It is easy to understand that Christianity's influence on medicine, instead of hampering, was most favorable. The Founder of Christianity Himself had gone about healing the sick, and care for the ailing became a prominent feature of Christian work. One of the Evangelists, St. Luke, was a physician. It was the custom a generation ago, and even later, when the Higher Criticism became popular, to impugn the tradition as to St. Luke having been a physician, but this has all been undone, and Harnack's recent book, "Luke the Physician," makes it very clear that not only the Third Gospel, but also the Acts, could only have been written by a man thoroughly familiar with the Greek medical terms of his time, and who had surely had the advantage of a training in the medical sciences at Alexandria. This makes such an important link in medical traditions that a special chapter has been devoted to it in the Appendix.
Very early in Christianity care for the ailing poor was taken up, and hospitals in our modern sense of the term became common in Christian communities. There had been military hospitals before this, and places where those who could afford to pay for service were kept during illness. Our modern city hospital, however, is a Christian institution. Besides, deformed and ailing children were cared for and homes for foundlings were established. Before Christianity the power even of life and death of the parents over their children was recognized, and deformed or ailing children, or those that for some reason were not wanted, were exposed until they died. Christianity put an end to this, and in two classes of institutions, the hospitals and the asylums, abundant opportunity for observation of illness was afforded. Just as soon as Christianity came to be free to establish its institutions publicly, hospitals became very common. The Emperor Julian, usually known as the Apostate, who hoped to re-establish the old Roman Olympian religion, wrote to Oribasius, one of the great physicians of this time, who was also an important official of his household, that these Christians had established everywhere hospitals in which not only their own people, but also those who were not Christians, were received and cared for, and that it would be idle to hope to counteract the influence of Christianity until corresponding institutions could be erected by the government.
From the very beginning, or, at least, just as soon as reasonable freedom from persecution gave opportunity for study, Christian interest in the medical sciences began to manifest itself. Nemesius, for instance, a Bishop of Edessa in Syria, wrote toward the end of the fourth century a little work in Greek on the nature of man, which is a striking illustration of this. Nemesius was what in modern times would be called a philosopher, that is, a speculative thinker and writer, with regard to man's nature, rather than a physical scientist. He was convinced, however, that true philosophy ought to be based on a complete knowledge of man, body and soul, and that the anatomy of his body ought to be a fundamental principle. It is in this little volume that some enthusiastic students have found a description that is to them at least much more than a hint of knowledge of the circulation of the blood. Hyrtl doubts that the passage in question should be made to signify as much as has been suggested, but the occurrence of any even distant reference to such a subject at this time shows that, far from there being neglect of physical scientific questions, men were thinking seriously about them.
Just as soon as Christianity brought in a more peaceful state of affairs and had so influenced the mass of the people that its place in the intellectual life could be felt, there comes a period of cultural development represented in philosophy by the Fathers of the Church, and during which we have a series of important contributors to medical literature. The first of these was Aëtius, whose career and works are treated more fully in the chapter on "Great Physicians in Early Christian Times." He was followed by Alexander of Tralles, probably a Christian, for his brother was the architect of Santa Sophia, and by Paul of Ægina, with regard to whom we know only what is contained in his medical writings, but whose contemporaries were nearly all Christians. Their books are valuable to us, partly because they contain quotations from great Greek writers on medicine, not always otherwise available, but also because they were men who evidently knew the subject of medicine broadly and thoroughly, made observations for themselves, and controlled what they learned from the Greek forefathers in medicine by their own experience. Just at the beginning of the Middle Ages, then, under the fostering care of Christianity there is a period of considerable importance in the history of medical literature. It is one of the best proofs that we have not only that Christianity did not hamper medical development, but that, directly and indirectly, by the place that it gave to the care of the ailing in life as well as the encouragement afforded to the intellectual life, it favored medical study and writing.
A very interesting chapter in the story of the early Christian physician is to be found in what we know of the existence of women physicians in the fourth and fifth centuries. Theodosia, the mother of St. Procopius the martyr, was, according to Carptzovius, looked upon as an excellent physician in Rome in the early part of the fourth century. She suffered martyrdom under Diocletian. There was also a Nicerata who practised at Constantinople under the Emperor Arcadius. It is said that to her St. John Chrysostom owed the cure of a serious illness. From the very beginning Christian women acted as nurses, and deaconesses were put in charge of hospitals. Fabiola, at Rome, is the foundress of the first important hospital in that city. The story of these early Christian women physicians has been touched upon in the chapter on "Medieval Women Physicians," as an introduction to this interesting feature of Salernitan medical education.
