2.

01 Medieval Period and Renaissance HPM

LE 2
Arcangel N. Diamante, MD, FPOGS, FPCS | September 7, 2018
TRANS 1

● Decline in scientific interest.

OUTLINE ● The saints, martyrs and their relics were venerated
● Promotion on “Good Samaritan” principle
I. Pre-Medieval Period ● Establishment of monasteries, religious centers & infirmaries
A. Fall of Roman Empire managed by Benedictine monks.
B. Age of Faith ● Preservation of the Latin text & medical writings.
C. Effect on Science and Art of Healing ● Division of Medicine
D. Rise of Christianity → Religious medicine: prayers, penitence, exorcism, relics,
incantations
II. Medieval Period → Human medicine: empirical methods, diet, herbal,
A. Early Medieval Period (5th-7th Century) phlebotomy, simple surgical operations
B. Middle Medieval Period (8th-12th Century)
C. Late Medieval Period (13th-14th Century) D. RISE OF CHRISTIANITY
III. Post-Medieval Period/Renaissance ● Saint King Edward
→ The Confessor
→ He lived a life of piety and sainthood
OBJECTIVES
→ He did not die as a martyr as he was not persecuted
→ He washed the neck of a scrofulous infertile woman
1. Conceptualize the importance of learning the art of healing
▪ The Scrofula disappeared and she later gave birth to twins
many years ago as it evolved into our modern practice.
▪ Scrofula – lymph nodes stricken by tuberculosis
2. Realize that there are ancient healing practices being
recognized up until the present day medical practice.
3. Describe cultures, practices, beliefs of prehistoric times onto the Saints with Specializations
different eras of civilization. ● Brothers St. Cosmas and St. Damián
4. Familiarize the primitive and ancient medical practices with → Patron of Physicians and Pharmacists
different tribes worldwide. → Skilled in medicine
→ They refused to accept payment for their services
I. PRE-MEDIEVAL PERIOD ● St. Apollonia
→ Patron of Dentistry
→ Her teeth were knocked out during martyrdom
A. Fall of Roman Empire
● St. Lucia
● Emperor Constantine
→ Patron of Ophthalmology
→ Stabilized the Roman Empire
→ Showed holding a disk containing her eyes that were torn out
● State Capital: Byzantium (Constantinople)
by her prosecutors
● State Religion: Christianity
● St. Sebastian
● 2nd Century AD
→ Patron for Pestilential diseases
→ Decline and fall of the Roman Empire due to anarchy, turmoil
→ Arrows pierced his body at the sites where plague buboes
and warfare
appeared
● Division of the empire between East & West became permanent
● San Fiacre
at the end of the 4th Century
→ Patron against hemorrhoids
● West entered an era known as the Dark Ages while the East
→ He had hemorrhoids and was healed after sitting on hot
flourished
stone while gardening
● There were changes in ideas about nature and physical
universe and also the nature of human beings and their
relationship with the Creator Charitable Institutions
● Benedictine monks provided missions for 500 years
B. AGE OF FAITH → Ptochia: for the poor
● Man must have a strong faith → Gerontochia: for the elderly
● Healing depends on God’s will → Xenodochia: for the strangers
● Healers were only instruments of God to effect cure → Brephotrophia: for the foundlings
● Spiritual emphasis is needed to save the immortal soul → Orphanotrophia: for the orphans
● Body is considered a Temple of God – must be taken care of ● St. Helena, Mother of Constantine I
and respected → founded a hospital in the Holy Land 330 AD
→ Dissection was prohibited ● St. Basil
● Natural disasters were acts of God for the misbehavior of → hospital for sick & poor, Cesaria, 369 AD
mankind. ● St. Ephraim
→ plague hospital, Edessa, 306-373 AD
● Fabiola
C. EFFECTS OF SCIENCE AND ART IN HEALING → a rich Roman matron
● Transition from Greco-Roman culture to Medieval Christianity → 1st Christian hospital in Europe (394 AD)
● Christianity transformed the status of the art of healing ● Hotel de Dieu of Paris (481 AD), Augustinian nun
● Medicine became subordinate to Theology → self-dedicated in nursing the sick
→ Medieval physicians gave all credit to God ● Pagan gods were replaced by Christian saints
● Hippocratic tradition was cursed by the Christian dogma. ● Temples were transformed into churches and cathedrals
→ His tradition, which was based from love of art, intellectual
● Church took on the nursing of hopeless cases and promised
curiosity, glorification of the healthy body & pursuit of
relief in the next world
physical well-being, no longer existed
HPM 1 / 5
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2.01 Medieval Period and Renaissance LE 2 TRANS 1

