The creation of medical training programs in a university set- ting was one of the most important developments in medicine during the Middle Ages, and the men who trained at universities became the elite of the medical profession. The university move- ment began in the 12th century with the founding of universities in Paris (1150), Bologna (1158), Oxford (1167), Montpellier (1181), and Padua (1222). In Oxford and Paris, medical instruction was informal at first. By the 15th century (1436), Padua had become the most highly respected of the medical schools, with fifteen med- ical professors.
Universities were originally founded as places to study Christian theology, and women were barred from becoming clergy in medieval times, so women were not admitted. The exception was in Salerno where women were permitted to teach and practice medicine. Though these women excelled and were well known for their medical skills, their numbers dwindled by the end of the 12th century and the profession came to be dominated by men.
In addition to excluding women, men of the Jewish religion were mostly kept out as well. (A few universities admitted Jews if
The Middle Ages
they were willing to pay higher fees.) Despite this discriminatory practice, Jewish men found ways to become educated, and they often had the finest reputations, which meant they were in high demand by royal and other noble households.
In all universities, a working knowledge of Latin was a pre- requisite for admission since the texts and lectures were in Latin. Incoming students also needed basic knowledge of logic and philosophy in preparation for medical courses. This lim- ited those who qualified. Members of the clergy or those who were training to be clergy had the right background because they learned Latin in order to read and understand theology. In addition, a few laymen from relatively wealthy families also had the opportunity to gain an education that prepared them for studying medicine.
The original curriculum in medical schools at that time was based on The Articella and Avicenna. (See the sidebar “The Arti-
cella as a Basis for University Teaching” on page 26.) During the
13th century, the Italian religious leader (later to achieve saint- hood) Thomas Aquinas (1225–74) introduced an emphasis on the naturalism of Aristotle in the university curriculum, integrating it with Aquinas’s own primary interests in scientific rationalism and theology.
As the educational system evolved and favored the training of clerics for the medical profession, it set up an interesting dynamic: Most physicians were clerics but later on, the clergy in many jurisdictions were forbidden from practicing medicine. While caring for the sick was viewed as a Christian duty, the church became concerned about two issues involving the prac- tice of medicine: The first was that blood was never to be shed by clergy, so clerics had to abstain from any sort of surgical treatment including any form of study that resulted in bleeding. The second issue had to do with financial success. Practicing medicine became lucrative, and the church worried that the clergy would neglect their religious responsibilities for personal gain.
Medieval healers and hospitals 5
To qualify as a doctor of medicine, a student underwent a full 10 years of training. After this formal education, there was a period of supervised practice that was like an internship, followed by an examination that was conducted by other physicians. If all went well, the physician was licensed to practice on his own. Only a few men successfully completed the course of study each year. Because there were so few graduates, the number of university-trained physicians was exceedingly small, meaning that only nobility or the very wealthy might have had access to these specially trained individuals.
The medicine practiced at this time was a blend of Galen’s theories as influenced by Hippocrates. Diagnoses were made by checking the pulse and studying the urine (uroscopy). Astrological charts were consulted and “critical days” were noted. The prime remedies were dietary changes to rebalance the humors, and the use of herbal drugs. The physicians who served the nobility were known as court physicians, and their role was actually a broad one. Records show that a court physician to Henry III of England was expected to counsel the steward about the choice of meat and drink served to the king. He was also to be on watch for signs of pestilence or the arrival at court of anyone who might have leprosy, and the king was to be warned of signs of either of these threats.
The ratio of physicians to townspeople in Florence, Italy, in 1338 provides an interesting picture of the time. Florence had the highest physician per capita rate with about 60 licensed phy- sicians for a population of about 120,000. After the Black Death, the ratio improved because of the precipitous drop in population: There were then 56 physicians for only 42,000 people. A few towns paid for physicians to oversee the care of the public and treat the poor, but for the most part, physicians treated those who could afford to pay. By 1211, the town of Reggio, Italy, not only paid a public physician, called a medici condotti, to help care for the poor, but they expanded the physician’s duties to include helping with inquests, treating the sufferers of plague, and tend- ing to injuries inflicted on prisoners.