by Jason Yousif
JYousif@ou.edu
BACKGROUND:
The "Medieval Period" or "Middle Ages" spanned the years 529 AD-1400, and can be divided into three different transitional periods: the Early Middle Ages lasted from 529 AD-800s, the 12th Century Renaissance was seen in the 1100s, and the High Middle Ages included the 1200s-1400. Medicine, during this large amount of time, was a continuation of the ancient, or Hellenistic medical tradition (Episode 2: Hellenistic Medicine). Not only were Medieval medical practitioners influenced by Greek and Roman theories of health and disease, diagnostic techniques, and therapeutic procedures, depicted primarily in works of Hippocrates and Galen; but Byzantinian and Arabian Medicine were also part of the underlying theory of healing during this time period. However, these contributions had to be adapted to new cultural circumstances that largely shaped their use and development (Lindberg, pg. 317).
A Medieval Hospital
National Library of Medicine
Weblink: Medieval Medicine
During the time of the eleventh and
twelfth centuries, there were a number of influences that began to
advance the Medieval medical tradition: the political and economic
renewal; a dramatic population increase, leading to social change,
urbanization, and expansion of education. Of all of these
influences, the one with the greatest affect was the rise of
universities, which gave a shift toward professionalization and
secularization. Student guilds at Bologna, monastic and
collegiate schools, and seats of learning like Paris and Salerno were
the best known examples of renewed urban medical activity that taught
the skill in the healing arts (The
Evolution of Modern Medicine).
MEDICAL PRACTITIONERS:
Almost everyone during the middle ages could claim they "practiced medicine". Simple domestic medicine was practiced in the home by families. If more knowledge or experience was needed, every community had people who had a talent in treating certain kinds of conditions. This consisted of midwives, people knowledgeable in herbs and herbal remedies, and bone-setters. Within the cities, "empirics" specializing in treatment of dental problems, wounds, and certain kinds of surgeries (for example, removing kidney stones, lancing boils, or repairing a hernia) could be found. Those with a higher level of professionalization included trained surgeons, university-educated physicians, skilled professional medical practitioners educated through apprenticeship, and apothecaries. To further complicate things, secular and religious practitioners, including clerics who combined religious duties with accepted medical practice could be found at many levels. Out of all the European cities, in 1338, Florence, Italy, had the most physicians per capita, with about 60 licensed medical practitioners of all kinds for a population of 120,000. After the ever tragic Black Death twenty years later, the number decreased to 56 medical practitioners for a population of roughly 42,000. Not only did men practice medicine during this time, but there were a substantial number of women active in obstetrics and gynecology and other medical specialties as well. The most famous woman was Trota, or Trotula, from twelfth-century Salerno, who produced a general work of practical medical remedies and advice (Lindberg, pgs. 327-329).
Trotula, a twelfth-century Salernitan medical practitioner
David Lindberg, The Beginnings of Western Science, 1992 (pg. 328)
MEDICAL PRACTITIONERS:
Almost everyone during the middle ages could claim they "practiced medicine". Simple domestic medicine was practiced in the home by families. If more knowledge or experience was needed, every community had people who had a talent in treating certain kinds of conditions. This consisted of midwives, people knowledgeable in herbs and herbal remedies, and bone-setters. Within the cities, "empirics" specializing in treatment of dental problems, wounds, and certain kinds of surgeries (for example, removing kidney stones, lancing boils, or repairing a hernia) could be found. Those with a higher level of professionalization included trained surgeons, university-educated physicians, skilled professional medical practitioners educated through apprenticeship, and apothecaries. To further complicate things, secular and religious practitioners, including clerics who combined religious duties with accepted medical practice could be found at many levels. Out of all the European cities, in 1338, Florence, Italy, had the most physicians per capita, with about 60 licensed medical practitioners of all kinds for a population of 120,000. After the ever tragic Black Death twenty years later, the number decreased to 56 medical practitioners for a population of roughly 42,000. Not only did men practice medicine during this time, but there were a substantial number of women active in obstetrics and gynecology and other medical specialties as well. The most famous woman was Trota, or Trotula, from twelfth-century Salerno, who produced a general work of practical medical remedies and advice (Lindberg, pgs. 327-329).
