Medieval Medicine: The Dark Ages

The Fall of Rome to the Goths in 476 and the Fall of Constantinople in 1453 to the Turks are often cited as marking the beginning and end of the Middle Ages. The common characterization of this period as the “Age of Faith” reflects a dramatic loss of confidence in the individual, but ultimately it does not provide an understanding of why man felt no longer capable of learning from his own observations and took life “on faith.”

In any of the sciences, one must be able to believe in a constancy of cause and effect which is not subject to the whims of forces beyond nature. Precisely this belief was wanting in the medieval period, and its lack was of prime significance to the static—even at times declining—nature of the sciences and to an increased interest in magic and other distinctly unnatural phenomena. Less important, though more commonly noted, was the unsettling influence on the period of marauding conquerors: the Muslim descendants of bedouin tribesmen of the East, and the Germanic invaders of the West. Although the intellectual impact of Arabic science on Western Europe did not become significant before the tenth or eleventh century, a common characteristic of many of the Germanic tribes, especially in Italy, Spain, and Gaul, was their ready acceptance of the cultural and intellectual milieu of the peoples they had conquered. Latin civilization, though at times forced to go underground, persisted.

Barbarian Invasions

The strong frontier north of Constantinople necessitated a more western migration for the Germanic peoples forced out of their territories by the tide of Slays more to the east. As the Goths and Lombards poured into northern Italy, the Slays completed the separation of East and West by occupying Dacia, the region through which land contact between Rome and Constantinople had been maintained.

In spite of the dissolution of the Western Empire, immediately following the Fall of Rome to the Goths, a transient period of relative stability was found in northern Italy and Gaul through establishment of the Frankish, Lombard, and Gothic kingdoms, especially under Theodoric (c. 454-526). Many Roman institutions appear to have survived, even if no longer under the authority of Rome. During the fifth to the seventh centuries, the Germanic peoples—Ostrogoths, Lombards, Franks, Visigoths—who had conquered the northern perimeter of the Western Empire easily adapted the sophisticated Roman system of jurisprudence to the development of practical codes regulating personal interactions within their communities. Issues of public health and concern with physicians were prime in all these codes. Probably physicians were still exclusively nonclerical. Fees were almost always defined by ordinance, and these were often high, but punishment for malpractice, or misfortune, was also severe. The physician’s rights and penalties were more commonly defined by the rank of the patient, and physicians themselves were probably of low status (certainly not among the “learned,” having little formal training). Hospitals under nonclerical administration existed in the sixth century at Lyons and Merida.

Other Germanic peoples, occupying lands to the north of the former empire where vestiges of Latin civilization quickly evaporated, had contact with neither Roman law nor Roman medicine. Among them the belief that supernatural forces engendered disease prevailed. The sick were cured by the word in exorcism and by the administering, internally and externally, of healing plant substances. Teutonic women were very important as healers, especially in battle, by bloodsucking. The Celtic peoples to the north and west of the Franks were under the general leadership of the Druids, who combined both priestly and curative functions. Even the tribes settling the Russian steppes had practitioners of folk medicine, the volkhava or wolfmen, who relied heavily on magical powers.

A major exception in northern Europe to this return to a folk medicine intertwining religious and medical functions was found in the British Isles, part of which had been brought into the Empire by Julius Caesar himself, where several centuries later Christianity was to follow. As the Roman Empire underwent its death throes, St. Patrick (c. 385-461), a native Briton, brought Christianity to the Celtic peoples of Ireland, and the spirit of monasticism became deeply rooted. In part because of the end of Roman influence in the British Isles, the Irish monks rapidly developed a tradition of firm independence while maintaining strong contact with the monastic communities of both Italy and the East. Later these monks, as missionaries, were to convert to Christianity and introduce Latin civilization to large numbers of Frankish and Teutonic conquerors of Europe who had had no direct contact with Mediterranean peoples.

The stability of northern Italy during the reign of Theodoric in the early sixth century was short-lived. Only so long as the conquering Goths and Lombards were able to remain aloof were they able to remain in charge. Unlike other migrators, they allowed the native Italian population to remain, and within a century the conquerors submitted culturally to the conquered. Although the adaptation of Roman institutions early served a general good, within a short time alliances among the various conquering peoples based on ties of blood and marriage disintegrated. Rivalry ensued. Isolationist anarchy was encouraged by the nearly total suppression of trade and a return of city-dwellers to the land.

