Medieval Latin West
After about the year 1000, conditions in the Latin west began to improve. It was a period that has since been called the High Middle Ages. Trade increased, scholars traveled more freely, and churches became richer. By 1300 the Church in Europe had established institutions of higher education. Armies hired trained physicians. And kings began to institute practices of sanitation.
In the 13th century Arabic (Moorish) strongholds in Spain fell to the Christians. Christian churchmen discovered the Arabic translations of Ancient Greek medical and philosophical treatises written by the Muslim scholars (e.g., Avicenna and Albucasis) and translated them from Arabic into Latin. The books formed a basis of the curriculum in medical education of students enrolled in European universities from 12th to 17th centuries AD.
Scholasticism was the dominant form of theology and philosophy in the Latin West in the early Middle Ages. It began around the 9th century, as a result of the Carolingian revival, and had its heyday from the 12th to 14th centuries. The aim of Scholasticism was to reconcile Christian theology with the Greek philosophy of Aristotle and his commentators. Scholastics wrote commentaries and glosses in textbooks that dealt with problems of psychology, metaphysics, cosmology, religion, and ethics.
A key element of scholasticism was the translation into Latin of the works of Aristotle. His work provided a comprehensive philosophical system for the scholastics that dealt with the entire human experience. It included questions of ethics, metaphysics, and politics. Jewish and Muslim commentators had already integrated Aristotle into their own systems of belief. It now was time for the Christians of the Latin East to reconcile Aristotle's materialist and natural points of view with Christian theology and philosophy.
Some main contributors to the scholastic movement of the 12th and 13th centuries in the Latin West were: Hildegard of Bingen, (1098-1179), Albertus Magnus (1193-1282), St. Thomas Aquinas, (1225-1274), Giacomo da Forli (1360-1414), Thaddeo Alderotti (1210-1295), and Peter of Abano (1259-1316).
Hildegard of Bingen, Albertus Magnus, and Thomas Aquinas used the scholastic method to combine the ancient classics, especially those of Aristotle, with medieval religious practice and Giocomo de Forti, Taddeo Alderotti, and Peter of Abano were physicians who applied scholasticism to the practice of medicine.
Latin Medicine in the high middle ages (1000-1500)
Much of medicine during this time was practiced in hospitals associated with religious monasteries. Those who had chronic illnesses were attended to in Christian medieval hospices and were located in the cloisters. Some monastic infirmaries were extended into the communities. These infirmaries were supported by religious charities at first, then, after 1100, became more secular, due to the Hospitalers of St. John.
Medical schools associated with newly emerging universities, provided medical support to the hospices for the sick and disabled. Taddeo Alderotti (1210-1295), an Italian physician, medical educator, and scholastic, founded a medical school in Bologna, Italy. Alderotti was a follower of Hippocrates, which was a departure from tradition in 13th century Italy that had adopted religious rather than natural explanations in their medical practices. He reintroduced Hippocratic practices of teaching students at the patient's bedside.
Alderotti used humor theory of Hippocrates to address questions of speech and speech disorder. For example, he regarded a sppech disorder as due to either excess moisture that affected the nerves linking the brain, tongue, and genitals, or from a problem with excess vapors associated with melancholy that arose from the brain and affected the tongue (Metzler, 2006, p. 77).
Another scholastic of this period was an Italian philosopher astronomer, and medical authority, Peter of Abano (1259-1316). He served as a professor of medicine in Padua, Italy, an important medieval medical center, which he helped to establish.
Like Alderotti, Peter theorized about speech and hearing problems. He identified a center in the brain located a specialized organ between the 5th, 6th, and 7th cranial nerves that he considered to be a center for expressing a "word of the voice" (Wollock, 1997, p. 145). He also separated the functions of speech and hearing:
… some [infants] hear [quite well] before those organs with which they speak, such as the tongue and the others, are untied and freed of the impediments that tie them, namely, superfluous moisture and softness and weakness of the muscles of the tongue (Wollock, 1997, p. 191, fn 3).
