Advocacy and Community: The Social Roles of Physicians in the Last 1000 Years. Part I in a 3-Part Series.

Karen E. Geraghty, PhD (c), Matthew K. Wynia, MD, MPH

In This Article

Healing in the Middle Ages (1000-1500 AD)

Figure 1. Medieval Hospital. Image courtesy of the National Library of Medicine.

As Western medicine emerged in Europe in the early Middle ages, it was characterized by a broad range of practitioners who specialized in the treatment of particular ailments of specific parts of the body.[1] Bonesetters, midwives, oculists, herbalists, barbers, along with many other folk healers, all claimed to have specialized techniques, instruments, and powers of healing. Competition for patients was fierce, and success as a healer depended on the patient's perception of how well the healer could explain the symptoms of the disease and produce an effective treatment, rather than by any claim to a systematic understanding of the nature of disease by the practitioner.

The theory of medical practice was grounded in variations of the basic tenets of Hippocratic medicine, which framed disease and illness as an imbalance of bodily humors.[2] Disease was understood not as an ontologically independent phenomenon invading the body, but rather as an individual expression of humoral imbalance.[3] To restore the balance -- and thus health -- it was therefore necessary for the healer to have a great deal of familiarity with the individual patient. The healer not only needed to know the expressed symptoms of the disease or illness but also had to put them in the context of the patient's personal history. Diagnosis, prognosis, and therapy were highly specific to the individual life of the patient.

As the influence of Christianity spread in the early Middle Ages, this specificity of individual humoral imbalance expanded to encompass the moral dimension. Illness and disease came to be viewed as physical manifestations of moral uncleanliness, and therapies were developed to incorporate prayer and religious instruction along with the physical treatments of bleeding, purging, and surgery. Religious and secular healing strategies were not viewed as incompatible, and often the goals of religious caring and medical curing overlapped. Indeed, many physicians were both priests and healers.[4,5] Although the conceptual basis of medical practice continued to remain relatively unchanged since the time of Hippocrates, the early Middle Ages is noted for the creation of 2 organizational shifts that were to leave lasting marks on the relationship of physicians to both individual patients and society at large.