Medieval medicine of Western Europe

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 Western Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Many simply placed their hopes in the church and God to heal all their sicknesses. However, there were medieval doctors. They did not know much legitimate information, as they had no basic understanding of the human anatomy, and antibiotics had not yet been discovered, so there was not much, then, that they could do for their patients.^[2] Ideas about the origin and cure of disease were not 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

Hippocratic Medicine

The Western medical tradition often traces roots directly to the early Greek civilization, much like the foundation of all of Western society. The Greeks certainly laid the foundation for Western medical practice but much more of Western medicine can be traced to the Middle East, Germanic, and Celtic cultures. The Greek medical foundation comes from a collection of writings known today as the Hippocratic Corpus.^[3] Remnants of the Hippocratic Corpus survive in modern medicine in forms like the “Hippocratic Oath” as in to “Do No Harm.^[4]”

The Hippocratic Corpus, popularly attributed to an ancient Greek practitioner known as Hippocrates, lays out the basic approach to health care. Greek philosophers viewed the human body as a system that reflects the workings nature and Hippocrates applied this belief to medicine. The body, as a reflection of natural forces, contained four elemental properties expressed to the Greeks as the four humors. The humors represented fire, air, earth and water through the properties of hot, cold, dry and moist, respectively.^[5] Health in the human body relied on keeping these humors in balance within each person.

Maintaining the humors within a patient occurred in several ways. The primary tool of the physician to balance the patient's humors. An initial examination took place as standard for a physician to properly evaluate the patient. The patient's home climate, their normal diet, and astrological charts were regarded during consultation. The heavens influenced every person in different ways by influencing elements connected to certain humors, important information in reaching a diagnosis. The physician could determine which humor was unbalanced in the patient and prescribe a new diet to restore that balance.^[6] Diet not only included food to eat or avoid but also an exercise regiment and medication.

Hippocratic medicine represented learned medical practice beginning with the Hippocratic Corpus having been written down so practitioners had to be literate.^[7] The written treatises within the Corpus are varied, incorporating medical doctrine from any source the Greeks came into contact with. At Alexandria in Egypt the Greeks learned the art of surgery and dissection, the Egyptian skill in these arenas far surpassed those of Greeks and Romans due to social taboos on the treatment of the dead.^[8] The early Hippocratic practitioner Herophilus engaged in dissection and added new knowledge to human anatomy in the realms of the human nervous system, the inner workings of the eye, differentiating arteries from veins, and using pulses as a diagnostic tool in treatment.^[9] Surgery and dissection yielded much knowledge of the human body that Hippocratic physicians employed alongside their methods of balancing humors in patients. The combination of knowledge in diet, surgery, and medication formed the foundation of medical learning upon which Galen would later greatly contribute.

Temple Healing

The Greeks clearly had been influenced by their Egyptian neighbors in terms of medical practice in surgery and medication but the Greeks also absorbed many folk healing practices including incantations and dream healing. In Homer's Iliad and Odyssey the gods are implicated as the cause of plagues or widespread disease and that those maladies could be cured by praying to them. This religious side of healing clearly manifested in the cult of Asclepius, whom Homer regarded as the great physician, and was deified in the third and fourth century BC.^[10] Hundreds of temples devoted to Asclepius have been found throughout the Greek and Roman empire to which untold numbers of people have flocked for cures. Healing visions and dreams formed the foundation for the curing process as the person seeking treatment from Asclepius slept in a special dormitory. The healing occurred either in the person's dream or advice from the dream could be used to seek out proper treatment for illness elsewhere. After wards the visitor to the temple bathed, offered prayers and sacrifice, and received other forms of treatment like medication, dietary restrictions, and an exercise regiment, keeping with the Hippocratic tradition.^[11]

Pagan and Folk Medicine

Medicine in the Middle Ages had its roots in pagan and folk practices. This influence was highlighted by the interplay between Christian theologians who adopted aspects of pagan and folk practices and chronicled them in their own works. The practices adopted by Christian medical practitioners around the 2nd century, and their attitudes toward pagan and folk traditions, reflected an understanding of these practices, especially humoralism and herbalism. The practices of Christian medicine stemmed from pagan and folk practices.