Peter also described the processes involved in speech articulation:
The tongue articulates by striking; it gathers the air in the throat (pharynx) and pushes it against the palate and the teeth, thereby giving the sound a definite shape. If the tongue did not articulate each time by striking, man would not speak clearly … (Wollock, 1997, p. 192, fn. 5, quoting from De Carnibus, viii606 Lit.).
Another important physician who adapted humor theory to account for speech problems was Jean de Saint-Amand, a 13th century physician. He treated a patient who was unable to talk by administering a drug that attracted phlegm from the head, thereby drying moisture from her tongue. He is said to have restored her speech, which she used during the period when she was given her final rights and then she died.
Following in this same tradition, Guy de Chauliac a 14th century surgeon practicing in France in the tradition of Galen, used humor theory to explain and treat speech problems. He saw stuttering as arising from an excess of moisture soaking the nerves, muscles, and the tongue. His treatment involved diverting the excess moisture by using cupping and blistering procedures. He also recommended sucking the humor through the brain using medicinal herbs such as mustard and ginger. And the third method was to wash and rub the tongue with medicines to dry it out (Hunt, 1852, pp. 28-29).
Medieval physicians, when focusing on the religious aspects of medicine, emphasized ancient ideas about astrological aspects of humor theory. That is, they used the position of the sun, moon and planets as well as the constellations to diagnose and treat disease. This astrological focus was expanded by the clergy and others who practiced medicine in the late middle ages.
During this period, medical practitioners depicted different signs of the zodiac and position of the sun, moon and planets as having governance over different parts of the body, as controlling different diseases, and as affecting the usefulness of different drugs.
Zodiac Man—illustrating the association between the signs of the zodiac and the parts of the body.
For example, to be effective, plants and herbs had to be collected during the times in which their associated planets were visible. These times were calculated from an almanac in which the rising and setting times of planets were given. To gather the medicinal plants and herbs at any other times would prevent them from being effective.
Other treatments besides herbal remedies were also prescribed using astrological signs. For example, bleeding, a common medical procedure used until the early 19th century, was considered most effective when the moon was in a particular constellation.
Medieval physicians in the Latin west typically combined astrology and humor theory to carry out theory practices. Geoffrey Chaucer, in his famous Canterberry Tales reflects their practices (along with their predeliction toward avarice as follows (translation from Medieval English):
THE PHYSICIAN
With us there was a doctor of physic;
In all this world was none like him to pick
For talk of medicine and surgery;
For he was grounded in astronomy.
He often kept a patient from the pall
By horoscopes and magic natural.
Well could he tell the fortune ascendent
Within the houses for his sick patient.
He knew the cause of every malady,
Were it of hot or cold, of moist or dry,
And where engendered, and of what humor;
He was a very good practitioner.
The cause being known, down to the deepest root,
Anon he gave to the sick man his boot.
Ready he was, with his apothecaries,
To send him drugs and all electuaries;
By mutual aid much gold they'd always won-
Their friendship was a thing not new begun.
Well read was he in Esculapius,
And Deiscorides, and in Rufus,
Hippocrates, and Hali, and Galen,
Serapion, Rhazes, and Avicen,
Averroes, Gilbert, and Constantine,
Bernard and Gatisden, and John Damascene.
In diet he was measured as could be,
Including naught of superfluity,
But nourishing and easy. It's no libel
To say he read but little in the Bible.
In blue and scarlet he went clad, withal,
Lined with a taffeta and with sendal;
And yet he was right chary of expense;
He kept the gold he gained from pestilence.
For gold in physic is a fine cordial,
And therefore loved he gold exceeding all (Chaucer, 1400, prelude)
Medieval Latin rhetoric and oratory
The study and expansion of classical rhetoric in the middle ages was considered important because it was used to resolve arguments about the boundaries of faith and reason. It was framed in this period as a way to resolve contradictions between Christian truth and Greek science (Overfield, 1984) and was an important tool applied to the arguments being made for and against scholasticism.
