Medieval University Medicine

“The Faculty of Medicine,” Nancy Siraisi

            In her summary of the medical faculties of medieval universities, author Nancy Siraisi begins by discussing the various reasons why a unified medical program emerged at universities, while at the same time stressing the fact that university-educated physicians were not the only medical healers, nor were they the only ones with access to the knowledge they held. The influx of Classical and Islamic knowledge in the eleventh century and the demographic growth of twelfth and thirteenth century Europe both proved to be important to the establishment and proliferation of medical faculties; the ancient texts gave them a theoretical backing and the population spike stimulated a propagation of schools and people willing (and able) to pay medical fees. It must be noted, however, that even during this time period and for a long time afterward, university-trained physicians were in the minority of the total practicing population. Often the different classes of physicians served a different caste of clientele, but most sects of practitioners had access to a similar literary repertoire and used many of the same techniques. What was unique to university medicine was its establishment of “institutional and intellectual characteristics that would continue to influence medical education well into the early modern period,” including most notably the establishment of a medical elite.[1]

There were relatively few major centers for medical education, and most of their differences lay not in their curriculum, but in the numbers of students they attracted and their reputations. Salerno was the earliest major center because its location in southern Italy provided it early access to translated ancient medical sources. In the twelfth and thirteenth century, medical authors at Salerno compiled articella, or “short treatises,” that included basic Hippocratic and Galenic tenants — these early textbooks served as an introduction to the study of medicine. Professors at Salerno were also the first to associate medicine closely with natural philosophy. As Salerno faded in prominence in the early thirteenth century, Montpellier was rising as another fashionable medical university, especially after 1220 when the school received papal recognition. The medical faculty at Paris and Bologna came into the picture around the same time, and smaller medical centers, notably Padua, began to pop up in northern Italy in the middle of the thirteenth century.

Siraisi, in her next section on social and economic considerations, begins by stating that university-educated doctors were viewed as the elites of their profession. They earned their living primarily from their practice, although some enjoyed court patronage or professorships (the latter two often found in conjunction). From their new positions of power, these men and the medical faculties in general were given novel responsibilities by the state, such as licensing power and advising the leaders and population on medical matters. Their student bodies were made up of pupils from a variety of locations, and many, as members of the secular clergy, funded their schooling through church institutions. After obtaining their degrees in four or five years of study, university-trained physicians found themselves quite employable, either as practitioners or professors for fledgling medical schools.

In its relation to other faculties at universities, medicine was most closely linked with the arts. Linked traditionally and practically — those studying medicine had to read Latin and have a grasp on logic, astrology, and natural philosophy — the arts and medicine were almost always studied in conjunction (although the arts normally came first). As far as what students of medicine actually studied, Galen and Hippocrates were prominent, but Islamic writings also made up a major component of the curricula. Their ideas were often taught out of articella, and the content was frequently polluted with commentary by later intellectuals. The daily routine, symptoms of disease, and remedies were the main subjects that most medical students studied during their varied years at university; the time required to complete a medical degree ranged from three to six years, most often followed by at least six months of actual practice. Students were also generally exposed to dissections for the purpose of familiarization with the internal structure of the human body. Surgery was a separate entity in medieval times, viewed as a lower form of art due to its lack of theoretical backing, but it nonetheless was taught at many universities (although sometimes not under the medical faculty). The reading and course requirements for surgeons were probably very similar to that of physicians.

Medicine was taught in much the same way as other academic disciplines, through lectio and disputatio. This tradition, according to Siraisi, had a hand in grounding medicine in the philosophical way of thinking. Questions were asked, disputes held, and conclusions were formed based upon the discourse. The linking of natural philosophy and medicine through these methodological similarities helped legitimize medical theory at a time when philosophy held a higher place in the echelons of university faculties.

After establishing medicine as closely linked with natural philosophy, Siraisi goes into a brief description of humoral theory and the theory of complexion. According to the theory, bodies contain four humors in equilibrium, but their natural balance can be disrupted by illness or trauma. It is the doctor’s duty to prescribe regimen/diet changes, surgery, or medicine to restore balance. Medicines were produced that contained elements that together might produce a shift in the balance of hot, dry, wet, and cold in the body. Additionally, it was taught that the movement of the heavens had direct impacts on the body’s equilibrium, and different doctors and medical schools either stressed or merely considered this notion when healing.

Siraisi closes her chapter on medieval medical universities by discussing the implications of the scholastic method of educating medical practitioners and how university- trained medical men differed from their more philosophically inclined colleagues at the universities. She asserts that the methods employed in teaching encouraged students to question ancient medical doctrine and note discrepancies between Classical and Islamic medical scholars. In their hands-on practices, Siraisi believes, doctors also were more likely to compare their experiences to the theories they were taught and modify their beliefs accordingly. Thus, medieval physicians employed empiricism in a more concrete way than those studying more metaphysical subjects. The institutions and teaching methods established in the middle of the thirteenth and early fourteenth century medical faculties had a lasting impact on the medical profession, producing elite medical men that engaged in a book-based, theoretical practice, and forming an educational tradition in the medical field that outlasted even the Black Death.

[1] Nancy Siraisi, “The Faculty of Medicine,” in A History of the University in Europe ed. Hilde de Ridder-Symoens (Cambridge: Cambridge University Press, 1992), 364.

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