476-1543.: Medicine survives the dark ages of medicine

Between 476 and 1543 A.D., medicine in western civilizations entered a dark age. Except for a few random collections, the knowledge of Hippocrates and Galen was lost and forgotten. People resorted to primitive methods of using superstition and religion to explain health and disease. However, thanks to Arabic physicians, medicine survived these dark ages by a thin thread.

While the Greeks and Romans were concerned with cleanliness, with the Romans connecting cleanliness with good health, peasants of the middle ages had no use for such nonsense.  The lack of the peasants ability to take baths was noted by the Bible as acceptable:    (2, page 85)

"Does your skin roughen without baths?  Who is once washed in the blood of Christ needs not wash again."  And St. Paul noted: "All things were 'counted dung but to win Christ.'" (2, page 85)

European peasants had no use for performing autopsies, and no time to do it either. They saw even touching a human corpse as morbid, disgusting and counterproductive. (2, pages 84-6)

Again, this was inculcated by the Bible, which preached that the only knowledge that was useful was Biblical knowledge that lead you on your way to heaven. (2, pages 84-6)

During this period Greek knowledge, and even the ancient Greek language, was unknown in western Europe.  This was unfortunate because, as medical historian Edward Withington said:

At this time Greek was still the key to all higher knowledge, especially in medicine.  Latin versions of some Galenic treaties, indeed, existed, yet they were so little known that Constantine the African could boast in the eleventh century that he was the first to translate that author.  Celsus, whose work might have formed an excellent text-book, was almost entirely forgotten." (1, page 176)

With a few exceptions, most people didn't need natural remedies and physicians to treat diseases, and they didn't seek to know the diagnosis nor the prognosis of diseases.  Instead, they lived the hard life, and prayed to God for health and for healing. All they needed, as Osler noted, was the Bible and the Church.

Yet not all was lost of the ancient way of life.  In the old world there were basically two groups of people, the: (4, page 2)

1. Elite or aristocrats:  They controlled wealth, religious institutions, government, bureaucracy. 
2. Peasantry: They did all the work.  They were the farmers, herders, builders and merchants.  They consisted of about 80 percent of the populace. (4, page 2)

In the middle ages this same system was maintained, although it was adjusted slightly.  The elite were called kings and queens, and the peasants were called serfs.  The system was called feudalism.

An interesting facet of this is that, despite their overwhelming majority, the peasants or serfs accepted this form of government perhaps because it was all they knew.  And while other forms of government may have been tried from time to time, such as the democracies and republics of Greece and Rome, none succeeded at motivating the populace better than the monarchy. (4, pages 6-7)

Another reason why this "elitist" system was so generally accepted may have been due to the Bible, which encouraged human beings to accept peasantry as your role in life, your part in the scheme of life that God intended for you.  (4, page 2-5)

The feudal system was such that those who obtained the most land, or control of the most resources, obtained the most power.  These are the folks who formed the Aristocracy.  They formed the family of kings and queens who made the laws to organize and motivate the peasants to farm and herd the land, build structures, and sell the merchandise.  The aristocracy represented God, and you were therefore obliged to honor and respect them.  (4, page 6)

Under this system the peasants had no identity. They worked 12 hour shifts every day year round, and even their kids were trained at an early age to do the work. There was little time for recreation, and little time to to sit around and wonder of a possible better way of life. It may best be explained by Norman Cantor: (4, page 7)

Some historians describe the ancient structure as a one-class system because other than in fifth-century B.C. Athens (always a significant exception) only one group -- the ruling elite -- had such a sense of identity.  Only the aristocracy had a distinct life-style, justified its own existence, loved itself as a class.  Not until much later did the bourgeoisie begin to develop class consciousness.  In the ancient world, only the elite knew things, knew how to do things, the ruling class was the only literate, conscious group in society.

So one can only imagine how easy it was for this aristocracy to shape the opinions of such a naive and ignorant populace. And one can also only imagine how difficult it would have been for any knowledge of the old world to have made its way through this era. Although, thankfully, some ancient works were so voluminous, copied so many times, and saved by some few groups of people, and some few schools, that some ancient works managed to survive.

A thin thread of medicine survived by the following means:

1.  School of Salernum in Northern Italy:  Osler explains that the better educated in Southern Italy continued to speak Greek and understand Latin, and "the cathedral and monastic schools served to keep alive the ancient learning."  Among the most significant was the School of Salernum "which for centuries kept alight the lamp of old learning, and became the centre of medical studies in the Middle Ages; well deserving it's name 'Civitas Hippocratica.'" (2, pages 86-7)

2.  Conquer of Spain allows for the rise of Arabian Medicine:  Ancient Greek and Roman medicine continued to be studied in Spain.  Mohamet was, according to Islam, was the last messenger of Allah, and it was he who encouraged Muslims to learn as much as they could.  So by the conquer of Spain in 720 A.D., the environment in the east had already been created that was conducive to learning.

