Transcript History of Medicine Lecture 3

LECTURE 3
Medieval medicine
Byzantine
medicine
Arabic medicine
The Middle Ages
Medieval Medicine
Byzantine medicine
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The Fall of Rome to the Goths in 476 and the Fall of
Constantinopole in 1453 to the Turks are often considered as marking
the beginning and end of the Middle Ages.
In spite of the dissolution of Western Roman Empire, immediately
following the Fall of Rome to the Goths, many Roman institutions
appear to have survived, even if no longer under the authority of
Rome.
The character and quality of medical practice during this period,
almost totally dominated by Church, has been unsatisfactory
The physician had become a part of the monastic environment and
their labour was devoted to unscientific methods such as prayers,
exorcisings, use of amulets, holy oil, relics of the saints.
Medieval Medicine
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As the medieval Church relied more and more on the intercession of
saints, they gained increased significance and consideration in Church
writings
The growing significance of superstition and magic in medieval Europe
is often attributed to the anarchy following the fall of Western Roman
Empire. However, similar superstitious developments can be found in
Constantinopole and the East
Some of the physicians trained in the Byzantine Empire were Aetius of
Amida, Paulos of Aegina and Nicolaos Alexandrinos. The last one, also
called "Myrepsos", wrote a vast treatise on pharmacology, "Dynameron",
in which he described 2656 prescriptions and their way of action. His
work was well appreciated in Europe/ especially at the universities of
Salerno and Paris, where it was considered the "official pharmacology"
until the seventeenth century.
Medieval Medicine
Arabic medicine
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During the first five centuries of the Christian era, the barbarian
invasions of Europe, the disasters and plagues, and the anti-Hellenism of
the Christian Church led to the loss of much of the Greek and Roman
writings. In the seventh century the expansion of the Arabs contributed
to the preservation of the classical learning still extant.
The Arabic world had had previous contact with Greek culture, including
medicine, before Muhammad's founding of Islam.
Over several hundred years, Islam extended into Africa, Spain and part
of France. There were three caliphates: in Baghdad, in Cordova (Spain)
and in Cairo.
Although physicians often continued to prepare their own medications,
pharmacy became a separate profession.
The important role of the Arabists in developing modern chemistry is
remembered in the significant number of current terms derived from
Arabic: alkali, alcohol, elixir, syrup.
Medieval Medicine
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The attitude of Islam toward the origin of disease was similar to the
Judaeo-Christian idea in that Allah caused illness as punishment for a
person's sins. The Islamic religion considered that there was an afterlife:
the soul that remained in the human body after death was reawakened
and rewarded appropriately in paradise. Because of this, dissection of
human body was forbidden and Arabic physicians relied on Galen for
their anatomical knowledge.
The practitioners used essentially the same methods as the Greeks and
Romans. Diagnosis was based on the patient's behaviour, the excretions,
the character and location of pain, the properties of the pulse. Even the
influence of the stars over health and disease was taken into
consideration. Because of the importance given on examining urine, the
half-filled urine flask became a symbol of the physician. The urine's
colour, consistency, sediments, smell and taste helped to determine what
was wrong with a patient, to predict his prognosis and to guide
treatment.
Medieval Medicine
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Since surgery was condemned, much of the cutting, cauterizing,
bandaging and bleeding was done by untrained doctors and charlatans.
Nevertheless, some physicians practiced surgery and wrote about it. The
most common surgical technique was cauterization.
A characteristic of Arabist therapy was the wide employment of drugs
of all kinds. New medications, including mineral as well as vegetable and
animal substances, were added to materia medica. Some of these
substances may have originated in China or India.
In the early years of Islam, medical practice was carried on by Christian
and Jewish physicians. Muslim physicians came upon the scene when
Alexandria, Gundishapur and other cities became centres of Muslim
intellectual life.
One of the most famous healers in the eastern caliphate was the Persian
Rhazes (abu-Bakr Muhammad ibn-Zakariya al-Razi, 850-923?).
A large part of his work was a compilation of the theories of
Hippocrates, Galen and others. Through the clarity of his writings and
his influence over students and physicians he brought much of Greek
medicine to the Arabic world.
Medieval Medicine
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The most influential Arabic contributor to medicine was Avicenna (abuAli al-Husayn ibn-Sina, 980-1037), also called "the prince of physicians"
and "the flower of Arabic culture”.
His main contribution in medicine was as a compiler and commentator.
