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Medieval medicine in Western Europe was composed of a mixture of existing ideas from antiquity. In the Early Middle Ages, following the fall of the Western Roman Empire, standard medical knowledge was based chiefly upon surviving Greek and Roman texts, preserved in monasteries and elsewhere. Medieval medicine is widely misunderstood, thought of as a uniform attitude composed of placing hopes in the church and God to heal all sicknesses, while sickness itself exists as a product of destiny, sin, and astral influences as physical causes. On the other hand, medieval medicine, especially in the second half of the medieval period (c. 1100–1500 AD), became a formal body of theoretical knowledge and was institutionalized in the universities. Medieval medicine attributed illnesses and disease, not to sinful behaviour, but to natural causes, and sin was only connected to illness in a more general sense of the view that disease manifested in humanity as a result of its fallen state from God. Medieval medicine also recognized that illnesses spread from person to person, that certain lifestyles may cause ill health, and some people have a greater predisposition towards bad health than others.[1]

Hospitals began to appear in great numbers in France and England. Following the French Norman invasion into England, the explosion of French ideals led most Medieval monasteries to develop a hospitium or hospice for pilgrims. This hospitium eventually developed into what we now understand as a hospital, with various monks and lay helpers providing the medical care for sick pilgrims and victims of the numerous plagues and chronic diseases that afflicted Medieval Western Europe. Benjamin Gordon supports the theory that the hospital – as we know it – is a French invention, but that it was originally developed for isolating lepers and plague victims, and only later undergoing modification to serve the pilgrim.[80]

Owing to a

Owing to a well-preserved 12th-century account of the monk Eadmer of the Canterbury cathedral, there is an excellent account of Bishop Lanfranc's aim to establish and maintain examples of these early hospitals:

But I must not conclude my work by omitting what he did for the poor outside the walls of the city Canterbury. In brief, he constructed a decent and ample house of stone…for different needs and conveniences. He divided the main building into two, appointing one part for men oppressed by various kinds of infirmities and the other for women in a bad state of health. He also made arrangements for their clothing and daily food, appointing ministers and guardians to take all measures so that nothing should be lacking for them.[81]

High medieval surgeons like Mondino de Liuzzi pioneered anatomy in European universities and conducted systematic human dissections. Unlike pagan Rome, high medieval Europe did not have a complete ban on human dissection. However, Galenic influence was still so prevalent that Mondino and his contemporaries attempted to fit their human findings into Galenic anatomy.

During the period of the Renaissance from the mid 1450s onward, there were many advances in medical practice. The Italian Girolamo Fracastoro(1478–1553) was the first to propose that epidemic diseases might be caused by objects outside the body that could be transmitted by direct or indirect contact.[82] He also proposed new treatments for diseases such as syphilis.

In 1543 the Flemish Scholar Andreas Vesalius wrote the first complete textbook on human anatomy: "De Humani Corporis Fabrica", meaning "On the Fabric of the Human Body". Much later, in 1628, William Harvey explained the circulation of blood through the body in veins and arteries. It was previously thought that blood was the product of food and was absorbed by muscle tissue.

During the 16th century, Paracelsus, like Girolamo, discovered that illness was caused by agents outside the body such as bacteria, not by imbalances within the body.

The French army doctor Ambroise Paré, born in 1510, revived the ancient Greek method of tying off blood vessels. After amputation the common procedure was to cauterize the open end of the amputated appendage to stop the haemorrhaging. This was done by heating oil, water, or metal and touching it to the wound to seal off the blood vessels. Pare also believed in dressing wounds with clean bandages and ointments, including one he made himself composed of eggs, oil of roses, and turpentine. He was the first to design artificial hands and Renaissance from the mid 1450s onward, there were many advances in medical practice. The Italian Girolamo Fracastoro(1478–1553) was the first to propose that epidemic diseases might be caused by objects outside the body that could be transmitted by direct or indirect contact.[82] He also proposed new treatments for diseases such as syphilis.

In 1543 the Flemish Scholar Andreas Vesalius wrote the first complete textbook on human anatomy: "De Humani Corporis Fabrica", meaning "On the Fabric of the Human Body". Much later, in 1628, William Harvey explained the circulation of blood through the body in veins and arteries. It was previously thought that blood was the product of food and was absorbed by muscle tissue.

During the 16th century, Paracelsus, like Girolamo, discovered that illness was caused by agents outside the body such as bacteria, not by imbalances within the body.

The French army doctor Ambroise Paré, born in 1510, revived the ancient Greek method of tying off blood vessels. After amputation the common procedure was to cauterize the open end of the amputated appendage to stop the haemorrhaging. This was done by heating oil, water, or metal and touching it to the wound to seal off the blood vessels. Pare also believed in dressing wounds with clean bandages and ointments, including one he made himself composed of eggs, oil of roses, and turpentine. He was the first to design artificial hands and limbs for amputation patients. On one of the artificial hands, the two pairs of fingers could be moved for simple grabbing and releasing tasks and the hand look perfectly natural underneath a glove.