Students of rhetoric during the middle ages also used their studies to learn the techniques of preaching. St Augustine of Hippo (354-430), held that those studying to be preachers and religious figures need to learn to use rhetoric to win souls of others. In order to do this they must learn and practice principles of rhetoric. Augustine also appealed to teachers and students of preaching that they use the wisdom and styles of Bible as a guide for learning oratory rather than using the ancient pagan classics such as Homer's Illiad and Odyssey as instructional material.
Augustine's De doctrina Christina, (Christian doctrine) (composed between 396 and 426 AD) offered the first of the medieval treatises on the communicative arts. In it he argued that students who are studying to be preachers and religious figures need to learn to use rhetoric to win souls and that in order to be good at that job, they need to learn some principles of discourse He favored imitation as a learning strategy over learning through principles or rules. Finally, Augustine appealed to teachers and students of preaching that they use the wisdom and styles of Bible as a guide for learning how to deliver speech, rather than learning ancient pagan classics such as Homer's Illiad and Odyssey.
Alcuin, (735-804) was another important figure who contributed to the ideas associated with rhetoric. He was the first Englishman to compose a work on rhetoric, was a Latinist, astrologer and classicist. His book, De Rhetorica, dealt mostly with Cicero's area of Invention—the process by which a speaker analyzes his subject and formulates the content of his speech.
Perhaps the best known and most influential of the scholastics was St Thomas Aquinas (1225-1274). His theories about rhetoric included aspects of Aristotelian philosophy and Christian theology. For example, he devised a psycholinguistic theory about how words arise. His object was to explain what was meant by "word" in the Gospel of St John (In the beginning was the word and the word was with God and the word was God).
Thomas in his book De Veritate distinguished three meanings for the word "word." He separated "word" having to do with the intellect, from the internal word, and from the spoken word. He said that the internal word was the expression of the intellect and the vocal word, or speech, was the expression of the internal word. Thomas says it this way:
There are in us three kinds of word: The word of the heart, the word of the voice, and the word, which holds the image of the voice. This is necessary because, since our speech is a particular kind of bodily operation, those things must concur for it which are necessary for any bodily motion.
Now a bodily motion of man, specifically which is voluntary, is necessarily preceded by deliberation and judgment in the intellective part. But because the intellect pertains to universals, while operations pertain to singulars, it is necessary … that there be some particular virtue of apprehending the intention of that singular to which the operation pertains. And thirdly it is necessary that motion in the body follow, through motive virtues impressed upon muscles and nerves; so that it almost seems to be a kind of syllogism, with the major universal held in the intellective part and the minor particular in the sensitive; finally the conclusion, the particular operation, follows under the command of the motive virtue. Indeed an operation holds the same place with respect to operables, as a conclusion with respect to speculatives (de Veritate iv1,1975, 119b trans by Wollock, 1997 p. 4).
An adversary of Thomas Aquinas was Dutch scholar Rudolph Agricola (1444-1485). Agricola designed techniques of rhetoric to argue against the scholastic such as Thomas Aquinas. In his well-known book De inventione dialectica he created a proper place in rhetorical studies for a broadly defined study of logic. His book emphasized methods involved in argumentation, then called dialectics. He portrayed arguments as a means for communicating rather than as a means for accessing the truth. In this way Agricola differed from his predecessors, such as Aristotle, and from his scholastic contemporaries.
Medieval Latin views of disability
The Christians regarded birth defects as a product of man's fallibility resulting from Adam and Eve's original sin. St. Augustine (354-430) claimed that infants born with disabilities must have resulted from man's sinfulness, since God would never have wanted babies to be born with a disability.
However, St. Augustine did not advocate getting rid of disabled babies. He felt that 'monstrous' births or those born 'defective' or 'deformed', will be restored to 'the normal shape of a man' upon resurrection (Augustine Enchiridon, 88). That is, Augustine's concern was not only out of sympathy for the disabled but also in support of the argument that they are part of God's design (Stainton, 2008). The medieval response to St. Augustine and the St. Benedictine was to provide "alms" and "charity" to the poor and marginalized rather than abandon or kill them, as the Spartans had done.
