Early Medieval Medicine in Europe

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Early Medieval Medicine in Europe

Overview

Early medieval medicine in Europe saw little change since antiquity. The collapse of the western Roman Empire brought barbarian invasions and the rise of warrior fiefdoms to Europe, both of which hampered civilization and its amenities—including the practice of scientific medicine. Medical care was provided in a practical fashion based upon ancient ideas, with little regard for scientific methods. Religious influences crept into medicine, as those confined to monastic cloisters struggled to keep medical studies alive by copying and preserving the few original medical manuscripts of the Dark Ages. Not until the second millennium, around 1100, would the scholarly pursuit of medicine in western Europe experience a rebirth, when Greek and Arabic medical texts were brought to southern Italy and translated for the Latin-speaking cloistered West.

Background

Medieval European physicians (physics) based their medical care mainly upon the teachings of Galen of Pergamum (born c. a.d. 130 in what is now Bergama, Turkey). Galen's writings were prolific, and were based upon the relationship among the body's four humors, or bodily fluids (blood, phlegm, yellow bile, and black bile), and the four elements of external nature (earth, air, fire, and water). Galen taught that illness stems from an imbalance of the humors and the elements, and that restoring this balance would effect a cure. Galen described over 300 pharmaceutical remedies (mostly herbal concoctions), utilized bloodletting (phlebotomy), and depicted disease as an individual susceptibility rather than a general affectation. Galen took a reasoned approach to medicine based upon direct observation of the patient. Although Galen incorporated philosophy into medicine, his practical approach saw the physician as an attendant of the patient, rather than an intermediary seeking healing from spiritual sources. Galen's writings remained the dominant influence in medicine for almost a thousand years.

By the end of the fourth century, the Roman Empire was formally split, with the two halves ruled by separate emperors. By the end of the sixth century, the West was further broken into fragmented kingdoms, repelling attacks from each other, as well as continued invasions from the East. The economy of the East thrived, while the great cities of the West declined. Amid the constant atmosphere of war, the development of medical science was given little encouragement to flourish, and eastern and western medical thought parted ways.

In western Europe, as the Latin language declined, cloistered monks became responsible for the care-taking and dissemination of medical literature. The Lorch Book of Medicine, written about 795 in a German Benedictine abbey, discussed the humors, and contains a brief text on simple anatomy and prognostics. The book also contained therapeutic recipes and dietary treatments, and other practical advice for tending the sick. Years earlier in England, monks in then-remote North Umberland produced a medical book in the non-Latin language of Anglo-Saxon. The monks (among them, Bede, the Venerable [c. 672-735]) referred to the English healer as laece, or leech, and cited extensive plant remedies. Bede's writings also attributed certain diseases to bad luck, darts shot by elves, snakes, insects, or dragons.

In approximately 950, England's King Alfred was convinced by a British nobleman to commission a manual of the established medical treatments of the day. The Leech Book of Bald combined the herbal practices of the Celts and Anglo-Saxons with that of the Greco-Romans and Arabs. Compiled by Bald, and scribed by a monk named Clid, the Leech Book of Bald is the oldest surviving Anglo-Saxon medical text. The book contains simplified Latin recipes with local ingredients replacing the exotic ones found in Mediterranean or Arab lands. Some scholars assert that the simplified language implies the book was intended to be shared with any of the literate population, and was meant to serve as a layman's manual, as well as the trained healer's aid. The book contains extensive herbal remedies containing mugwort, periwinkle, violets, vervain, wood betony, and yarrow, among other botanical treatments. Included in the Leech Book are remedies for constipation containing psyllium, a form of treatment still in use today. Other remedies invoked charms, prayers, drinking of potions made of water in which frogs were boiled, or walks on a moon-lit night.

Meanwhile, by the time of Muhammad's death in 632, almost all of Arabia had been won over to Islam, as well as Egypt and Spain, where Córdoba became Islam's European capital. After enduring prolonged warfare between the Byzantine (Roman) and Persian Empires, social chaos was exacerbated by 200 years of periodic outbreaks of bubonic plague. Although medicine in early Islam also included mysticism, such as holding the "evil-eye" and "jinn" responsible for disease, by the early ninth century, traditional medicine was called into question. Islamic medicine then embarked on the pursuit of scholarship, launching a major translation movement to recapture the knowledge of classical Greece and Rome by translating the works of Galen and others into Arabic.