Trotula, a twelfth-century Salernitan medical practitioner
David Lindberg, The Beginnings of Western Science, 1992 (pg. 328)
DISEASE,
DIAGNOSIS, PROGNOSIS, & THERAPY:
Of course the diagnostic measures and therapies used by medical practitioners varied during this time, due to the varying levels of education, specialty, and professional circumstances. However, much of the following fundamentals of medical practice and belief could be found in much healing activity, due to the beliefs and practices of learned physicians passing down to other kinds of healers, as well as folk medicine and its remedies passing upward from other kinds of healers to learned physicians (Lindberg, pg. 332). Due to the influence of Greek medicine, medieval disease theories were also based on the doctrine of the four humors. Corresponding to the presence of these humors (hot, cold, wet, dry) were four temperaments: sanguine, phlegmatic, bilious, and melancholic. The body was then composed of seven certain "naturals": the elements, the temperaments, the humors, the members or parts, the virtues of faculties, the operations or functions, and the spirits. Certain "non-naturals", nine in number, were thought to preserve the health of the body, and thy included: air, food, drink, movement, response, sleeping, waking, excretion, retention, and passions. Disease was then thought to usually arise from alterations of the composition of the humors, and the treatment indications corresponded with the doctrines. They included: evacuation, tenuation (use of diethypropion), cooling, heating, purging, or strengthening (The Evolution of Modern Medicine).
Other treatment techniques were also available if disease or sickness was thought to result from the departing of a person's normal temperament. Since the humors result from what food is consumed, the first technique was dietary, since the maintenance of health required a suitable diet. Drugs could also be used to help restore balance, and they were classified according to their predominant qualities. If more drastic treatment was thought necessary, vomiting, purging, and blood-letting could also be used. In order to figure out which one to use, the physician needed to know about the patient's life-style, including diet, exercise, sleep, sexual activity, and bathing, in order to determine his or her specific temperament and the management required to maintain it. After observing the patient for a period of time, the physician would offer advice needed for the recovery and maintenance of health. Due to this, learned physicians during this time could be portrayed as medical advisers, with a primary responsibility for preventive medicine (Lindberg, pg. 333).
The most common form of medical healing, however, was drug therapy, due to the increasing study of medicinal botany. The most common ingredients in drugs were of course herbals, but mineral and animal substance were also used. Many drugs arose from folk remedies, including certain plant substances effective as laxatives or pain-killers. However, not all drugs were as effective. Most were simply harmless, while some were either quite dangerous, or downright disgusting. In one example of the latter, pig manure was thought to be an effective cure for nose-bleeds. Theriac, a drug made from viper's flesh and other ingredients, was an acquired drug with remarkable curative properties. In the twelfth-century, Antidotarium Nicolai stated:
Of course the diagnostic measures and therapies used by medical practitioners varied during this time, due to the varying levels of education, specialty, and professional circumstances. However, much of the following fundamentals of medical practice and belief could be found in much healing activity, due to the beliefs and practices of learned physicians passing down to other kinds of healers, as well as folk medicine and its remedies passing upward from other kinds of healers to learned physicians (Lindberg, pg. 332). Due to the influence of Greek medicine, medieval disease theories were also based on the doctrine of the four humors. Corresponding to the presence of these humors (hot, cold, wet, dry) were four temperaments: sanguine, phlegmatic, bilious, and melancholic. The body was then composed of seven certain "naturals": the elements, the temperaments, the humors, the members or parts, the virtues of faculties, the operations or functions, and the spirits. Certain "non-naturals", nine in number, were thought to preserve the health of the body, and thy included: air, food, drink, movement, response, sleeping, waking, excretion, retention, and passions. Disease was then thought to usually arise from alterations of the composition of the humors, and the treatment indications corresponded with the doctrines. They included: evacuation, tenuation (use of diethypropion), cooling, heating, purging, or strengthening (The Evolution of Modern Medicine).
