Middle Ages

After the twelfth century, medieval medical knowledge in the Occident ceased to be based solely on a number of scattered Greek and Latin manuscripts carefully collected and preserved for centuries in monasteries and schools. A rapidly growing number of classical medical texts, including the Canon of Avicenna and clinical treatises of Rhazes, were translated from Arabic to Latin. Nonetheless, the theory of four humors and qualities remained the basis for explaining health and disease. It was supplemented by the notion that an essential or "radical" moisture was needed to ensure proper mental and physical functioning. Based on the natural wetness of bodily tissues, this element played an important role in explaining disease, senility, and death.

The inclusion of medicine in early university studies had momentous consequences. Teachers devised formal curricula and identified a specific body of medical knowledge to be mastered by students. For the first time, physicians could acquire an academic degree in the field of medicine, thus laying claim to greater competency and legitimacy. Among the first schools to offer medical studies was in Salerno, around 985, but the real growth in medical education occurred in the thirteenth century with the founding of three major university centers: Montpel-lier and Paris in France, Bologna in Italy. Because a medieval medical education stressed theory, rhetoric, and philosophical speculation, graduates acquired an unprecedented degree of prestige and status. In contrast, the practical aspects of healing lacked intellectual standing, and surgery was therefore excluded from university studies. Graduates, in turn, created select medical organizations - often under royal patronage - and worked hard to achieve a monopoly on practice.

Teaching centers became focal points for medical investigations. Human dissection, for example, began at the University of Bologna toward the end of the thirteenth century, prompted by forensic as well as medical considerations: Both lawyers and practi tioners were interested in ascertaining the causes of death from foul play or epidemic disease. In 1316, a Bolognese professor, Mondino de Luzzi, wrote the first modern treatise on anatomy. This specific interest was continued at other universities, including those of Padua, Florence, and Pisa. All works on anatomy were designed to illustrate the descriptions of Galen, still the absolute authority on the subject.

In response to repeated and deadly plague epidemics - the first pandemic struck Europe between 1348 and 1350 - northern Italian city-states instituted a series of public health measures designed to protect the healthy elite from the ravages of the disease. Because poisonous miasma was blamed for the humoral imbalance that caused susceptibility to plague, authorities isolated ships whose crews and cargoes were suspected of carrying miasma. The isolation - or so-called quarantenaria — necessary to neutralize the offending particles lasted for 40 days. Venice and Ragusa were among the first cities to implement such measures, the former in 1348, the latter in 1377. Burial regulations, the control of water supplies, the cleansing or burning of contaminated possessions - all inaugurated a comprehensive sanitary program widely adopted by other European cities in ensuing centuries.

The emergence during the twelfth century of lay communities in which the principal focus of charitable work was care of the sick can be seen as a response to Europe's growing burden of disease. The Knights of St. John, the Teutonic Knights, and the Augustinian Brotherhood played key roles in this evolution. Hospital foundations, sponsored by the rulers of newly created kingdoms or local bishops, provided the poor, elderly, unemployed, and sick with spiritual and physical care in the form of diet and nursing. The rising prevalence of leprosy after 1200 forced the establishment of nearly 20,000 shelters to separate these stigmatized sufferers from the general population. With the onset of plague after 1348, local authorities set up quarantine stations and pesthouses aimed at isolating those suspected of harboring the disease.

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