Medieval Medicine - The Medieval System

The Medieval System

Starting in the areas least affected by the disruption of the fall of the western empire, a unified theory of medicine began to develop, based largely on the writings of the Greek physicians on physiology, hygiene, dietetics, pathology, and pharmacology, and is credited with the discovery of how the spinal cord controls various muscles. From Gentile's dissections, he described the heart valves and determined the purpose of the bladder and kidneys.

Galen of Pergamum, also a Greek, was the most influential ancient physician during this period. In of his undisputed authority over medicine in the Middle Ages, his principal doctrines require some elaboration. Galen described the four classic symptoms of inflammation (redness, pain, heat, and swelling) and added much to the knowledge of infectious disease and pharmacology. His anatomic knowledge of humans was defective because it was based on dissection of animals, mainly apes, sheep, goats and pigs. Some of Galen's teachings tended to hold back medical progress. His theory, for example, that the blood carried the pneuma, or life spirit, which gave it its red colour, coupled with the erroneous notion that the blood passed through a porous wall between the ventricles of the heart, delayed the understanding of circulation and did much to discourage research in physiology. His most important work, however, was in the field of the form and function of muscles and the function of the areas of the spinal cord. He also excelled in diagnosis and prognosis. The importance of Galen's work cannot be overestimated, for through his writings knowledge of Greek medicine was subsequently transmitted to the Western world by the Arabs.

Anglo-Saxon translations of classical works like Dioscorides Herbal survive from the 10th Century, showing the persistence of elements of classical medical knowledge. Compendiums like Bald's Leechbook (circa 900), include citations from a variety of classical works alongside local folk remedies.

Although in the Byzantine Empire the organized practice of medicine never ceased (see Byzantine medicine), the revival of methodical medical instruction from standard texts in the west can be traced to the church-run Schola Medica Salernitana in Southern Italy in the Eleventh century. At Salerno medical texts from Byzantium and the Arab world (see Medicine in medieval Islam) were readily available, translated from the Greek and Arabic at the nearby monastic centre of Monte Cassino. The Salernitan masters gradually established a canon of writings, known as the ars medicinae (art of medicine) or articella (little art), which became the basis of European medical education for several centuries.

From the founding of the Universities of Paris (1150), Bologna (1158), Oxford, (1167), Montpelier (1181) and Padua (1222), the initial work of Salerno was extended across Europe, and by the Thirteenth century medical leadership had passed to these newer institutions. To qualify as a Doctor of Medicine took ten years including original Arts training, and so the numbers of such fully qualified physicians remained comparatively small.

During the Crusades European medicine began to be influenced by Islamic medicine, though Islamic scholars such as Usamah ibn Munqidh also described their experience with European medicine as 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".

By the Thirteenth Century many European towns were demanding that physicians have several years of study or training before they could practice. Surgery had a lower status than pure medicine, beginning as a craft tradition until Roger Frugardi of Parma composed his treatise on Surgery around about 1180. A stream of Italian works of greater scope over the next hundred years, spread later into the rest of Europe. Between 1350 and 1365 Theodoric Borgognoni produced a systematic four volume treatise on surgery, the Cyrurgia, which promoted important innovations as well as early forms of antiseptic practice in the treatment of injury, and surgical anaesthesia using a mixture of opiates and herbs.

The great crisis in European medicine came with the Black Death epidemic in the 14th century. Prevailing medical theories focused on religious rather than scientific explanations for this epidemic.