Nanomedicine, Volume I: Basic Capabilities

© 1999 Robert A. Freitas Jr. All Rights Reserved.

Robert A. Freitas Jr., Nanomedicine, Volume I: Basic Capabilities, Landes Bioscience, Georgetown, TX, 1999 Medicine in the Middle Ages

The passage from the glorious days of Rome to the Middle Ages was often violent, especially in the West, with wave after wave of barbarian onslaughts from the East. These culminated in the sack of the Eternal City by Alaric's Goths in 410 AD, which effectively ended the western empire and frayed the thread of learned medicine. Thus Galen had no effective successor. Indeed, medieval medicine may be summed up as a corrupted version of Galenism. The true scientific tradition did not reappear in the West until the 16th century, after a lengthy incubation in the Islamic world. For example, in England the Venerable Bede (ca. 672-735) and his monks possessed many medical writings, and knowledge of plant remedies was extensive, but the English healer used chants and charms, predicated on the belief that certain diseases and bad luck were caused by darts shot by elves, while other ailments involved a "great worm," a term applied to snakes, insects, and dragons.

By contrast with the naturalist focus of Hippocratic and Galenic medicine, healing became more authoritarian and intertwined with religion, for the rising Church taught that there was a supernatural plan and purpose to everything, including sickness and death. Christian and Jewish healing traditions became more prominent. Disease could be cured by prayers or by invoking the names of saints, by exorcism, by amulets or number magic, or by transferring the sickness to animals, plants, or to the soil. Certain maladies such as leprosy were associated with the Almighty's punishments for sin, according to the Book of Leviticus:

"When a man shall have in the skin of his flesh a rising [a swelling], a scab, or bright spot, and it be in the skin of his flesh like the plague [the spots] of leprosy...and the plague in sight be deeper than the skin of his flesh it is a plague of leprosy: and the priest shall look on him, and pronounce him unclean."

Such polluting diseases were curable by the Lord alone, encouraging some Jewish people to reject human medicine in favor of the divine, citing the fate of King Asa (ca. 914-874 BC), who "sought not the Lord, but his physicians," and whose foot sores consequently worsened, and he died. On the other hand, while Jewish dietary rituals (e.g. kosher food) are principally expressions of religious precepts about pollution and purification, a useful practical effect is to limit exposure to foodborne diseases such as trichinosis.2215

Many of the distinguished surgeons of the Middle Ages were clerics, but the practice of medicine and surgery by members of the Church was not favored by the hierarchy. Many laws were passed against the practice of medicine for worldly profit. In 1215 the Fourth Lateran Council forbade all sub-deacons, deacons, or priests to practice that part of surgery that had to do with burning and cutting. Finally, Pope Honorius III (d. 1216) prohibited all persons in holy orders from practicing medicine in any form, which meant that the educated classes were prohibited from performing any type of surgery.

In Europe in the Middle Ages, practitioners unsuccessfully sought to cure wounds by treating only the weapons that caused them, using an ointment on the offending knife or sword known as a weapon salve. Physicians practiced urine-gazing (uroscopy), but proper chemical analysis of urine did not develop until the 18th century. Medieval medicine is the source of many humorous "remedies" in contemporary diatribes against modern medicine -- such as being strapped into a halter and walked around a pigsty three times for mumps, drinking water from the skull of a bishop to treat rheumatism, or nuzzling a mouse to cure the common cold.2216 But we must recognize that such treatments were not put forth as reasonable science. Rather, they serve as a reminder of the results of injecting mystical or religious elements into medicine as a substitute for good science.

The Middle Ages are also remarkable for their plagues, which became more numerous as people crowded closer and closer together in urban centers of increasing population density. Plague records from China during this period often show 50%-70% mortality rates, and China probably served as the original source of the greatest of the bubonic plagues that swept through Europe in the 14th century, known as the Black Death. The disease broke out in 1346 among the armies of a Mongol prince who laid siege to the trading city of Caffa in the Crimea. This compelled his withdrawal, but not before the disease had entered Caffa, whence it rapidly spread by ship throughout the Mediterranean.

The initial shock in 1346-1350 was severe. Die-offs varied widely, with some small communities experiencing total extinction and others, such as Milan, being spared entirely. The lethal effect of the plague may have been enhanced by the fact that it was propagated not solely by the bites of fleas carried on infected rodents, but also was transmitted person to person as a result of inhaling bacillus-filled droplets that had been coughed or sneezed into the air by an infected individual. Lung infections of this kind were observed to be 100% lethal in Manchuria in 1921, the only time modern medicine has directly observed airborne plague communication, so it is tempting to assume a similar mortality for pneumonic plague in 14th century Europe. Mortality rates for sufferers from bubonic infection transmitted by flea bite varies from 30% to 90%. All told, the best estimate of European plague-induced mortality is that about one-third of the population died during the initial five-year period.

The plague returned in the 1360s, the 1370s, and thereafter, and European population declined irregularly as a result, reaching a low point in England sometime between 1440-1480.2210 People learned to minimize infection risk via quarantine, a practice which stemmed from Biblical passages prescribing the ostracism of lepers. Plague sufferers were treated as though they were temporary lepers, with a standard 40-day quarantine for people and incoming ships at all major ports. However, since the role of fleas and rats in disease propagation remained unknown until the end of the 19th century, quarantine measures were often ineffectual. Through the 17th century, occasional plague outbreaks that carried off up to a third or a half of a city's population in a single year were considered normal.2211 For example, Venetian statistics show that in 1575-77 and again in 1630-31, a third or more of the city's population died of plague.2212

Pre-modern medicine was powerless against bubonic plague. Before antibiotics reduced the disease to triviality in 1943, the average mortality rate was 60%-70% of those affected, despite all that the best hospital care could accomplish.2213 The last recorded outbreak of plague that ran its course without benefit of penicillin and related antibiotics (which destroy the infection rapidly) occurred in Burma in 1947, with 78% lethality.2214


Last updated on 5 February 2003