Medicine joins the university curriculum
By the thirteenth century, medicine was one of the established higher subjects in the new universities, along with theology and law. Where one faculty of medicine was strong, others tended to copy its habits, so the subject became more standardized across Europe. The spread was uneven. Some universities, such as Bologna, Paris, Montpellier and Padua, gained reputations for medicine, while others had only a small medical presence or none at all.
What follows is about the shared features of that teaching: books, methods, degrees, and what students really took away from them.
Who entered the faculty
A student normally came to medicine after completing a course in arts, where he studied grammar, logic and natural philosophy. The reasoning was that medicine depended on understanding nature, so philosophy was a necessary base. Medical study then took a number of years, though exact lengths changed with time and place. Students were mostly men, and they were usually from families able to pay for years of study. Costs for books, fees and living expenses were considerable, which limited the profession to the comfortable.
The set texts
The curriculum centered on a small shelf of authoritative works, many of them translated from Greek and Arabic into Latin in the twelfth and thirteenth centuries. These included:
- an introductory collection of short works, widely used as a first textbook
- writings attributed to Hippocrates, including aphorisms
- the many writings of Galen on the body, health and disease
- Arabic works, including the Canon of Medicine by Ibn Sina and others by authors such as Rhazes and Haly Abbas, known through Latin versions
Over time, Latin commentaries grew up around these books, and a student often learned them through the commentaries. Authority was central: the aim was to understand and apply what the great writers had said, rather than to test it by experiment.
Lectures and disputation
Teaching followed the same pattern as in other faculties. A master read a passage aloud and explained it, and students listened and took notes. Beyond lectures, students and masters took part in disputations, formal debates in which a question was argued from both sides using the texts and logic. Typical questions concerned the nature of the elements, the effects of climate, or how a particular drug worked.
The theoretical framework was humoral. The body was thought to contain four humors that needed balance, and the qualities of hot, cold, wet and dry shaped understanding of illness and remedies. The related ideas about the four elements helped explain why a food or herb might be called “warming” or “drying.” A physician judged a patient’s complexion, or temperament, and sought to counter imbalance with diet, rest, herbs or bloodletting. Humoral medicine was a coherent system, even if modern research does not support its explanations.
Practical learning
Hands-on training in a university setting was limited, and its extent is debated. Some medical students observed practicing physicians or visited patients. Examination of the body after death was rare, and when it happened it was often to illustrate the standard texts rather than to find out something new. Around the early fourteenth century, teachers in Bologna are traditionally credited with performing public dissections, but these were occasional and reinforced the written authorities. Surgery was often considered a separate craft, though some universities developed surgical teaching, and surgeons commonly learned by apprenticeship.
The physician’s practical skills included taking the pulse, looking at urine, which was a major diagnostic tool, and advising on regimen, meaning diet, exercise, sleep and emotional balance. Many of his patients were wealthy, since a trained physician was expensive. Astrological timing sometimes played a role in treatment decisions, since many physicians linked the planets to the body’s fluids.
Degrees and the profession
Students were examined and, if they passed, received a degree and license. A licentiate could practice and sometimes teach. Cities and rulers sought to regulate who could call himself a physician, and the guild of physicians in some towns sought to guard its status against surgeons, apothecaries and other healers. Enforcement was uneven, and unlicensed practitioners worked everywhere.
What it did and did not achieve
University medicine did several important things. It systematized knowledge, made translations available and produced a class of professionally trained physicians who helped to form public health measures in some cities. It also supported the work of medieval hospitals and the writing of treatises on specific problems, including plague.
Its limits were equally clear. Most people were treated by medieval midwives, barbers, village healers using medicinal herbs, priests and family members rather than by university graduates. The theories taught by the faculties were often wrong, and the emphasis on authority could slow change. In the long run, however, the habit of organized study and debate created an environment in which later revisions of anatomy and physiology could take place, even though those developments lie beyond the medieval period.