Among the first Roman institutions to be dispensed with were those of law and medicine. Might increasingly made right, and doctors and patients each had to fend for himself. Ultimately, for reasons not entirely clear, nonclerical physicians just ceased to exist. One influence, however, was the ascendancy of the Church in Rome—especially the papacy—in the vacuum created by the moving of the capital of the Western Roman Empire to Ravenna. The Church maintained the strongest link to the past, and this was reinforced by its continued contact with the Eastern Church. The deference of the conquerors, especially important in northern Italy and Gaul, to the traditions of the culturally superior conquered peoples, became more and more a deference to the Church of Rome, as the legal, social, and intellectual carry-overs of the imperial period were successively lost or even suppressed by the anarchic conditions surrounding the Goths’ squabbling and attempts to reestablish society.

Monasteries, Medicine, and Miracles

St. Benedict of Nursia encouraged the care of the sick in the statutes founding his order at the monastery of Monte Cassino on the site of an ancient temple of Apollo. However, because the cure of disease was possible only through prayer and divine intervention, St. Benedict forbade the study of medicine. Thus, the Healing Mission of Christ was institutionalized in a fashion that was to control medical care almost completely for the next five hundred years.

Aurelius Cassiodorus (480-573), after serving as private secretary to Theodoric the Great, entered the Benedictine order and recommended the study of Latin translations of Hippocrates, Galen, and Dioscorides, as well as the works of Caelius Aurelianus. Within a short period, the provision of medical care had become integral to the Benedictine order. In an age where literacy was most uncommon, the Benedictines also made a conscious effort to preserve the literary tradition of the Latin world. Though by no means confined to medical tracts, many were thereby preserved, even if these treatises had little or no influence upon the kind of medicine that was being practiced within the monasteries housing them.

Many well-developed ancient medical procedures, especially surgical, were lost, and cauterization replaced many techniques of surgery. Pharmacology abandoned all experimental aspects and regressed to a simplified herbalism characteristic of many types of folk medicine. But as the Benedictine and other orders expanded and extended themselves across Western Europe, an herb garden, a library with scribes to do copying, and an infirmary were almost always the essential elements of a monastery.

The Celtic peoples of Britain and Ireland were early to adopt the monastic way of life and even maintained better and longer contact with the Eastern orders than did the Italian monasteries. Fired by a new religion and culture totally alien to their Druidic past, they not only incorporated the Benedictine penchant for the preservation of Latin civilization but also, in the seventh century, began to transport this back to the European continent, where as missionaries under St. Columbanus (d. 615) in Gaul, St. Gall (d. 646) in Switzerland, and St. Willibrord (d. 739) in the Frankish domains, the Benedictines converted many Frankish and Germanic tribes and established monasteries, the most notable of which were St. Gall and Fulda. All were more or less modeled after the Benedictine monasteries of Italy, and the ascendancy of clerical medicine was assured.

Monasteries founded near centers of medical learning in the old Empire were often able to establish a connection with whatever had survived the disruption of the Empire, as at Ravenna in Italy, Lyons in Gaul, and Merida in Spain. When Charlemagne had unified under single rule many of the Frankish and Germanic tribes at the end of the eighth century, he not only was anxious to attain legitimacy by being crowned Holy Roman Emperor by the Pope but also sought to extend Latin civilization through schools associated with church and crown. Not only at the Schola Palatii, where famous Englishmen taught the sons of Charlemagne and other nobles, but also throughout the system of cathedral schools medicine was expected to be taught in addition to classical studies and politics based upon the economy of the Roman Empire and the papacy.

The character and quality of medical practice during this period—almost totally dominated by the Church—left much to be desired, at least to the modern eye. Although physicians had become so much a part of the medieval monastic environment that many monasteries had entire divisions for the medici (those members of both higher and lower orders whose major occupation was medicine), much of their labor was devoted to such unscientific techniques as prayer, the laying on of hands, exorcisings, use of amulets with sacred engravings, holy oil, relics of the saints, and other elements of supernaturalism and superstition.

Reliance upon the quasi-magical was not restricted to medicine in the Middle Ages, but it must be granted that the supernatural was called upon to do more in that field than was common for other human endeavors—even in the “Age of Faith.” The origins of this situation lay only partly in the Healing Mission of Christ. Much of the appeal of Jesus derived from his miracles, the vast majority of which were of a healing nature. Also, as the expected Day of Judgment failed to arrive and problems on earth seemed magnified by plague, war, and economic and political anarchy, people in general felt powerless to help themselves. At first, God was beseeched directly for assistance. The early Church, especially before it became an established church, had little formal organization; and though, of course, there were always leaders, no priestly caste with extraordinary functions appears to have existed. However, even after the Crucifixion, miracles continued to be a mainstay of the Church’s development and growth. Although the Grace of God remained the mediator of these miracles, particular holy individuals began to be thought of as intercessors for these actions, and as had been true in the development of the concept of Christ’s divinity, the newer miracles began to be regarded as evidence of the sanctity of the people through whom they were performed. Thus, the substantiation of sainthood progressively required the performance of miracles, which then led to the expectation of further miraculous intervention, even after the death of the individual saint.

