THE INFLUENCE OF CHRISTIANITY ON MEDICINE UP TO THE RENAISSANCE

(A Brief Overview) Sacred Medical Order - Church of Hope

"How true it is that in reading this history one finds modern discoveries that are anything but discoveries, unless one supposes that they have been made twice."--DU JARDIN: Histoire de la Chirurgie, Paris, 1774

There is one important feature of this article that I may recommend it to present-day readers, and that is that our past medieval-medical colleagues, when medicine embraced the rudiments of science, faced the problems of medicine and surgery and the allied sciences that we are still facing now. Upon the study of medieval medical discoveries, it is obvious there was much more dedicated power and temper of mind, and they very often anticipated solutions -- much oftener, indeed, than most of us, unless we have paid special attention to our Western medical history, most doctors of which today have little to no idea of this source of dedication.

This article and accompanying webpage does not constitute, then, a mere contribution to a theme that has mildly interested the last few generations, that of the continuous progress of the human race and its marvelous advance, but rather emphasizes that puzzling question: How is it that men make important discoveries and inventions, and then, time after a time, we forget about them so that they have to be made or done over again?

This is as true in medical science and in medical practice, as in every other department of human effort. It does not seem logical that mankind should ever lose sight of the progress in medicine and surgery that has been made in recent years, yet the history of the past would seem to indicate that, in spite of its unlikelihood, it might well have come about in times prior?

Whether this is the lesson of this article or not for the reader, I shall leave for readers to judge, for it has intentionally been put into print by this author not only here, but in our trilogy of books on Ecclesiastical Medicine, Pharmacy, and Nursing.

PREAMBLE

Over the last two millennia, Christian doctors, pharmacists, and nurses, inspired by the example and teaching of Jesus of Nazareth, have been at the forefront of efforts to alleviate human suffering, cure disease, and advance knowledge and understanding. Jesus of Nazareth taught: 'Whatever you did for one of the least of these brothers of mine, you did for me.' (Matthew 25:40) The fact that the first "hospitals" as we know them today began due to monks, nuns, and missionaries since the earliest days of the Christian movement, bears a conspicuous mark on the ascent of human medical care. The establishment of Christian hospitals brought personalized care to the sick, irrespective of race, age or nationality. Monastic infirmaries served as the only organized health care centers with teaching clinics and sacred libraries of the medical works of the Greeks, Judiasm, Persia, Egypt, and Islam. The Knights Hospitallers were responsible for building hospitals all over the Levant, the Mediterranean (Cyprus, Cos, Rhoades, and Malta), and Germany, impelling a renaissance in medicine, nursing and surgery.

As well as taking a leading role in caring for the sick, Christians also played a very important part in the furthering of medical and scientific knowledge. Together, early on, Jews and Christians took the lead in collecting and copying manuscripts all over Europe after the burnings of the Great Library at Alexandria. They rescued much of the medical knowledge for the religiously tolerant Arabic Empire and for later generations of monks. Christianity thus gave medical men and women a new perspective and allegiance that their lives are spent in joyful, grateful service of God who has redeemed them and given them new life. In many ways, Christianity and medicine are natural allies; medicine gives men and women unique opportunities to express their faith in daily practice caring for others, embodying the commands of our Lord Jesus Christ.

Beginnings

Christianity made its appearance at a time when religion played a much more important role in health care than it does today. As historians Ferngren and Amundsen point out, this is not necessarily because the ancients were more credulous or superstitious than we are today, but mainly because they realized that so much of life, including ill health, lay beyond their control. Ancient civilizations on the shores of the Mediterranean believed in a multitude of gods or goddesses, magical forces and supernatural powers which affected their health and culture. But at least since the days of Homer there also existed physicians who practiced forms of empirical medicine, and during the 5th and 4th centuries BC the Hippocratic school of doctors established the foundations of rational or scientific medicine as we know it today, where superstition, magic and supernatural factors were less relevant in their worldview. Hippocrates, the father of medicine, thus liberated the West of medicine which was reliant on the exclusive belief on supernatural forces controlling health and disease. Man, by understanding nature, could intervene for positive solutions.