The practice of medicine in the early Middle Ages was in fact empirical and pragmatic. It focused mainly on curing disease rather than discovering the cause of diseases.^[12] Often it was believed the cause of disease was supernatural. Nevertheless, approaches to curing disease existed. People in the Middle Ages considered medicine through an understanding of the humors. This approach was likely influenced by a largely rural existence in which people understood the influences of the elements of the sustenance of agriculture. Since it was clear that the fertility of the earth depended on the proper balance of the elements, it followed that the same was true for the body, within which the various humors, as they were understood, had to be in balance.^[13] This approach greatly influenced medical theory throughout the Middle Ages.

Folk medicine of the Middle Ages ostensibly dealt with the use of herbal remedies for ailments. The practice of keeping gardens teeming with various herbs with medicinal properties was a traditional practice influenced in medieval Europe by the gardens of Roman antiquity.^[12] Many early medieval manuscripts have been noted for containing practical descriptions for the use of herbal remedies. These texts, such as the Pseudo-Apuleius, included illustrations various plants that would have been easily identifiable and familiar to Europeans at the time.^[12] Monasteries later became centers of medical practice in the Middle Ages and carried on the tradition of maintaining gardens containing medicinal herbs. Herb gardens contained plants with healing properties. These gardens became specialized and capable of maintaining plants from Southern Hemispheres as well as maintaining plants during winter.^[12] The practice of gardening for the purpose of supplying the ingredients necessary in medieval herbal medicinals was influenced by a rural folk tradition.

Again, that Europe in the early Middle Ages was largely rural and agricultural influenced folk medical practices at the time. Hildegard of Bingen was an example of a medieval medical practitioner who took her cues from this folk medical tradition. Her understanding of the elements in nature informed her commentary on the humors of the body and the remedies she described in her medical text, Causae et curae, were greatly influenced by her familiarity with folk treatments of disease. In the rural society of Hildegard's time, much of the medical care was provided by women, along with their other domestic duties. Not surprisingly, their kitchen were stocked full of the herbs and other substances required in folk remedies for many ailments.^[13] Causae et curae illustrated a view of symbiosis of the body and nature, that the understanding of nature could inform medical treatment of the body. However, Hildegard maintained the belief that the root of disease was a compromised relationship between a person and God.^[13] Many parallels between pagan and Christian ideas about disease existed during the early Middle Ages. Many viewed medicine as being part of the natural order and therefor sought medical help for illness. Most of the focus of this early medicine remained focused on cures for rather than the causes of diseases. Christian views of disease differed from those held by pagans because of a fundamental difference in belief: Christians' belief in a personal relationship with God greatly influenced their views on medicine.^[14] However, in spite of this key difference, Christian medical practitioners gave much credence to pagan tradition.

Evidence of pagan influence on emerging Christian medical practice was provided by many prominent early Christian thinkers, such as Origen, Clement, and Augustine, who studied natural philosophy and held important aspects of secular Greek philosophy that were in line with Christian thought. They believed faith supported by sound philosophy was superior to simple faith.^[14] Other similarities between Christian and pagan views on medicine existed. Christian ideas about the role of physicians were influenced by previous pagan ideals. The classical idea of the physician as a selfless servant who had to endure unpleasant tasks and provide necessary, often painful treatment was of great influence on early Christian practitioners. The metaphor was not lost on Christians who viewed Christ as the ultimate physician.^[14] Another similarity shared with the pagan perspective was the view of the relationship between disease and the individual. Pagan philosophy had previously held that the pursuit of virtue should not be secondary to bodily concerns. Similarly, Christians felt that, while caring for the body was important, it was second to spiritual pursuits.^[14] Early Christianity was eager, for the most part, to borrow these certain aspects of pagan classical philosophy.

The practice of medicine in medieval Europe was longstanding. A classical pagan view of medicine in which the main focus was on treating and curing disease survived as the practice of medicine evolved through the Middle Ages. People in medieval Europe had long been practicing folk medicine as evidenced by the tradition of the herb garden. The continued practice of gardening in monasteries later on and the practicality and accessibility of the works of Hildegard of Bingen and other, as mentioned previously, illustrated a longstanding precedent of medical practice. The roots of medieval medicine in the pagan and folk medicine that preceded it illustrate a development of medical practice that took place in Europe over a long period of time.

Monasteries

Monasteries developed not only as spiritual centers, but also centers of intellectual learning and medical practice. Locations of the monasteries were secluded and designed to be self-sufficient, which required the monastic inhabitants to produce their own food and also care for their sick. Prior to the development of hospitals, people from the surrounding towns looked to the monasteries for help with their sick.

