medieval medicine

The medieval notion of anatomy, c.1508. The findings of the Ancient Greek physician Galen, whose studies were based on the dissection of animals, were the only source of anatomical knowledge until 1543. Andreas Vesalius then published his classic work De humani corporis fabrica which was based on his own observation of human corpses.

In European history, medicine of the Middle Ages (5th–15th centuries); the period c. 500–c. 1000 is also known as the Dark Ages. The rate of medical progress was far slower than it had been in the ancient Egyptian, Greek, and Roman eras. Medicine and public health even suffered regression during the Dark Ages, as much of the knowledge of the classical world was initially lost following the fall of the Roman Empire. The 15th century saw the beginning of the Renaissance, when the old ideas that had dominated both classical and medieval medicine were challenged and often disproved.

Loss of classical heritage From the beginning of the 5th century waves of barbarian tribes invaded Italy from northern Europe, ravaging Rome in 410 and 451. The last emperor in Rome was deposed in 476, marking the end of 700 years of dominance in Europe. The Romans had used the knowledge of the Greeks, together with their strong government, good communications, and great wealth, to develop a medical system more advanced than anything Europe would see for the next 1000 years. With the collapse of the Roman Empire much of this was lost.

Although the Romans had developed very good public health systems, the majority of their cities and homes were destroyed or abandoned by the native populations once the Romans had gone. The aqueducts that had brought fresh water to Roman cities and the public baths that had helped with cleanliness and fitness fell into disrepair. Most of the books of classical theorists and physicians such as Hippocrates and Galen were either burned or lost in the upheaval across Europe, and the understanding of the body that they had given was no longer used on a widespread basis.

Effects of war and instability After the 5th century the new map of Europe was marked by many separate small kingdoms, whose rulers were constantly fighting and using their wealth to build armies and defences rather than health facilities. Money was no longer available to pay for public baths, hospitals, and aqueducts, or to fund the development of new technology. War and the collapse of strong centralized rule also disrupted trade and communications in Europe, both of which had contributed to the Roman Empire's accumulation of power and knowledge. The spread of ideas slowed, as doctors were unable to travel safely to share ideas.

Following the end of the Dark Ages in about 1000, medicine in Europe improved, although the changes mainly mirrored the situation under the Romans. Europe became more settled, the number of wars decreased, and there was more wealth. Harvests increased, leading to more trade and healthier people. With a more peaceful and prosperous environment, the conditions for increased learning returned.

Dominance of the church During the Dark Ages the only remaining copies of classical texts were held by the increasingly powerful Roman Catholic Church, which had survived the fall of the Roman Empire. The church dominated medicine throughout the medieval period, but in the Dark Ages it forbade dissection and promoted the idea that illness was the result of sinful behaviour not nature, as stated by Hippocrates and Galen. The church controlled the writing of books through its monasteries, making it difficult to pursue new ideas that might challenge the church's power and beliefs. The creation or spread of new ideas through education was hindered, as this was also controlled by the church, and the training of new doctors virtually halted.

The power of the church was enormous in the Dark Ages. It promoted superstition over rationality in the explanation of disease, reversing the work of Hippocrates and Galen, and banned any books that challenged the authority of the Bible, including many medical texts. The church did, however, keep the main libraries of the age, including many classical texts. Although medicine regressed during the Dark Ages, the monks who collected the works of classical medical scholars kept the possibility of future progress alive.

When Europe entered a more settled period after the Dark Ages, the Catholic Church looked again at the philosophical ideas of Galen and his belief that Nature had a divine purpose. His description of the human body as perfect was regarded as praise for God as the creator. The decision of the church to promote Galen's theories as infallible, and acceptance of the ideas of Hippocrates, had a major impact on medicine in Europe.