II. MEDIEVAL PERIOD B. MIDDLE MEDIEVAL PERIOD (8TH – 12TH

● Recovery from Dark Ages
A. EARLY MEDIEVAL PERIOD (5TH – 7TH Century) ● Role of the church: conversion and acculturation of barbarians
● Dark Ages ● Feudalism:
● Fall of Rome to Goths → Peace and order
→ Led by German chieftain Odoacer → Common people (peasants/ serfs) work for landlords
(vassals) as slaves for monetary exchange in order to
Barbarian Invasion establish a stable way of life
● Knighthood and chivalry
● Divisions
→ North: Vikings (Scandinavian Pirates) → Idealism
→ Truthfulness and righteousness
→ East: Magyars (Natives of Hungary)
→ Defend the church and their lords
Volkhava (Wolfmen from Russia)
→ South: Saracen (Muslin – Arabia) → Protect the poor and the weak
● Economic growth
→ West: Franks and Goths (German Tribes)
→ Formation of guilds with specialization
Celts (Barbarians from Ireland and Great Britain)
→ New trade routes along the area of the west
● Effects of Barbarian Invasion
→ Loss of regulated medical practice ● Growth of Art
→ Forerunner of Renaissance
→ Supernatural forces control life and disease
→ Art of literature, music, architecture, sculpture
→ Reliance on magical powers, incantations, exorcism
● Charlemagne: “Charles the Great”
→ Healing done by tribal leaders
▪ Herbals → Crowned by Pope Leo III (800 AD)
→ Emperor of the Holy Roman Empire for 1000 years
▪ Blood sucking
→ Promoted the Spread of Christianity
▪ Cauterization
→ Static nature of science
● Excruciating medical treatments Major Development in Medicine
→ Surgery only used in life or death circumstances ● Regulation of physician training and development of ideas to
→ No reliable forms of anesthesia promote public health and prevent spread of diseases
→ Surgery was described as crude, blunt, and horribly painful ● Establishment of institutions to provide care for the infirm
→ Lithotomy – removal of stones from the urinary bladder ● Hospital in Baghdad (world’s largest city during that time)
→ Dwale (anesthesia) – concoction of gall from boar, opium, ● University-trained physicians for high rank nobility; folk healers
henbane, hemlock, and vinegar for the lower ranks
→ Wine was used as antiseptic ● Diagnosis of medieval physicians:
→ Spells → History-taking: narration of symptoms; physical examination
▪ Rituals and religious penance as form of cure (revival of Hippocratic System)
▪ Pagan beliefs or rituals: a stone outside with a living → Uroscopy: diagnose the problem of a patient through urine;
creature like an, fly, or rat is a good omen from Arab medicine
→ Eye cataract surgery: used pointed instruments to pierce ▪ Duke of Bavaria: Skeptic about urinalysis
through cornea and take out cataract − He submitted the urine of a pregnant patient claiming it
→ Blocked bladders: metallic catheters were inserted to as his own. It was then authorized that the Duke was
bladder since syphilis and gonorrhea were very rampant going to have a baby. This led to his acceptance and
→ Surgeon on the battlefield pulls arrows without anesthesia belief in the urine test
▪ Dr. Albucasis – designed a spoon to take out the head of ● Extensive use of drugs as herbal remedies
the arrow → Theriac: Ancient remedy to cure all diseases
▪ Bloodletting: cure for all ailments ▪ Leech books (Bald’s) – compilation of ancient disease
▪ Theory of 4 humors (Galen and Hippocratic theory) (arthritis, eye disorders, burns, scalds, unwanted
▪ Childbirth: women are told to prepare for death pregnancy, impotence, infertility)
▪ Clysters: Medieval period of injecting medicine in anus ● Surgical treatment: Derived from Greco-Roman procedures
▪ Hemorrhoids: treated with hot irons → Suturing and dressing of wounds
→ Drainage of abscess
→ Reduction of fractures, dislocations, and amputations
→ Cauterization
→ Extraction of arrows, cataract, and tooth
→ Lithotomy
→ Burns – dressing composed of mixtures of egg white, fats,
and herbs or egg yolk, turpentine, and wine
● Leeches: worms used to collect small amount of blood
→ Secretes anti-clotting substances
→ 30-50cc of blood is extracted, after it falls off on its own
● Blood Letting (phlebotomy): To balance humors
→ 2 ways of blood letting
▪ Derivation: Drainage at a point close to the affected area
▪ Revulsion: Drainage at a remote point
Figure 1. Hemorrhoids treated with hot iron → Dangers: Cutting through arteries & nerves, infection, and
impending shock

