What happened when the Roman Empire
After the fall of the Roman Empire in the west during the fifth century, much of the medical knowledge of the
Greeks and Romans was lost to people living in Western Europe. The collapse of the Roman Empire led to a
breakdown in law and order, with no effective central government and a return to pagan tribal societies. This
was the time of the so called Dark Ages in Europe. Roman style government and society continued in the
Byzantine Empire based around the city of Constantinople but this empire was cut off from the rest of
Europe. Had it not been for the emergence of the Arab Empire in the seventh century then the knowledge of
the Greeks and Romans might have been lost permanently to Western society.
The Arab Empire was
at its height between
the eigth and the
sixteenth century when it controlled what is now Spain, North Africa and the whole of the Middle East as far as
India. Followers of Muhammad were taught that there is always a cause and a cure for every disease. This
belief encouraged medical research and the importance of recording and transmitting this knowledge. Works by
Hippocrates and Galen were translated into Arabic along with translations of both Indian and Chinese
writers. These translations were then combined into large encyclopaedias and summaries into which Arab
writers added their own comments based on research they had undertaken.
Europe gradually emerged from the Dark Ages as the Christian church became more powerful. St Benedict
founded the first monastery at Monte Cassino in Italy in 529 AD and these quickly grew in number and
influence. Monks played an important role in spreading Christianity within Europe and in 595 AD, Benedictine
monks arrived in England led by Augustine who later became the first Archbishop of Canterbury. As
monasteries were built throughout Europe, they became not only religious centres but also centres of learning.
As well as translating and copying religious works, monks also copied books by writers such as Hippocrates and
Galen. Constantine the African was a Benedictine monk who by his work helped to reintroduce Greek
medicine to Christian Europe.
The Rule of St Benedict states that "before and above all things, care must be taken of the sick”. Virtually
every monastery had an infirmary for the monks or nuns, and this led to care being made for other patients.
Almost a half of the hospitals in medieval Europe were directly linked with monasteries or other religious
Monks weighing ingredients and mixing potions for patients
What happened to medicine when the Roman Empire
Phase 1: Chaos Phase 2: the Phase 3:
Tribes overrun Church Stability
Rome and turn on Missionaries sent to Wars cease and
each other warring tribes societies regain
Public health Thousands of stability
systems and churches and Trade and money
libraries destroyed monasteries appear increase
Money spent on The Church is the People begin to
defence rather only strong travel
than medicine centralised Church sets up
Trade disrupted so organisation left – universities for
countries are power doctor training
poorer Pope tells people Armies begin to
Travel is what to believe and take doctors with
dangerous so how to behave them to planned
communication Priests and monks battles
stops are the only people Rulers began to
War disrupts who read. The try and clean up
education and Church controls towns
technological education. Communications
development The Church open up again
Soldiers rather teaches
than doctors are supernatural
trained explanations for
Constantine the African was an eleventh-century translator of Greek medical texts.
He was a native of Carthage, then under Arab rule. As a Christian he had a good knowledge of
Latin, enabling him to translate medical works from Arabic. He was invited to join the Schola Medica
Salernitana by Alfano I, Archbishop of Salerno c.1065 in order to help with the translation of various
Arabic manuscripts. In this way he helped reintroduced Greek medicine to Christian Europe. His
translations of Hippocrates and Galen first gave the West a view of Greek medicine as a whole.
Constantine the African (born c. 1020, Carthage or Sicily, died 1087, monastery of Monte Cassino).
Constantine possessed much knowledge in many different languages, such as Greek, Latin, Arabic, and
several Oriental languages. He had acquired these different languages during his extensive travels in
Syria, India, Ethiopia, Egypt, and Persia. He studied at the University of Salerno, which was Europe's
first organized medical school. Later, he entered the Monte Cassino, the monastery founded by St.
Benedict in 529.
The first translation from Arabic to Latin from the works of Constantine the African was the Complete
Book of the Medical Art (the Kitab) in 1087. This text was the first comprehensive Arabic medical text.
The significance of this text was that it was an important resource for the student of the transmission
of scientific ideas. The Complete Book of the Medical Art contains a collaboration of 128 known
manuscripts. This text also contains a survey of the 108 known Latin manuscripts of Constantine the
African. This text rapidly became part of the standard medical curriculum for students.
His 37 translated books from Arabic to Latin, which, introduced Islam's extensive knowledge of Greek
medicine to the West. His translations of Hippocrates and Galen first gave the West a view of Greek
medicine as a whole.
How did Galen’s works survive into the Middle Ages?
