed his intolerance to outweigh his discretion, as when he prefaced his lectures at Basel by publicly burning the works of Avicenna and Galen. The authorities and medical men were understandably outraged. Widely famous in his time,Paracelsus remains a controversial figure to this day. Despite his turbulent career, however, he did attempt to bring a more rational approach to diagnosis and treatment, and he introduced the use of chemical drugs in place of herbal remedies.
A contemporary of Paracelsus, Girolamo Fracastoro of Italy wasa scholar cast from a very different mold. His account of the disease syphilis, entitled Syphilis sive morbus Gallicus (1530; “Syphilis or the French Disease”), was written in verse. Although Fracastoro called syphilis the French disease, others called it the Neapolitan disease, for it was said to have been brought to Naples from America by the sailors of Christopher Columbus. Its origin is still questioned, however. Fracastoro was interested in epidemic infection, and he offered the first scientific explanation of disease transmission. In his great work, De contagione et contagiosis morbis (1546), he theorized that the seeds of certain diseases are imperceptible particles transmitted by air or by contact.
The history of medicine, perhaps more than that of any other discipline or skilled occupation, illuminates broad social and cultural patterns of the period.
To a medieval mind, the distinction between natural and supernatural was not always very clear. This shows in the perception of the causes of ailments, and the obscure treatments thought to help sick patients. The Catholic Church played a large role in development as well as management of medieval medicine. It contained it within bounds of one religion, disallowing most pagan healing practices. more
The underlying principle of medieval medicine were four humors – black bile, yellow bile, phlegm, and blood. The balance of these four allowed for the well-being of a person. more
Medicine in itself developed. Based on some Greek and Near Eastern principles and embellished with the discoveries of the Middle Ages, it set the foundation for contemporary medicine. more
Medieval medicine, for most part, was very forgiving about who practiced and who healed. Clergy and laymen, men and women, were allowed to practice medicine. The extent of this practice was not limited all throughout the Middle Ages. The final unification came with the Black Death, when the need for doctors to heal the sick was stronger than any prejudice against their origin. more
The education system has developed in order to teach law and medicine to the willing. Guilds were created to allow crafts to prosper. The middle class of the society was in the making. more
The Humors
One of the basic principles of medieval medicine was that of the four humors of which a human body was composed. The balance between these four (blood, phlegm, yellow bile, and black bile) was essential for the well-being of a person.
Medieval Europe holds many of its foundations in the classical world of Ancient Greece and Rome. Just the same, “the theory of the four humours (bodily fluids) arose out of Hellenic philosophy in an attempt to relate all things to universal laws” (Cameron 159). And so we have parallels drawn between particular aspects of the surrounding world. The humors were oftentimes attributed to appropriate seasons, properties such as hot, cold, dry, and wet, signs of Zodiac in groups of three, four ages of mankind – infancy, adolescence, adulthood, and old age, and even sometimes to the four Evangelists – Matthew, Mark, Luke, and John, as well as the compass directions. (Eveow, we still use words “choleric”, “sanguine”, “phlegmatic” and “melancholy” to describe personalities.)
Such balance and classification of the world was of utmost importance, hence the balance of humors within a human body was necessary for health. Balance of humors in humans was achieved by diet, medicines, and phlebotomy (blood-letting).
The eating habits of a medieval person depended mostly on the geographical location and financial status. Obviously, persons of low income (about 90% of the population in the feudal social system of medieval Europe) could not afford extravagant additions to their diets such as spices or sugar. In addition, transport of food was either outrageously expensive or just impossible due to the lack of a good method of preservation of food – obviously refrigeration has not yet been invented. As a result, a common medieval person’s diet consisted of either wheat, meat, or fish, depending on location. Only two groups were combined together at most in many cases. This diet would be supplemented with the available vegetables, fruit, or herbs available during the season in the area.
This is not to say though that a medieval person did not realize the importance of a proper diet. Many sources cite the physicians’ opinions on the significance of a well-balanced diet. In addition, many guiding writings recorded as conversations with medieval students exist to show that the medievals cared for appropriate nutrition. Most of the cases provide examples of diets somewhat parallel to the food pyramid created by modern science.
