Medieval Medicine: Byzantine, Arabic, and the Middle Ages

1. LECTURE 3 Medieval medicine

2. Byzantine medicine • Arabic medicine • The Middle Ages

3. Medieval Medicine Byzantine medicine • 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.

4. Medieval Medicine • 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.

5. Medieval Medicine Arabic medicine • 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.

6. Medieval Medicine • 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.

7. Medieval Medicine • 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.

8. Medieval Medicine • The most influential Arabic contributor to medicine was Avicenna (abu-Ali 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.

9. Medieval Medicine • 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.

10. Medieval Medicine • 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.

11. The Middle Ages • 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.

12. Medieval Medicine • 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.

13. Medieval Medicine • 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.

14. Medieval Medicine • 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.