Mediavel Medicine

It is usually regarded as an age of decadence and of stagnation, and the very name “mediaeval” implies the negation of progress, and suggests backwardness, superstition, and sloth.

It is true that at this stage of history medicine had sunk to a very low level indeed. The prevailing conception of disease was archaic ; diagnosis and prognosis were based on the state of the stars and on inspection of the urine ; treatment consisted of blood-letting and the use of herbs whose nature was ill understood; anatomy was taught from ancient texts or at best from animal dissection ; alchemy was directed towards the discovery of an elixir of life ; and surgery was of the meddlesome type.

Nevertheless, mediaeval medicine does not present a picture of unrelieved gloom. Here and there a shaft of light appears to herald the coming brightness of the revival of learning. Schools of medicine were opening and methods of teaching improved. Anatomy, though still full of Galenic misconceptions, was recognized as the foundation of surgery, and some bold spirits even dared to hint that Galen might not be entirely reliable

Medical Training

The medical school of Salerno gave place to that of

Montpellier.ParisPauda

Montpellier, like Salerno, was a health resort. It was a district famous for its intellectual interests, and including a large Greek element.

However, with the rise of the medical schools of Padua and of Paris and the departure of the Popes from Avignon, Montpellier was less frequented.

During the early days of the school of Montpellier the most distinguished teacher was:

ARNOLD OF VILLANOVA, who wrote the commentary on the Regimen of Salerno.

Arnold and Surgery

That Arnold practised surgery as well as medicine is obvious from the following selections from his aphorisms :" To postpone opening an abscess is dangerous."" The bite of a mad dog should be enlarged and encouraged to bleed." He also gave advice not usually found in modern textbooks. For example :" To drive away mice, fumigate with pomegranate, hellebore, sulphur, and shells of shrimps. The mice will flee and never come back."

Arnold medical practice

His book on poisons begins : “In this book I propose, with God's help, to consider diseases of women, since women are poisonous creatures. I shall then treat of the bites of venomous beasts."

Graduate of Montpellier

Montpellier attracted students from many countries, including a number of enterprising Englishmen. There was:

GILBERTUS ANGLICUS (d. 1250), who wrote a compendium of medicine which contained nothing new, though the recipe for Gilbert's ointment for gout is worth quoting as an example of mediaeval pharmacy.

JOHN OF GADDESDEN (1280-1361), who became professor at Merton College, Oxford

Graduate of Montpellier

BERNARD DE GORDON (c. 1285), another student or teacher of Montpellier, contributed to the garden of medicine by writing the Lilium Medicinae, which still exists in rare manuscript form. It contains the first description of a truss and the first mention of spectacles.

PETRUS HISPANUS (c. 1277) was born at Lisbon, and after a brilliant career as a student of theology and medicine, was appointed physician to Pope Gregory X.

TADDEO ALDEROTTI (1223-1303), Although he wrote many commentaries, his chief claim to fame lies in his introduction of a new form of medical literature, called "consilia.“ These were discussions of clinical cases, giving a description of the symptoms and full details of treatment. Sometimes these notes were sent to unseen patients, or supplied to “practitioners“ by “consultants.” “Consilia“ are essentially mediaeval in character, and reflect the scholastic type of medical philosophy.

Mediaval Droctors

Many Medieval doctors carried with them a vademecum (meaning 'Go-with-me') book of diagnoses and a urine chart. Usually, they examined the colour, smell and taste of the patient's urine, and made an on-the-spot guess as to what they might be suffering from. Pictures from the time make it clear that doctors also did clinical observation, and took their patient's pulse.

Doctors’ Reputation

I know that your bedside is besieged by doctors, and of course this fills me with fear. As Pliny said, in order to gain fame they buy it with our lives. They learn their art at our cost, and even our death brings them experience; only a doctor can kill without punishment. Remember what it says on the gravestones: "I died of too many doctors".

