--from the Prologue to The Canterbury Tales (c. 1390)
   by Geoffrey Chaucer

Handing-on the Art of Healing

Europeans had limited access to the works of Hippocrates and Galen before 1000 CE.  Healing was less an art than a practiced craft.

Illness itself aroused ambivalent feelings.  If a disease was the result of divine action (possibly to test or punish the victim), it might be sinful to interfere with its course except through prayer, repentence and hope for a miracle.  On the other hand, those who ministered to the needs of the sick were considered agents of charity.  Many were members of the clergy.  Surely it was good to do whatever was necessary to restore the well-being of the temple of the soul. 

Still, it was best to avoid getting sick in the first place!  One's chances for preserving and maintaining good health could be improved by keeping the body's four humors in balance through routine bleeding or cupping:

A patient is bled to insure humors are kept in balance.

A clyster (enema) was often used to purge a patient of the toxins in bodily waste.

Goals:

• standardizing and preserving Christian dogma
• scriptoria (copying and storing sacred and selected secular manuscripts) 

• preserving and practicing Christian lifestyle
• herbaria (maintaining herb and vegetable gardens; orchards)
• vivaria (husbanding domesticated animals)
• valetudinaria (providing hospice care for residents and wayfarers)

• The infirmarius was the monk in charge of maintaining the health of his fellows through regular bleeding and purging.  His practice was guided by astrology and numerology as much as Hippocrates' Prognostics.

Monks prepare herbal medicines.

Cathedral schools (8th c)

• founded by Charlemagne (742-814)

• most notable:
• Paris
• Chartres

• served similar purpose to monastery schools

• prepared professionals in law and medicine as well as theology

• product of guild system
• Paris:  guild of masters
• Bologna:  guild of students

• four faculties:  Arts, Theology, Law, Medicine

• seven liberal arts

Although its origins are hazy, the first formal European medical school was founded in Salerno, Italy around the 9-10th century CE.  Its early teachers included Greeks, Romans, Jews and Muslims.  Women were admitted as pupils.  The curriculum included anatomy, dissection, practical medicine and professional behavior.

• Southern Spain--Arabic to Latin
• Cordova
• Toledo
• Seville

• Southern Italy and Sicily--Arabic and some Greek to Latin
• Salerno
• Monte Cassino (monastery founded by St. Benedict in 529)
• Palermo
• Syracuse

The fifty-year period between 1285-1335 was a transitional period in which medical practice in Europe took firm shape as a secular occupation.  Church officials questioned whether a cleric could continue to serve as a priest after the death of a patient under his care.  Regulations were introduced forbidding priests to practice surgery, although they were permitted to treat wounds, sores and fractures.  For a time, monks were forbidden to leave their monasteries to study medicine, although this impractical rule was eventually softened.

Thanks to Avicenna, the works of Galen were finally being put into a form that could be fruitfully studied.  Concordances and summaries appeared as teaching aids.  Europeans began to view medicine as more of a science than an art or a craft.  Best practice can be derived from first principles rather than trial and error:

• maintain and/or restore the balance of the patient's bodily humors
• preserve and/or restore the patient's constitution by manipulating diet, sleep, exercise, sex, climate
• observe the progress of a patient's illness carefully and take action (bleed, sweat, administer drugs, perform surgery...) to bring the patient to crisis as soon as possible

Those who read Galen's works carefully discovered occasional conflicts with Aristotle and other authorities.  Teachers and students worked to reconcile these differences through academic disputation.

Sanguine
  happy
  healthy

Phlegmatic
  slow
  droopy

[Physicians] boast that they understand an illness when they don't.

They drag illnesses out so that they can get more money from the sick.

They prescribe syrups and electuaries and other things for the sick because they share in the profits that the apothecaries make on what they sell to their patients. 

Every day we see that when the physician's cure goes wrong, he blames it on the patient, saying that he hasn't followed the right diet or didn't tell the truth about his illness.  It is they who should be blamed for the mistakes they make, yet they blame the patient, who doesn't deserve it. 

Physicians who first of all understand the illness, they ... can treat it:  but every day we see physicians treating their patients haphazardly because they don't understand the illness.

 --Ramon Llull (1272)

• History 135F Home Page

• excerpts from Al'-Arjuzat fi' t-tibb (Poem on Medicine) by 'Abu 'Ali al-Husain ibn 'Abd Allah ibn Sina, called Avicenna (980-1037)

• Regimen Sanitatis Salerni (The School of Salernum), English translation (1608) by Sir John Harington (1561-1612) accompanied by excerpts from The English physitian: or an astrologo-physical discourse of the vulgar herbs of this nation (1652), by Nicholas Culpeper (1616-1655):

• Part I.  Diet
• Part II.  Medicinal Herbs
• Part III.  Humors

• The Pisse-Prophet... (1637), by Thomas Brian (c.1600-?)