A combination of both spiritual and natural healing was used to treat the sick. Herbal remedies, known as Herbals, along with prayer and other religious rituals were used in treatment by the monks and nuns of the monasteries. Herbs were seen by the monks and nuns as one of God’s creations for the natural aid that contributed to the spiritual healing of the sick individual. An herbal textual tradition also developed in the medieval monasteries.^[15] Older herbal Latin texts were translated and also expanded in the monasteries. The monks and nuns, reorganized older texts so that the text could utilized more efficiently, adding a table of contents for example to help find information quickly. Not only did they reorganize existing texts, but they also added or eliminated information. New herbs that were discovered to be useful or specific herbs that were known in a particular geographic area were added. Herbs that proved to be ineffective were eliminated. Drawings were also added or modified in order for the reader to effectively identify the herb. The Herbals that were being translated and modified in the monasteries were some of the first medical texts produced and used in medical practice in the Middle Ages.^[16]

Not only were herbal texts being produced, but also other medieval texts that discussed the importance and imbalance of the humors.Hildegard of Bingen, a well known abbess, wrote about Hippocratic Medicine using humoral theory and how balance and imbalance of the elements affected the health of an individual along with other known sicknesses of the time, and ways in which to combine both prayer and herbs form nature to help the individual become well. She discusses different symptoms that were common to see and the known remedies for them.^[17]

In exchanging the herbal texts among monasteries, monks became aware of herbs that could be very useful but were not found in the surrounding area. The monastic clergy traded with one another or used commercial means to obtain the foreign herbs.^[18] Inside most of the monastery grounds there had been a separate garden designated for the plants that were needed for the treatment of the sick. A serving plan of St. Gall depicts a separate garden to be developed for strictly medical herbals.^[19] Monks and nuns also devoted a large amount of their time in the cultivation of the herbs they felt were necessary in the care of the sick. Some plants were not native to the local area and needed special care to be kept alive. The monks used a form of science, what we would consider today, botany to cultivate these plants. Foreign herbs and also plants determined to be highly valuable were grown in gardens with in close proximity to the monastery in order for the monastic clergy to hastily have access to the natural remedies.

Medicine in the monasteries was concentrated on assisting the individual to return to normal health. Being able to identify symptoms and remedies was the primary focus. In some instances identifying the symptoms led the monastic clergy to have to take into consideration the cause of the illness in order to implement a solution. Research and experimental processes were continuously being implemented in monasteries to be able to successful fulfill their duties to God to take care of all God's people.

Christian Charity

By AD 400 a community without a healer was, by Jewish law, no proper community. The Jews took their duty to care for their fellow Jews seriously. This duty extended to lodging and medical treatment of pilgrims to the temple at Jerusalem.^[20] Temporary medical assistance had been provided in classical Greece for visitors to festivals and the tradition extended through the Roman empire, especially after Christianity became the state religion prior to its decline. In the early Medieval period hospitals, poor houses, hostels, and orphanages began to spread from the Middle East, each with the intention of helping those most in need.^[21] Charity, the driving principle behind these healing centers, encouraged the early Christians to care for others. The cities of Jerusalem, Constantinople, and Antioch contained some of the earliest and most complex hospitals with many beds to house patients and staff physicians with emerging specialties.^[22] Some hospitals were large enough to provide education in medicine, surgery and patient care. St Basil (AD 330-79) argued that God put medicines on the Earth for human use, which many early church fathers agreed that Hippocratic Medicine could be used to treat the sick and satisfy the charitable need to help others.

Medicine

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 Arabic during the 13th 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 until that time. The Canon became an authoritative text in European medical education until the early modern period. Other influential texts from Arabic authors include De Gradibus by Alkindus, the Liber pantegni by Isaac Israeli ben Solomon, and Al-Tasrif' by Abulcasis.

At Schola Medica Salernitana in Southern Italy, 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.

During the Crusades the influence of Islamic medicine became stronger. The influence was mutual and Islamic scholars such as Usamah ibn Munqidh also described their experience with European medicine 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".^[23]

Classical medicine

Anglo-Saxon translations of classical works like Dioscorides Herbal survive from the 10th century, showing the persistence of elements of classical medical knowledge. Other influential translated medical texts at the time included the Hippocratic Corpus attributed to Hippocrates, and the writings of Galen.

