Medieval medicine c1000–c1500

Medieval medicine sat at a crossroads of three traditions — Greek-Roman ideas (especially Galen and Hippocrates), the Christian Church with its emphasis on prayer and pilgrimage, and everyday folk healing by women and herbalists. Examiners want you to explain how these traditions produced continuity in medical thinking for over a thousand years, and to identify the rare changes that did occur.

Hippocratic theory — the four humours

The theory of the four humours came from the Greek doctor Hippocrates (c.460–370 BC). The body, he taught, contained four fluids:

• Blood (warm and wet)
• Yellow bile (warm and dry)
• Black bile (cold and dry)
• Phlegm (cold and wet)

Health was a balance of these humours. Illness meant one was in excess. This explained why a fever (excess of blood) could be cured by bloodletting; why phlegm in winter could be cleared by purging; why a vomit might restore a stomach.

Linked to the four humours was the doctrine of opposites: a hot illness was treated with cold remedies and vice versa. The four humours also matched the four seasons and the four temperaments (sanguine, choleric, melancholic, phlegmatic) — a complete theoretical system.

Galen — the dominant authority for 1,500 years

Claudius Galen (c.129–210 AD) was a Greek physician working in Rome. He performed dissections on animals (human dissection was banned), and developed an extensive theory of anatomy and physiology. His ideas:

• Refined the four humours into a clinical system.
• Argued the body had three "spirits" — natural, vital and animal — flowing through veins, arteries and nerves.
• Described many anatomical structures (sometimes wrongly — e.g. the rete mirabile, which exists in pigs but not humans).

Why was Galen accepted for 1,500 years?

• Christian Church saw his idea of a soul-bearing body as compatible with Christianity.
• The Church controlled most universities and hospitals — endorsing Galen's authority.
• His writings were comprehensive — every condition had a Galenic explanation.
• No new observations were possible without dissection — which the Church discouraged.
• Translation through Arabic scholars (Ibn Sina, Rhazes) preserved Galen's texts during Europe's Dark Ages.

The role of the Church

The Church dominated medieval medicine in three crucial ways:

• Theological — illness was God's will, often a punishment for sin. Cure required confession, prayer, pilgrimage.
• Educational — universities required Church approval; medical training meant studying Galen, not new observation.
• Institutional — most hospitals were attached to monasteries (e.g. St Bartholomew's in London, founded 1123). They offered care, prayer and rest, but rarely cured — they were closer to hospices.

The training of physicians

• Universities at Bologna, Paris, Oxford taught medicine from the 12th century.
• Curriculum was based on Galen, Hippocrates and Avicenna's Canon of Medicine.
• Students studied for 7+ years — but rarely saw a patient.
• Physicians charged high fees and treated only the rich.

Surgery and barber-surgeons

Surgery was considered low-status and often performed by barber-surgeons — practical men with knives but no university training. Their work included:

• Bloodletting — the most common treatment.
• Tooth extraction.
• Wound dressing — for soldiers and labourers.
• Setting fractures.

Pain relief was minimal (alcohol, opium) and infection killed many patients. Anaesthesia and antiseptics did not exist.

Folk healing and women

Most ordinary people never saw a physician. Care was provided by:

• Wise women / herbal healers — women in villages with knowledge of medicinal plants (chamomile for digestion; willow bark — containing salicylic acid — for fever; garlic for infection).
• Apothecaries — sellers of remedies in towns.
• Pilgrimage — to shrines such as St Thomas Becket at Canterbury.

Continuity, not change

Medieval medicine was characterised by continuity:

• Galen and the four humours remained dominant for over 1,000 years.
• Treatments (bloodletting, purging, prayer) changed little from 500 to 1500.
• The Church's authority discouraged new observation or dissection.
• No germ theory, anaesthetic or antibiotic existed.

What did change?

• Translation of Greek and Arabic texts (esp. through Toledo c.1100).
• Early universities began medical degrees from c.1200.
• Some royal physicians began limited human dissection in Italy from c.1300 (Mondino de Liuzzi).
• The Black Death (1348) sparked fierce debate — but did not overturn humoral theory.

Examiner skill — using sources

You'll often see images of bloodletting charts, zodiac men, monastic herb gardens. Identify:

• The idea behind the source (humours? prayer? astrology?).
• Its purpose (instructional, devotional, decorative).
• Its provenance (monastic manuscript, university text, medical school illustration).