Then arrived health care based on the teachings of Christ, as recorded in the New Testament, primarily of a religious nature. Although this need not imply conflict with empirical medicine, history tells us that antagonism did soon arise in the Church, and despite the fact that positive influences were acknowledged and practiced, the historical view is that the developing Christian church eventually retarded the advance of medical science, in Medieval times in particular, is a common one conclusion (Porter). However, authors Nutton, Avalos and others have warned that much research still needs to be done to verify traditional statements on this issue. In this study I have endeavored in our books to analyze the intricate interplay between the Christian church and rational medicine (as represented by Graeco-Roman medical concepts) during the first 1500 years of Christendom.

Health care systems before and at the time of Christ

1. Judaism.

Christianity's health concepts were moulded on the traditional Hebrew health care system, based on monotheistic principles, as mainly outlined in the Pentateuch. In essence this was a ritualistic community health care system with more than 600 commands and bans, 213 of which are described in Leviticus (Wassermann, Avalos). Hygiene played an important role but all illness and cure were controlled by Yahweh, although a dualistic concept involving Satan did appear after the Babylonian exile. Priests and prophets acted as healers.

Ben Sira was a second century BCE Jewish scribe, sage, and allegorist from Jerusalem, and the author of the Wisdom of Sirach, or the "Book of Ecclesiasticus". He is also known as Joshua ben Sirach, Shim`on ben Yeshu`a ben Sira, Jesus son of Sirach, or Jesus Siracides. He wrote his work in Hebrew, possibly in Alexandria, Egypt ca. 180–175 BCE, where he is thought to have established a school. This text had later been translated into Greek by his grandson. The Biblical Scripture we follow honors doctors as we see in Ecclesiasticus: 38:1: Honor the physician with the honor due him, according to your need of him, for the Lord created him… There is mention of miracle cures by prophets (e.g. II Kings 20:7-11; II Kings 5:14) and raising from the dead (I Kings 17:24). Lepers were banned from society, although it is now generally agreed that tsaraat, the Hebrew word later translated as leprosy, originally referred to a variety of non-specific skin afflictions considered to have been sent by God to indicate his displeasure.

Historian Avalos suggests that despite their strict monotheistic religion, many Hebrews visited sorcerers (pagans) and made use of minor gods, figurines and amulets as curing aids. At the time of Christ, Judaism was significantly influenced by a post-Alexandrian Hellenistic culture in Palestine, and Jews almost certainly visited pagan healers in temples, as well as secular physicians. In fact, by the 2nd century BC Jewish medical practitioners who had adopted Greek empiric medicine, in so far as it was not antithetical to Jewish religion, were common (Ferngren and Amundsen).

2. Other religions.

From early antiquity religions influenced health care systems, but it is also true that even in early Egypt and Mesopotamia there were already physicians practicing empirical (secular) medicine. At the time of Christ the ancient Egyptian Isis-religion was still widely popular and her shrines could be found in early centers of Christianity, like Ephesus, Athens, Philippi and Corinth. Popularized by Plutarch, she was seen as a goddess of healing, and the temples of Isis were often associated with Serapis, a healing deity of unsure origin. The Serapeum of Alexandria was one of the most famous healing sanctuaries of the ancient world.

The Mesopotamians had the healing gods Ninib and Ninazu, and the goddess Gula had temples in various centers in the Middle East and a reputation for resurrecting the dead. Mithraism, named after Mithras, possibly derived from an older Persian deity of the same name, had cave shrines as its hall mark and was originally associated with healing rituals, not unlike early Christianity. Originating in the 1st century, the cult lasted 400 years, but recent research shows little evidence of interference with Christianity.

Asclepius, Greek god of health and patron saint of physicians, was popularized in the 5th century BC, when Asclepian temples of healing (Spas) first appeared in Epidaurus, and later spread widely through Mediterranean countries. The shrines were visited by pilgrims who mainly came for miraculous cures by means of incubation – the practice of sleeping in the temple while waiting for healing instructions through dreams. There is evidence that dietary regimes, exercise and music therapy and encouragement to adopt healthy life styles, often formed part of the therapeutic ritual. These Asclepieia were popular in Roman times, in part because they offered healing without charge, and accepted all, irrespective of social standing. Healing by incubation sleep was also popular with a variety of other so-called oriental mystery religions, where magic and astrology played a role in association with the widespread use of amulets, charms and incantations.

3. Secular Graeco-Roman Medicine.

By common consensus, modern scientific medicine has its roots in Greek medicine of the 5th century BC, and the Hippocratic School in particular. It may be called rational medicine in so far as it was based on natural and demonstrable phenomena, and contemporary knowledge of human physiology and anatomy.