Other treatment techniques were also available if disease or sickness was thought to result from the departing of a person's normal temperament. Since the humors result from what food is consumed, the first technique was dietary, since the maintenance of health required a suitable diet. Drugs could also be used to help restore balance, and they were classified according to their predominant qualities. If more drastic treatment was thought necessary, vomiting, purging, and blood-letting could also be used. In order to figure out which one to use, the physician needed to know about the patient's life-style, including diet, exercise, sleep, sexual activity, and bathing, in order to determine his or her specific temperament and the management required to maintain it. After observing the patient for a period of time, the physician would offer advice needed for the recovery and maintenance of health. Due to this, learned physicians during this time could be portrayed as medical advisers, with a primary responsibility for preventive medicine (Lindberg, pg. 333).
The most common form of medical healing, however, was drug therapy, due to the increasing study of medicinal botany. The most common ingredients in drugs were of course herbals, but mineral and animal substance were also used. Many drugs arose from folk remedies, including certain plant substances effective as laxatives or pain-killers. However, not all drugs were as effective. Most were simply harmless, while some were either quite dangerous, or downright disgusting. In one example of the latter, pig manure was thought to be an effective cure for nose-bleeds. Theriac, a drug made from viper's flesh and other ingredients, was an acquired drug with remarkable curative properties. In the twelfth-century, Antidotarium Nicolai stated:
"Theriac...is
good for the most serious afflictions of the entire human body: against
epilepsy,
catelepsy, apoplexy, headache, stomach ache, and migraine; for hoarseness of voice and
constriction of the chest; against bronchitis, asthma, spitting of blood, jaundice, dropsy,
pneumonia, colic, intestinal wounds, nephritis, the stone, and choler; it induces menstruation
and expels the dead fetus; it cures leprosy, smallpox, intermittent chills, and other chronic ills;
it is especially good against all poisons, and the bits of snakes and reptiles...; it clears up every
failing of the senses [?], it strengthens the heart, brain, and liver, and makes and keeps the entire
body incorrupt" (Lindberg, pg. 335).
catelepsy, apoplexy, headache, stomach ache, and migraine; for hoarseness of voice and
constriction of the chest; against bronchitis, asthma, spitting of blood, jaundice, dropsy,
pneumonia, colic, intestinal wounds, nephritis, the stone, and choler; it induces menstruation
and expels the dead fetus; it cures leprosy, smallpox, intermittent chills, and other chronic ills;
it is especially good against all poisons, and the bits of snakes and reptiles...; it clears up every
failing of the senses [?], it strengthens the heart, brain, and liver, and makes and keeps the entire
body incorrupt" (Lindberg, pg. 335).
Two prominent diagnostic techniques,
both recommended by various writers, including Galen, were seen during
this time. Urinalysis was thought to reveal the state of the
liver. Critical to the features of urine included color, odor,
clarity, and consistency. Giles of Corbeil, a thirteenth-century
medical writer, states that "thick urine, whitish, milky, or bluish
white, indicates dropsy, colic, the stone, headache, excess of phlegm,
rheum in the members, or a flux" (Lindberg, pg. 335).
Urine Color Chart, connecting color variations with various digestion stages
David Lindberg, The Beginnings of Western Science, 1992 (pg. 336)
Examination of the pulse, on the other hand, was thought to reflect the
state of the heart. When taking a patient's pulse, a physician
tried to determine its duration, breadth, strength, regularity, and so
on. This was also a useful prognosis and diagnosis, as failing
pulse could be used to foretell the time of death. A number of
various pulse classification schemes and pulse varieties were
developed. In the thirteenth century, an anonymous treatise
offered the following classification scheme:
Urine Color Chart, connecting color variations with various digestion stages
David Lindberg, The Beginnings of Western Science, 1992 (pg. 336)
"The
varieties of pulses are differentiated by the physician in a number of
ways, in particular
according to five considerations: (1) motion of the arteries; (2) condition of the artery;
(3) duration of diastole and systole; (4) strengthening or weakening of pulsation;
(5) regularity or irregularity of the beat. Ten varieties of pulse derive from these
considerations" (Lindberg, pg. 337).
Diagnosis by Pulse
David Lindberg, The Beginnings of Western Science, 1992 (pg. 337)
according to five considerations: (1) motion of the arteries; (2) condition of the artery;
(3) duration of diastole and systole; (4) strengthening or weakening of pulsation;
(5) regularity or irregularity of the beat. Ten varieties of pulse derive from these
considerations" (Lindberg, pg. 337).