An example eating habit to pursue by a medieval person would be as follows: first meat, for it is most easily available, then vegetables, eggs, fish, cheese, butter, and beans, and eventually either water or ale, and in cases of exceptional wealth – wine.
For more information on actual healing methods, please see the healing section of this site.
Whenever medieval medicine is mentioned in a conversation among persons of our modern age, the first uttered words usually pertain to the practice of blood-letting in the Middle Ages. It is probably due to the shocking value of such treatment as well as its eventual failure and ineffectiveness in most cases.
Phlebotomy (blood-letting) was considered by medieval medicine to be a form of surgery. This view was based on the belief that each organ within a human body had its own organ of origin and, therefore, letting the blood from a specific vein would affect a particular organ. “It was not enough that a patient be bled, he must be bled from a proper vessel. There was a theory that various internal organs were connected with various superficial veins, so that bleeding from these veins drew noxious humours from organs which could not otherwise be reached” (Cameron 165). Because the internal organs were to be in a way worked on, phlebotomy became a surgical procedure.
Blood-letting allowed for the control of humors in a particular part of the body. Phlebotomy was administered in two ways, via derivation or revulsion. Derivation meant letting of blood at a point close to the affected area, and revulsion meant that blood was let at the most remote point to the affected area. Both methods had specific indication for use in the case of different illnesses and were widely employed by medieval physicians.
The dangers of blood-letting are obvious; infection, weakening of the already sick organism, cutting up an artery instead of a vein causing unstoppable bleeding, accidental cutting of nerves, and the loss of consciousness by the patient were the most common issues a medieval doctor had to deal with while administering phlebotomy. More often thaot, the result of blood-letting was either continual sickness or death of a patient.
As improbable as it sounds, phlebotomy fit perfectly within the humor theory. “Blood withdrawn from a normal individual forms a homogeneous clot, but blood withdrawn from one suffering from any number of pathological conditions separates not layers as it clots, the red corpuscles sinking so fast that the clotted blood consists of a lower, red part, and an upper, yellow part” (Cameron 160). Such observation along with common symptoms such as the excretion of phlegm during a regular cold, or even “black bile” during the bowel movement were probably the reasons for the concoction of the faulty humor theory.
Faulty observation and misdiagnoses built the foundation for the theory of humors as the major medical explanation for health disorders of the medieval peoples. For example, the most common time for phlebotomy was at the end of Lent (the 40 day period before Easter, during spring). After a long and cold winter, during which the major food group for most was salted meat, many persons have developed the first symptoms of scurvy out of the lack of vitamin C in their diet. As soon as Lent began, meat was prohibited according to the Catholic tradition, and the diet was soon implemented with other ingredients, especially fresh herbs and vegetables again available during the spring time. The improved diet obviously resulted in improved health of a medieval person. On the other hand, at the same time phlebotomy was administered in order to balance out the accrued “bad” humors of winter. The final result was that phlebotomy, rather than the improved diet, was perceived as the immediate cause of improved health status of the population.
More detailed information on the treatment of particular ailments during the Middle Ages can be found in Tacuinum Sanitatis (The Medieval Handbook) – a collection of colored plates assigning humoral qualities to everyday items.
EPIDEMICS
Black Death and Leprosy
The two most curious epidemics during the Middle Ages were Black Death and leprosy. Due to the specific environmental circumstances of medieval Europe and the religion of medieval people, these two epidemics had great social repercussions.
Black Death
In early 1347, a fearful epidemic of bubonic plague broke out in Constantinople. From then on, this great plague would reach Europe and kill approximately from one-fourth to nine-tenths of the human population in the affected areas.
What is the Black Death, also known as the Black Plague, Bubonic Plague, or just the Plague? From a modern medical point of view, it is a pneumonic type of an infection, highly contagious, which could be transmitted via inhalation, ingestion, or even slight abrasion of skin. Usually, lung lesions occur, hearth and kidneys turn into fatty goo, and death may occur from hearth failure. The walls of blood vessels are attacked frequently causing hemorrhages and acute blood poisoning. It is fatal in almost all cases.