Supernatural powers, magic and superstition were mostly excluded from the medical system, although a modicum of religion was retained. In the Hippocratic Oath, for example, homage was still paid to Asclepius. Philosophers like Aristotle and his Peripatetic School later made useful contributions, but the major scientific progress before the Christian era came from the Alexandrian School of Medicine in the 3rd century BC, and Herophilus (who first dissected human cadavers) and Eristratus in particular.

The Dogmatic, Empiric and Methodist movements all had their contributors to the development of rational medicine, and during the first century the Roman nobleman Celsus (probably not a physician himself) wrote an extraordinary encyclopædia of contemporary medical, knowledge the De re medicina. This summarized secular medicine of the time at the beginning of Christianity. At that stage certain basic surgical techniques and the treatment of injuries and fractures were reasonably developed. As far as the etiology of internal diseases was concerned, explanations revolved around a presumed imbalance of 4 bodily humors (blood, phlegm, yellow bile and black bile), 4 elements (earth, air, fire and water) and 4 qualities (hot, cold, dry and moist). Prevention of illness was important, and treatment lay in restoring disturbed balances by way of diet, exercise, baths and a variety of drugs (the majority of which would have been quite ineffectual). There were no hospitals for the civic sick, and Hippocratic medicine (even Judaic traditions) allowed physicians to withdraw from treatment of incurable disease.

In the second century Rufus of Ephesus and Soranus added to medical knowledge, but it was the colossus Galen who consolidated Hippocratic medicine and cast it into a mould which remained largely unchanged until the Renaissance in the 15th century. Galen, whose immense medical bibliography (in Greek) consisted of more than 2,500,000 words, based his clinical medicine on health science as understood in his day, insisted on a honorable and professional code of conduct for physicians, and rejected all magic, miracles and superstition.

Basis of Christian health care

The actions and teachings of Christ and their interpretation by the evangelists and authors of epistles in the New Testament, laid the foundations of early Christian health care. As in Judaism, the new religion laid great stress on the role of God who, in the final instance, controlled all illness. Health care thus had a strong religious bias, and belief in an omnipotent God lay at the root of healing.

During his ministry on earth, Jesus had raised people from the dead, and cured a large number of persons and a variety of illnesses. These were accepted as miraculous cures, and for a while after his death (according to Acts) his apostles also healed miraculously in the name of God. Although mention is occasionally made of anointment (James 5:15), laying on of hands (Mark 16:18), fasting (Mark 9:29), drinking of wine (I Tim. 4:23) and even the use of a simple eye preparation (John 9:6; Rev. 3:18), the healing process was based on the elementary notion that faith alone could cure illness.

In James 5:14-15, the ill are advised to visit the church elder who will effect cure by way of prayer and anointment. Etiology of disease was unimportant, since treatment was the same for all illnesses. Exorcism is strikingly described in the Gospels, but the role of exorcism in Christian dogma has remained a controversial issue up to present times.

Secular physicians are rarely mentioned in the New Testament, and then often with a negative connotation (Luke 9:43), although Paul did refer to Luke as the beloved physician (Col. 4:14). Central to the New Testament's understanding of illness, is the development of a Christian theology of suffering and repentance. While living in an imperfect world of sin, the Christian should expect and accept suffering, and know that not all illnesses would be cured.

Christianity and secular medicine: 1st‚ 2nd, 3rd Centuries

Evidence shows that early Christianity actually showed little animosity towards Graeco-Roman medicine. There was indeed nothing in Hippocratic medicine which could be seen as seriously antithetical to Christian theology or practice, and it is obvious that Christians took to Greek medicine very early on. Most pagan religions of the time had an element of supernatural healing which complemented rather than competed with secular medicine and Christian practice. There is however, no mention by name of a Christian physician until the late second century when one Alexander of Phrygia suffered martyrdom for his faith. It is thus probable that in illness Christians visited their priests as well as physicians. The majority of Church Fathers found it amicable to accommodate empirical medicine in the new religion.

