Something that many people do not realise is that cultures, technology, science and learning can go backwards as well as forwards. Just as you can have progression, you can also have regression. Although the way Europe is going this idea will become very real to people very soon, if it hasn’t already. The story of medicine in the Middle ages may be best split in to three areas; Western Europe, the Eastern Roman Empire and the Muslim world. Christianity grew as a religion across the Roman Empire, until Emperor Theodosius I made it the official religion.
During the A.D. 600s the religion of peace, known as Islam, had emerged in the Middle East and promptly set about conquering neighbouring lands. Peacefully, of course. So peaceful was this expansion that by 750 A.D. it reached through North Africa, cross the sea to Portugal and most of Spain, eastwards in to modern day Pakistan and north through Turkey and to the shores of the Black Sea. Mediterranean Islands such as Malta also provided strategic naval bases. Expansion later increased again with the Ottoman Empire. In this way the Christian West was cut off to a large degree from the East, and all its ancient medical knowledge, as Dario Fernandez-Morera explains in his excellent book, “The Myth of the Andalusian Paradise”(I would recommend this book to gain a better overall appreciation of the Islamic world at the time).
As we saw previously in part 4 the Romans had built upon Greek learning, culture and engineering. Their medicine was based around the theory of the four humours and the works of Hippocrates and Galen. This continued in the Eastern Roman Empire, often called Byzantium. The Empire’s wealth and resources allowed many of the Roman technology and public health facilities to continue. The Empire continued to train doctors for the army, but went beyond this.
— Byzantine Empire (@byzantinephil) October 22, 2017
Thanks to the teachings of Christianity, caring for the poor became one of the aims of the church. The church set up and paid for hospitals, often by individual bishops. Many doctors were university trained, for example at the University of Constantinople. Some hospitals also had wards for specific conditions. The idea of Christian charity and help for the poor led to the idea that they should be provided with medical treatment.
Sts Constantine and Helena from Hosias Loukas
Today the Orthodox Church commemorates St. Helena finding the Precious Cross pic.twitter.com/O914nJTPTd
— The Byzantine Legacy (@ByzantineLegacy) March 6, 2017
Many works were written, mostly including Galen and Hippocrates, but also with some new findings. An example is the Medical Compendium in Seven Books by Paul of Aegina. Paul taught at Alexandria, and includes writings on bone structures and fractures. Along with others they helped Constantinople to become a centre of medical knowledge. Paul’s works, for example, were disseminated across the Arab world. Indeed the Emperor often made gifts of medical and other knowledge to others during diplomatic efforts:
“In 948 the Christian emperor of the Greek Roman Empire, Armanius, gave Abd al-Rahman III, the Umayyad caliph of Córdoba, Dioscorides’s works in the original Greek. But Muslims in Córdoba did not have anyone who knew Greek. As a result, the Roman emperor also sent a Greek monk, who instructed the Muslim ruler’s slaves in Greek.” (Fernández-Morera, Darío. The Myth of the Andalusian Paradise (p. 66). Intercollegiate Studies Institute.)
The Muslim World
This is a dispassionate look at Islamic medieval medicine, without reference to modern Islam, or coloured by my own political or religious views. It is not a judgement on the overall culture at the time or today (most regular blog readers know my views). History is what it is and doesn’t care about feelz. It doesn’t and should not change. We don’t want to stray in to BBC revisionist territory.
Through conquests of other lands that were part of the old Roman, Greek and Persian world, and some gifts from Constantiople, The Muslim world had access to a substantial amount of medical knowledge. Initially medicine was based on the lifestyle of the prophet Mohammed. For example:
“Ibn Khaldun, in his work Muqaddimah provides a brief overview over what he called “the art and craft of medicine”, separating the science of medicine from religion: You’ll have to know that the origin of all maladies goes back to nutrition, as the Prophet – God bless him! – says with regard to the entire medical tradition, as commonly known by all physicians, even if this is contested by the religious scholars. These are his words: “The stomach is the House of Illness, and abstinence is the most important medicine. The cause of every illness is a poor digestion.”
— Ibn Khaldūn, Muqaddima, V, 18″-From Infogalactic.
Later they incorporated works from the classical world including Galen and Hippocrates. Some progress was made during this period. Ali ibn Sahl Rabban al-Tabari stressed the link between physical and psychological treatments, and the need for counselling. Ibn al-Nafis discovered that the blood in the right ventricle of the heart is instead carried to the left by way of the lungs. Ibn al-Haytham took a straight forward approach towards vision by explaining that the eye was an optical instrument.
The Islamic world also had hospitals. These were divided in to same sex wards and had same sex staff, as per Islamic rules. The doctors were professional and in some areas had to pass exams to practice. Many treatments were herbal as they were in other areas and other times. Lists of Greek herbal remedies were available. Use was also made of the poppy and hemp as pain relief and anaesthesia.
Surgery was built on knowledge from the ancient world, but doctors were in some cases reluctant to use it due to lower success rates. Blood letting and cauterisation were used, as they were in ancient times. Eye operations could be performed, for example to treat cataracts. Some antiseptic techniques were being used, for example washing an are before an operation, and using wine, salt water, vinegar and other things which had some antiseptic properties.
Attitudes to women varied. There are records of midwives, wet nurses, nurses in hospital as already mentioned and also female doctors. Elsewhere medical texts advised: “Men stay away from women during their menstrual periods, “for this blood is corrupt blood,” and could actually harm those who come in contact with it. Much advice was given with respect to the proper diet to encourage female health and in particular fertility. For example: quince makes a woman’s heart tender and better; incense will result in the woman giving birth to a male; the consumption of water melons while pregnant will increase the chance the child is of good character and countenance; dates should be eaten both before childbirth to encourage the bearing of sons and afterwards to aid the woman’s recovery; parsley and the fruit of the palm tree stimulates sexual intercourse; asparagus eases the pain of labour; and eating the udder of an animal increases lactation in women.“-Infogalactic
There was also a strand of the supernatural, for example: “The use of invocations to God, and prayers were also a part of religious belief surrounding women’s health, the most notable being Muhammad’s encounter with a slave-girl whose scabbed body he saw as evidence of her possession by the Evil Eye. He recommended that the girl and others possessed by the Eye use a specific invocation to God in order to rid themselves of its debilitating effects on their spiritual and physical health.“-Infoglactic
Islamic medicine built upon what had come previously and in some areas expanded it. As Islam expanded its territories new knowledge was gained. Ideas could be spread through the common language of Arabic and medicine was often patronised by a Caliph or wealthy local ruler, allowing large works to be written and maintained in libraries, etc. Islamic doctors did challenge Galen in some areas, but they still on the whole followed the Graeco-Roman medical traditions of the four humours and Hippocratic methods. New knowledge on anatomy was gained, and public health was available through hospitals. All was not always rosy, as the new medical knowledge had to be justified as it came from non-believers, and dissection was not allowed so progress in understanding anatomy was slow. I mentioned that progress could go backwards as well as forwards, so next we will look at Western Europe…
© Jonathon Davies 2018
(Pictures from the Public Domain.)