Medieval medicine of Western Europe
In the Middle Ages, the medicine of Western Europe was composed of a mixture of existing ideas from antiquity. In the Early Middle Ages, following the fall of the Western Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Medieval medicine is widely misunderstood, thought of as a uniform attitude composed of placing hopes in the church and God to heal all sicknesses, while sickness itself exists as a product of destiny, sin, and astral influences as physical causes. But, especially in the second half of the medieval period, medieval medicine became a formal body of theoretical knowledge and was institutionalized in universities. Medieval medicine attributed illnesses, and disease, not to sinful behavior, but to natural causes, and sin was connected to illness only in a more general sense of the view that disease manifested in humanity as a result of its fallen state from God. Medieval medicine also recognized that illnesses spread from person to person, that certain lifestyles may cause ill health, and some people have a greater predisposition towards bad health than others.
Influences
Hippocratic medicine
The Western medical tradition often traces its roots directly to the Ancient Greek civilization, much like the foundation of all of Western society. The Greeks certainly laid the foundation for Western medical practice but much more of Western medicine can be traced to the Near East, Germanic, and Celtic cultures. The Greek medical foundation comes from a collection of writings known today as the Hippocratic Corpus. Remnants of the Hippocratic Corpus survive in modern medicine in forms like the "Hippocratic Oath" as in to "Do No Harm".The Hippocratic Corpus, popularly attributed to an Ancient Greek medical practitioner known as Hippocrates, lays out the basic approach to health care. Ancient Greek philosophers viewed the human body as a system that reflects the workings of nature and Hippocrates applied this belief to medicine. The body, as a reflection of natural forces, contained four elemental properties expressed to the Greeks as the four humors. The humors represented fire, air, earth, and water through the properties of hot, cold, dry, and moist, respectively. Health in the human body relied on keeping these humors in balance within each person.
Maintaining the balance of humors within a patient occurred in several ways. An initial examination took place as standard for a physician to properly evaluate the patient. The patient's home climate, their usual diet, and astrological charts were regarded during a consultation. The heavens influenced each person in different ways by influencing elements connected to certain humors, important information in reaching a diagnosis. After the examination, the physician could determine which humor was unbalanced in the patient and prescribe a new diet to restore that balance. Diet included not only food to eat or avoid but also an exercise regimen and medication.
Hippocratic medicine was written down within the Hippocratic Corpus, therefore medical practitioners were required to be literate. The written treatises within the Corpus are varied, incorporating medical doctrine from any source the Greeks came into contact with. At Alexandria in Ancient Egypt, the Greeks learned the art of surgery and dissection; the Egyptian skill in these arenas far surpassed those of Greeks and Romans due to social taboos regarding treatment of the dead. The early Hippocratic practitioner Herophilus engaged in dissection and added new knowledge to human anatomy in the realms of the human nervous system, the inner workings of the eye, differentiating arteries from veins, and using pulses as a diagnostic tool in treatment. Surgery and dissection yielded much knowledge of the human body that Hippocratic physicians employed alongside their methods of balancing humors in patients. The combination of knowledge in diet, surgery, and medication formed the foundation of medical learning upon which Galen would later build upon with his own works.
Temple healing
The Greeks were influenced by their Egyptian neighbours, in terms of medical practice in surgery and medication. They also absorbed many folk healing practices, including incantations and dream healing. In Homer's epic poems Iliad and Odyssey, the Greek gods are implicated as the cause of plagues or widespread disease and that those maladies could be cured by praying to them. The religious side of Greek medical practice is clearly manifested in the cult of Asclepius, whom Homer regarded as a great physician and who was deified in the 4th and 3rd centuries BCE. Hundreds of temples devoted to Asclepius were founded throughout the Hellenistic and Roman Empire to which untold numbers of people flocked for cures. Healing visions and dreams formed the foundation for the curing process as the person seeking treatment from Asclepius slept in a special dormitory. The healing occurred either in the person's dream or advice from the dream could be used to seek out the proper treatment for their illness elsewhere. Afterwards the visitor to the temple bathed, offered prayers and sacrifice, and received other forms of treatment like medication, dietary restrictions, and an exercise regiment, in keeping with the Hippocratic tradition.Pagan and folk medicine
Some of the medicine in the Middle Ages had its roots in Pagan and folk practices. This influence was highlighted by the interplay between Christian theologians who adopted aspects of Pagan and folk practices and chronicled them in their own works. The practices adopted by Christian medical practitioners around the 2nd century CE, and their attitudes toward Pagan and folk traditions, reflected an understanding of these practices, especially humoralism and herbalism.The practice of medicine in the early Middle Ages was empirical and pragmatic. It focused mainly on curing diseases rather than discovering the cause of diseases. Often it was believed the cause of disease was supernatural. Nevertheless, secular approaches to curing diseases existed. People in the Middle Ages understood medicine by adopting the ancient Greek medical theory of humors. Since it was clear that the fertility of the earth depended on the proper balance of the elements, it followed that the same was true for the body, within which the various humors had to be in balance. This approach greatly influenced medical theory throughout the Middle Ages.