The fundamental reason for the use of physical, empirical medicine and natural therapies within the monasteries can be found from the historical records of the early church fathers - Clement of Alexandria, Saint John Chrysostom, and Augustine of Hippo. Because of the church fathers' acceptance of empirical medicine as a consequence of spiritualism, early Christianity and monasticism endorsed it as a common and useful practice. The basic spiritual foundation which instructed monks to practice natural medicine was that "the material world was created by God for man's use." Natural and physical forms of medical care were created by God, in order to assist humanity in coping with and curing illnesses. Although these practices treat the body and not the soul, they remain fundamentally spiritual because of their divine origin

In their writings, the early church fathers addressed divine origin, explaining the efficacy of empirical medicine stems from God's will behind their use. John Chrysostom states that "God gave physicians medicine" (Chrysostom, John. Homily 8 on Colossians.). Clement of Alexandria explains that medicine in general, including natural science, was fundamentally spiritual, being a creation of God:

"Health obtained through medicine is one of these things that has its origin and existence as a consequence of divine Providence as well as human cooperation".

Augustine attributes the healing properties of medicine to God:

For as the medicines which men apply to the bodies of their fellow-men are of no avail except God gives them virtue who can heal without their aid, though they can not without His, and yet they are applied; and if it be done from a sense of duty, it is esteemed a work of mercy or benevolence; so the aids of teaching of medicine, applied through the instrumentality of man, are of advantage to the soul only when God works to make them of advantage [Augustine. On Christian Doctrine, J.F. Shaw].

In effort and effect, these natural therapeutics of Christian medicine were viewed to work only in concert with God's will. God heals through spiritual medicine and physicians have no utility without the blessings of God. This is the way the early church fathers addressed why we need empirical medicine, despite their unquestionable belief that ultimate authority of healing rested in God. All cures, spiritual, physical, with the assistance of physicians and helpers, were a gift of God. Monk physicians utilized spiritual and empirical medicines, but their ultimate concern never leaves the commitment to God and spiritualism. Because the efficacy of empirical medicine comes directly from God, to resort to it without first praying to and trusting in God would be futile. The monks' spiritual treatment of disease was based on the important concept that God creates illness as punishment for sins. The monks believed that pain, disease, and other such trials and tribulations were sent for admonition, for correction of past deeds, and to make one mindful for the future. Healing was emergence out of sin. Prayer and good behavior served as a way to ward off illness. The monks viewed sickness not as simply a punishment, but as a way to become closer to God. Disease and sickness was "sent or permitted for his [a Christian's] ultimate good by a God who loves him and will cause all things to work together for his good."

In this viewpoint, monks used spiritual medicine as a way to improve their relationships with God and refresh their souls, having confidence that any suffering was necessary by God's plans. As exemplified by patients in monastic hospitals were kept in close contact with chapels and continued to attend religious services, continuously praying for their cure and acceptance for repentance of sins.

The new Christian ethic of almsgiving (charity); piety and caring for the old, poor and infirm in hospitals soon gained a prominence for the church which was out of proportion to the number of Christians in the Roman world. Visiting the sick, elderly and poor was a duty incumbent on all Christians. The modern hospital concept had its origin in the early Christian communities and historian Sigerist states that their compassion and long term care for suffering was fundamentally different from anything known before in humanity. Neither the pagan temples nor the mystery religions created a caring community like that of early Christianity. In time, even those Roman emperors who had instituted persecution of Christendom, commented favorably on the Christians' altruistic assistance to all victims of the epidemics (probably small pox) which ravaged the Roman empire during the 2nd, 3rd, and 4th centuries.

Equally, Christian health ministration was also continued in spite of patients' poor prognosis for cure – situations in which patients would probably have been abandoned even by empiric doctors. But gradually latent tensions arose between early Christianity and Graeco-Roman medics based mainly on criticism that too much trust was being placed on physicians rather than God; neglect of the spiritual value of sickness (believers should accept suffering); increasing desire for healing through the use of supernatural means in view of the prevailing belief in the demonic cause of illness.

During the 2nd century Galen's medicine was approved by a group of Christians led by Theodorus of Byzantium, but others, like Tertullian and the heretic Marcion in particular, found empirical medicine unacceptable. Origen attacked Celsus' medical system, but in agreement with the majority of church leaders, approved of treatment by physicians as long as the spiritual side of healing was not neglected. Tatian was hostile, but Ferngren and Amundsen suggest that the hostility was really in reaction to perceived magical practices. In the late 3rd century, Eusebius, bishop of Caesarea during the reign of Emperor Diocletian (who instituted severe Christian persecution in 303) approved of Hippocratic medicine, but wrote against perceived anti-Christian sentiments in the teachings of many Greek philosophers; and warned that Galen was treated as a god by many physicians (Eusebius, Eccl.Hist. V 8, 6-17).