The position of a medieval doctor faced with Black Death was that of certainty that the air surrounding the infected area is at fault. Because the Plague would attack a particular region, kill off everyone within it, and then move on to an adjacent region, the circulating and moving air was blamed for the deaths. The idea of the infection of the atmosphere dates back to Galen; what is shocking is the fact that no medieval doctor formed a logical explanation for Black Death, which would interfere with the poisoned atmosphere theory. Details of the symptoms were gathered by many in literary forms, yet surprisingly, nobody bothered to put together all the information and logically analyze the occurrences at hand.
Eventually, not being able to deny the evidence of their own eyes, people started to make a connection between an infected person and the increasing number of the infected around that person. Given the disgusting nature of the disease itself and its apparent infectiousness, the infected individuals instead of received pity were ostracized. During the later months of Black Death in Europe, it was common to see unburied corpses piled on top of each other in dug up holes.
In addition to actual contact with an infected person, rats and fleas played a role in spreading the disease. The rats were basically used as transport for the fleas who would not mind living partially on humans, partially on rats. This way, enough bacteria from one person could be easily transported to another by the means of a flea. The rats provided for easier spread of the disease on a larger geographical scale.
No cure has been found for the Plague in the Middle Ages, although on occasion, the more glory-seeking doctors would visit hospitals or the sick in other areas and speak up their thoughts on this illness, mostly in order to have their voice heard and obtain fame within the medical world.
Leprosy
Leprosy is an infectious disease caused by Mycobacterium leprae, a first cousin of tuberculosis bacteria. Unlike tuberculosis, leprosy bacteria cannot be grown outside living animal cells, and even within them they multiply very slowly; they can remain dormant, alive but inactive, for a long time. Leprosy bacteria probably spread from person to person as readily as tuberculosis, but disease less often follows, both because the bacteria are less virulent and because most people have a high degree of natural resistance to the disease.
Why then, such panic about it during the Middle Ages? First of all, as scary as leprosy sounds, we cannot be sure that what is described as leprosy was in fact this particular disease in the Middle Ages. It seems that this name was given oftentimes to many other disfiguring diseases. This is a great example of the underlying principles of medieval European world; more often thaot, in cases of disfigurement it was not the actual educated doctors who would diagnose a patient, but rather it would be the priests or even the common people who would become the arbiters of the disease. The cure for leprosy was not known and the treatment prescribed was usually isolation.
In many cases, leprosy would mean separation from family, from husband or wife. Some European countries would allow the spouse to join the leper or divorce may be a solution. This was a difficult decision, for under law, a leper held no rights, and under Church doctrines, a leper was considered dead. A spouse of a leper had to decide whether to abandon his or her chosen life partner or join them in non-existence. Additionally, if a wife and husband decided to leave together, they might have a hard time finding a leper colony that would accept both males and females, as such colonies were usually gender biased.
A leper in a leper colony would more often thaot suffer from depression due to sudden abandon of known circle of family and friends, and the new unfamiliar surroundings. In addition, a leper, as opposed to any other sick person in the Middle Ages, could not expect visits, for leprosy was thought to be extremely contagious.
With time, leper colonies and hospitals suffered a decline. In the early 16th century, the leper population was practically nonexistent. This is mostly due to Black Death, which has killed a great portion of the population, including the already sick (and possibly more prone to the disease) lepers.
Healing and Hospitals
The medicine in the early middle ages was mostly based on the remaining Greek and Roman texts stored in monasteries, some schools, and courts. Most of the information contained in these texts were passed upon the students in the form of at most imperfect translations. The most popular basis for medieval medicine was the medical treatise Galen from ancient Greece. Unfortunately, despite the great attention to the outer anatomy of a human, Galen does not contribute much to the actual processes that take place within a human body. His greater omission is that of blood circulation. On the other hand, he does attempt to describe the functions of human organism, such as breathing in a way, which contrasts with the previously widely believed theories of Plato. Galen takes under consideration the difference between voluntary and involuntary functions (such as the fact that breathing was voluntary – a big gap in Plato’s reasoning), and also he points out the lack of synchronization between respiration and pulse. Unfortunately, this is as far as Galen goes in his analysis of a human body.