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2.01 Medieval Period and Renaissance LE 2 TRANS 1

→ German doctor and Benedictine nun

→ The Book of Simple Medicine
▪ 1st female book author to discuss the therapeutic values
of plants, animals, and metals
→ The Book of Compound Medicine
▪ discusses the causes & treatment of diseases, sexuality,
and astrology
● Tortula of Salerno (11th-12th Century AD)
→ First female professor of medicine in Italy
→ World’s first gynecologist
→ Diagnosed uterine prolapse (uterine polyps)
→ De Passionibus Mulierum
▪ Emphasized the need for physicians to specialize in
women’s health & diseases
→ Preferred simple and natural remedies
→ Recommended a diet for mothers during breastfeeding
→ Used powdered pepper to induce labor

Figure 2. Extraction of a Cataract Great Doctors of Medieval Times

● Rhases (901 AD)
Rise of the Universities (9th Century) → Chief physician of Baghdad
→ Differentiated smallpox from measles
● Establishment of cathedral schools teaching philosophy, math,
→ Classified chemicals into metals, salts and spirits
and science
→ Discovered kerosene, distilled alcohol and mercurial
● Earlier medical knowledge kept in monasteries
ointments
● Benedictines preserved medical writings and provided medical
● Albucasis (963 AD)
care
→ Refined modern surgical techniques
● Medical education was one of the major innovations of the
→ Used animal (sheep) gut for sutures
middle age; established regular curriculum and technical
→ Designed arrow spoons
knowledge
● Alhazen (1025 AD)
● Medical practitioners were both members of:
→ Developed scientific method in his study of optics
→ Clergy: educated by the church
→ He innovated the use of lenses for magnification and vision
→ Laymen: from universities (nobility) or medical guild (middle
correction
class)
● Avicenna (1030 AD)
● Course of study
→ Prince of Physicians
→ Students enter university at age 14
→ Canon of Medicine (Al Quanun)
→ 1st part: Liberal Arts (2 parts)
▪ Described the progression of cancers and the treatment of
▪ Trivium: grammar, dialectic, rhetoric
early tumors by complete removal
▪ Quadrivium: arithmetic, geometry, astronomy, music
● Avenzoar (1147 AD)
→ 2nd part: Bachelor of Arts, Master’s degree (2-yearsdebate)
→ Established intravenous infusion using silver needles;
→ 3rd part: Law, Medicine, or Theology
procedures for tracheostomy
▪ Wanted more theology graduates than doctors
→ First parasitologist to describe itch mite causing scabies
● Prominent medical schools and universities
● Al-Nafis (1242 AD)
● 3 subsidy sources of the universities
→ Discovered the complete separation between the right and
→ Medical School of Salerno (Italy)
left ventricles
▪ Most popular
→ Described the path of pulmonary and coronary circulation
▪ Followed teachings of Hippocrates and Galen
● Roger Bacon (1249 AD)
→ University of Montpellier (France)
→ Used convex lenses for eyeglasses and correction of
▪ Rivaled Salerno based on Greek concepts
farsightedness
→ University of Paris (France)
▪ Supervised by the French King and the Church ● Mondino de Liuzzi (1315 AD)
→ Read the works of Galen
▪ Emphasized more on surgery
→ Performed the public dissection of human cadavers
▪ Other schools: Bologna, Padua, Naples, France (financed
→ Teaching method involved a specific sitting decorum known
by the Church), England and Germany (financed by the
as a prosecutor
State), Scandinavia
● Ibn Khatima (1317 AD)
● 3 subsidy sources of the universities
→ Hypothesized that infectious diseases were transmitted by
→ Financed by students themselves (hire teachers and pay
particles that spread from person to person (bubonic plague)
them), The State, The Church
C. LATE MEDIEVAL PERIOD
Women in Medicine ● Influence of Crusaders
● Three choices for women in the medical profession: → Open trade between the East and West
Practitioner, Midwife, Nurse → Establishment of military hospitals
● Saint Walpurga (799 AD) ● Rise of the middle class (merchants, craftsmen)
→ English princess ● Population growth and urbanization
→ Studied medicine and founded a convent in Germany ● Economic revolution = Agricultural boom
→ Served as an herbalist and a healer in hospitals & ● Epidemic of 1315
infirmaries → Malnutrition caused by a disastrous harvest
→ Often depicted holding a flask and stylized bundle of stalks of
grains
● Hildegard of Bingen (1098-1179 AD)

