12 May

One of the major innovations of the Middle Age was the formal estab- lishment of university education in medicine during the twelfth and thirteenth centuries. However, only a tiny fraction of all medical practi- tioners had any university training. The influence of the faculties of medicine  was  more  closely related  to  the  establishment  of  a  regular curriculum,  authoritative texts, technical knowledge, and a medical elite than  to the absolute  number  of university-trained physicians.

The  creation   and   distribution  of  universities   and   faculties  of

medicine throughout Europe  were very uneven. Students  often  had  to undertake  long  journeys   in  search  of  suitable   mentors.   Moreover, the  universities  of  the  Middle  Ages  were  very  different  from  both the ancient centers of learning and their modern counterparts, especially in terms  of the relationships among  students,  faculty,  and  administra- tors.  The exact origins  of some of the major  universities  are obscure. Indeed,  ‘‘university’’ was originally  a rather  vague term  that  referred to any corporate status  or association  of persons.  Eventually,  the term was formally  associated  with institutions of higher learning.  Some his- torians  believe that  the  ‘‘age of  reason’’ began  in the  universities  of the late Middle Ages, with the institutionalization of a curriculum  that demanded  the exploration of logic, natural philosophy,  theology, medi- cine, and law. Large numbers  of students,  all of whom shared Latin as the language of learning, were drawn to universities to study with teach- ers known for particular areas of excellence. Many students  entered the universities at the age of 14 or 15 years after securing the rudiments  of the  seven liberal  arts:  grammar, rhetoric,  logic, arithmetic,  geometry, astronomy, and music.

The medical texts available  for use by the time medical faculties were established  included  many  translations from  Greek  and  Arabic manuscripts, as well as new Latin  collections and commentaries.  How- ever, before the fifteenth century, students  and professors  lacked access to  many  of  the  surviving  works  of  Hippocrates,  Galen,  and  other ancient  writers.  Some  of Galen’s  most  important texts,  including  On Anatomical   Procedures,   were   not   translated  into   Latin   until   the sixteenth century.  Some manuscripts  were extremely rare and many of the Latin  texts attributed to Hippocrates and Galen were spurious.

Although  the rise of the university  as a center for training  physi- cians is an  important aspect  of the history  of medieval  medicine,  for much  of this  period  learned  medicine was still firmly associated  with the  church  and  the  monastery.   With  its  library,  infirmary,  hospital,

and herb gardens, the monastery  was a natural center for medical study and  practice.  On the other  hand,  charitable  impulses towards  the sick were sometimes  obliterated  by an all-consuming  concern  for the soul, coupled with contempt for the flesh. Some ascetics refused to make allowances   for  the  ‘‘indulgence’’  of  the  flesh,  even  for  sick  flesh. St. Bernard  of Clairvaux  (1091–1153), a mystic who engaged in harsh, self-imposed penances, expected his monks to live and die simply. Build- ing infirmaries, taking medicines, or visiting a physician were forbidden. St. Bernard thought it ‘‘unbefitting religion and contrary  to simplicity of life’’ to allow such activities.

Many exemplary stories about  the lives of saints and ascetics sug- gested that a regimen of self-imposed privations  led to health, longevity, and peace of mind. Ascetics might fast several days a week, eat nothing but bread,  salt, and water, stay awake all night in prayer,  and give up bathing  and  exercise (some  saints  were famous  for  sitting  on  pillars for years at a time). However, the reactions of saints and ascetics to dis- eases and accidents that  were not self-inflicted might be quite different. Here the stories vary widely. Some ascetics accepted medical or surgical treatment for disorders such as cancer and dropsy, whereas others cate- gorically  refused  to  accept  drugs  or  doctors.   Some  were  fortunate enough to be cured in a rather  Asclepian fashion by ministering  angels who appeared  in dreams to wash their wounds and anoint  their bruises.

The founders of some religious orders took a more temperate  view

of the needs of the sick, and infirmaries  and hospitals  were established as adjuncts  to monasteries  in order  to provide charity and care for the sick. Within  many  religious orders,  the rules of St. Benedict (ca. 480–

547) provided  reasonable  guidelines for care of the sick. Although  the monastic  routine  called for hard  work,  special allowances  were to  be made for the sick, infirm,  and  aged. The care of the sick was such an important duty that those caring for them were enjoined to act as if they served  Christ  directly.  There  is suggestive  evidence  that  monks  with some medical knowledge were chosen to care for the sick.

By the eleventh century, some monasteries  were training their own

physicians. Ideally, such physicians would uphold the Christianized ideal of the healer who offered mercy and charity towards  all patients,  what- ever their status and prognosis might be. The gap between the ideal and the  real  is suggested  by  evidence of  numerous  complaints  about  the pursuit  of  ‘‘filthy lucre’’ by  priest-physicians.   When  such  physicians gained  permission  to practice  outside  the monastery  and  offered their services to  wealthy  nobles,  complaints  about  luxurious  living and  the decline of monastic  discipline were raised.

The  ostensibly  simple  question  of  whether  medieval  clergymen were or were not  forbidden  to practice  medicine and surgery has been the subject  of considerable  controversy.  Only excessive naivete´  would lead  us  to  expect  that  official  records  and  documents  are  a  realistic

reflection  of  the  status  of  forbidden   practices.  The  official  Church position  was made  explicit  in numerous  declarations  and  complaints about  the  study  and  practice  of medicine  and  surgery  by clergymen. Several  twelfth-century papal  decisions  expressed  a  desire  to  restrict the practice of medicine by monks.  The declarations  of the Council of Clermont  (1130), the Council of Rheims (1131), and the Second Lateran Council  (1139) all contain  the statement:  ‘‘Monks and canons  regular are not  to study  jurisprudence  and  medicine for the sake of temporal gain.’’ This statement  referred specifically to the pursuit  of money, not to the study  and  practice  of medicine or law. Obviously,  the need for so  many  official  prohibitions indicates  how  difficult  it  was  to  make practice accord with policy.

Another  myth about  medieval medicine is the assumption that the

Church’s  opposition  to  ‘‘shedding human  blood’’ prohibited surgery. This prohibition was based  on opposition  to  shedding  blood  because of  hatred   and  war,  not  to  surgery  in  general,  and  certainly  not  to venesection  (therapeutic  bloodletting). The idea that  this position  had any  medical  significance  was  essentially  an  eighteenth-century hoax. Venesection  was actually  a fairly common  procedure,  performed  both prophylactically and therapeutically. When carrying out this important surgical procedure,  the doctor  had  to consider  complicated  rules that related the patient’s condition  to the site selected, as well as the season of the year, phase  of the moon,  and  the most  propitious time of day. Some guidance was offered by simple illustrations  depicting commonly used phlebotomy  sites, but these pictures were highly stylized and very schematic.

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