However, towards the end of the 2nd century significant shifts in basic Christian theological thinking had set in, including greater emphasis on demonic possession as cause of disease (and exorcism as treatment) and miracle cures. Up until then miraculous cures were considered to have been confined to the Gospel era (Ferngren & Amundsen 1994:2977). Gradually this attitude would progressively distance Christians from secular medicine as the dark ages would emerge.

Christianity and secular medicine: 4th ‚5th and 6th Centuries

This period which included the fall of the Western Roman Empire in 476, also brought significant changes to the organization of Christianity. Diocletian's persecutions at the turn of the 4th century were followed quite dramatically by Constantine's victory at the Milvian bridge and the proclamation of Christianity as state religion in 313. Constantine's successors, Constantius II and Theodosius, affirmed the new religion, forbade public sacrifices, closed pagan temples and even colluded in acts of violence against cult sites, including the destruction of Alexandria's Serapeum in 391. It is unlikely that more than 10% of Rome's population was Christian at this stage, but historically, the state's administration became Christian.

The Church experienced progressive change. The creation of Manichaeism in 310 (the first new religious movement to emerge from Christianity) introduced a cult of ascetic "apostolic" faith, and facilitated the widespread appearance of hermits and "holy men." With this came a growing emphasis on supernatural healing, exorcism and apostolic charismata, already introduced by the Phrygian Montanists in the late 2nd century. Tertullian, for instance, who became a Montanist late in life, laid great faith in a Christian woman in Carthage who possessed the supernatural gift of miraculous healing. Magic which had been universally condemned by early Christian authorities, now emerged in the popularisation of amulets, charms and healing incantations. This was initially denounced by church leaders like Chrysostom and Augustine, but gradually the dividing line between acceptable supernatural healing and magic became blurred, and eventually even Augustine exhibited ambivalence in these matters.

In addition to claims of miraculous healing by ascetics in particular, there arose a new spiritual elite venerated for their self-denial and ability to perform miracles. Origen, Basil and Macarius initiated a two-tiered concept in which it was quite in order for ordinary Christians to consult empirical physicians, but exalted Christians were expected to believe solely in religious healing.

The concept of healing saints, originating with the medical martyrs, Cosmas and Damian (4th century), developed into a veritable pantheon of healing saints. Eventually saints were later even dedicated to specific diseases. With the saints came healing shrines, often at the sites of earlier pagan healing temples, and the use of healing relics associated with the saints. At the Councils of Ephesus (431) and Chalcedon (452), so-called heretical sects were identified and excommunicated – including the Monophysite movement (popular in Byzantium) and the Syriac-speaking Nestorian Christians (Church of the East). The latter continued to play a significant role in medicine when they withdrew to found a medical school in Edessa. Subsequently banished from Roman Catholicism in 489, they scattered far and wide, and eventually found asylum in Persia where a flourishing medical school was established in Jundi-Shapur. This school subsequently exerted a profound influence also on Islamic medicine.

The church's movement towards supernatural and magical healing would then impact negatively on empirical medicine lasting centuries. Nutton suggests that in order to accommodate this development, many empiric doctors became less "scientific" in their approach and study of medicine. The extent to which this official stance of the church actually affected the ordinary citizen's health care, is difficult to assess. Church leaders like Basil (4th century), Diadochus (5th century), John of Ephesus (6th century) and Cassiodorus (6th century) supported empirical physicians while warning against over-confidence in physical medicine. Theodore of Sykeon (5th century) and others were highly critical of physicians (Horden).

Despite the Roman state's official Christian character, a large number of prominent physicians were blatantly pagan, or had pagan sympathies, e.g. Oribasius, Gesius and Agapius of Alexandria. The Church always suspected the medical profession of being a stronghold of paganism and heresy but Cassiodorus, Aëtius of Amida of martyrdom, Paul of Aegina and Alexander of Tralles were professing Christians or had strong Christian sympathies. Even then Nutton points out that physicians like Alexander of Tralles also made use of amulets and charms in their treatment.

During these times of early Christianity the rise of monasticism was responsible for the creation of monasteries - often with associated medical facilities and hospitals which were under religious control. Treatment, by lay physicians or monks trained in medicine, was administered to inmates as well as the civic population, and in due course physicians practiced outside the realm of the church. Some of these monasteries, like that of St. Basil in Caesarea and St. Benedict in Monte Casino, became centers of medical excellence in the 4th-5th centuries. Here classical texts were collected and copied manually, and some medical teaching was done. None of these could, however, compare with the great medical teaching institutions which later arose in Islam during its Golden Age. Nutton also makes the point that physicians in late antiquity became professionally better organized, and developed prominent public profiles as civil servants, ambassadors, church leaders, and some even saints.

