One of the major innovations of the Middle Age was the formal establishment of university education in medicine during the twelfth and thirteenth centuries. However, only a tiny fraction of all medical practitioners had any university training. The influence of the faculties of medicine was more closely related to the establishment of a regular curriculum, authoritative texts, technical knowledge, and a medical elite than to the absolute number of university-trained physicians.
The creation and distribution of universities and faculties of medicine throughout Europe were very uneven. Students often had to undertake long journeys in search of suitable mentors. Moreover, the universities of the Middle Ages were very different from both the ancient centers of learning and their modern counterparts, especially in terms of the relationships among students, faculty, and administrators. The exact origins of some of the major universities are obscure. Indeed, ''university'' was originally a rather vague term that referred to any corporate status or association of persons. Eventually, the term was formally associated with institutions of higher learning. Some historians believe that the ''age of reason'' began in the universities of the late Middle Ages, with the institutionalization of a curriculum that demanded the exploration of logic, natural philosophy, theology, medicine, and law. Large numbers of students, all of whom shared Latin as the language of learning, were drawn to universities to study with teachers known for particular areas of excellence. Many students entered the universities at the age of 14 or 15 years after securing the rudiments of the seven liberal arts: grammar, rhetoric, logic, arithmetic, geometry, astronomy, and music.
The medical texts available for use by the time medical faculties were established included many translations from Greek and Arabic manuscripts, as well as new Latin collections and commentaries. However, before the fifteenth century, students and professors lacked access to many of the surviving works of Hippocrates, Galen, and other ancient writers. Some of Galen's most important texts, including On Anatomical Procedures, were not translated into Latin until the sixteenth century. Some manuscripts were extremely rare and many of the Latin texts attributed to Hippocrates and Galen were spurious.
Although the rise of the university as a center for training physicians is an important aspect of the history of medieval medicine, for much of this period learned medicine was still firmly associated with the church and the monastery. With its library, infirmary, hospital, and herb gardens, the monastery was a natural center for medical study and practice. On the other hand, charitable impulses towards the sick were sometimes obliterated by an all-consuming concern for the soul, coupled with contempt for the flesh. Some ascetics refused to make allowances for the ''indulgence'' of the flesh, even for sick flesh. St. Bernard of Clairvaux (1091-1153), a mystic who engaged in harsh, self-imposed penances, expected his monks to live and die simply. Building infirmaries, taking medicines, or visiting a physician were forbidden. St. Bernard thought it ''unbefitting religion and contrary to simplicity of life'' to allow such activities.
Many exemplary stories about the lives of saints and ascetics suggested that a regimen of self-imposed privations led to health, longevity, and peace of mind. Ascetics might fast several days a week, eat nothing but bread, salt, and water, stay awake all night in prayer, and give up bathing and exercise (some saints were famous for sitting on pillars for years at a time). However, the reactions of saints and ascetics to diseases and accidents that were not self-inflicted might be quite different. Here the stories vary widely. Some ascetics accepted medical or surgical treatment for disorders such as cancer and dropsy, whereas others categorically refused to accept drugs or doctors. Some were fortunate enough to be cured in a rather Asclepian fashion by ministering angels who appeared in dreams to wash their wounds and anoint their bruises.
The founders of some religious orders took a more temperate view of the needs of the sick, and infirmaries and hospitals were established as adjuncts to monasteries in order to provide charity and care for the sick. Within many religious orders, the rules of St. Benedict (ca. 480547) provided reasonable guidelines for care of the sick. Although the monastic routine called for hard work, special allowances were to be made for the sick, infirm, and aged. The care of the sick was such an important duty that those caring for them were enjoined to act as if they served Christ directly. There is suggestive evidence that monks with some medical knowledge were chosen to care for the sick.
By the eleventh century, some monasteries were training their own physicians. Ideally, such physicians would uphold the Christianized ideal of the healer who offered mercy and charity towards all patients, whatever their status and prognosis might be. The gap between the ideal and the real is suggested by evidence of numerous complaints about the pursuit of ''filthy lucre'' by priest-physicians. When such physicians gained permission to practice outside the monastery and offered their services to wealthy nobles, complaints about luxurious living and the decline of monastic discipline were raised.
The ostensibly simple question of whether medieval clergymen were or were not forbidden to practice medicine and surgery has been the subject of considerable controversy. Only excessive naivete would lead us to expect that official records and documents are a realistic reflection of the status of forbidden practices. The official Church position was made explicit in numerous declarations and complaints about the study and practice of medicine and surgery by clergymen. Several twelfth-century papal decisions expressed a desire to restrict the practice of medicine by monks. The declarations of the Council of Clermont (1130), the Council of Rheims (1131), and the Second Lateran Council (1139) all contain the statement: ''Monks and canons regular are not to study jurisprudence and medicine for the sake of temporal gain.'' This statement referred specifically to the pursuit of money, not to the study and practice of medicine or law. Obviously, the need for so many official prohibitions indicates how difficult it was to make practice accord with policy.
Another myth about medieval medicine is the assumption that the Church's opposition to ''shedding human blood'' prohibited surgery. This prohibition was based on opposition to shedding blood because of hatred and war, not to surgery in general, and certainly not to venesection (therapeutic bloodletting). The idea that this position had any medical significance was essentially an eighteenth-century hoax. Venesection was actually a fairly common procedure, performed both prophylactically and therapeutically. When carrying out this important surgical procedure, the doctor had to consider complicated rules that related the patient's condition to the site selected, as well as the season of the year, phase of the moon, and the most propitious time of day. Some guidance was offered by simple illustrations depicting commonly used phlebotomy sites, but these pictures were highly stylized and very schematic.
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