А medieval depiction of muscle anatomy of a human.
Various leech books (physician’s desk reference) were written compiling many illnesses, their symptoms, and treatments. Originally physicians would deal with their patient either in the patient’s home, or the patient would be brought to the physician. This did not allow for free exchange of ideas or experiences among physicians and oftentimes advice on the treatment of a particular patient would be obtained by recording the symptoms in a letter and sending it to another physician. Hospitals did not have place until the later middle ages.
Leech books worth notice: Bald’s Leechbook and Leechdoms, Wort curing, and Starcraft of Early England.
Other examples of common treatments for particular ailments could be pounding henbane and hemlock and laying it on painful thighs, herbal potions to cure jaundice, vomiting and bloodletting for paralysis, and for belly disease – chewing laurel leaves, swallowing the juice, and laying the leaves on the navel. These examples are translations from Bald’s Leechbook.
Bald’s Leechbook, one of the few remaining, proposes a curious structure for the analysis of a human body. Book I of this leech book writes about leechdoms against affections of the head and goes down through eyes, ears, and throat to thighs, legs, and feet. It contains prescriptions for a various assortment of ailments, such as “tumours or abscesses, skin affections, paralysis, fevers, bites of snakes, wounds, intestical worms, and so on” (Wright 14). The second book deals with the “recognition of signs of disease and the occasional attempts at diagnosis” (Wright 15).
The medication of this time were mostly herbal substances. This combined with the diets, which specified the type and amount of food (possibly in unison with the principles of humors) and exercise to be applied. In addition, and usually in more advanced or severe cases, surgery would take place. This included but was not limited to practices such as blood letting, amputations, or setting bones.
Given the uncertainty of academic medicine, many a time the medieval person would turn towards certain charms, special prayers, or specific Christian rituals. It was not terribly uncommon to believe in cases of miraculous healing. Since most of the population of the medieval Europe did not live in the cities where they could take advantage of the learned un-superstitious university doctors, more often thaot they turned for help to the local healers who were usually nurses, halfwives, or just plain experts of herbal remedies. In addition, a more wealthy resident of a city, after consulting the more learned doctors and obtaining no visible effects, would similarly turn for help to the supernatural way of healing, be it a prayer or a visit to the local herbal expert.
Hospitals, or rather centers for the sick became steadily more popular. Of course, the majority still received treatment at home. For the chosen few who had the cash to spend could use the services of the monasteries or the few hospitals in the more urban areas.
“Love of god, compassion for humanity, and concern for their own welfare encouraged people to build hospitals” (Kealy 82). With time, the houses adjacent to some monasteries evolved from shelters for the poor (xenodochia) into places where the sick were cared for by skilled physicians. The greatest development of hospitals occurred in the 12th century.
The term hospital was vital and flexible. It encompassed hotels for travelers and indigent students, dispensaries for poor relief, clinics and surgeries for the injured, homes for the blind, the lame, the elderly, the orphaned, and the mentally ill, and leprosaria for people of all ages and classes.
Almost one half of the built hospitals was directly affiliated with monasteries, priories, and churches. Many hospitals, imitating religious communities, formulated precise rules of conduct, required a uniform type of dress, and integrated several worship services into their daily routine.
However, the traditional spiritual context of the hospital enhanced, but did not overshadow, their genuine therapeutic achievements. “Adopting a religious model was not only the tradition of the times, it was also an eminently successful therapeutic device. Through prayer, patients were supposed to help each other and, indeed, to assist their relatives and friends and people everywhere. Many hospitals had definite local community responsibilities – education and housing students, feeding paupers, maintaining bridges, and sponsoring commercial fairs. All this was both good theology and good psychology” (Kealy 97).
Surgery and Dissection
Few references to medieval surgical operations exist apart from bloodletting. This is probably due to the procedures were not known until the 19th century.
This is not to say that anaesthesia was not attempted in the Middle Ages. Many potions were known to a medieval surgeon which were to be used during surgery. Some of the potions used to relieve pain or induce sleep during the surgery were themselves potentially lethal. For example, one of these consisted of lettuce, gall from a castrated boar, briony, opium, henbane, and hemlock juice – the hemlock juice could easily have caused death.
