THE EARLY MEDIEVAL PERIOD (FIFTH
TO TENTH CENTURIES CE)
The Roman Empire disappeared as an organized entity following
the sacking of Rome in the fifth century CE. The
eastern empire survived in Constantinople, with a highly
centralized government. Later conquered by the Muslims,
it provided continuity for Greek and Roman teachings in
health. The western empire integrated Christian and pagan
cultures, looking at disease as punishment for sin. Possession
by the devil and witchcraft were accepted as causes
of disease. Prayer, penitence, and exorcising witches were
accepted means of dealing with health problems. The ensuing
period of history was dominated in health, as in all other
spheres of human life, by the Christian doctrine institutionalized
by the Church. The secular political structure was
dominated by feudalism and serfdom, associated with a
strong military landowning class in Europe.
Church interpretation of disease was related to original
or acquired sin. Man’s destiny was to suffer on Earth and
hope for a better life in heaven. The appropriate intervention
in this philosophy was to provide comfort and care
through the charity of church institutions. The idea of prevention
was seen as interfering with the will of God. Monasteries
with well-developed sanitary facilities were
located on major travel routes and provided hospices for
travelers. The monasteries were the sole centers of
learning and for medical care. They emphasized the tradition
of care of the sick and the poor as a charitable duty of
the righteous and initiated hospitals. These institutions
provided care and support for the poor, as well as efforts
to cope with epidemic and endemic disease.
Most physicians were monks guided by Church doctrine
and ethics. Medical scholarship was based primarily on the
teachings of Galen. Women practicing herbal medicine
were branded as witches. Education and knowledge were
under clerical dominance. Scholasticism, or the study of
what was already written, stultified the development of
descriptive or experimental science. The largely rural population
of the European medieval world lived with poor nutrition,
education, housing, sanitary, and hygienic conditions.
Endemic and epidemic diseases resulted in high infant,
child, and adult mortality. Commonly, 75 percent of
newborns died before the age of five. Maternal mortality
was high. Leprosy, malaria, measles, and smallpox were
established endemic diseases with many other less welldocumented
infectious diseases.
Between the seventh and tenth centuries, outside the
area of Church domination, Muslim medicine flourished
under Islamic rule primarily in Persia and later Baghdad
and Cairo; Rhazes and Ibn Sinna (Avicenna) translated
and adapted ancient Greek and Mosaic teachings, adding
clinical skills developed in medical academies and hospitals.
Piped water supplies were documented in Cairo in
the ninth century. Great medical academies were established,
including one in conquered Spain at Cordova.
The Cordova Medical Academy was a principal center
for medical knowledge and scholarship prior to the expulsion
of Muslims and Jews from Spain and the Inquisition.
The Academy helped stimulate European medical thinking
and the beginnings of western medical science in anatomy,
physiology, and descriptive clinical medicine.