BACKGROUND: The "Medieval Period" or "Middle Ages" spanned the years 529 AD1400, and can be divided

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MEDIEVAL PERIOD OF MEDICINE
Seminar by Dr.Nisamol V.M. IInd PG, Materia
Medica GHMC, Calicut
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BACKGROUNDThe "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
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In European history, medicine of the Middle Ages
(5th15th centuries) 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.
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Western medicine advanced very little in Europe
during the Middle Ages.  medieval Europe became
a place where medical practice was in places
regressing rather than progressing. Scholarship
fell into the religious sphere, and clerics were
more interested in curing the soul than the
body.  Many theologians considered disease and
injury to be the result of supernatural
intervention and insisted that cures were only
possible through prayer
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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, it was commonly believed
that the disaster was a punishment from God.
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Although medicine and surgery were related,
medieval practitioners drew a distinct line
between them.  Generally, physicians treated
problems inside the body, and surgeons dealt with
wounds, fractures, dislocations, urinary
problems, amputations, skin diseases, and
syphilis.  They also bled patients when directed
byphysicians.There were a variety of different
medical practices available to people in Medieval
Times they may have been treated by monks
following the Hippocratic theory of the Four
Humours, by apothecaries who specialised in
herbal remedies or by doctors who made use of
charms.
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As the church taught that God sent illness, and
that repenting would cure all evils, many people
at the time believed that pilgrimage would cure
them. Other theories were based upon astrology,
the movement of the sun and stars. Astrology
played an important part in Medieval
medicine.Some physical cures were administered
for purely superstitious reasons herbal remedies
being prescribed as they would rid the body of
evil spirits. During this period, medicine
began to be recognized as a profession based upon
formal education, standardized curriculum, and
legal regulation. In some regions, physicians
were required to pass examinations before
beginning practice.  Untrained physicians were
subject to prosecution and fines, and state
licensing became common. 
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Loss of classical heritageFrom 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. The Romans had used the knowledge of the
Greeks, together with their strong government,
good communications, and great wealth, to develop
a medical system. 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.
Most of the books of classical theorists and
physicians such as Hippocrates and Galen were
either burned or lost, and the understanding of
the body that they had given was no longer used
on a widespread basis.
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Effects of war and instabilityAfter 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.
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Dominance of the churchDuring the Dark Ages the
only remaining copies of classical texts were
held by the increasingly powerful Roman Catholic
Church. 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 behavior. 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.It promoted
superstition over rationality in the explanation
of disease, and banned any books that challenged
the authority of the Bible, including many
medical texts.
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The first encyclopedia of medicine in Arabic was
Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah
("Paradise of Wisdom"), written in seven parts,
c. 860.Muhammad ibn Zakariya Razi (Rhazes) wrote
the Comprehensive Book of Medicine in the 9th
century. deal with pediatrics and child
development, as well as psychology and
psychotherapy.Avicenna (Ibn Sina), a Hanbali and
Mu'tazili philosopher and doctor in the early
11th century, was another influential figure. He
is regarded as the father of modern medicine. His
important writtings are-The Canon of Medicine
andThe Book of Healing.Abu Rayhan al-Biruni's
Kitab-al-Saidana was an extensive medical
encyclopedia which synthesized Islamic medicine
with Indian medicine. His medical investigations
included one of the earliest descriptions on
Siamese twins
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Medieval European medicine became more developed
during the Renaissance of the 12th century, when
many Arabic medical texts on both ancient Greek
medicine and Islamic medicine were translated
during the Latin translations of the 12th
centuryThe most influential among these texts
was Avicenna's The Canon of Medicine. Other
influential translated medical texts at the time
included the Hippocratic Corpus attributed to
Hippocrates, Alkindus' De Gradibus, the Liber
pantegni of Haly Abbas In Indian continent,
the mid evial period starts from the beginning of
the Mohammedan rule upto the end Mug Hal period.
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Medieval townsCities 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.
The conditions for the spread of disease were
perfect in medieval towns.
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Regression and continuity in medieval
medicineThe period 5001500 began with regress
and stagnation in medicine, but ended in some
progress. But by the end of the period the
teachings of Galen and Hippocrates were
considered infallible. 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..
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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. He also discovered new
treatments for diseases such as syphilis
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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 1500's, Paracelsus, discovered that illness
was caused by agents outside the body such as
bacteria, not by imbalances within the body.
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The medieval systemThe church set up new centres
of learning from the 10th century onwards. The
medical school of Salerno(the mother of medical
school), Italy, was in existence by the 11th
century, and by 12th century, there was a
flourishing medical school in Montpellier in
France.ARNOLD VILLANOVAs famous book was
BREVIARIUM PRACTICE. His advice as a surgeon was
to postpone an opening of abscess is dangerous"
and the bite of mad dog should be enlarged and
encouraged to bleed". Another personality during
this period was BERNARD DE GORDOM. In his
writings the LILLIUM MEDICINAE he gave
description of TRUSS and the first mention of
SPECTACLES.
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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
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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. . 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
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Due to the influence of Greek medicine, medieval
disease theories were also based on the doctrine
of the four humor.  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. 
Theories of medicine
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The success of herbal remedies being 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, the seeds of
skullcap (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
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SURGERYSome 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. 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 to
reduce pressure and drain pus and blood etc.  All
of these procedures were no doubtedly performed
with the slightest amount of anesthetics or
sedatives. 
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The Healers A distinctive feature of this period
is the variety of healers Clerical medicine,
often called monastic medicine, was provided as
part of a religious duty, with payments and
income made via a church rather than directly
Folk Healers passed on their knowledge from
master to apprentice, and were more accessible to
the peasant or labourer than physicians
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Saints were also used to heal the sick. Although
healing by saints (miracles) would not be
considered medicine today, in medieval times,
this method was just as valid as any other form
of healing. Female physician women practised
all branches of medicine during the Middle
Ages.One famous woman physician was the Italian
Trotula of Salerno, whose works on women's
ailments spread across Europe, Even after the
fourteenth century women continued to function as
midwives
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The hospital systemIn 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. Patients were supposed
to help each other through prayer and calm,
perhaps benefiting as much from this as from any
physical treatment offered.
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