* The Roman Empire had collapsed in the fifth century. The Empire had been under attack by a group called the “barbarians”.
* After the collapse of the Roman Empire, there wasn’t a single government running, instead power lay in the hands of kings and chieftains who controlled the barbarian tribes.
* Barbarians were warriors who loved fighting and warfare.
* The new rulers did not look out for the health and welfare of the Romans like the Roman government had once done. Instead to them the job of a ruler was to fight!
* When the barbarian tribes first arrived they were non-Christians, they worshipped their own gods. They soon converted to Christianity and the barbarians kings and chieftains relied upon the priests as they could read and write and were well educated.
* This way the church stayed in power even when the rest of the Roman civilisation was falling apart!
* The start of the medieval period is sometimes known as the Dark Ages.
* After the barbarians took over there were several consequences for medicine: 1) Centres for the training of doctors disappeared.
2) Roman public health systems collapsed
3) Many of the important books of the Greeks and Romans were lost and destroyed.
* There wasn’t a proper system for the training of the doctor and some people claimed to be doctors when they weren’t.
* Throughout must of the barbarian empire, the Roman system sanitations had broken down. Public bath houses fell apart and aqueducts were no longer maintained. New barbarian rulers neither had the Roman technical knowledge nor the interest to keep these things in shape.
* The collapse of the Roman Empire lead to a chaos in the west but in the Middle East followers of Prophet Mohammed (pbuh) established a new Islamic Empire. During the following centuries Islamic doctors made a huge contribution to medicine.
* The success of the Islamic doctors depended entirely on the government, in those days the Islamic Empire was a single state run by one man called Caliph.
* Many Caliphs were interested in science and during the reign on Caliph Harun -Al Rashid (AD786-609) a centre of translation was set up in Baghdad.
* He also set up a major hospital in Baghdad in AD805. In contrast with the Christian hospitals, this hospital aimed to treat as well as care.
* A medical school and library were also set up in the hospitals. Soon similar hospitals around the Islamic Empire were also built.
* They provided the hospital for everyone!
* Doctors were permanently present at the hospitals and there were also medical students working alongside these physicians.
* It was the Islamic world that first opened up hospitals for the mentally ill. Like Christians, Islamic doctors did not see people with mental illnesses as being possessed by spirits. Instead they saw the mentally retarded as victims of the unfortunate illness.
* There were some Islamic doctors who made a great contribution to medicine:
1) Rhazes – was the first person to discover the difference between small pox and measles and stressed the importance of clinical observation of the patient.
* 2) Avicenna – wrote the great million word medical encyclopaedia of medicine known as “The Canon”.
Church in the medieval time
* The middles ages were a very religious and supernatural time. God was said to intervene in daily life and make people sick or better depending on their actions.
* Conditions such as blindness and leprosy were seen as being sent by God. Even though Hippocratic doctors dismissed the supernatural explanation for these things 2000 years before. They thought that people with mental illnesses had an evil spirit in them and flogged them.
* The medieval Church was a very conservative organisation and was suspicious of change and was not usually interested in new ideas.
* The dissection of the human body was not formally forbidden by the Church but the Church discouraged this kind of experimentation.
Medieval Diagnosis and treatment
* Explanation of disease changed very little during the Middle Ages. Medieval doctors accepted the Greek idea of the four humours and believed that imbalance of these could cause illness.
* The main means of diagnosis was “uroscopy”, the study of urine through the use of the doctor’s senses.
* Some doctors were so convinced of the power of urine inspection that they did not bother to meet the patient. Instead they sent a patient to collect the sample.
* Medieval people had other explanations of disease. People looked to religious or supernatural explanations of disease.
* Towards the end of the Middle Ages, astrology had become a popular idea. According to astrology the health of people was influenced by the position of the stars and planets.
* In the 12th century universities were set up and began to train doctors and give them examinations before they were qualified. E.g. Montpellier in France.
* One negative result in this was that woman doctors found it extremely difficult to practice as the universities were strictly for men only.
* Most European universities didn’t open doors for women until the late 19th century.
* University doctors saw themselves superior to barber-surgeons and apothecaries.
Medieval Public Health
* People sometimes assumed that during the Middle Ages no one took any interest in hygiene. This was not true.
* Most wealthy people took care to keep clean. Bathing in wooden tubs was common. Rich people also disliked the stench of human waste.
* Monks and nuns who lived monasteries were usually wealthy enough to ensure a good standard of hygiene.
* We know from monastic records that monks and nuns had baths six to seven times a year.
* Most of the poor people lived in the countryside where there were access to clean water and enough space to get rid of waste.
* Public lavatories were often provided by generous rich people when they died and made a will.
* Dick Whittington left money in his will for a large public lavatory to be built next to the River Thames.