L3: The Middle Ages

Question 1

What is the importance of nosokomeia?

Answer 1

• These are thought to be some of the first informal hospitals during medieval times and were based on Church’s charitable missions. These were poorhouses, hostels and hospices. - Nosocomial infections are those acquired in hospitals.

Question 2

Explain how Galenism contributed to medieval stagnation of medicine and medical education.

Answer 2

• Contemporary medical texts during medieval times were of Galen and other ancients. - Little original medical writing took place in Europe during medieval times - Galen’s fame and ideas spread widely - By ~ 500 CE, Galen’s work existed at Library of Alexandria and was taught as part of standardized medicine - Monasteries became teaching centers for medicine and also pseudo-hospitals - The Articella (little art of medicine) was written during the 11th century in Italy: Galen predominated in this text, but it also included work from Hunayn, Hippocrates and other ancients. - Oribasius collected excerpts of Galen and others. He simplified, rehashed and publicized this work. When this was summarized, it altered the legacy of Galen - Paul of Aegina: wrote a medical encyclopedia called the Seven Books of Medicine, which mostly referred to Galen - As a result of the profuse mention of Galen’s work, his mistakes in anatomy and physiology were perpetuated: ie. pores in cardiac septum, humans with 3-chambered heart, arteries pump blood, humans with 5-lobed liver, venisection. - University-based medical education arose in the 12-13th century in Italy and France. Most education still was via apprenticeship. MD and MB degrees were established. - Articella was used in universities, together with Avicenna’s (Islamic physician) Qanun. Therefore, much of Galen was upheld. - Islamic medicine contributed highly to medieval medicine: Johannitius, Rhazes and Avicenna

Question 3

Describe the origin of hospitals during medieval times.

Answer 3

• Hospitals grew out of Christian monasteries’ charitable mission (with Islamic examples) and evolved into larger institutions.

Question 4

Describe how the rise of Christianity affected medical practices.

Answer 4

• Christianity became the official Roman religion in 313 CE (by edict) - It emphasized the soul and not the body - Manual medicine/healing became more common - Certain diseases were again associated with “God’s punishment” as they were during antiquity – Egyptians and Greeks — sin and sickness = similar states - Church’s charitable missions led to founding of imformal “hospitals” that were derived from poorhouses, hostels and hospices. These were known as “nosokomeia.” - In the late middle ages, regulation of medicine began by the Church. Effort began to restrict monks from becoming physicians for pay and desserting church - Dissection frowned upon, only executed criminals were dissected - Shrines for spiritual healing arose

Question 5

Explain how the medieval social / political climate altered the practice of healing.

Answer 5

• In the early middle ages (~330 CE), cities were becoming much smaller, people were spreading out/ venturing to the countryside - Medical learning regressed to a state of that before Hippocrates - Galenism arose - Medicine was rural, based on remedies in books known as “leechbooks” - Herbalist and quacksalvers practiced medicine - Monasteries preserved books/texts for the preservation of language, incidentally preserved medical texts

Question 6

Describe some diseases of the middle ages: include treatment and consequences.

Answer 6

• a.) Bubonic plague (1340s) – “black death”, killed ~ 25% of Europe, no treatment, consequence: quarantines - b.) Leprosy (1179-1350) – Hansen disease, no cure, thought to be a result of being “unclean”, associated with sin, associated with sexual intercourse, consequences: leper colonies, quarantines - c.) Insanity – thought to be a humoral imbalance, causal theories (moon, sin, witchcraft etc.), many remedies, none curative; affected were tortured or executed as witches, received care in monasteries and special hostels. St. Mary’s of Bethlehem (“Bedlam”) was psychiatric hospital in 1247. - d.) Women’s Health – obstetrics was duty of all-female midwives or relatives (some man-midwives were known); female anatomy and physiology were considered imperfect, thought to be vessels for development of infant containing male seed

Question 7

What is the Articella?

Answer 7

• English translation: the Little Art of Medicine - It is an important medical text of the 11th Century that originated in Italy. Galen predominated throughout this text, but also included Islamic and Greek views. - Used in university-based medical teaching during medieval times

Question 8

Explain the standardization/regulation of medicine during the middle ages.

Answer 8

• Many practitioners were present during the middle ages, such as herbalists, apothecaries, midwives, bone-setters, barber-surgeons etc. - With the rise of university medical education in 12-13th centuries, medical guilds began in Italy during the 13-14th centuries. - There was an increased need for public health initiatives: food, water purity standards, proper waste disposal, regulation of livestock in tows - Guilds/colleges began processes that resulted in medicine becoming a distinct profession: standardized curricula (eg. Articella), formalized education (university vs apprenticeship), examinations, licensing and legal regulation (first steps) - Distinction between “regularly trained” physicians and quacks seen