As we can see, the “margin of safety was dangerously narrow between effective anaesthesia and death from respiratory depression” (Campbell 39-40). Hence, surgery was not attempted short of cases of life-threatening injuries. The workload of medieval surgeons would increase during war and the Plague. To the right is a diagram found in one of medieval leech books depicting the “wound man”; this diagram shows possible injuries a surgeon might have to treat during his career.
The exploration of the human body fascinated medieval surgeons. The need to find out what is inside of a human being drove the few brave with strong stomachs to dissection of the deceased. Unfortunately, this practice was strongly advised against by the Catholic Church.
The Church was against any sort of manipulation of dead bodies. During the Crusades, it was a common practice to cook out human bones in order to facilitate return of remains to homelands for proper burial. Many popes not only condemned dissection, but sometimes even went out of their way in order to stop it. The popes w ho acted most against dissection were Innocent III, Gregory IX, Sixtus VI, and Bonifatius VIII. Some of them acted on the threat to “excommunicate anybody who dissected a human body or cooked out human bones.” Additionally, “a kind of inquisition resulted in which anyone found guilty of molesting the dead was burned at the stake or otherwise severely punished” (Kevorkian 34).
An important fact to point out is that the Church not only allowed but actually ordered caesarean sections on dead pregnant women in attempt to save the soul of the unborn infant.
The illustration above is a depiction of dissection of Mother Agrippina.
The fascination with the human body, however, was not put to its end and continued and flourished in the Renaissance.
Education
The practitioners of medicine in medieval Europe were both members of clergy and laymen. The clergy was educated by the Church, while the laymen either attended universities or joined a medical guild. The people who would normally join the clergy or universities were the sons of nobility. Guilds, on the other hand, offered an attempt at creation of the middle class in medieval Europe. Guilds consisted of merchants, who were not noble born, and their children who had an opportunity to choose a different craft. Usually though the craft “ran” in the family and the children were expected to continue the family tradition of a particular craft.
The concept of the university had its origins in the Middle ages. Schools had existed for centuries, as had academies of higher learning, but formalized, structured organizations created for the express purpose of education a group of scholars in selected disciplines did not come into being until the 13th century.
The course of study was as follows:
• Students enter the university at the age of 14.
• First part of schooling lectures). These are divided into two parts:
o trivium – “three ways”, consisting of grammar dialectic, and rhetoric
o quadrivium – “four ways”, consisting of arithmetic, geometry, astronomy, and music
Two years of debate or disputations – upon the completion of this stage with satisfying results on the examinations, the students would be awarded a bachelor of arts degrees.
In order to pursue a master’s degree, further studies were necessary. This usually meant another year of study.
Finally, students who held master’s degrees were allowed to study such disciplines as law, medicine, or theology. Depending on one’s course of study, this could mean up to 12 more years of education.
Students in medieval universities experienced the same distractions in their lectures as students today, as seen by the students in this scene of a 14th century German classroom. (From Staatliche Museum, Berlin.)
Medicine became a standard part of the medieval curriculum, and it is not uncommon to encounter educated clerics requesting medical handbooks and both seeking and giving medical advice.
Guilds were efficient and selfish organizations that had as a goal the protection of interest of their respective members. The well-being and honor of the craft depended upon the mutual cooperation of its members. Such attitude provided for great teamwork, exchange of ideas among the members, and development of the craft.
Guilds offered its members a certain level of protection, which turned out to be significant especially in medical guilds. Under the protection of a guild, physicians were allowed to practice medicine undisturbed by the less forgiving outsiders. Additionally, in many cases, guilds would encourage treatment of all patients, the poor and the rich the same, regardless of their financial status. The charge for service was according to what the patient could pay.
Renaissance Medicine
Introduction to the Renaissance Medicine.
Medicine was challenged in Europe by the rise of experimental investigation, principally in dissection, examining bodies in a manner alien to other cultures. The work of individuals like Andreas Vesalius and William Harvey challenged accepted folklore with scientific evidence. Understanding and diagnosis improved but with little direct benefit to health. Few effective drugs existed, beyond opium and quinine, folklore cures and almost or actually poisonous metal-based compounds were popular, if useless, treatments.