Medical catastrophes were more common in the late Middle Ages and the Renaissance than they are today. During the Renaissance, trade routes were the perfect means of transportation for disease. Eight hundred years after the Plague of Justinian, the bubonic plague returned to Europe. Starting in Asia, the Black Death reached Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in Crimea), and killed 25 million Europeans in six years, approximately 1/3 of the total population and up to a 2/3 in the worst-affected urban areas. Before Mongols left besieged Crimean Kaffa the dead or dying bodies of the infected soldiers were loaded onto catapults and launched over Kaffa's walls to infect those inside. This incident was among the earliest known examples of biological warfare and is credited as being the source of the spread of the Black Death into Europe.

The plague repeatedly returned to haunt Europe and the Mediterranean from 14th through 17th centuries. Notable later outbreaks include the Italian Plague of 1629–1631, the Great Plague of Seville (1647–1652), the Great Plague of London (1665–1666), the Great Plague of Vienna (1679), the Great Plague of Marseille in 1720–1722 and the 1771 plague in Moscow.

Before the Spanish discovered the New World (continental America), the deadly infections of smallpox, measles, and influenza were unheard of. The Native Americans did not have the immunities the Europeans developed through long contact with the diseases. Christopher Columbus ended the Americas' isolation in 1492 while sailing under the flag of Castile, Spain. Deadly epidemics swept across the Caribbean. Smallpox wiped out villages in a matter of months. The island of Hispaniola had a population of 250,000 Native Americans. 20 years later, the population had dramatically dropped to 6,000. 50 years later, it was estimated that approximately 500 Native Americans were left. Smallpox then spread to the area which is now Mexico where it then helped destroy the Aztec Empire. In the 1st century of Spanish rule in what is now Mexico, 1500–1600, Central and South Americans died by the millions. By 1650, the majority of New Spain (now Mexico) population had perished.

Contrary to popular belief[83] bathing and sanitation were not lost in Europe with the collapse of the Roman Empire.[84][85] Bathing in fact did not fall out of fashion in Europe until shortly after the Renaissance, replaced by the heavy use of sweat-bathing and perfume, as it was thought in Europe that water could carry disease into the body through the skin. Medieval church authorities believed that public bathing created an environment open to immorality and disease. Roman Catholic Church officials even banned public bathing in an unsuccessful effort to halt syphilis epidemics from sweeping Europe.[86]

In order for an army to be in good fighting condition, it must maintain the health of its soldiers. One way of doing this is knowing the proper location to set up camp. Military camps were not to be set up in any sort of marshy region.[87] Marsh lands tend to have standing water, which can draw in mosquitos. Mosquitos, in turn, can carry deadly disease, such as malaria. As the camp and troops were needed to be moved, the troops would be wearing heavy soled shoes in order to prevent wear on soldiers’ feet.[87] Waterborne illness has also remained an issue throughout the centuries. When soldiers would look for water they would be searching for some sort of natural spring or other forms of flowing water. When water sources were found, any type of rotting wood, or plant material, would be removed before the water was used for drinking. If these features could not be removed, then water would be drawn from a different part of the source.[87] By doing this the soldiers were more likely to be drinking from a safe source of water. Thus, water borne bacteria had less chance of making soldiers ill. One process used to check for dirty water was to moisten a fine white linen cloth with the water and leave it out to dry. If the cloth had any type of stain, it would be considered to be diseased. If the cloth was clean, the water was healthy and drinkable.[87] Freshwater also assists with sewage disposal, as well as wound care. Thus, a source of fresh water was a preemptive measure taken to defeat disease and keep men healthy once they were wounded.

Physicians

Surgeons

In Med

In Medieval Europe the surgeons social status improved greatly as their expertise was needed on the battlefield.[88] Owing to the number of patients, warfare created a unique learning environment for these surgeons. The dead bodies also provided an opportunity for learning. The corpses provided a means to learn through hands on experience. As war declined, the need for surgeons declined as well. This would follow a pattern, where the status of the surgeon would flux in regards to whether or not there was actively a war going on.[88]

First medical schools

Medical school also first appeared in the Medieval period. This created a divide between physicians trained in the classroom and physicians who learned their trade through practice. The divide created a shift leading to physicians trained in the classroom to be of higher esteem and more

