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Forget Folk Remedies, Medieval Europe Spawned a Golden Age of Medical Theory

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It’s often said that there was no tradition of scientific medicine in medieval times. According to the usual narrative of the history of progress, medicine in the European Middle Ages – from around the 5th to the 15th centuries – was a formless mass of superstition and folk remedies; the very antithesis of science.

And those who look in medieval medicine for precursors of modern pathology, surgery, antibiotics, or genetics will of course find it a failure. But if we’re looking for a coherent medical system that was intellectually and emotionally satisfying to its practitioners and patients, and based on written authorities, rational enquiry, and formal teaching, then medieval Europe produced one of the most influential and scientific medical systems in history.

Medieval medicine did take many forms. Some of it was non-literate and based on inherited traditions, some on the use of simple herbs, while other remedies were based on blaming elves or demons or sin for sickness. Sometimes it was practised by women for their families and servants.

But if we are careful with our definition of “science”, and use it to mean not (as often happens) what we now think is correct but rather a rationally organised body of knowledge about the natural world, then medieval medicine did use scientific methods.

And it was in the 11th century that Europe witnessed a medical revolution. Scholars and physicians in southern Italy, especially in the city of Salerno, began to study and teach ancient medical texts after a hiatus of 500 years or more. We know this from surviving 11th and 12th-century manuscripts that are only now being collectively studied, especially those of a little known medical textbook called the Articella.

Does your bad humour ail thee? Wellcome Library Collection

Does your bad humour ail thee? Wellcome Library Collection

The Articella

How we view medieval medicine, at the expense of alternate forms, is partly due to the nature of the surviving evidence we have. Apart from rare archaeological finds, this comes mostly from manuscripts primarily from the second half of the Middle Ages (c.1000-1500AD). Many of these manuscripts are copies of medical texts written much earlier, between about 400BC-1000AD. Some of these were in Latin, and had long sat ignored in monastic libraries. Others were in Arabic or Greek and were traded or carried across the Mediterranean to be translated into Latin.

These texts didn’t just appear; they were actively sought, translated and edited by newly curious medical teachers and practitioners. And they are how we know about a revolution in 11th-century European medicine.

By about 1100AD, an international body of philosophers and physicians, stretching north from Salerno to England, and east from Iberia to the German empire, had organised five Latin texts into a textbook called  Ars Medicinae  (“The Art of Medicine)” and later nicknamed the Articella (“The Little Art”). The five texts were the  Isagoge (or “Introduction”) of Johanittius (an Arab Christian), the Aphorisms and Prognostics of Hippocrates,  On Urines  by Theophilus, and On Pulses by Philaretus. After about 1150, many copies of the Articella also include Galen’s  Tegni (or Ars medica ).

This may seem an overwhelming syllabus, but the entire Articella is shorter than any modern medical textbook. Each text served a different function in the classroom. The  Isagoge was a brief introduction to medical theory. And through Hippocrates’ Aphorisms and Prognostics, students learned brief and useful statements on medical practice by this father of medicine. The Byzantine Greek texts by Theophilus and Philaretus were the most practical, giving instructions for making diagnoses and prognoses with a patient’s urine and pulse. The  Tegni encompassed and surpassed the first five texts, and so served as the basis of university exams and commentaries for centuries to come.

By 1200 the Articella was accepted throughout Europe as the foundation of medical education. Medieval university faculties of medicine made the Articella required reading along with the Canon of Medicine by Avicenna, first translated into Latin in the 1170s.

Articella, still going in 1534. Wellcome Images

Articella, still going in 1534. Wellcome Images, ( CC BY-NC )

And after the invention of printing, the book appeared in at least 16 editions to 1534, surviving well beyond the usual dates for the Middle Ages.

It’s obvious that the Articella was popular, but why does it matter so much? The vast number of healers, men and women, had never read it. But the widespread acceptance of the Articella set the bar for medicine across Europe.

Every doctor, especially itinerant male healers in search of a wide clientele, had to know (or at least pretend to know) the rational medicine taught in the schools.

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