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2.01 Medieval Period and Renaissance LE 2 TRANS 1

Figure 3. Sufferers of the Bubonic Plague

Epidemics of the Middle Ages Figure 4. Medieval Plague Doctor

1. Plague or Black Death (14th-17th Century AD)
● Causative agent: Yersinia pestis 2. Leprosy or Hansen’s Disease
● Clinical manifestations: ● Causative agent: Mycobacterium leprae (Hansen, 1874)
→ Bubonic or Glandular ● Mode of transmission: Prolonged close contact
▪ Mode of transmission: Bites of infected fleas ● Clinical Manifestations:
▪ Incubation period: 2-3 days → Chronic progressive skin affliction causing skin eruptions,
▪ Symptoms: Fever, painful swollen lymph nodes boils, scabs, and leading to a characteristic “lion-faced”
(buboes), and discoloration of the skin appearance
▪ Mortality rate: 50% → Emperor Constantine was afflicted with leprosy
→ Pneumonic ▪ Healed by Saint Sylvester
▪ Mode of transmission: Droplet spread ▪ Converted to Christianity after being cured
▪ Symptoms: Pulmonary abscesses, coughing of blood → Lepers were labelled “unclean” and a source of physical
(hemoptysis), and generalized spread and moral pollution by the Bible
▪ Mortality rate: 100% → Lepers used a cane or a long stick to indicate the things
→ Septicemic they wanted
▪ Mode of transmission: Direct invasion of the blood → The afflicted were isolated in different houses called Lazar
causing damage to the internal organs houses
▪ Symptoms: Cell death due to severe lack of blood → They wore a special attire and carried a bell or rattle to
supply (gangrene), bleeding, and coma leading to indicate their presence
death
▪ Mortality rate: 100%
● The number of dead vastly outnumbered the living and were
burned because of the foul smell
● Plague doctors wore a distinct outfit:
→ A “crow-like” mask with sweet-smelling substances carried
in the “beak” to combat stench
→ A coat developed to protect against the plague Figure 5. People Afflicted with Leprosy
● Treatment:
→ Theriac III. POST-MEDIEVAL PERIOD/ RENAISSANCE
▪ “antidote to all poisons”
▪ Cure for bites of serpents & mad dogs ● Rebirth or revival of learning of the arts & sciences (Greek &
→ Diet, surgically opening the bubo, scarification Roman)
→ Cupping: Local suction of the affected area ● Separates the middle age & modern period
→ Cauterization: Burning to destroy the infected tissue ● Eagerness for discovery
→ Poultices: Soft mass spread on cloth (antiseptic) ● Learning focused on man (Humanism)
● Giovanni Boccaccio (1313-1375 AD) ● Anatomy & Physiology were the first subjects of concern
→ Decameron
▪ Florence, Italy = “City of Corpses” RENAISSANCE PERIOD (15TH - 16TH CENTURY)
▪ Half of the population died with not enough people to
bury the dead ● Contributing factors:
▪ The epidemic spread to the Mediterranean and → Printing – dissemination of information
Western Europe killing 42 million people → Economic revival
● Yersinia pestis is a class A Bioterrorism agent and can be → Discovery of sea routes
used as a biological weapon → Travelling from east to west led to more communication, and
high rise of disease
→ Emergence of independent City States
→ Revival of the Arts (Florence, Italy)
▪ Michaelangelo- he was able to get a good description of
the anatomy of man by dissecting even though he was not
a doctor
▪ Leonardo Da Vinci – studied anatomy
▪ Raphael