The Arabs now had access to the wisdom of the ancient sages of Greece and Rome, although they were all in Latin.  Osler explains that by the end of the 9th century the Arabs translated much of the Ancient Greek and Roman writings, and were able to use this knowledge to further advance science and medicine.  A perfect example here is Rhazes who defind smallpox,  Maimonides who wrote a treaties on asthma, and Avicenna who was known as the Prince of Physicians.

Thomas Bradford said medicine started its transfer from the west to the east as early as the time of Charlemagne (742-814), "though it became more marked in the following centuries." (7, pages 74-75)

Beginning with the crusades knowledge started to make it's way back to Europe.  Men like Constantinus Africanus translated the works such as Hippocrates and Galen  from Arabic back into Latin at Salernum.  The works of Rhazes, Maimonides, Avicenna and others were likewise translated for Western Europe.

The Muslims added little knowledge to anatomy considering the Muslim religion also prohibited autopsies, but they did add quite a bit to knowledge of diseases, and provided the Europeans with quite a few additional herbal remedies. (2, page 91- 104)

To learn more about how the Arabs saved medicine click here. 

3.  The rise of universities in the 13th century:  Around the 14th century associations of persons with particular skills started to form during the Middle ages, otherwise known as universities.  These were places where people could share ideas and study.  Universities in northern Italy were mainly controlled by students from various nations.  The students arranged lectures and hired teachers.  Yet those of Paris were controlled by the teachers.

Knowledge of ancient writers, especially Aristotle and Galen, were preserved by such schools in Italy and Spain.  The Arabs gained access to this resource.  Books of Avicenna, Albucasis and Rhazes were also studied.  Study of human anatomy was encouraged for the first time since Galen's day, and a book of anatomy (or at least a book on how to perform autopsies) was published by Mundinus in 1316, "a book that served as a text book for the next 200 years."  It was difficult to get a body for autopsy, and permission was often required, although it was accomplished.  Usually the bodies were those of condemned criminals.  (2, page 106)

Science and medicine were not advanced in the west until around 1543 when a man named Andreas Vesalias published a book called De Humani Corporis Fabrica in 1543.  For the first time in over a thousand years medicine was once again moving forward. Yet that would be a fear years down the road.  For now, the most amazing development during the Dark Ages of Medicine was Arabic Medicine, which will be discussed in an upcoming post.

Read about AndreasVesalias by clicking (to be published 3/28/13).
Read how medicine survived the dark ages by clicking (to be published 1/15/13).
Read the end of the Dark Ages of Medicine (to be published  10/1/13)

References:

1. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. 
2. Osler, William Henry, "The Evolution of Modern Medicine: A series of lectures delivered at Yale..." page 85
3. Meryon, "
4. Cantor, Norman F, "The Civilization of the Middle Ages: A Completely Revised and Expanded Edition of Medieval History," 1993, first edition, Harper Collins Publishers
5. Cantor, Norman, "The Civilization of the Middle Ages: A Completely Revised and expanded Edition of Medieval history: The Life and Deal of a Civilization," 1993, Harper Collins Publishers, New York
6. Johnston, Harold Whetstone, "The Private Life of Romans," 1908, Chicago, Atlanta, New York, Scott, Foresman and company
7. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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476-1543: The dark ages of medicine

Alexandrian fire by Hermann Goll (1876)
Photo from Hellenistic Period at factsanddetails.com
When Rome burned, with it burned wisdom

It's amazing how people could go from living amid the flourishing civilizations of Ancient Greece and Rome to living as desolates in a world where learning stopped and knowledge retrogressed.  This is what essentially occurred beginning with the fall of Rome in 476 A.D. 

From the 5th through the 11th century, knowledge of science and literature was limited to a select few, such as the clergy, according to historian Edward Withington in his 1894 book "Medical History from the Earliest Times,"  (1, page 175).

In the meantime, during the dark ages, if you didn't have a need to know, you were left in the dark, literally.  This is one reason the Middle Ages, the Medieval era, is so often referred to as the Dark Ages.  People were kept illiterate and ignorant, and for the most part they accepted this ignorance as the path to eternal life in heaven.

For the most part, and with only a few exceptions, the Ancient Greek language was all but unknown in Western Europe.  This was unfortunate because "at this time Greek was still the key to all higher knowledge, especially in medicine," said Withington.  "Latin versions of some Galenic treaties, indeed, existed, yet they were so little known that Constantine the African (1020-1087) could boast in the eleventh century that he was the first to translate that author.  Celsus, whose work might have formed an excellent text-book, was almost entirely forgotten." (1, page 176)

William Osler, in a 1913 lecture at Yale, explained that "Knowledge other than that which made a man 'wise unto salvation' was useless.  All that was necessary was contained in the Bible or taught by the Church.  This simple creed brought consolation to thousands and illumined the lives of some of the noblest of men.  But 'in seeking a heavenly home man lost his bearing upon earth.'" (2, page 85)

With a few exceptions, most people didn't need natural remedies to treat diseases, and they didn't seek to know the diagnosis nor the prognosis of disease.  They lived the hard life, and they prayed to God for health and for healing.  They did not need natural medicine. They did not need physicians.  All they needed, as Osler noted, was the Bible and the Church.
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While the dark ages for western civilization ended in the 11th century, the dark ages of medicine lingered on until the 16th century.  Thankfully, however, while the west was clouded by the dark ages, the opposite was occurring in the east, where there was a bright cloud, and medicine flourished.