Diagnosis by Pulse
David Lindberg, The Beginnings of Western Science, 1992 (pg. 337)
SURGERY:
From traveling emperics with a specialty in a certain surgical procedure, to university-educated surgeons working under a king or pope, one could find many different kinds of surgeons, all with different education levels and specializations. Most surgery performed by most of these so-called "surgeons" was quite daring. Some common procedures included lancing a boil, setting a broken bone, dressing an ulcer or sore, blood-letting, cleaning and suturing a wound, rescuing a dislocated joint, and cautery (application of hot irons to various parts of the body creating ulcers that unwanted fluids could drain). Some other quite routine or ambitious procedures included the operation for the removal of a cataract, the routine removal of external hemorrhoids, the removal of a bladder stone, the surgical correction of a hernia, the dangerous fracture of the skull through trephining (making small holes in the skull with a saw) to reduce pressure and drain pus and blood, as well as others. All of these procedures were no doubtedly performed with the slightest amount of anesthetics or sedatives. The operation for removal of a cataract included inserting a sharp instrument through the cornea and forcing the lens of the eye out of its capsule and down to the bottom of the eye (Lindberg, pgs. 341-342).
Operation for Cataract Removal
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340)
From traveling emperics with a specialty in a certain surgical procedure, to university-educated surgeons working under a king or pope, one could find many different kinds of surgeons, all with different education levels and specializations. Most surgery performed by most of these so-called "surgeons" was quite daring. Some common procedures included lancing a boil, setting a broken bone, dressing an ulcer or sore, blood-letting, cleaning and suturing a wound, rescuing a dislocated joint, and cautery (application of hot irons to various parts of the body creating ulcers that unwanted fluids could drain). Some other quite routine or ambitious procedures included the operation for the removal of a cataract, the routine removal of external hemorrhoids, the removal of a bladder stone, the surgical correction of a hernia, the dangerous fracture of the skull through trephining (making small holes in the skull with a saw) to reduce pressure and drain pus and blood, as well as others. All of these procedures were no doubtedly performed with the slightest amount of anesthetics or sedatives. The operation for removal of a cataract included inserting a sharp instrument through the cornea and forcing the lens of the eye out of its capsule and down to the bottom of the eye (Lindberg, pgs. 341-342).
Operation for Cataract Removal
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340)
One text describing the removal of a
bladder stone states:
"If
there is a stone in the bladder make sure of it as follows: have a
strong person sit on a bench,
his feet on a stool; the patient sits on his lap, legs bound to his neck with a bandage, or steadied on
the shoulders of the assistants. The physician stands before the patient and inserts two fingers of
his right hand into the anus, pressing with his left fist over the patient's pubes. With his fingers
engaging the bladder from above, let him work over all of it. If he finds a hard, firm pellet it is a
stone in the bladder... If you want to extract the stone, precede it with light diet and fasting for
two days beforehand. On the third day, ... locate the stone, bring it to the neck of the bladder;
there, at the entrance, with two fingers above the anus incise lengthwise with an instrument and
extract the stone" (Lindberg, pg. 341).
Operation for Scrotal Hernia Removal - Patient is both held and tied down.
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340)
Operation for Nasal Polyps Removal
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340)
his feet on a stool; the patient sits on his lap, legs bound to his neck with a bandage, or steadied on
the shoulders of the assistants. The physician stands before the patient and inserts two fingers of
his right hand into the anus, pressing with his left fist over the patient's pubes. With his fingers
engaging the bladder from above, let him work over all of it. If he finds a hard, firm pellet it is a
stone in the bladder... If you want to extract the stone, precede it with light diet and fasting for
two days beforehand. On the third day, ... locate the stone, bring it to the neck of the bladder;
there, at the entrance, with two fingers above the anus incise lengthwise with an instrument and
extract the stone" (Lindberg, pg. 341).
Operation for Scrotal Hernia Removal - Patient is both held and tied down.
