Episode 2: Medieval Europe
Project -- Introduction -- Episode 1: Egypt -- Episode 2: Medieval Europe -- Episode 3: Renaissance -- Conclusion
To better understand medicine in medieval Europe a background in Hellenistic medicine is often recommended. I suggest you read Nick's episode on Galen.
Background:
Medieval medicine stemmed from “Greek and Roman theories of health and diseases, diagnostic techniques, and therapeutic procedures” (Lindberg, 321). Islamic medical practices were then added to this classical foundation (Lindberg, 327). Medicine became a separate discipline in medieval universities during this time which influenced the course of medicine (Lindberg, 333). The practice of medicine flourished in monasteries. Caring for sick members of the community was an important obligation to these religious centers (Lindberg, 322). This led to the development and spread of hospitals (Lindberg, 327). Soon, tension arose “between the naturalism of medical tradition (the assumption that natural causes are at work) and supernaturalist tradition (miraculous healing) within Christianity (Lindberg, 324). The church did not outright denounce secular medicine; they only denounced the failure to acknowledge divinity (Lindberg, 325). Practitioners:
Simple medicine was practiced in every home by family members. If more knowledge was required, each community had various specialists. For example, there were midwives, bone-setters, and people who knew how to mix herbs. In cities, “empirics” could be found that specialized in treatment of wounds, dentistry, and minor surgeries (removal of kidney stones and repair of hernias are some examples). The clergy was also ever present (Thorndike). Once medical education shifted from monasteries to universities, there was a shift toward professionalization due to the demand from urban elites. Trained surgeons and skilled medical apprentices turned physicians emerged. Not only did men practice medicine during this time, but there were a substantial number of women active in obstetrics,gynecology, and other medical specialties as well. (Lindberg, pgs. 327-329). Diagnosis Based on Physiology: There were two diagnostic techniques during this period that relied heavily on knowledge of anatomical knowledge. One was urinalysis.  Urine Color Chart, connecting color variations with various digestion stages
David Lindberg, The Beginnings of Western Science, 1992 (pg. 336)
Practitioners believed urinalysis revealed the state of the liver. Urine was analyzed based on color, clarity, odor, and consistency. Giles of Corbeil, a thirteenth-century medical writer, states that "thick urine, whitish, milky, or bluish white, indicates dropsy, colic, the stone, headache, excess of phlegm, rheum in the members, or a flux" (Lindberg, pg. 335). The other technique was the examination of the pulse (a technique taken from Galen). The pulse was thought to reflect the state of the heart. Duration, breadth, strength, and regularity were analyzed. This is actually a useful tool. A failing pulse can foretell death. Pulse classification schemes were developed. In the thirteenth century, an anonymous treatise offered the following classification scheme: "The varieties of pulses are differentiated by the physician in a number of ways, in particular according to five considerations: (1) motion of the arteries; (2) condition of the artery; (3) duration of diastole and systole; (4) strengthening or weakening of pulsation; (5) regularity or irregularity of the beat. Ten varieties of pulse derive from these considerations"
(Lindberg, pg. 337).
Surgery: There were many different kinds of surgeons during this period. There were traveling empirics to university-educated surgeons working under kings and popes. There were many common procedures such as lancing boils, setting bones, dressing ulcers, blood-letting, suturing wounds, fixing dislocated joints, and cautery (application of hot metal to the body to create ulcers so unwanted fluids could drain out). Surgeons also performed more routine, yet more daring, procedures such as removal of cataracts, removal of external hemorrhoids, and removal of kidney stones. One of the most daring procedures of this period was the surgical correction of hernias. This involved drilling holes in the skull (trephining) to relieve pressure and drain blood and pus.  Operation for Scrotal Hernia Removal - Patient is both held and tied down.
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340) These procedures were performed without anesthetics or sedatives. Ouch! Here is a passage describing the removal of bladder stones (try to imagine the experience without sedatives):
"If there is a stone in the bladder make sure of it as follows: have a strong person sit on a bench, his feet on a stool; the patient sits on his lap, legs bound to his neck with a bandage, or steadied on the shoulders of the assistants. The physician stands before the patient and inserts two fingers of his right hand into the anus, pressing with his left fist over the patient's pubes. With his fingers engaging the bladder from above, let him work over all of it. If he finds a hard, firm pellet it is a stone in the bladder... If you want to extract the stone, precede it with light diet and fasting for two days beforehand. On the third day, ... locate the stone, bring it to the neck of the bladder; there, at the entrance, with two fingers above the anus incise lengthwise with an instrument and extract the stone" (Lindberg, pg. 341).
I was also surprised to learn that nasal polyps were successfully removed during this time. I have had this surgery twice before. Recovery is painful and I could not imagine the surgery or recovery without any sedatives.
 Operation for Nasal Polyps Removal
David Lindberg, The Beginnings of Western Science, 1992 (pg. 340) Interpretation: Even though most of the findings during this time were heavily influenced by Galen and other Greek and Roman texts, this doesn't mean the medieval period did little to advance medicine. They opened the door to many things including surgery, herbal medicines, and urinalysis. Without this era and its contributions to medicine, there may have been a large halt in medicine’s progression. -----------------------------------------------------------------------------------------------------------------------------------------
Bibliography and Notes:
Primary Sources and notes are found under each picture. David Lindberg, The Beginnings of Western Science (Chicago, Chicago University Press, 1992). This book is an amazing source for anything regarding pre-modern science. It has several chapters devoted to this period. Lindberg keeps the reader interested throughout each chapter (usually representing periods). It is reliable because Lindberg is a professional historian of science and is extremely knowledgeable in his field.
William Osler, The Evolution of Modern Medicine (http://www.gutenberg.org/files/1566/1566-h/1566-h.htm ). This E-text contains very descriptive information on all things medicine. The thing that interests me most about this work is the amount of detail Osler goes into concerning the large spectrum of topics discussed.
Thorndike, Lynn. "Vatican Latin Manuscripts in the History of Science and Medicine,” Isis, 1929, Vol. 13, No. 1, pp. 53-102. Stable URL: http://www.jstor.org/stable/224598. This is a great resource that lists many physicians and their specialities. Mostly during the 1400s but some are from before 1400. I think it is reliable because I found it on ISIS and it is from a historian translating primary sources.
Natalie Griffin
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