Impact

While medicine maintained a scholarly (and mostly Galenic) course in the eastern empire, learned medicine languished in the West during the early Middle Ages. The number of schools declined, and trained physicians almost disappeared. Latin, the universal language of scholars of the time, took sanctuary in the church. Mysticism and ritual gained favor. The Leech Book of Bald is representative of the spirit of early medieval Europe—a classical base overwhelmed by a mysticism that impeded scientific discovery.

Along with the break-up of the Mediterranean civilizations, the rise of Christianity coincided with the stagnation of medical science in Western Europe. From the early fifth century, Christianity was the sole official religion of the region. Christianity stressed that there was a divine plan for every occurrence, and that Christian rituals and sacraments covered every significant event in the life of a believer, even illness and suffering. Christianity also maintained that the body and soul were separate, and demanded obedience to its doctrines of subordination. The physic only treated the body, while the Church cured the eternal soul. As the soul was prized above the flesh, Christian doctrines became ingrained in medicine.

While disease was often attributed to punishment by God, and suffering was a trial to be embraced before paradise, the Church also continued a mission of healing in early Medieval Europe. By the year 700, many monasteries contained makeshift hospitals, with monks dedicated to the care of the sick. By contrast, the Islamic hospitals that followed a short time later, were larger, more elaborate institutions. As Galenic, or classically trained, physics became fewer in number during the Dark Ages, monasteries became the refuge for those with illnesses not amenable to homestyle herbal remedies or rituals.

The role of women in medieval healthcare expanded, and as fewer trained physics were available, this expanded role became necessary for the maintenance of everyday health. Most women possessed a rudimentary knowledge of herbal remedies and first aid in order to tend to the needs of her household. Those with greater knowledge or skill became village healers. A few women wrote medical texts. Hildegard von Bingen (1098-1179), a German Benedictine herbalist, practiced medicine in her role as abbess of Rupertsberg. Hildegard's Book of Simple Medicine was a compendium of traditional lore featuring herbalism, religion, superstition, and folk medicine. Hildegard wrote on the natural causes of disease, advising treatment on the principle of opposites. Hildegard claimed that herbs were a gift from God, and those unable to be healed by herbs were willed by God to die. Approximately 300 years later, as men regained the prominent role in healthcare delivery, women healers were ostracized from the professional practice of medicine and, on occasion, were executed as witches.

Medieval texts revealed childbirth to be an all-woman affair. The mother was supported by a female healer/midwife, relatives, and neighbors. The social status of midwives began to rise, and some villages paid the local midwife to act in an official capacity for cases involving women's illnesses, childbirth, and care of infants. Midwives were also called upon to certify virginity and infant deaths, and to provide treatment for infertility. Medical attitudes toward reproduction (known as "generation" during medieval times) were not puritanical. The village midwife or healer had many remedies at her disposal (herbs and potions believed to contain the qualities of aphrodisiacs) for restoring humoral balance through sexual release.

Medical mathematics and astrology were reintroduced in early medieval European medicine, and combined the mathematical tradition of the ancients with the mysticism of the Church. The physic used tangled calculations and handy charts to illustrate the significance of the motions of the heavens on health and illness. Zodiac charts included the 12 signs, along with areas of the body each sign was said to influence. Often, herbs and minerals were included on the charts to denote the optimum time for their effectiveness. Because it was felt that God endorsed the powers of celestial bodies (God sent a star to announce Christ's birth), images of Christ sometimes appeared on zodiac charts, or Christ was portrayed with a halo of 12 sun rays, symbolizing the zodiac's 12 heavenly bodies. Physics used the zodiac charts to help determine the imbalance of the four elements in an ill patient.

The Islamic translations of ancient medical works by Galen and others set the stage for the reawakening of scholarly medical thought in the West. The Archbishop of Salerno, Alphanus (d. 1085) traveled to Constantinople in 1063 where he became familiar with Greek medical texts. Alphanus wrote Premnon Physicon, a philosophical approach to medicine that was inspired by the texts he studied in Constantinople. Alphanus's writings introduced the West to a Christianized Galenism, and advocated a scholarly approach to medicine that put the physic above the everyday village healer. Salerno soon became a known center for academics, funneling vast numbers of Arabic and Greek translations to the West. For the first time in 400 years, Latin scholars could share in contemporary medical thought. The academic rigor at Salerno provided impetus for the founding of the great western universities (Paris, Bologna, Oxford) that would, in turn, play a fundamental role in the great awakening that was the Renaissance.

BRENDA WILMOTH LERNER