The Renaissance was a period in European history during which there was a revival in the ideas of ancient Rome and Greece. Culture, art, science and medicine were studied by aristocrats and scholars who prized themselves on their education. Ideas flourished and the newly invented printing press allowed books to be produced quickly. Before this, books were slowly and painstakingly copied by hand. Although very few people could read and write, the printing press was a revolution in information technology and resulted in ideas spreading around Europe like never before. It is hard to believe its impact but the printing press was the information superhighway of its day.
Medical research and major breakthroughs
Medicine remained dominated by the teachings of the church but physicians began to learn more about the human body. They read books translated from Arabic medical texts and began to study anatomy in a scientific and systematic way. Andreas Vesalius and Leonardo Da Vinci dissected human bodies and made the first anatomical drawings. These helped in understanding the organs and systems of the human body. The church did not permit the dissection of ‘God fearing bodies’ so it was often the bodies of criminals or ‘sinners’ that were used. Doctors learned about anatomy from watching these dissections. Sometimes the criminal was alive at the start of proceedings as part of their punishment!
During the Renaissance, the human body was regarded as a creation of God and the ancient Greek view of the four humors prevailed. Sickness was due to an imbalance in these humors and treatments, such as bleeding the patient or inducing vomiting, were aimed at restoring the balance of these four humors.
In 1628, William Harvey published his new theory that the heart acts as a muscular pump which circulates blood around the body in the blood vessels. Discoveries during the Renaissance laid the foundations for a change in thinking leading to the view that the body is made up of specialised systems that work together; the basis of medical knowledge that we still see today.
As the understanding of the body increased, so did the development of new medicines. Building on knowledge of herbs and minerals taken from Arabic writings, Renaissance pharmacists experimented with new plants brought from distant lands by explorers like Christopher Columbus. The bark of the Quina tree contained an ingredient called quinine which is still used in the treatment of malaria. The leaves of the tobacco plant were thought to have medicinal properties, although we now know it is responsible for an enormous number of deaths. Laudanum, an opium-based painkiller, was prescribed for many disorders and remained in use up until Victorian times. However, progress was slow and many medicines remained little more than superstitious potions containing ingredients like worm’s livers and tongue of newt.
As new continents were explored, and trade between different parts of the world increased, it allowed the global spread of disease. This often had devastating effects as whole populations were exposed to pathogens against which they had no natural immunity. Bubonic plague moved along trade routes from China and killed more than a third of Europe’s population. When the Spanish colonised South America, they brought smallpox which killed many native Aztecs and Incas.
Diseases can spread rapidly when a pathogen enters a new population that has never been exposed to it. This is because none of the population has any natural immunity to the disease.
Hospitals and healthcare
The majority of people were too poor to be treated by trained doctors. Major cities had hospitals. For example, the Santa Maria Nuova in Florence, treated wealthy patients. These hospitals were amongst the first medical schools in Europe to start teaching medicine. Surgery improved and techniques such as tying wounds to stop bleeding began to be used. Previously, bleeding was stopped by cauterizing, or burning, the wound with red hot metal.
Surgical instruments remained basic. A surgeon would perform operations with the most basic set of instruments: a drill, a saw, forceps and pliers for removing teeth. If a trained surgeon was not available, it was usually the local barber who performed operations and removed teeth.
Paracelsus (Theophrastus Bombastus von Hohenheim)) Paratsel’s (Teofrastus Bombastus background of Khoenkhaym) (1493-1541) doctor, naturalist and philosopher, one of pioneers of organic chemistry and medicine. Gave systematic description of many diseases, used knowledge in chemistry for pharmacology; studied folk medicine. Wrote and taught not on Latin, but in German. The pseudonym that he chose was supposed to mean his superiority over the famous Ancient Rome doctor and naturalist Cornelius Celsus, as Paracelsus acknowledged no authorities.