With the possible exception of Oribasius (4th century), Titius (6th century) and Paul of Aegina (7th century), no physicians since Galen in the 2nd century added significantly to the existing basis of medical knowledge. The dark ages were descending upon emerging Christendom with the collapse of the eastern Roman empire.

Early Middle Ages: 7th - 12th Centuries

After the fall of Rome (c. 480), Constantinople (Byzantium) became the capital of the Graeco-Roman world although the papal presence did not leave Rome. In the 11th century the Western (Rome) and Eastern (Constantinople) sections of the Christian Church separated permanently because of irreconcilable differences regarding the nature of the Trinity. The powerful Church exerted growing pressure on virtually all aspects of community life and in general this was unfortunately not conducive to original scientific endeavors and free thinking including the profession of medicine .

During the so-called "Iconoclastic controversy" (740-843) the Church eventually accepted images of holy individuals as privileged artifacts, relics, singled out for particular devotion. This was condemned as idolatry by the Jews and Islam, but in Christendom it lead to the increased acceptance of magical healing, seen as a legitimate supernatural phenomenon potentiated by saints, shrines and holy relics. Pilgrimages ensued to healing shrines like that of Rocamadour in Southern France with its black Madonna. Healing of the body became part of a repentance ritual which could not succeed fully unless the soul was also liberated from sin. Healing shrines became money makers for the Church (Mason; Sumpton; Biller). In its most extreme form, this eventually led to prohibitions of Jewish doctors from some Church hospitals (Porter), and the delaying of treatment until after a confession had been heard by a priest. When Christian groupings like the Waldensian Order proclaimed against saints, shrines and relics, they were ruthlessly persecuted as heretics by the Inquisitions set up in the 13th century to purge Christianity of heresies. The Spanish and Portuguese Inquisitions remained nominally in existence up to the 18th century. During the 12th century, the theology of suffering which determined that lepers, victims of other chronic diseases and periodic epidemics, should carry their afflictions with grace and repent for their sins, led to serious conflicts between Church and empirical medicine. While secular health authorities insisted on isolation of the sick and avoidance of mass gatherings as an attempt to rational hygiene, the Church persisted with public shows of repentance and religious marches to glorify God and confound Satan. However, Palmer states that throughout there was also a large degree of effective co-operation between scientists and the clergy, and with progressive secularization of the health profession these problems gradually disappeared.

Medical schools would now begin at the new Medieval universities of Salerno (11th century) and Montpellier (12th century). Universities in Paris, Oxford, Cambridge, Bologna and Padua would follow in the 13th-14th centuries. Although tentatively under Church control, these institutions based their curricula on classical secular medicine - with a strong influence from Islamic and Persian sources.

Late Middle Ages and Renaissance: 13th - 16th Centuries

The emergence of new medical knowledge from the emerging universities of Salerno, Montpellier and others, as well as a progressive secularization of health care as civic hospitals appearing all over Europe, public physicians started replacing monastic medicine, which lead to new tensions between Church and secular medicine once again (Aitken). Gradually losing its moral and intellectual leadership, the Church, however, retained its wealth, privileges and persecuting power. The Inquisition, introduced in the 13th century to define and deal with heresies, also affected medicine as the Church adopted a medical dogma based on aspects of mainly Galenic and Hippocratic teachings. Doctors tried for suspected heresies in their medical writings included D'Abano in 1315 who died during the trial and his remains were exhumed and burnt at the stake. The infamous trial of Servetus had him burned at the stake for unacceptable criticism of Galen as well as theological heresy (1553). In all, the Inquisitions influenced medicine indirectly by suppression rather than directly by hampering education through the banning of certain texts, restrictions on student intake at religious universities, and exclusion of heretic teachers (Jews in particular). These problems specifically affected Spain.

The Lateran Council of 1215 forbade physicians not approved by the Church from attending the sick, but it was soon clear that this ban (aimed primarily at Jewish doctors) could not be enforced. The Council also barred clerics in higher orders (the monk physicians) from operating and practicing for personal gain. Bernard of Clairvaux (12th century) initiated this action against monastic medicine in order to ensure greater spiritual rather than medical activities in monasteries. He was also very critical of physicians, stating that there are "better cures in the School of Christ than in the School of Galen."