In a very different vein, Saint Francis of Assisi (1181-1226) revered the poor, sick and disabled, modeling his religious approach on that of Jesus. Francis's disciples divested themselves of worldly possessions, lived among the poor, sick and disabled, and dedicated their lives to serving those who were unable to care for themselves.
Early medieval writers in Europe treated speech as being a psychological rather than a corporeal function. Speech was considered to be the product of the soul's action upon the mind and the body.
Venerable Bede, writing in England in the late 7th and early 8th centuries, exemplifies this religious view of speech disorders. He described a stuttering regimen performed by the 7th century Bishop John of Beverly that combines a religious ritual with a bit of speech therapy:
… John told the poor lad to come to him, and when he had entered he ordered him to put out his tongue and show it to him; then he took him by the chin, and making the sign of the holy cross on his tongue, told him to retract it and speak. "Pronounce some word," he said: "say yea." The lad's tongue was loosed and at once he did what he was told. The bishop then proceeded to the names of letters: "Say A." and he said "A." "Now say B," he said, which the youth did. And when he had repeated the names of each of the letters after the bishop, the latter added syllables and words for him to repeat after him. When he had uttered every word accordingly, the bishop set him to repeat longer sentences, and he did so. All those who were present say that all that day and the next night, as long as he could keep awake, the youth never stopped saying something and expressing his own inner thoughts and wishes to others, which he had never been able to do previously (from Bede, 1995, p. 268).
Phonation and articulation were included in most medical texts in the early middle ages, but speech and injuries to it were considered to be beyond the power of the physician to intervene. Once the classical texts became available to those in the west, there was a renewed interest in examining the human body and its functions. Surgeons and anatomists in 16th century Europe shifted their views treating speech more as an anatomical phenomena than a god-given one.
Notable among the later medieval physicians who adopted the views of the classical medical writers like Galen, was Bernard of Gordon (1250-1318), who taught at the University of Montpellier in France. In his encyclopedia called Lily of Medicine, he presented a classification of the symptoms of speech disorders, dividing them into five types: (1) mutes, (2) those who express a concept with difficulty, (3) those who corrupt letters (e.g., those who cannot say the letter s) and (5) those who break words apart (Wollock, 1997, p. 365-366). Bernard subscribed to humor theory when assigning causes to speech problems, following the views of Galen. He, as did his predecessors, held that speech disorders of the tongue (articulation disorders), for example, were caused by an excess of moisture from the brain obstructing the lingual nerves (O'Neill, 1980, p. 163).
Medieval Latin education and rehabilitation
After 1100, at the onset of the High Middle Ages, those in the Latin West began studying ancient manuscripts that had been translated by Jewish scholars. This allowed them access to Greek and Arabic works on science, philosophy, and medicine. Christian monasteries were the primary centers of learning.
By 1200, colleges and universities had emerged as new centers of learning. Some universities were established by scholars, others grew out of professional guilds in which guild members aimed to train and control the members.
Universities generally specialized in a particular branch of learning; Bologna was famous for its law faculty, others for medicine or theology. Theology was the most prominent area of scholarship of the period as theologians sought to synthesize the rational philosophy of the Greeks with the Christian faith of the Latin West in an intellectual movement known as scholasticism.
Monastic schools were associated with monasteries. They were instituted early in this medieval period, in the sixth century. Individual teachers occasionally set schools of their own beginning in the mid-eleventh century. The teachers sometimes traveled. Peter Abelard, for example, conducted such a "school" at Melun in the very early eleventh century. Cathedral schools were associated with medieval churches. They were similar to monastic schools but the education was mostly for clerics.