Galen of Pergamon, a Greek, was one of the most influential ancient physicians. 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 animals, mainly apes, sheep, goats and pigs.^[24] Some of Galen's teachings held 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.

Medieval Surgery

Early medieval Surgery traces its roots to ancient times in Egyptian and Greek societies. One of the earliest influences on early European surgery was the great physician Galen. He was the first to incorporate the practice of dissection and many other types of surgical operations.

The emersion of universities in Western Europe brought about the study of medicine as a focus of learning. The University of Padua and the University of Bologna were two Italian universities that focused on the study of medicine. The students from these schools would spend years working for a degree in medicine.

During the Crusades, surgeons would go around to determine whether the soldiers were dead or alive. Some surgeons became specialized in removing arrow heads from their patients bodies^[25] The other form of surgeons during the Middle Ages were the Barber surgeons. Barber surgeons were in any medieval town and would mainly cut beards and hair. On occasion these men would be called for doing small operations like bloodletting (the practice of taking small quantities of blood to prevent illness or disease) or treating sword and arrow wounds. When doing operations on patients, doctors would only use anesthetics on the patients who had enough money to pay for its use. Most of the time patients would be given a piece of wood or leather to bite down on during the surgical procedure.

Special medical procedures like the practice of Trepanning (Making a small incision in the skull) was mainly for patients who suffered from head pressure or mental illnesses. Cauterization (Using a hot piece of metal to burn the flesh and instantly close an open wound) was a common remedy for those who had deep wounds that could not be closed. The fastest way to close these wounds was to cauterize the wound. Amputation was a procedure used to remove the limbs of a patient to stop future disease. Amputation was a very violent practice and often caused later problems for the patients. During these procedures many patients would die either from shock due to blood loss or later infections of the operated area.

Important medieval contributions

Though it is not readily recognized the Middle Ages contributed a great deal to medical knowledge. This period contained progress in surgery, medical chemistry, dissection, and practical medicine. While there might not be a huge monumental event, the Middle Ages laid the ground work for later larger discoveries. There was a slow but constant progression in the way that medicine was studied and practiced. It went from apprenticeships to universities and from oral traditions to documenting texts. The most well-known preservers of texts, not only medical, would be the monasteries. The monks were able to copy and revise any medical texts that they were able to obtain. Besides documentation the Middle Ages also had one of the first well known female physicians, Hildegard of Bingen.

Hildegard was born in 1098 and at the age of fourteen she entered the double monastery of Dissibodenberg.^[26] She wrote the medical text Causae et curae in which many medical practices of the time were demonstrated. This book contained diagnosis, treatment, and prognosis of many different diseases and illnesses. This text was able to shed light on medieval medical practices of the time. It also shows the vast amount of knowledge and influences that she had available that she mentioned in her works. In this time period medicine was taken very seriously and it is shown with Hildegard's detailed descriptions on how to perform medical tasks.^[27] The descriptions are nothing without their practical counterpart and Hildegard was thought to have been an infirmarian in the monastery where she lived. An infirmarian treated not only other monks but pilgrims, workers, and the poor men, women, and children in the monastery's hospice. Because monasteries were located in rural areas the infirmarian was also responsible for the care of lacerations, fractures, dislocations, and burns.^[28] Along with typical medical practice the text also hints that the youth (such as Hildegard) would have received hands-on training from the previous infirmarian. Beyond routine nursing this also shows that medical remedies from plants, that were either grown or gathered, was something that had a significant impact of the future of medicine. This was the beginnings of the domestic pharmacy.^[29]

Although plants were the main source of medieval remedies, around the sixteenth century medical chemistry became more prominent. "Medical chemistry began with the adaptation of chemical processes to the preparation of medicine".^[30] Previously medical chemistry was characterized by any use of inorganic materials, but it was later refined to be more technical, like the processes of distillation. John of Rupescissa's works in alchemy and the beginnings of medical chemistry is recognized for the bounds in chemistry. His works in making the philosopher's stone, also known as the fifth essence, was what made him well known.^[31] Distillation techniques were mostly used and it was said that by reaching a substance's purest form the person would find the fifth essence, and this is where medicine comes in. Remedies were able to be made more potently because there was now a way to remove nonessential extras. This opened many doors for medieval physicians because new, different remedies were being made. Medical chemistry provided an "increasing body of pharmacological literature dealing with the use of medicines derived from mineral sources".^[32] Medical chemistry also shows the use alcohols in medicine and though these events were not huge bounds it was influential in determining the course of science. It was the start of differentiation between alchemy and chemistry.