References:

1. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. 
2. Osler, William Henry, "The Evolution of Modern Medicine: A series of lectures delivered at Yale..." page 85

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100 B.C.: The beginning of the decline of wisdom

In order to understand the medicine of a given point in time, it's essential to understand the people of that time.  So here is a glimpse into the era of ancient Rome at the time when Christianity was just forming.

The ancient Greeks significantly advanced wisdom for the ancient world, and this knowledge was a gift handed to the Romans. The problem was that the gift was only available to the chosen few, while the majority continued to live in abject poverty.

This is key here, because the way the Roman majority was treated by the ruling class would help set up the entire structure of the Jewish way of life. This lead to the planting of the seeds of Christianity, which slowly grew into a full and flourishing tree that provided hope to the majority, although at the expense of wisdom.

So, life for the majority was not very good. This was explained best by medical historian Thomas Lindsley Bradford in his 1898 book "Quiz questions on the history of medicine:"

Draper tells us that just before the coming of Christ Rome was very wicked. Rome then contained two millions and a quarter of inhabitants, but of these only about ten thousand were of the gentry, the upper ten; there were about one hundred and twenty-five thousand populace or plebs. The plebs were often paupers in feeling, many of them were given public alms; they had cheap board, free admission to the theatres and gladiatorial shows, where the combats of the gladiators was not calculated to impress with fine feeling. There was about a million slaves, held as chattels, in the most abject misery. They might be killed at the will of their masters, and sometimes they were horribly mutilated, the physicians often having to perform these acts. There was no middle class at Rome. All these were kept in order by the numerous guards, generally mercenaries and foreigners. In Caesar's time, Rome the city which ruled the world was terribly depraved. Politicians had become demagogues; the concentration of power and increase of immorality proceeded equally. The Roman power included one hundred and twenty millions of people. Wealth was the only standard of social distinction. Law was of no value; the suitor was compelled to deposit a bribe before a trial could be had. Draper in his intellectual development of Europe says of this period of Roman history: The social fabric was a festering mass of rottenness. The people had become a populace; the aristocracy was demoniac; the city was a hell. No crime that the annals of human wickedness can show was left unperpetrated—remorseless murders; the betrayal of parents, husbands, wives and friends. Poisoning was reduced to a system; adultery degenerated into incest, and crimes that cannot be written. Women of the higher class were so depraved, lascivious and dangerous, that men could not be compelled to contract matrimony with them; marriage was displaced by concubinage; even virgins were guilty of inconceivable immodesties; great officers of state and ladies of the court of promiscuous bathings and naked exhibitions. In the time of Caesar it had become necessary for the government to put a premium on marriage. He gave rewards to women who had many children; prohibited those women under forty-five years of age and having no children, from wearing jewels and riding in litters, hoping by such social distinctions to correct the evil. It went from bad to worse, so that Augustus in view of the general avoidance of legal marriage, and resort to concubinage with slaves, was compelled to impose penalties on the unmarried—to exact that they should not inherit by will except from relations.The Roman women reckoned the years not from the consuls but from the men they had lived with. Gluttony was carried to loathsomeness. It was said of them—they eat that they may vomit, and vomit that they may eat. At the taking of Perusium, three hundred of the most distinguished citizens were solemnly sacrificed at the altar of Divius Julius by Octavius. Moral principle was extinct, it was a nation of atheists. Religious sentiment was entirely effaced. It was skeptical thought that governed the minds of the scholars; Varro, one hundred and ten years B. C, said that the gods were to be received as mere emblems of the forces of matter. Lucretius recommends that the mind be emancipated from the fear of the gods; Cicero was a skeptic. Some thought a virtuous life should be lived; some were cynics, some stoics. Epictetus (55-135 A.D), the slave and philosopher, taught that suicide was man's privilege. Seneca (4 B.C.-65 A.D.) said that time is our only possession, and that nothing else belonged to man. And we may well understand the influence all this must have had on the medical doctrines of the physicians of that time.

Bradford then posed the question: "What effect had Christianity on medicine?" His answer:

Rutherford Russell says that it is likely that Christianity must at first have acted injuriously on medicine. Jesus Christ was celebrated as a healer; he went about healing the sick and restoring to life. To the people of his time his principal occupation was the healing of the sick. This power possessed by the Saviour was given by him to his disciples. Luke had been a physician; but how could he prescribe after the manner of men, when he was able to heal by the grace of God? Thus medicine based as an art on the natural order of things, was for a time superseded by the preternatural power of certain men. But between religion and science there was a barrier great and unsurmountable.

So while Christianity did help to improve the plight of the poor, it did so (at least initially) by taking away from the aristocracy the gift of wisdom from the Greeks. It would be another thousand years before wisdom would come back to the civilized world, and another 1700 years before a system was created to encourage common folks to use their wisdom to improve medicine for all the masses.

References:

1. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

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