The Empire splits into an eastern half and a western half. The eastern
half contains Greece
In 410 AD the Roman Empire Collapses when Rome is sacked
The eastern half is temporarily taken over by Arabs. They find Galen’s works
and translate them from Greek into Arabic. The originals are lost
Whilst travelling in Italy, Constantine hears that there is no knowledge of Galen’s
works in Western Europe
Constantine the African, a Muslim merchant with some medical knowledge, can
read Arabic. He reads Galen’s works
He gets some of Galen’s works and brings them to Monte Cassino in Italy. He
learns Latin and becomes a monk. Between 1070 and 1087 he translates
some of Galen’s works into Latin
In total, half of Galen’s writings survive to the Middle Ages. They form the basis
of medical thought until the Renaissance
In the twelfth century more of Galen’s works are translated. The Christian
Church agrees with Galen’s ideas because they reflect Christian beliefs about
the body being the best possible design, made in God’s image.
Medicine Through Time The Middle Ages:
Disease & its Treatment
What was religion’s role in medicine during the Middle Ages?
During the Middle Ages religion came to dominate all aspects of life throughout much of Europe. The Christian
church established monasteries, which served as hospitals, and later began to provide training for
doctors. At the same time, medical schools based on Islamic practice were gaining a high reputation at
centres like Salerno in Italy and Montpellier in France.
Infirmary for the sick in 13th Century Europe
The Christian Church saw it as the duty of all Christians to help the sick and needy, but they had no particular
method for treating disease beyond faith and prayer. The population relied on local healers, who were often
women. By 1200, the training of doctors had become established, in universities in Western Europe which
were controlled by the Church. The work of Galen was translated from Greek into Arabic and then into Latin.
His ideas about medicine fitted well with Christian beliefs by abiding by a set of pre-determined natural laws. By
and large, the Christian church during this period resisted any change. Dissection, for example, was forbidden
until the 14th century, and even then it was strictly controlled and only took place in medical schools within
universities. Students watched dissections carried out by the teacher’s assistant.
The Islamic religious influence was more positive in the Middle Ages. Islam reached the peak of its
civilisation in AD 1000, with Baghdad as its capital. Based on the Qu’ran, the religion gave clear instructions
on social responsibilities, such as the rich providing for the poor, and the healthy caring for the sick. On this
principle, many hospitals were founded.
At the same time, Arab medical scholars greatly admired the works of the Greek doctors
Galen and Hippocrates. They applied the Greek methods of observation to their
treatments of disease. Rhazes was a Persian doctor who worked in the hospitals of
Baghdad around 900AD. His methods of observation led him to discover the difference
between measles and smallpox. This was one of the earliest recorded examples of a doctor
being able to identify a specific disease.
Portrait of Rhazes
Alchemists found new ways of purifying chemicals in their attempts to create gold. In Islamic cultures at least,
religion furthered some aspects of the treatment of disease.
Think about this:
• How the early Christian church, despite its charity, hindered an understanding of disease and its
• How the instructions of the Quran encouraged charity and subsequent development of public health care
• Why both Islamic and Christian religions supported the work of Galen.
Punishment from God
What’s the idea?
• This idea was particularly popular during the Middle Ages when the church was a very powerful
• People had many superstitious beliefs in the Middle Ages; among them was the belief that God and the
Devil influenced health.
Tell me more
• Frightening epidemics like the plague were seen as God’s punishment for people’s sins.
• Even more personal disasters like the death of a child or sickness were seen as the result of sin.
• Sometimes disease was believed to be a trial sent by God to cure people of their pride.
• This idea remained influential as long as the church remained powerful. As science progressed and
specific causes of disease were identified, the belief in punishment from God declined.
• However, as recently as the early 1980s, many people saw the outbreak of AIDS as God’s judgement on
The role of monasteries
The best chance of living a healthy life in the Middle
Ages would have been in a monastery. Why was
Although individual monks took a vow of poverty,
monasteries were usually very wealthy because rich
barons gave them land and endowments. Many
monasteries were able to set up profitable
businesses; the Cistercians for exam very successful
sheep farmers. They used their resources to help the
sick and the poor. Some monasteries had hospitals Monastery Hospital, Montserrat, Spain
and all had sick bays for monks who fell ill.
Monasteries were also usually built in remote country areas, not in the centres of towns. Monks had plenty of
time on their hands, and often experimented with herbs and plants which they made into medicines. Their
treatments were based on these herbs and plants but also in their belief in the power of God. Patients were also
kept clean and allowed plenty of rest.
• During the Middle Ages monasteries were very wealthy and some ran profitable businesses
• Some monasteries had hospitals attached; treatments would combine natural remedies with religious
• Monks had the time and opportunity to experiment with creating medicines.
Did the Christian Church help or hinder medical progress?
What was the Church’s What does the Source Explain how this helped
role in: show? or hindered the
development of medicine
Developing new medical ideas P76 Source 1
Knowledge of anatomy P68 Source 1
P77 Source 6
Public health P77 Source 3
P60 Source 7
Training doctors P57 & 68
Did the Christian Church help or hinder medical progress?
What was the Church’s What does the Source Explain how this helped or
role in: show? hindered the development
Spreading medical knowledge P57
Care of the sick P72-73
The search for effective P76-77 Sources 2 3 4
Licensing healers P69
Explaining disease P64-65