Andreas Vesalius wrote what is considered to be one of the most important books in the history of medicine, The Fabric of the Human Body (1543). It was a complete map of the human body, complete with life like illustrations. It showed many of Galen’s ideas to be wrong, and soon Vesalius’ view of anatomy (the study of the structure of the body) became accepted by doctors and surgeons.
Andreas Vesalius was born in Brussels in 1514. His great grandfather and grandfather had been doctors and his father a chemist. Vesalius studied medicine at several European universities, and soon gained a reputation as a good anatomist, gaining good knowledge of the structure of the body by examining skeletons.
The Church now allowed human dissection, but did not allow bodies to be boiled up to produce skeletons. Vesalius desperately wanted to examine the human skeleton. The only way he could do this was to wait until the bodies of hung criminals had decomposed on the gallows. When the bones were bare he would remove the bodies and smuggle them back into town to study them.
Vesalius was so successful that he became Professor of Surgery (responsible for teaching anatomy) at Padua University when he was just 23. At this time, the Catholic Church said that the works of Galen were inspired by God. So, in the universities of Europe, anatomy was taught by professors who simply read aloud from Galen’s books. If dissections took place they were usually carried out by Barber Surgeons who had no medical qualifications and who were not allowed to question the word of Galen.
In contrast, Vesalius gave lectures in which he carried out dissections in front of his students, explaining his own theories and not relying on those of Galen. Hundreds came to watch each lecture. He also encouraged his students to examine the human body for themselves.
Vesalius also believed that accurate illustartions of various parts of the body would help his students to understand anatomy (the structure of the body) and physiology (what each part of the body works and functions) that much more quickly and effectively. These illustrations were carefully labelled and explained. Many doctors at the time opposed this idea, saying it was unscientific. Vesalius ignored them and in 1538 he published Tabulae Sex, a set of drawings (6 sheets) that accurately illustrated parts of the human body, as well as animal anatomy. Vesalius, by showing parts of the human body, the liver for example, highlighted the fact that Galen’s descriptions of the human body had often been incorrect.
In 1543, his masterpiece, The Fabric of the Human Body, was published. It was a very detailed study of anatomy, illustrated throughout by some of the most accomplished artists of the Renaissance. It was based on knowledge gained from human dissections. It provided a complete map of the human body. It showed for the first time how nerves are connected to muscles, how bones are nourished, and the complex structure of the brain.
Vesalius corrected some of Galen’s errors, such as the idea that humans had the same number of bones in the spine as monkeys, and that the human jaw is made up of two bones when in fact there is only one.
Ambroise Pare is a key individual in the history of medicine who has been called the founder of modern surgery as he significantly changed the way people thought about surgery. He was born in France in 1510. He began training as a barber surgeon in 1533. He became a military surgeon for the French army in 1537. By the time of his death, aged 80, he had been surgeon to four French Kings and was the most famous surgeon of his age.
As France was often at war during the 1500’s, Pare had plenty of time to practice his craft as a military surgeon. Three main problems faced surgeons at this time. They were pain, infection and bleeding. These 3 factors caused many patients to die. The musket (a form of gun) was becoming the most widely used weapon, but the method of treating the wounds – cauterisation – caused a lot of pain. Pare wanted to find a way to overcome this problem.
The ways of treating gunshot wounds before Pare.
1) If the wound was not too serious, it was filled with boiling oil to stop the bleeding.
2) If the patient needed an amputation, the area would be burnt with a red hot iron, called a cautery iron, to stop the bleeding.
Pare’s Method
Pare developed two new methods for treating gunshot wounds.
1) (For less serious wounds) Pare made an accidental discovery when he ran out of oil that he had been using to pour into gunshot wounds. He used a digestive (ointment) instead, made from egg yolks, rose oil, and turpentine. He discovered that this reduced pain greatly. Cauterisation was not necessary and the ointment soothed the area around the wound. It also fought infection, making the wound heal quicker.
2) (For amputations) Pare made sure the patient was strong by feeding him meat and eggs. He tied the area above the part to be amputated, using a ligature. This held the skin covering the muscles and bones and cut off the blood supply to the area that would be amputated. Once the limb was amputated Pare would use a Crows Beak (an instrument that resembles a pair of pliers) to pull out arteries and veins before tying them off and sewing them up as quickly as possible using silk thread. This meant less bleeding and therefore less chance of death from loss of blood.