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2.01 Medieval Period and Renaissance LE 2 TRANS 1

→ Fall of Constantinople (1453) to the Turks REVIEW QUESTIONS

→ Immigration of Greek Scholars to Italy
→ Rise of Universities in Northern Italy 1. Which place in Europe did most of the Renaissance take
→ Health threats: place?
▪ Syphilis: Scourge of the Renaissance a. Brussels, Belgium
▪ Gonorrhea: oldest and most common venereal disease b. Paris, France
▪ Small pox c. Florence, Italy
▪ Influenza d. Rome, Italy
2. Which is a discovery of William Harvey?
Great Medical Men of Renaissance a. Soothing dressing for gunshot wounds
1. Andreas Vesalius (1514-1564) b. Constant blood flow
● From Brussels c. Mercury as a treatment for syphilis
● Challenged Galen’s anatomy d. Convex lenses for eye glasses
● Father of Modern Human Anatomy 3. What is Saint King Edward’s known alias?
● “De Humani Corporis Fabrica” (On the Fabric of the a. The Saint
Human Body) - 1st complete textbook in anatomy b. The Rock
2. Ambroise Pare (1510-1591) c. The Vampire
● From France d. The Confessor
● Father of Modern Surgery 4. Who wrote the famous book, Canon of Medicine?
● Royal Surgeon a. Hildegrad of Bingen
● Soothing dressings (egg yolk + rose oil + turpentine + b. Avicenna
wine) for gunshot wounds; wine to combat infections; initiated c. Avenzoar
artery ligation and cauterization d. Giovanni Boccaccio
● External cephalic version (done by manipulating the 5. What was the technique employed by ancient Arabs to
maternal abdomen to turn the baby’s position to cephalic) diagnose a patient’s using urine?
● First to design artificial hands and limbs a. Uroscopy
3. Paracelsus (1493-1541) b. Urinalysis
● Full name: Phillippus Aureolus Theoprastus Bombastus c. Reagent Strip
von Hohenheim d. Iris Diagnostics
● He doesn’t want to believe in Celsus, a Greek philosopher
(Para: means opposed)
● An empiricist, and practiced Chemical Medicine (all Answers: c, b, d, b, a
substances are poison)
● Founder of Anesthesia – first to use ether on animals REFERENCES
● Father of Toxicology [HPM 1.04]2018/09/07. Medieval and Renaissance Medicine.
4. Girolamo Fracastoro of Italy (1478-1553) Arcangel N. Diamante, MD, FPOGS, FPCS.
● 1530: “Syphilis Morbus Gallicus” (Syphilis or the Gallic
Disease) 2021-A & C Transcriptions
● 1546: “De Contagion” - air particles cause diseases
● Suggested mercury for treatment of Syphilis Diagnostic Microbiology (12th edition) Bailey and Scott’s
5. William Harvey (1570-1651)
● English medical doctor
● Father of Modern Physiology
● Theory of Blood Circulation: Blood from the heart will
circulate throughout the body in a constant and perpetual
motion.
● Challenged Galen’s Theory, which states that blood is
consumed by the part that it supplies, it does not circulate
but is rather replenished by the liver and the heart.

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