The Middle Ages brought a new way of thinking and a lessening on the taboo of dissection. Dissection for medical purposes became more prominent around 1299.^[33] During this time the Italians were practicing anatomical dissection and the first record of an autopsy dates from 1286. Dissection was first introduced in the educational setting at the university of Bologna to study and teach anatomy. The fourteenth century was the huge spread of dissection and autopsy in Italy and was not only taken up by medical faculties, but by colleges for physicians and surgeons.^[34]

The founding of the Universities of Paris (1150), Bologna (1158), Oxford, (1167), Montpelier (1181) and Padua (1222), extended the initial work of Salerno 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.

Roger Frugardi of Parma composed his treatise on Surgery around about 1180. 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.

Compendiums like Bald's Leechbook (circa 900), include citations from a variety of classical works alongside local folk remedies.

Theories of medicine

Although each of these theories has distinct roots in different cultural and religious traditions, they were all intertwined in the general understanding and practice of medicine. For example, the Benedictine abbess and healer, Hildegard of Bingen, claimed that black bile and other humour imbalances were directly caused by presence of the devil and by sin.^[35] Another example of the fusion of different medicinal theories is the combination of Christian and pre-Christian ideas about elf-shot (elf- or fairy-caused diseases) and their appropriate treatments. The idea that elves caused disease was a pre-Christian belief that developed into the Christian idea of disease-causing demons or devils.^[36] Treatments for this and other types of illness reflected the coexistence of Christian and pre-Christian or pagan ideas of medicine.

Humours

The underlying principle of medieval medicine was the theory of humours. This was derived from the ancient medical works, and dominated all western medicine 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	ELEMENT
Black 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.

Herbalism

Herbs were commonly used in salves and drinks to treat a range of maladies. The particular herbs used depended largely on the local culture and often had roots in pre-Christian religion.^[36] The success of herbal remedies was often 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, skullcap seeds (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 were believed to exist.

Many monasteries developed herb gardens for use in the production of herbal cures,^[37] 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.

Christian Interpretation of Illness and Continued Influence

Medicine in the Middle Ages was rooted in Christianity through not only the spread of medical texts through monastic tradition but also through the beliefs of sickness in conjunction with medical treatment and theory. 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. From a Christian perspective disease could be seen either as a punishment from God or as an affliction of demons (or elves, see first paragraph under Theories of Medicine). The ultimate healer in this interpretation is of course God, but medical practitioners cited both the bible and Christian history as evidence that humans could and should attempt to cure diseases. For example the Lorsch Book of Remedies or the Lorsch Leechbook contains a lengthy defense of medical practice from a Christian perspective. Christian treatments focused on the power of prayer and holy words, as well as liturgical practice.^[38]

However, many monastic orders, particularly the Benedictines, were very involved in healing and caring for the sick and dying.^[39] In many cases, the Greek philosophy that early Medieval medicine was based upon was compatible with Christianity.^[40] Though the widespread Christian tradition of sickness being a divine intervention in reaction to sin was popularly believed throughout the Middle Ages, it did not rule out natural causes. For example, the Black Death was thought to have been caused by both divine and natural origins.^[41] The plague was thought to have been a punishment from God for sinning, however because it was believed that God was the reason for all natural phenomena, the physical cause of the plague could be scientifically explained as well. One of the more widely accepted scientific explanations of the plague was the corruption of air in which pollutants such as rotting matter or anything that gave the air an unpleasant scent caused the spread of the plague.^[42]

Hildegard of Bingen played an important role in how illness was interpreted through both God and natural causes through her medical texts as well. As a nun, she believed in the power of God and prayer to heal, however she also recognized that there were natural forms of healing through the humors as well. Though there were cures for illness outside of prayer, ultimately the patient was in the hands of God.^[43] One specific example of this comes from her text Causae et Curae in which she explains the practice of bleeding:

Bleeding, says Hildegard, should be done when the moon is waning, because then the "blood is low" (77:23-25). Men should be bled from the age of twelve (120:32) to eighty (121:9), but women, because they have more of the detrimental humors, up to the age of one hundred (121:24). For therapeutic bleeding, use the veins nearest the diseased part (122:19); for preventive bleeding, use the large veins in the arms (121:35-122:11), because they are like great rivers whose tributaries irrigate the body (123:6-9, 17-20). 24 From a strong man, take "the amount that a thirsty person can swallow in one gulp" (119:20); from a weak one, "the amount that an egg of moderate size can hold" (119:22-23). Afterward, let the patient rest for three days and give him undiluted wine (125:30), because "wine is the blood of the earth" (141:26). This blood can be used for prognosis; for instance, "if the blood comes out turbid like a man's breath, and if there are black spots in it, and if there is a waxy layer around it, then the patient will die, unless God restore him to life" (124:20-24).^[43]

Monasteries were also important in the development of hospitals throughout the Middle Ages, where the care of sick members of the community was an important obligation. These monastic hospitals weren’t only for the monks who lived at the monasteries but also the pilgrims, visitors and surrounding population.^[44] The monastic tradition of herbals and botany influenced Medieval medicine as well, not only in their actual medicinal uses but in their textual traditions. Texts on herbal medicine were often copied in monasteries by monks but there is substantial evidence that these monks were also practicing the texts that they were copying. These texts were progressively modified from one copy to the next, with notes and drawings added into the margins as the monks learned new things and experimented with the remedies and plants that the books supplied.^[45] Monastic translations of texts continued to influence medicine as many Greek medical works were translated into Arabic. Once these Arabic texts were available, monasteries in western Europe were able to translate them, which in turn would help shape and redirect western medicine in the later Middle Ages.^[46] The ability for these texts to spread from one monastery or school in adjoining regions created a rapid diffusion of medical texts throughout western Europe.^[47]

The influence of Christianity continued on into the later periods of the Middle Ages as medical training and practice moved out of the monasteries and into cathedral schools, though more for the purpose of general knowledge rather than training professional physicians. The study of medicine was eventually institutionalized into the medieval universities.^[41] Even within the university setting, religion dictated a lot of the medical practice being taught.For instance, the debate of when the spirit left the body influenced the practice of dissection within the university setting. The universities in the South believed that the soul only animated the body and left immediately upon death. Because of this, the body while still important, went from being a subject to an object. However, in the north they believed that it took longer for the soul to leave as it was an integral part of the body.^[48] Though medical practice had become a professional and institutionalized field, the argument of the soul in the case of dissection shows that the foundation of religion was still an important part of medical thought in the late Middle Ages.

Medical practitioners

Members of religious orders were major sources of medical knowledge and cures. There appears to have been some controversy regarding the appropriateness of medical practice for members of religious orders. The Decree of the Second Lateran Council of 1139 advised the religious to avoid medicine because it was a well-paying job with higher social status than was appropriate for the clergy. However, this official policy was not often enforced in practice and many religious continued to practice medicine.^[37]

There were many other medical practitioners besides clergy. Academically trained doctors were particularly important in cities with universities. Medical faculty at universities figured prominently in defining medical guilds and accepted practices as well as the required qualifications for physicians.^[37] Beneath these university-educated physicians there existed a whole hierarchy of practitioners. Wallis suggests a social hierarchy with these university educated physicians on top, followed by “learned surgeons; craft-trained surgeons; barber surgeons, who combined bloodletting with the removal of “superfluities” from the skin and head; itinernant specialist such as dentist and oculists; empirics; midwives; clergy who dispensed charitable advice and help; and, finally, ordinary family and neighbors”.^[37] Each of these groups practiced medicine in their own capacity and contributed to the overall culture of medicine.

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.^[49]

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.^[50]

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.^[51]

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.^[52] He also proposed new treatments for diseases such as syphilis.

In 1543 the Flemish Scholar Andreas Vesalius wrote the first complete textbook on human anatomy: "De Humani Corporis Fabrica", meaning "On the Fabric of the Human Body". Much later, in 1628, William Harvey explained the circulation of blood through the body in veins and arteries. It was previously thought that blood was the product of food and was absorbed by muscle tissue.

During the 16th century, Paracelsus, like Girolamo, discovered that illness was caused by agents outside the body such as bacteria, not by imbalances within the body.

The French army doctor Ambroise Paré, born in 1510, revived the ancient Greek method of tying off blood vessels. After amputation the common procedure was to cauterize the open end of the amputated appendage to stop the haemorrhaging. This was done by heating oil, water, or metal and touching it to the wound to seal off the blood vessels. Pare also believed in dressing wounds with clean bandages and ointments, including one he made himself composed of eggs, oil of roses, and turpentine. He was the first to design artificial hands and limbs for amputation patients. On one of the artificial hands, the two pairs of fingers could be moved for simple grabbing and releasing tasks and the hand look perfectly natural underneath a glove.