The first Crusade which descended on Jerusalem in 1099, led to the discovery of a small hospital managed by the humble Brother Gerard. Thousands of casualties descended upon the monks of the Order of St. John. From that time, the 'Hospitallers' of St. John, as it would be called, implemented a movement that would spread for centuries. It had an enormously beneficial effect on health care when the emerging Knights of St. John in the 13th century were responsible for the building of hospitals all over the Levant, Mediterranean and in German speaking countries. Other Hospitallers Orders would emerge - notably St. Lazarus for the lepers, and the Teutonic Knights (German).

The "Black Death" (bubonic plague) which ravaged Europe in 1348 clearly demonstrated the medical profession's ignorance of the cause and management of epidemic disease. According to a famous physician of the time, Guy de Chauliac, noted belief that it was caused by the conjunction of Saturn, Jupiter and Mars, and the community largely resorted to supernatural aid. In the end the Jews were blamed and in spite of papal Bulls declaring them innocent, a massacre ensued in Switzerland and Bavaria.

During the 15th century a combination of factors such as the migration of Greek scholars to the West after the fall of Constantinople in 1453, and the discovery of the printing press in 1454, caused an explosion of knowledge which had been building up since the disintegration of the Islamic Empire in the 13th century. This triggered the cultural and scientific rebirth of Europe which we know as the Renaissance (15th-16th century). Conservative elements in the Church resisted the new tide, and in the field of medicine discoveries by Vesalius, Paracelsus, Fallopio, Sylvius and many others caused resentment and reactions. However, the old order was truly gone, and when Martin Luther initiated the Reformation in 1517, and Henry VIII broke with the Vatican, two decades later, closing the monastaries, the Christian church had lost its hegemony. In due course Christianity and medicine would be re-aligned according to the realities of the Age of Enlightenment.

Conclusion

In summary we may say that Christianity's first great contributions to medicine lay in the early establishment of caring communities, notably the 'hospital,' which brought personalized medical care to the sick, irrespective of nationality, social status, age or disease including virulent epidemic diseases. This ultimately led to the creation of hospitals as we know them today. Monastic institutions also served as health centers with limited teaching activities, and libraries of classical information when Medieval Europe was paying little attention to the advancement of knowledge. It is also an ironic truth that the Nestorian (Orthodox) Christians, banned from the Church in the 5th century, were instrumental in the establishment of empirical medicine in Islam.

On the negative side the Church's decision to accept the healing powers of saints and their shrines and relics as theological dogma after the 5th century, distanced it from empirical medicine. There is reason to believe that the Christian and monastic physicians still continued to make use of both secular medicine and religious healing. The latter was seen as a form of legitimate supernatural cure and not magic. The precise role of faith healing has indeed remained a problem for many Christians through the ages, even up to the 20th century.

During the Middle Ages the Church's authoritative hand did not encourage original scientific thought outside the realms of its predestined medical dogma based largely on the teaching of the Greek master Galen in particular. Dissent was treated with growing displeasure, even ex-communication, and once it was equated with heresy (after the 13th century), death at the stake could be the punishment. There is little evidence that this happened often, but restrictions placed on the medical fraternity by the Inquisitions (in Spain particularly) did lead to serious dissatisfaction, even from devout members of the Church. Jewish doctors were specifically targeted, but mainly due to their professional excellence they could not be excluded from society. The curious intellectual lethargy which characterized Medieval times, was, however, of complex causation and cannot be attributed only to a very conservative Church hierarchy.

Suffice it to say, in spite of all these considerations and obstacles, devout Christians made significant scientific advances, particularly in anatomy and physiology. As a result of this dedication, pharmacy emerged as chemical analysis was becoming scientific, with mineral medicines being added to the Materia Medicas. The idea of liberation in the renaissance ushered in the nursing profession, beginning with those of the protestant faiths. Women would now become more accepted as partners in medical care.

Medical history in Christendom is truly a complex mix of considerations but the theme so outlined remains appreciated. By a short study of the remarkable findings of such noble men, paving the way to allow us today to know and appreciate anatomy and physiology, infectious diseases, mental illness, etc. give one a gestalt beyond the route memory so emphacized in today's medical schools. Their work and lives are truly respected and should be venerated!

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REFERENCES

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Avalos, H 1999. Health care and the rise of Christianity. Massachussets: Hendrickson Publ.

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