During the early Christian centuries much was owed to the genius and the devotion to medicine of distinguished Jewish physicians. Their sacred and rabbinical writers always concerned themselves closely with medicine, and both the Old Testament and the Talmud must be considered as containing chapters important for the medical history of the periods in which they were written. At all times the Jews have been distinguished for their knowledge of medicine, and all during the Middle Ages they are to be found prominent as physicians. They were among the teachers of the Arabs in the East and of the Moors in Spain. They were probably among the first professors at Salerno as well as at Montpellier. Many prominent rulers and ecclesiastics selected Jewish physicians. Some of these made distinct contributions to medicine, and a number of them deserve a place in any account of medicine in the making during the Middle Ages. One of them, Maimonides, to whom a special chapter is devoted, deserves a place among the great makers of medicine of all time, because of the influence that he exerted on his own and succeeding generations. Any story of the preservation and development of medical teaching and medical practice during the Middle Ages would be decidedly incomplete without due consideration of the work of Jewish physicians.
Western medical literature followed Roman literature in other departments, and had only the Greek traditions at second hand. During the disturbance occasioned by the invasion of the barbarians there was little opportunity for such leisure as would enable men to devote themselves with tranquillity to medical study and writing. Medical traditions were mainly preserved in the monasteries. Cassiodorus, who, after having been Imperial Prime Minister, became a monk, recommended particularly the study of medicine to the monastic brethren. With the foundation of the Benedictines, medicine became one of the favorite studies of the monks, partly for the sake of the health of the brethren themselves, and partly in order that they might be helpful to the villages that so often gathered round their monasteries. There is a well-grounded tradition that at Monte Cassino medical teaching was one of the features of the education provided there by the monks. It is generally conceded that the Benedictines had much to do with the foundation of Salerno. In the convents for women as well as the monasteries for men serious attention was given to medicine. Women studied medicine and were professors in the medical department of Salerno. Other Italian universities followed the example thus set, and so there is abundant material for the chapter on "Medieval Women Physicians."
The next phase of medical history in the medieval period brings us to the Arabs. Utterly uninterested in culture, education, or science before the time of Mohammed, with the growth of their political power and the foundation of their capitals, the Arab Caliphs took up the patronage of education. They were the rulers of the cities of Asia Minor in which Greek culture had taken so firm a hold, and captive Greece has always led its captors captive. With the leisure that came for study, Arabians took up the cultivation of the Greek philosophers, especially Aristotle, and soon turned their attention also to the Greek physicians Hippocrates and Galen. For some four hundred years then they were in the best position to carry on medical traditions. Their teachers were the Christian and Jewish physicians of the cities of Asia Minor, but soon they themselves became distinguished for their attainments, and for their medical writings. Interestingly enough, more of their distinguished men flourished in Spain than in Asia Minor. We have suggested an explanation for this in the fact that Spain had been one of the most cultured provinces of the Roman Empire, providing practically all the writers of the Silver Age of Latin literature, and evidently possessing a widely cultured people. It was into this province, not yet utterly decadent from the presence of the northern Goths, that the Moors came and readily built up a magnificent structure of culture and education on what had been the highest development of Roman civilization.
The influence of the Arabs on Western civilization, and especially on the development of science in Europe, has been much exaggerated by certain writers. Closely in touch with Greek thought and Greek literature during the eighth, ninth, and tenth centuries, it is easy to understand that the Arabian writers were far ahead of the Christian scholars of Europe of the same period, who were struggling up out of the practical chaos that had been created by the coming of the barbarians, and who, besides, had the chance for whatever Greek learning came to them only through the secondary channels of the Latin writers. Rome had been too occupied with politics and aggrandizement ever to become cultured. In spite of this heritage from the Greeks, decadence took place among the Arabs, and, as the centuries go on, what they do becomes more and more trivial, and their writing has less significance. Just the opposite happened in Europe. There, there was noteworthy progressive development until the magnificent climax of thirteenth century accomplishment was reached. It is often said that Europe owed much to the Arabs for this, but careful analysis of the factors in that progress shows that very little came from the Arabs that was good, while not a little that was unfortunate in its influence was borrowed from them with the translations of the Greek authors from that language, which constituted the main, indeed often the only, reason why Arabian writers were consulted.
With the foundation of the medical school of Salerno in the tenth century, the modern history of medical education may be said to begin, for it had many of the features that distinguish our modern university medical schools. Its professors often came from a distance and had travelled extensively for purposes of study; they attracted patients of high rank from nearly every part of Europe, and these were generous in their patronage of the school. Students came from all over, from Africa and Asia, as well as Europe, and when abuses of medical practice began to creep in, a series of laws were made creating a standard of medical education and regulating the practice of medicine, that are interesting anticipations of modern movements of the same kind. Finally a law was passed requiring three years of preliminary work in logic and philosophy before medicine might be taken up, and then four years at medicine, with a subsequent year of practice with a physician before a license to practise for one's self was issued. In addition to this there was a still more surprising feature in the handing over of the department of women's diseases to women professors, and the consequent opening up of licensure to practise medicine to a great many women in the southern part of Italy. The surprise that all this should have taken place in the south of Italy is lessened by recalling the fact that the lower end of the Italian peninsula had been early colonized by Greeks, that its name in later times was Magna Græcia, and that the stimulus of Greek tradition has always been especially favorable to the development of scientific medicine.