Folk medicine of the Middle Ages dealt with the use of herbal remedies for ailments. The practice of keeping physic gardens teeming with various herbs with medicinal properties was influenced by the gardens of Roman antiquity. Many early medieval manuscripts have been noted for containing practical descriptions for the use of herbal remedies. These texts, such as the Pseudo-Apuleius, included illustrations of various plants that would have been easily identifiable and familiar to Europeans at the time. Monasteries later became centers of medical practice in the Middle Ages, and carried on the tradition of maintaining medicinal gardens. These gardens became specialized and capable of maintaining plants from the Southern Hemisphere as well as maintaining plants during winter.
Hildegard of Bingen was an example of a medieval medical practitioner who, while educated in classical Greek medicine, also utilized folk medicine remedies. Her understanding of the plant based medicines informed her commentary on the humors of the body and the remedies she described in her medical text Causae et curae were influenced by her familiarity with folk treatments of disease. In the rural society of Hildegard's time, much of the medical care was provided by women, along with their other domestic duties. Kitchens were stocked with herbs and other substances required in folk remedies for many ailments. Causae et curae illustrated a view of symbiosis of the body and nature, that the understanding of nature could inform medical treatment of the body. However, Hildegard maintained the belief that the root of disease was a compromised relationship between a person and God. Many parallels between pagan and Christian ideas about disease existed during the early Middle Ages. Christian views of disease differed from those held by pagans because of a fundamental difference in belief: Christians' belief in a personal relationship with God greatly influenced their views on medicine.
Evidence of pagan influence on emerging Christian medical practice was provided by many prominent early Christian thinkers, such as Origen, Clement of Alexandria, and Augustine, who studied natural philosophy and held important aspects of secular Greek philosophy that were in line with Christian thought. They believed faith supported by sound philosophy was superior to simple faith. The classical idea of the physician as a selfless servant who had to endure unpleasant tasks and provide necessary, often painful treatment was of great influence on early Christian practitioners. The metaphor was not lost on Christians who viewed Christ as the ultimate physician. Pagan philosophy had previously held that the pursuit of virtue should not be secondary to bodily concerns. Similarly, Christians felt that, while caring for the body was important, it was second to spiritual pursuits. The relationship between faith and the body's ailments explains why most medieval medical practice was performed by Christian monks.
Monasteries
developed not only as spiritual centers, but also centers of intellectual learning and medical practice. Locations of the monasteries were secluded and designed to be self-sufficient, which required the monastic inhabitants to produce their own food and also care for their sick. Prior to the development of hospitals, people from the surrounding towns looked to the monasteries for help with their sick.A combination of both spiritual and natural healing was used to treat the sick. Herbal remedies, known as Herbals, along with prayer and other religious rituals were used in treatment by the monks and nuns of the monasteries. Herbs were seen by the monks and nuns as one of God’s creations for the natural aid that contributed to the spiritual healing of the sick individual. An herbal textual tradition also developed in the medieval monasteries. Older herbal Latin texts were translated and also expanded in the monasteries. The monks and nuns reorganized older texts so that they could be utilized more efficiently, adding a table of contents for example to help find information quickly. Not only did they reorganize existing texts, but they also added or eliminated information. New herbs that were discovered to be useful or specific herbs that were known in a particular geographic area were added. Herbs that proved to be ineffective were eliminated. Drawings were also added or modified in order for the reader to effectively identify the herb. The Herbals that were being translated and modified in the monasteries were some of the first medical texts produced and used in medical practice in the Middle Ages.
Not only were herbal texts being produced, but also other medieval texts that discussed the importance of the humors. Monasteries in medieval Europe gained access to Greek medical works by the middle of the 6th century. Monks translated these works into Latin, after which they were gradually disseminated across Europe. Monks such as Arnald of Villanova also translated the works of Galen and other classical Greek scholars from Arabic to Latin during the Middle Ages. By producing these texts and translating them into Latin, Christian monks both preserved classical Greek medical information and allowed for its use by European medical practitioners. By the early 1300s these translated works would become available at medieval universities, forming the foundation of medical education.
Hildegard of Bingen, a well known abbess, wrote about Hippocratic Medicine using humoral theory and how balance and imbalance of the elements affected the health of an individual, along with other known sicknesses of the time, and ways in which to combine both prayer and herbs to help the individual become well. She discusses different symptoms that were common to see and the known remedies for them.
In exchanging the herbal texts among monasteries, monks became aware of herbs that could be very useful but were not found in the surrounding area. The monastic clergy traded with one another or used commercial means to obtain the foreign herbs. Inside most of the monastery grounds there had been a separate garden designated for the plants that were needed for the treatment of the sick. A serving plan of St. Gall depicts a separate garden to be developed for strictly medical herbals. Monks and nuns also devoted a large amount of their time in the cultivation of the herbs they felt were necessary in the care of the sick. Some plants were not native to the local area and needed special care to be kept alive. The monks used a form of science, what we would today consider botany, to cultivate these plants. Foreign herbs and plants determined to be highly valuable were grown in gardens in close proximity to the monastery in order for the monastic clergy to hastily have access to the natural remedies.
Medicine in the monasteries was concentrated on assisting the individual to return to normal health. Being able to identify symptoms and remedies was the primary focus. In some instances identifying the symptoms led the monastic clergy to have to take into consideration the cause of the illness in order to implement a solution. Research and experimental processes were continuously being implemented in monasteries to be able to successfully fulfill their duties to God to take care of all God's people.