A History of Medicine with a Focus on Mental Illness – Part 3
Middle Ages (AD 400 – AD 1200)
AD 400 – AD 800 (The Early Middle Ages)
Important Highlights
- Hospitals were being established throughout Europe. Many places of healing were extensions of monasteries.
- In many cases, little is known about how much the new hospitals played a role in serving the mentally ill.
- During the early Middle Ages, the mentally disturbed were primarily cared for in the monasteries.
- Libraries were in short supply – Monasteries served as early Middle Ages libraries.
- Some monasteries, as centers of book copying and study, would later become the first universities of higher learning.
Early AD 400s
St Augustine (345-430) Contributes to the Adding of Hospitals
Augustine, as bishop of Hippo in northern Africa, would write the most influential book in the West for the next thousand years, The City of God. Second only to the Bible in influence for a time, The City of God would later influence Charlemagne to enact many reforms, including the copying of books that had survived all the changes and turmoil of the time to keep alive the “light of learning.” The City of God would, no doubt, influence Charlemagne in his desire to build hospitals, as his goal was to make his kingdom reflect the City of God on earth as much as he possibly could. Additionally, Augustine himself was instrumental in adding hospitals in his time. “St. Augustine (354–430), bishop of Hippo in northern Africa, was instrumental in adding hospitals in the West”(6).
AD 476
Last Emperor of Rome (Western Empire)
With the fall of the city of Rome to the barbarian leader, Odoacer, a German conqueror, many things would change in the West. The Western part of Rome would go through a dearth of knowledge over time, and medicine and hospital building would be scaled down as finances and knowledge ran short.
Later, the notable Christian leaders, King Charlemagne of France (786-814) and King Alfred of Wessex (in England, 871-899), would see to it that the “light of learning” would not be extinguished in the West. Charlemagne in particular would enact reforms to the monasteries to ensure book copying was accurate and readable. Charlemagne put leaders in place to create a standard script known as Carolingian minuscule. “… more than 90 percent of the works of ancient Rome that we know nowadays exist in their earliest form in Carolingian manuscripts. These manuscripts form the basis of nearly all modern editions”(7).
In the East, the Empire would continue for some time, and hospitals and medicine would continue to grow for some time beyond this point. Eventually, science and learning would make a comeback in the West and surpass the East. The East would eventually be sacked by the Crusaders (1204) and fall to the Ottoman Empire and Islam with the conquest of Constantinople (1453).
Roman life would continue in the West after it falls to the Germans, as the church would assume a greater role in governing day-to-day activities. There is no clear-cut demarcation of when the church would grow to have more say in activities. The church was busy helping people after war and famine had ravished the city, and many would look to the church for leadership and help. This pattern had been established earlier in history as the church helped the poor and widows during a plague and other such activities.
Many monasteries were also places of healing. And, in general, the institution of the church was in charge of a great deal of the medicine going on.
AD 489
Abbey of Monte-Cassino, Italy, Founded
About 500 years prior to the first University, medicine was being studied by the Benedictine Monks. If one was to care for the sick, it would be quite natural to study for this purpose.
“The first real efforts to study the art and science of healing (medicine) occurred in the Abbey of Monte-Cassino, Italy, founded by the Benedictines in the year 528. Gabriel Compayre says that here the monks studied medicine ‘with marked devotion.’ From here ‘the taste of medical studies spread as far as Salerno, and by the eleventh century, the little town had become an intellectual center which attracted students from all parts of Western Europe’”(6).
AD 540
Nestorians Build Hospital in Syria
The Council of Ephesus (431) declared the Nestorians to be a heretical position. This would lead the Nestorians to flee to Syria. Here, in the city of Gondishapur on the Persian Gulf, the Nestorians would establish a hospital and center of medical knowledge(9). Later, this area would be conquered by Islam and would become part of the inspiration and model of the hospitals built in Baghdad and elsewhere.
By AD 750
The Growth of Christian Hospitals
Hospitals operated throughout Continental Europe. Never before seen in history, now taken for granted, Christians had revolutionized care for the sick. This was done because Christians were taught to care and think about others. “Love your neighbor as yourself” is the second (most primary) command in the Bible; the first command being to love the Lord your God. Loving God would entail following His commands to care for the sick, poor, and those in need of charity and compassion.
“By 750 the growth of Christian hospitals, either as separate units or attached to monasteries, had spread from Continental Europe to England. About this time the city of Milan in Italy established a hospital that specialized in caring for foundlings. During his reign in the eighth century, Charlemagne, emperor of the Holy Roman Empire and a strong defender of the sick and poor, constructed numerous hospitals. And by the mid–1500s there were 37,000 Benedictine monasteries that cared for the sick.
Nearly four hundred years after the Christians began erecting hospitals, the practice drew the attention of the Arabs in the eighth century”(6).
AD 800 – AD 1200 (The Later Middle Ages)
Introduction
In addition to revolutionizing medicine through the creation of hospitals, Christians revolutionized education. They had practiced from early on the teaching of women and the poor. Now, they would introduce higher learning in a way never seen before. Along the way, the investigative process was to be cultivated and encouraged. With few exceptions, the Roman and Greek cultures thought manual labor to be dishonorable and so discouraged physical investigation of their thoughts and theories. “Archimedes was ashamed for having built devices that aided his studies in geometry”(6). Christians would come to encourage the investigative process, leading to greater knowledge of science and medicine.
AD 768-814
Charlemagne
Charlemagne reigned as king of the Franks from 768 AD to 814 AD. He was crowned Holy Roman Emperor on Christmas of 800 AD.
“It wasn’t until Charlemagne… that we see a larger revival in hospitals and learning in general. He tried his best to ‘revive the light of learning’ in his kingdom, which was of considerable size and wealth. …he loved the book by Augustine, City of God. He read it often and, even more often, would have his favorite scribe, Alcuin, read it to him.
He set about to create the ‘city of God’ on earth as best as he could. More than 90% of all the books from ancient Rome and Greece are with us today because Charlemagne ordered that they be copied. If he did not order them to be copied, they would have likely been lost.” Reference??
AD 786-809
Reign of Caliph Harun al-Rashid
During this time period, the first hospital was built in Islam. Muslims would come to see support of hospitals as a sign of piety(8).
Mental Wards First Developed
Although mental health patients had been cared for by Christians for some time, the Muslims were the first to add care for the mentally ill into the larger hospital setting.
“Although Islamic hospitals evolved from Christian institutions, they experienced a unique development. They differed strikingly from their Byzantine counterparts by including separate sections for mental patients. Gradually these psychiatric wards became the most prominent features of bimaristani. Neither Byzantine nor medieval Western hospitals had wards for mental patients (Dols)”(8).
AD 1158
First University
The first university came to exist around AD 1158. As the monasteries were relied upon to be the early libraries and places to copy books, it was quite natural for these places to become centers of learning. The only thing necessary was a benefactor such as Fredrick Barbarossa.
“The scriptoria and libraries in the Benedictine monasteries of Europe in the sixth and seventh centuries, however, were by no means full-fledged universities. These came later. With the academic footing provided by the Benedictine monasteries, the first universities arose in the twelfth and thirteenth centuries… the university commonly cited to be the first is the University of Bologna, Italy, founded in 1158, which has been credited to Emperor Frederick Barbarossa’s efforts”(6).