The church set up new centres of learning from the 10th century onwards. The medical school of Salerno, Italy, was in existence by the 11th century, and by 1220 there was a flourishing medical school in Montpellier in France. Also set up in the 13th century were new medical schools in Padua and Bologna in Italy. The rational ideas of clinical observation, cleanliness, and the theory of humours (four body fluids: phlegm, blood, yellow bile, and black bile) became important again. Doctors used urine charts to assess the patient's illnesses, combing clinical observation with the four humours. While this process was positive, its impact on medical progress was limited. The doctors and professors of the universities taught the ideas of Galen as facts that could not be challenged. Mondino de Luzzi the Italian surgeon who reintroduced the study of anatomy to Europe, based his Anathomia Mundini/Anatomy (1316) on Galen's On the use of Parts, and only carried out dissections to prove the validity of Galen's theories. However, human dissection was rarely allowed and normally only on criminals after execution, as the church regarded it as an extension of their punishment. Students would look only for the parts of the body that Galen described, as any challenge to Galen's ideas was viewed as heretical. By the end of the Middle Ages it was clear to many doctors that Galen was wrong, but it was difficult to change the centuries-old traditions of medicine and the church.

Influence of the Muslim world While Europe abandoned the ideas of classical medicine in the Dark Ages, Islamic medicine developed them further. The ancient texts of Greece and Rome had been translated into Arabic in the 5th century by the followers of Nestorius, who had been thrown out of Constantinople in 431 for his heretical teachings and lived in exile in Persia (modern Iran). The foundation of Islam in the early 7th century, and subsequent appearance of strong, centralized empires, made the Muslim world more stable than Europe at this time. Medicine and public health flourished. Doctors were trained in universities and hospitals and the great libraries of Baghdad and Cairo allowed access to classical and new ideas. The trade links of the Arabs with India and Persia allowed them to discover new ingredients for medicines, as well as other medical traditions. The theories of Islamic medicine slowly filtered into Europe as trade and contact increased, particularly after Spain was taken by the Muslim Moors in the early 8th century and during the Crusades (1096–1291).

Popular medicine While the practice of medicine developed among the learned and wealthy in society, the majority of the population continued with their traditional superstitions, beliefs, and remedies. Doctors had always been too expensive for the peasant populations of Europe, so they dealt with illness as best they could. Herbal preparations were used, and administered by men and women who had learned their knowledge from previous generations. The travelling ‘doctors’ of markets and fairs were a common source of cures. Broken limbs or open wounds were usually treated by barber-surgeons, who had learned their skills as apprentices. The developing science of medicine found in the universities and cities had little impact on the daily life of the average person.

Religious belief in the cause of disease was strong. Scrofula, a tuberculosis of the lymph glands, was known as the King's Evil. Monarchs would tour their lands to touch the victims of scrofula in the belief that their closeness to God would allow them to cure the sick. When the Black Death (bubonic plague) swept across Europe in the mid-14th century, killing between one-third and half of the population, it was commonly believed that the disaster was a punishment from God. Blame for the plague was also attributed to the Jewish communities of Europe or to unusual events such as earthquakes. Christian flagellants toured Britain and Germany in prayer and penance for the sins of the world, stripping themselves half-naked and whipping themselves constantly.

Medieval towns Cities and towns were extremely unhealthy places to live in the Middle Ages. Outbreaks of disease were regular, and the result of the appalling conditions. Town councils took no responsibility for public health as the Romans had done. There was no provision of clean drinking water, the streets were filled with rubbish and sewage that was often left uncollected, and toilets were allowed to flow into the drinking water supplied by local rivers. Only when there were outbreaks of disease such as the Black Death or plague would town councils act to clean up the streets, although such efforts would be abandoned once the epidemic had passed. Animals were kept in towns for sale or slaughter and their excrement and entrails were left in the streets or dumped in the rivers. The conditions for the spread of disease were perfect in medieval towns.

Regression and continuity in medieval medicine The period 500–1500 began with regress and stagnation in medicine, but ended in some progress. Much of the knowledge of the Greeks and Romans was unused for centuries, but by the end of the period the teachings of Galen and Hippocrates were considered infallible. The Catholic Church was the dominant force, and its impact was both negative and positive. By the end of the Middle Ages the basis of scientific knowledge was in place and the will to challenge Galen's dominant theories was growing. The ground had been laid for the advances of Renaissance medicine.

See also medieval medicine (English).