Medical school also first appeared in the Medieval period. This created a divide between physicians trained in the classroom and physicians who learned their trade through practice. The divide created a shift leading to physicians trained in the classroom to be of higher esteem and more knowledgeable. Despite this, there was still a lack of knowledge by physicians in the militaries.[89] The knowledge of the militaries’ physicians was greatly acquired through first hand experience. In the Medical schools, physicians such as Galen were referenced as the ultimate source of knowledge. Thus, the education in the schools was aimed at proving these ancient physicians were correct. This created issues as Medieval knowledge surpassed the knowledge of these ancient physicians. In the scholastic setting it still became practice to reference ancient physicians or the other information being presented was not taken seriously.[90]

Level of care

The soldiers that rec

The soldiers that received medical attention was most likely from a physician who was not well trained. To add to this, a soldier did not have a good chance of surviving a wound that needed specific, specialized, or knowledgeable treatment.[89] Surgery was oftentimes performed by a surgeon who knew it as a craft. There were a handful of surgeons such as Henry de Mondeville, who were very proficient and were employed by Kings such as King Phillip. However; this was not always enough to save kings’ lives, as King Richard I of England died of wounds at the siege of Chalus in AD 1199 due to an unskilled arrow extraction.[89]

Wound treatment

Treating a wound was and remains the most crucial part of any battlefield medicine, as this is what keeps soldiers alive. As remains true on the modern battlefield, hemorrhaging and shock were the number one killers. Thus, the initial control of these two things were of the utmost importance in medieval medicine.[89] Items such as the long bow were used widely throughout the medieval period, thus making arrow extracting a common practice among the armies of Medieval Europe. When extracting an arrow, there were three guidelines that were to be followed. The physicians should first examine the position of the arrow and the degree to which its parts are visible, the possibility of it being poisoned, the location of the wound, and the possibility of contamination with dirt and other debris. The second rule was to extract it delicately and swiftly. The third rule was to stop the flow of blood from the wound.[89] The arrowheads that were used against troops were typically not barbed or hooked, but were slim and designed to penetrate armor such as chain mail. Although this design may be useful as wounds were smaller, these arrows were more likely to embed in bone making them harder to extract.[91] If the arrow happened to be barbed or hooked it made the removal more challenging. Physicians would then let the wound putrify, thus making the tissue softer and easier for arrow extraction.[92] After a soldier was wounded he was taken to a field hospital where the wound was assessed and cleaned, then if time permitted the soldier was sent to a camp hospital where his wound was closed for good and allowed to heal.[93]

Blade and knife wounds

Another common injury faced was those caused by blades. If the wound was too advanced for simple stitch and bandage, it would often result in amputation of the limb. Surgeons of the Medieval battlefield had the practice of amputation down to an art. Typically it would have

Another common injury faced was those caused by blades. If the wound was too advanced for simple stitch and bandage, it would often result in amputation of the limb. Surgeons of the Medieval battlefield had the practice of amputation down to an art. Typically it would have taken less than a minute for a surgeon to remove the damaged limb, and another three to four minutes to stop the bleeding.[92] The surgeon would first place the limb on a block of wood and tie ligatures above and below the site of surgery. Then the soft tissue would be cut through, thus exposing the bone, which was then sawed through. The stump was then bandaged and left to heal. The rates of mortality among amputation patients was around 39%, that number grew to roughly 62% for those patients with a high leg amputation.[92] Ideas of medieval surgery are often construed in our modern mind as barbaric, as our view is diluted with our own medical knowledge. Surgery and medical practice in general was at its height of advancement for its time. All procedures were done with the intent to save lives, not to cause extra pain and suffering. The speed of the procedure by the surgeon was an important factor, as the limit of pain and blood loss lead to higher survival rates among these procedures.[92] Injuries to major arteries that caused mass blood loss were not usually treatable as shown in the evidence of archeological remains.[91] We know this as wounds severe enough to sever major arteries left incisions on the bone which is excavated by archaeologists. Wounds were also taught to be covered to improve healing. Forms of antiseptics were also used in order to stave off infection. To dress wounds all sorts of dressing were used such as grease, absorbent dressings, spider webs, honey, ground shellfish, clay and turpentine. Some of these methods date back to Roman battlefield medicine.[93]

Bone breakage

Sieges were a dangerous place to be, as broken bones became an issue, with soldiers falling while they scaled the wall amongst other methods of breakage. Typically, it was long bones that were fractured. These fractures were manipulated to get the bones back into their correct location.[92] Once they were in their correct location, the wound was immobilized by either a splint or a plaster mold. The plaster mold (an early cast) was made of flour and egg whites and was applied to the injured area. Both of these methods left the bone immobilized and gave it a chance to heal.[92]

Burn treatmentBurn treatment also required a specific approach by physicians of the time. This was due to burning oil and arrows or boiling water, which were used in combat. In the early stages of treatment there was an attempt to stop the formation of blisters. The burn was prevented from becoming dry by using anointments placed on the burn. These anointments typically consisted of vinegar, egg, rose oil, opium, and a multitude of different herbs.[92] The ointment was applied to affected area, and then reapplied as needed.

See also