The most renowned of his approximately one hundred books was "The
Canon" (Al-Qanum). Considered a "medical bible", Avicenna's "Canon"
was for centuries the standard if not the only accepted text-book of
general medicine. Much of it was derived from classical Greek sources,
of which even the worst were better than anything that the Europe of
the time had to offer. The book had five sections: theoretical medicine,
simple remedies, and their treatment, general illness and pharmacology .
The most famous Jewish physician in Arabic medicine was Maimonides
(Moses ben Maimon, 1135-1204). Born in Cordova, he emigrated in
Morocco together with other Jews when the Muslim dynasty of the
Almohades began to persecute nonbelievers. He later went to Palestine
and then to Cairo where financial needs forced him to enter medicine as
a career.
Medieval Medicine
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The general health of the population and its hygienic
conditions probably were the same in Latin Europe and in
the Muslim world. Medical treatises of the era reveal a
concern with the same diseases, acute and chronic. The
Arabic descriptions of epidemics marked by skin eruptions
may indicate that such plagues were as prevalent in the world
of Islam as in Christian countries.
The best-known of the great hospitals in the Middle Ages
were at Baghdad, Damascus and Cairo. In Baghdad clinical
reports of cases were collected and preserved for teaching.
The hospital and medical school at Damascus had elegant
rooms and an extensive library.
Probably the largest was the Mansur Hospital in Cairo,
founded in the thirteenth century. Separate sections were
built for different diseases, such as fevers, eye conditions,
diarrhea, wounds and female disorders.
Medieval Medicine
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The Arabic medicine had an important contribution in keeping alive the
spirit of inquiry that had died in Europe at the end of the second
century with Galen and in preserving the great medical books of
antiquity.
The Middle Ages
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By the year 1200 the orders of the Dominicans and
Franciscans controlled the intellectual life of Paris. The
Church continued to play a central role in the feudal society.
The growing power of the monastic orders led more directly
to Rome than the legendary roads of the ancient Roman
Empire
Physicians trained in the universities were available only to
the higher ranks of society. The poor continued to rely on
folk-healers, as well as barber-surgeons. Childbirth remained
in the hands of midwives.
In contrast to the complex medicinal formulations of trained
physicians, folk-healers relied on simple remedies and
rudimentary magic. With the growth of cities in the twelfth
and thirteenth centuries, there was an increase in the number
of apothecaries and pharmacies.
Medieval Medicine
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Although the Church retained control of the universities throughout the
Middle Ages, monastic medicine declined rapidly. In the twelfth and
thirteenth centuries, control of hospitals and infirmaries was transferred
from the Church to municipalities by mutual agreement. Some of the
great hospitals in Europe were founded now: the Hotel-Dieu in Paris,
Santo Spirito in Rome and St. Thomas's and St. Bartholomew's in
England.
Throughout the period of the declining Roman Empire and the Dark
Ages, leprosy was endemic at low levels in Western Europe. After the
Crusaders began coming back home the number of lepers increased
tremendously. During the Middle Ages, the stigma of leprosy was not
restricted to the disease as we know it today but was applied to a variety
of dermatologic diseases. Nevertheless, all individuals called lepers were
rejected and isolated by the society and forced to wear distinctive
clothing. However, the Order of Lazarus was so sympathetic to the care
of lepers that their house was called "leprosarium" and thousands were
soon built throughout Europe.
Medieval Medicine
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The most notorious epidemic imported from the East was that of the
Black Death or bubonic plague.
Although plague had been known in Europe since ancient times, its
reappearance in the mid-fourteenth century was dramatic and
devastating.
Throughout Europe, physicians, when available, protected themselves in
elaborate clothes and masks with pointed beaks in which they kept
vinegar and sweat-smelling solutions to counteract the smell of pus and
decaying bodies.
In 1485, a new disease characterized by severe sweating appeared in
England, known as ,,sudor anglicus”, it brought death within days.
Famine was common and malnutrition as well.
In the Middle Ages there was a virtual explosion of cults devoted to all
kinds of saints who might help cure saints.
Medieval Medicine
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The general population had little contact with physicians and these rules
were followed: diet was very important in the treatment of illness, drugs
were often used, mysticism became prevalent and amulets were
commonly used.
Surgery was limited to wounds, fractures, dislocations, amputations and
the opening of abscesses.
During the Middle Ages many public baths were established. Some of
them used stream therapeutically.