Medical catastrophes were more common in the late Middle Ages and the Renaissance than they are today. During the Renaissance, trade routes were the perfect means of transportation for disease. Eight hundred years after the Plague of Justinian, the bubonic plague returned to Europe. Starting in Asia, the Black Death reached Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in Crimea), and killed 25 million Europeans in six years, approximately 1/3 of the total population and up to a 2/3 in the worst-affected urban areas. Before Mongols left besieged Crimean Kaffa the dead or dying bodies of the infected soldiers were loaded onto catapults and launched over Kaffa's walls to infect those inside. This incident was among the earliest known examples of biological warfare and is credited as being the source of the spread of the Black Death into Europe.

The plague repeatedly returned to haunt Europe and the Mediterranean from 14th through 17th centuries. Notable later outbreaks include the Italian Plague of 1629–1631, the Great Plague of Seville (1647–1652), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679), the Great Plague of Marseille in 1720–1722 and the 1771 plague in Moscow.

Before the Spanish discovered the new world (continental America), the deadly infections of smallpox, measles, and influenza were unheard of. The Native Americans did not have the immunities the Europeans developed through long contact with the diseases. Christopher Columbus ended the Americas' isolation in 1492 while sailing under the flag of Castile, Spain. Deadly epidemics swept across the Caribbean. Smallpox wiped out villages in a matter of months. The island of Hispaniola had a population of 250,000 Native Americans. 20 years later, the population had dramatically dropped to 6,000. 50 years later, it was estimated that approximately 500 Native Americans were left. Smallpox then spread to the area which is now Mexico where it then helped destroy the Aztec Empire. In the 1st century of Spanish rule in what is now Mexico, 1500–1600, Central and South Americans died by the millions. By 1650, the majority of New Spain (now Mexico) population had perished.

Contrary to popular belief^[53] bathing and sanitation were not lost in Europe with the collapse of the Roman Empire.^[54][55] Bathing in fact did not fall out of fashion in Europe until shortly after the Renaissance, replaced by the heavy use of sweat-bathing and perfume, as it was thought in Europe that water could carry disease into the body through the skin. Medieval church authorities believed that public bathing created an environment open to immorality and disease. Roman Catholic Church officials even banned public bathing in an unsuccessful effort to halt syphilis epidemics from sweeping Europe.^[56]

See also

• History of medicine
• History of hospitals
• History of nursing
• Byzantine medicine
• Irish medical families
• Islamic medicine
• Life expectancy
• Medieval demography
• Theriac
• Ibn Sina Academy of Medieval Medicine and Sciences
• Beak doctor costume
• Plague doctor contract
• Plague doctor

Footnotes

Further reading

• Bowers, Barbara S. ed. The Medieval Hospital and Medical Practice (Ashgate, 2007); 258pp; essays by scholars
• Getz, Faye. Medicine in the English Middle Ages. (Princeton University Press, 1998). ISBN 0-691-08522-6
• Mitchell, Piers D. Medicine in the Crusades: Warfare, Wounds, and the Medieval Surgeon (Cambridge University Press, 2004) 293 pp.
• Porter, Roy.The Greatest Benefit to Mankind. A medical history of humanity from antiquity to the present. (HarperCollins 1997)
• Siraisi Nancy G (2012). "Medicine, 1450–1620, and the History of Science". Isis 103 (3): 491–514. doi:10.1086/667970. PMID 23286188. 

Primary sources

• Wallis, Faith, ed. Medieval Medicine: A Reader (2010) excerpt and text search

External links

• Medieval Medicine
• "Index of Medieval Medical Images" UCLA Special Collections (accessed 2 September 2006).
• "The Wise Woman" An overview of common ailments and their treatments from the Middle Ages presented in a slightly humorous light.
• "MacKinney Collection of Medieval Medical Illustrations"
• PODCAST: Professor Peregrine Horden (Royal Holloway University of London): 'What's wrong with medieval medicine?'
• Walsh, James J. Medieval Medicine(1920), A & C Black, Ltd.
• Interactive game with medieval diseases and cures
• Encyclopedic manuscript containing allegorical and medical drawings From the Rare Book and Special Collections Division at the Library of Congress

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