The earliest universities to emerge were in Italy and France. Salerno, Italy was the site of the first, which as established in ninth century. Bologna, Italy its doors to higher education in the eleventh century (1088).Universities sometimes started as scholastic guilds, similar to tradesmen's guilds. Others grew from cathedral schools. For example, the cathedral school at Paris evolved into the University of Paris in 1160, known for its theological focus. Oxford and Cambridge in England also date from the 12th century, with Oxford beginning in 1167 and Cambridge in 1209.
Universities were divided into faculties, the four most common being arts, law, medicine, and theology. Some specialized. For example, the University at Salerno specialized in medicine, the University of Bologna in law.
Faculties within a single university had different curricula. For example, the subject of philosophy that emphasized the teachings of Aristotle was cultivated first and foremost in the arts faculty. When the newly translated works of Aristotle first appeared at the University of Paris they were incorporated into the curriculum in its faculty of arts.
The liberal arts curricula of the medieval universities typically consisted seven subjects. The main three, or trivium, were grammar (grammatical), rhetoric and Aristotelian logic (called dialectics). In the 12th century an additional four or the quadrivium were added in many universities. These included arithmetic, geometry, astronomy and music. Students studied classic works and wrote and presented their theses before a panel of faculty.
The three areas of the trivium included subjects that were defined in different ways than they are today. In medieval times grammar meant more than parts of speech, sentence structure, or morphology. It also included art of interpretation and entailed the study of a fully articulated science of interpretative analysis. Dialectics was taught as a means for testing evidence. That is, it was the study of proofs for an argument, a method of dialogue, or ways for analyzing logical structure. And rhetoric included oratory devices such as alliteration as well as the five other aspects of discourse laid out by Cicero: discovery, arrangement, memory, style and delivery. (inventio, dispositio, memoria, elocutio, and pronunciatio).
Alcuin, (735-804), an Englishman, founded several liberal arts schools and organized a significant library in York, England. Alcuin's schools taught the trivium—grammar, rhetoric, and logic. Among his pupils were many influential intellectuals. Alcuin was recruited by Charlemagne, emperor to what is now France, to head a school that elevated literacy and scholarship throughout the Europe.
A leading and long lasting figure in medical education of these medieval times was Constantine the African (1015-1087 AD). He studied and taught medicine at the University of Salerno, in Salerno, Italy in the 11th century. He attracted attention there for his translation and interpretation of ancient and Arabic medical texts of Galen and Avicenna. His translations became part of Salerno's medical curriculum and were subsequently used throughout the Latin East in medical education.
There were also efforts in the medieval Latin East to create methods for remediating and supporting those with disabilities and the deaf. Rudolphus Agricola (1444-1485), a 15th century Dutch scholar, for example, wrote about his having taught a person who was deaf to communicate orally and in writing.
Medical treatments of different disabilities were also available and followed traditional approaches, such as that offered by ancient ventricular theory. Augustine of Hippo recommended different treatments for impairments in different ventricles.
Since there is no bodily motion following sensation without an interval of time, and since we cannot act spontaneously after a lapse of time except with the aid of memory, the medical writers point out that there are three ventricles in the brain. One of these, which is in the front near the face, is the one from which all sensation comes; the second, which is in the back of the brain near the neck, is the one from which all motion comes; the third, which is between the first two, is where the medical writers place the seat of memory. Since movement follows sensation, a man without this seat of memory would be unable to know what he ought to do if he should forget what he has done. Now, the medical writers say that the existence of these ventricles has been proved by clear indications in cases in which these parts of the brain have been affected by some disease or pathological condition. For when sensation, motion, or memory of motion were impaired, there was a clear indication of the function of each ventricle, and by applying remedies to these different ventricles physicians determined which parts needed healing. (Augustine, 401/1982, vol. 2, pp. 18 - 19)
One popular method of rehabilitation during this time period was through miracles. Mystics and saints of the period were said to have cured a number of people with disabilities and health problems, including the following: resurrections of the dead, contagious illnesses, paralyses, wounds, and sterility. Among the highest reported incidence of cures were of those in which vision was restored to the blind, hearing and speech to the deaf, and mental health to whose who were mentally ill (Metzger, 2006, p. 130).