In 1575 Pare published, The Collected Works of Surgery. This work was initially attacked by the French Faculty of Physicians, but thanks to the support of Henry II, the King, the book began to spread Pare’s ideas across Europe. Over time these ideas began to change the way that surgeons approached their work – especially when treating wounds and performing amputations. Surgeons now knew that for operations to be successful they would have to combat pain, infection and bleeding using methods similar to those used by Pare.
Pare’s method, although groundbreaking, still left some problems to be solved in the future. Even though Pare’s use of a digestive (ointment) when treating wounds reduced the risk of infection, many patients still died from infection as effective antiseptics had not yet been invented.
Pare’s method of using silk thread to tie off arteries could actually cause infection. Instruments used during operations were not often clean – there was no knowledge of germs – therefore bacteria on those instruments (and the silk thread) was often transferred to the wound and sealed inside.
William Harvey was born in England in 1578. He studied medicine at Padua University between 1598 and 1602. He was very interested in anatomy, particularly the work of Vesalius. After leaving university he worked as a doctor at St Bartholomew’s Hospital, London, and then as a lecturer in anatomy at the Royal College of Surgeons. He was also physician to both James I and Charles I.
Although Vesalius had proven that some of Galen’s ideas were incorrect, Galen’s explanation of the function of the heart was still accepted. Galen said that blood was made in the liver, and got into the arteries through holes in the septum of the heart. He said that blood was continually being made – to make up for the fact that it was used up by the body.
Like Pare and Vesalius, Harvey believed in the importance of careful observation, dissection and experiments in order to improve his knowledge of how the body worked. In 1615 Harvey began to work on the idea that blood circulated around the body. Around this time, water pumps were invented. This gave Harvey the idea that perhaps the heart worked in the same way as a water pump, and pumped blood around the body.
Harvey wanted to study the body as a living system, so he needed to dissect things which were still alive. He chose to study cold-blooded animals like frogs because their hearts beat slowly. This enabled him to see each separate expansion and contraction of the heart. He also dissected the bodies of dead criminals to ensure that the human heart was the same as that of the live animals he had studied.
Harvey’s study of beating hearts showed him that the heart was pushing out large volumes of blood. He proved that each push happened at the same time as the pulse which could be felt at the neck and at the wrist. He realised that so much blood was being pumped out by the heart, that it could not be used up and replaced by new blood as Galen had said. This suggested that there was a fixed amount of blood in the body, and that it was circulating.
Harvey now needed to prove his theory. By trying to pump liquids the wrong way past the valves in veins and arteries, Harvey proved that they were all ‘one-way’ systems. This proved his theory that blood flowed out from the heart through the arteries, and it flowed back through the veins to the heart where it was recycled again. He also devised a simple experiment that anyone could use on themselves to prove that blood only flows one way through the veins. By bandaging the upper arm, the valves show up as nodules on the vein. If your finger is pushed along the vein from one valve to the next, away from the heart, the section of vein will be emptied of blood. It will stay empty until you take your finger off. Harvey published his theory of the circulation of blood in his book, On the Motion of the Heart, in 1628. He included a sketch of how to perform this simple experiment, to prove his theory to readers.
Harvey’s theory met with opposition because it suggested that if there was a fixed amount of blood in the body, then there was no need for the practice of blood letting. Blood letting was a very common and well respected medical practice, which had been used ever since ancient times, (e.g. in the Four Humours). After his book was published he actually lost patients, as his ideas were considered strange for the time. Despite this, soon after his death, his theory was soon widely accepted. Over the next 300 years his theory was used to build up knowledge of what the blood did in various parts of the body as it circulated. Harvey made a great contribution to medical knowledge, but it was not until the 1900’s that the knowledge was used in medical practices. Medical practices in the Renaissance were not changed by Harvey’s work. Blood letting still continued to be a popular practice, and it was only in the 1900’s that doctors realised the importance of checking a patient’s blood flow by checking their pulse.