A letter from the poet Petrarch to Pope Clement VI (c.1350)

The Restoration of Anatomy

Although the value of anatomy as the foundation of medicine

gained recognition in the later Middle Ages, the teaching of the

subject remained theoretical owing to the prevalent antipathy to

dissection of the human body.

At the University ofTubingen, for example, it was decreed that"every three yearsthe body of a criminal shall be dissected. All

who take partshall attend a mass for the subject's soul and

shall afterwardsattend the remains to the grave."

The dissection was open to scholars and professional men, as well as to physicians and students. It consisted in a perfunctory examination of the contents of the abdomen and thorax, and lasted for only a few days. The actual work was performed by a menial called a prosector, while the professor, seated on an elevated platform, pointed out from afar the various structures which had been exposed. The cranium was seldom opened, and there was no systematic dissection of the muscles, nerves, and vessels of the limbs.

The first attempt to remedy this condition of affairs and to introduce the systematic teaching of anatomy,

“part“ by” part,” was made by Mondino de Luzzio, or MUNDINUS (ca. 1275-1326), His Anatomia^ written in 1316, is the

first practical manual of anatomy, and he is therefore entitled to be called the “restorer“ of anatomy.

The stomach is described as spheroid, the liver as possessing five lobes

the heart as having three ventricles, and thebrain as under the control of a red worm (known to us

now asthe choroid plexus). To crown all, he depicted a seven-

chambereduterus. He gives a most superficial account of the

extremities ;and as for the bones, he remarks that these might be

better studied if cleaned by boiling, but "to do so would be sinful."

Surgery also "Restored"

The most famous surgeon of later mediaeval times was a pupil of Mundinus.

GUY DE CHAULIAG (1300-67), andJOHN OF ARDERNE (1307-90),Guy insisted on the importance of anatomy,

“without which one can do nothing in surgery"

A good surgeon should be courteous, sober, pious, and merciful,

not greedy of gain, and with a sense of his own dignity."2 Hewas interested in the radical cure of hernia, though he did

notadvise operation in every case, preferring the use of a truss

wheneverpossible. When he did operate, he placed the patient inwhat we now call the Trendelenberg position, and he

criticizedthe prevailing method of sacrificing the testicle in order toobliterate the canal.

John of Arderne was a specialist in what is now called proctology,

and he showed his originality by inventing a new operationfor fistula, which consisted in boldly incising the wall and

checkingthe bleeding by sponge pressure. He was careful to

recognizecancer of the rectum, of which he gave a clear description,

notingthat treatment can only be palliative, that no operation

should beattempted, and that friends should be warned of the fatal

issue.

Medieval Hospitals

The care of the sick poor was a duty incumbent upon Christians

from the earliest times, and it is easy to understand how the first

hospitals were of ecclesiastical foundation.Some of the great hospitals of London were

founded at thetime, and were under the control of the

Church : St. Bartholomew'sin 1 1 23,* and St. Thomas's in 1215.

Besides hospitals there were institutions in which lepers couldbe segregated and nursed. Leprosy was a common disease inthe Middle Ages, and numerous leper houses, or" lazar"houses,existed in Britain and throughout Europe. 1 When he walkedabroad each leper was obliged to wear a distinctive dress, and tocarry a bell or clapper to announce his presence, and thus waniall persons to avoid him.

The Herbal in Medical Literature

A descriptive account of the plants used in medicine was essential to the physician in the days prior to the development ef synthetic pharmacy.

Many of the remedies formerly derived from plants are now produced synthetically by chemical processes ; consequently the art of “simpling” that is, of collecting plants, or “simples,“ and using them to prepare “compound“medicines is now.

Among the earliest “herbals“ is that of:Dioscorides: De materia medica libri quinque

Herbarium of APULEIUS PLATONICUS

The earliest English printedherbals are those of RYCHARDE BANGKES,

whose He? ball (1525)was very popular, and of PETER TREVERIS,

who called his bookThe grete herball (1526), although neither

work has any claim tooriginality.OTTO BRUNFELS in his Herbarium vivaeeicones (1530)