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340)
Operation for Nasal Polyps Removal
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340)
ANATOMY:
No doubtedly the most influential person in this area during the Medieval Period was Andreas Vesalius. Some say his De Humanis Corporis Fabrica, a textbook of human anatomy, marks the beginning of modern medicine with its publication in 1543 (Vesalius the Humanist). In examination of this text, there is a clear Galenic organization, as the skeleton is first discussed, follow by the muscles, the cardiovascular system, and ending with the brain and organs of the abdominal and thoracic cavities (Debus, pg. 60). In this edition, Vesalius was quite conservative on his treatment of the heart and arterial and venous systems, where he rejected Galen's position on the interventricular pores of the septum:
On the frontispiece of this text one can clearly see a female cadaver, a dog, and a monkey. The dog and monkey were to be dissected after Vesalius, who is seen dissecting the body, was done with the female cadaver.
De Humanis Corporis Fabrica Frontispiece, 1543, Basel.
Weblink: http://hsci.cas.ou.edu/exhibits/exhibit.php?exbgrp=-999&exbid=48&exbpg=3
No doubtedly the most influential person in this area during the Medieval Period was Andreas Vesalius. Some say his De Humanis Corporis Fabrica, a textbook of human anatomy, marks the beginning of modern medicine with its publication in 1543 (Vesalius the Humanist). In examination of this text, there is a clear Galenic organization, as the skeleton is first discussed, follow by the muscles, the cardiovascular system, and ending with the brain and organs of the abdominal and thoracic cavities (Debus, pg. 60). In this edition, Vesalius was quite conservative on his treatment of the heart and arterial and venous systems, where he rejected Galen's position on the interventricular pores of the septum:
"The
septum is formed from the very densest substance of the heart. It
abounds on both sides
with the pits. Of these none, so far as the senses can perceive, penetrate from the right to the
left ventricle. We wonder at the art of the Creator which causes blood to pass from right to
left ventricle through invisible pores" (Debus, pgs. 60-63).
with the pits. Of these none, so far as the senses can perceive, penetrate from the right to the
left ventricle. We wonder at the art of the Creator which causes blood to pass from right to
left ventricle through invisible pores" (Debus, pgs. 60-63).
A second edition of De Humanis Corporis Fabrica was
published by Vesalius in 1555, in which he still rejects Galen's views,
but makes it seem as if it were a painful mistake:
"Not
long ago I would not have dared to turn aside even a hair's breadth
from Galen. But it
seems to me that the septum of the heart is as thick, dense and compact as the rest of the heart.
I do not see, therefore, how even the smallest particle can be transferred from the right to the
left ventricle through the septum" (Debus, pg. 63)
seems to me that the septum of the heart is as thick, dense and compact as the rest of the heart.
I do not see, therefore, how even the smallest particle can be transferred from the right to the
left ventricle through the septum" (Debus, pg. 63)
On the frontispiece of this text one can clearly see a female cadaver, a dog, and a monkey. The dog and monkey were to be dissected after Vesalius, who is seen dissecting the body, was done with the female cadaver.
De Humanis Corporis Fabrica Frontispiece, 1543, Basel.
Weblink: http://hsci.cas.ou.edu/exhibits/exhibit.php?exbgrp=-999&exbid=48&exbpg=3
The more than 700 pages of the text
contain information for physicians and the well to do, along with
stunning, artistic illustrations (16th-Century
Life Sciences).
De Humanis Corporis Fabrica Plate of the Human Muscles, 1543, Basel.
Weblink: http://hsci.cas.ou.edu/exhibits/exhibit.php?exbgrp=-999&exbid=48&exbpg=3
De Humanis Corporis Fabrica Plate of the Human Muscles, 1543, Basel.
Weblink: http://hsci.cas.ou.edu/exhibits/exhibit.php?exbgrp=-999&exbid=48&exbpg=3
INTERPRETATION:
In my view, the Medieval Period contributed a lot to the advancement of medicine. The contributions and findings discussed here don't include everything the Medieval Period offered in the field of medicine. Their contributions go way beyond the brief summary of key topics I thought relevant. There are numerous contributions during this time by the Arabians and those of Byzantine. Even though most of the findings during this time were heavily influenced by Galen and other previous observations, it doesn't mean the Medieval Period did little to advance medicine. They opened the light on things including surgery, herbal medicines, urinalysis, the variety of medical practitioners able to practice the art of healing, and numerous accounts of other details. Without the Medieval Period and its contributions to medicine, there may have, in my eyes, been a large halt in its development. I think Andreas Vesalius was able to allow others to accept human dissection, and lead it to progress to what it has become today. We no doubtedly owe much gratification in the advancement of this field to the Medieval Period.