The Christian priest’s assumption of many of the roles of the imperial Roman priest after the Church became an established religion accelerated the development of his function of intercessor with God. (The adjective “pontifical” was derived from pontifex maximus, chief priest of pagan Rome.) The process of increasing the distance between the ordinary individual and God accelerated in both East and West. In the Eastern Church during the most sacred portion of the Mass, a screen was (and still is) placed between the congregation and the celebrants.

As the medieval Church relied more heavily on the intercession of saints, the saints themselves gained increased significance and consideration in Church writings, liturgy, and iconography. Although the evangelist St. Luke was himself a physician, the first saints whose intercession was sought almost exclusively for relief from disease were the twins Cosmas and Damian. Born in Cilicia in the third century, they were physicians who in the hope of gaining converts to Christianity provided their services without fee. They suffered a grotesque martyrdom in the year 278 during the reign of Diocletian but soon gained a following, at first in the East and later in the West, for numerous miraculous cures both in life and after death. Furthermore, under the patronage of Emperor Justinian (483-565), the church of their name in Constantinople, modeled on the temples of Asclepios, was open day and night for the cure of the sick by incubatio. Their most famous miracle occurred at a church named after them in a formerly pagan temple at the edge of the Forum in Rome, where they appeared posthumously to replace the gangrenous leg of the church’s sacristan with the leg of a Negro who had died of old age. Their popularity in the West expanded quickly, and they soon gained importance iconographically not only for physicians and surgeons but also for closely related apothecaries and barbers.

Another Eastern saint to gain popularity in both East and West as a patron of medicine was Pantaleon of Nicomedia (d. c. 305). Like Saints Luke, Cosmas, and Damian, Pantaleon practiced medicine among the sick poor without accepting fees. In doing this, and because he was a Christian, he gained the enmity of his pagan colleagues and was put to death. His cult was early established in the East and later spread to Rome and Western Europe. (Ironically, Pantaleon was later associated in Venetian commedia dell’arte with the image of the comic, which slowly supplanted, at least in the West, the concept of the healing saint, and his name even provided the term “pantaloon” for men’s trousers.)

The utilization of saints as intercessors with the divine developed during the period 500-1000 but became even more “specialized” thereafter. The growing belief in the intercessory powers of the Virgin (so-called Mariolatry), especially encouraged by the French troubadors’ cult of chivalry, also supported belief in the efficacy of saints. As we shall see, medicine and the devotion to various saints were to become more intertwined when miraculous cures were to be sought not only of Christian physician martyrs but also of individual saints associated with specific diseases or even parts of the body.

The growing significance of superstition and magic in medieval Europe is often attributed to the anarchy following the fall of the Western Empire, but such a view is overly simplistic, especially as this antirationalism was strongest in the later Middle Ages, after the year 1300. Moreover, similar superstitious developments can be found in Constantinople and the East. Alexander of Tralles (525-605) was a skilled physician and independent scientist with excellent powers of observation. He bound himself to neither Hippocrates nor Galen (nor to any of the schools in between) and traveled extensively in Spain, Gaul, Italy, and Greece before settling down in Rome. Though he made many independent observations and startlingly accurate deductions about many diseases—such as the origin of epilepsy in the brain (an association reported by Hippocrates in the fifth century B.C.), the use of finger pressure in edema (fluid under the skin) and ascites (fluid in the abdomen), and the detection of an enlarged spleen by palpation—he was also capable of advising rather obviously magical cures. For intermittent fever, he advised carrying an olive upon which were written the mystical but meaningless syllables “ka, ra, a.” Many another physician trained in the Byzantine Empire was able to combine the concepts of a rationally derived Hellenistic medicine with chants and potions, dung-filled amulets, and chants.

Comments 2
  1. Is this about the history of medicine or the history of people's views of medicine? What about the fact that there were hospitals in Justinian's reign? I think there's too much emphasis on miracles and Mariolatry, etc. Did Christianity have any positive effect on medicine? Seems to be the usual tired anti-Christianity stuff.

  2. This was a great read. Also a great help with my project for the history of medicine, life science, & public health!

Leave a Reply

Your email address will not be published. Required fields are marked *