BIBLIOGRAPHY:
My primary sources are all reliable because most of them focused on the translations of surviving text. That of Magruder has many images of surviving texts, including works of De Fabrica, by Vesalius. My secondary sources, Lindberg and Debus, are also reliable because both authors are professional historians of science, and it is quite evident that both of them are quite knowledgeable on the issues they chose to discuss in their works. In order to create my own interpretation of the episode, I collected a numerous amount of sources, including others not mentioned in the bibliography. From these, I read through each and narrowed them down to the ones I felt stated everything the clearest. I was then able to make a summarization of the remaining sources, and compiled the most pertinent information I saw necessary into this episode.
In my view, the Medieval Period contributed a lot to the advancement of medicine. The contributions and findings discussed here don't include everything the Medieval Period offered in the field of medicine. Their contributions go way beyond the brief summary of key topics I thought relevant. There are numerous contributions during this time by the Arabians and those of Byzantine. Even though most of the findings during this time were heavily influenced by Galen and other previous observations, it doesn't mean the Medieval Period did little to advance medicine. They opened the light on things including surgery, herbal medicines, urinalysis, the variety of medical practitioners able to practice the art of healing, and numerous accounts of other details. Without the Medieval Period and its contributions to medicine, there may have, in my eyes, been a large halt in its development. I think Andreas Vesalius was able to allow others to accept human dissection, and lead it to progress to what it has become today. We no doubtedly owe much gratification in the advancement of this field to the Medieval Period.
BIBLIOGRAPHY:
- William Osler, The Evolution of Modern Medicine (Online Reader). This E-text contains very descriptive information on Greek Medicine, Medieval Medicine, the Renaissance and rise of anatomy and physiology, the rise and development of modern medicine, as well as the rise of preventive medicine. The thing that interests me most about this work is the amount of detail Osler goes into concerning the large spectrum of topics discussed.
- University of Virginia Health System, "Antiqua Medicina: Vesalius", Vesalius the Humanist, http://www.med.virginia.edu/hs-library/historical/antiqua/texth.htm. This web page contains an exhibit on medicine during the antique days. It discusses topics including Homer, Hippocrates, Galen, and others. The thing that interests me most about this work is the large amount of knowledge on the subject matter the creator seems to have.
- Kerry Magruder, "Materia Medica and Herbals", 16th-century Life Sciences, http://hsci.cas.ou.edu/exhibits/exhibit.php?exbgrp=-999&exbid=48&exbpg=1.
This website contains information on topics including different people
who made contributions to science during the Medieval Period, along
with information on Andreas Vesalius, botany, astrology, and
medicine. The thing that interests me most about this work is the
large amount of images of documents from the 16th-century Magruder is
able to provide.
- David Lindberg, The Beginnings of Western Science (Chicago, Chicago University Press, 1992). This text is an amazing view of pre-modern science, not just in medicine, but also in astronomy, mathematics, physics, and many other aspects of science. The thing that interests me most about this work is the large amount of detail and information depicted on many different eras of pre-modern history, instead of just focusing on one. It is a greatly useful source.
- Allen G. Debus, Man and Nature in the Renaissance (United Kingdom, Cambridge University Press, 1978). This text primarily deals with the time of the Renaissance, and the influences by man. It goes into detail on things including, alchemy, botany, Galen, and other topics. The thing that interests me most about this work is the large amount of detail Debus is able to go into in a work of roughly 150 pages.
My primary sources are all reliable because most of them focused on the translations of surviving text. That of Magruder has many images of surviving texts, including works of De Fabrica, by Vesalius. My secondary sources, Lindberg and Debus, are also reliable because both authors are professional historians of science, and it is quite evident that both of them are quite knowledgeable on the issues they chose to discuss in their works. In order to create my own interpretation of the episode, I collected a numerous amount of sources, including others not mentioned in the bibliography. From these, I read through each and narrowed them down to the ones I felt stated everything the clearest. I was then able to make a summarization of the remaining sources, and compiled the most pertinent information I saw necessary into this episode.