The late Middle Ages in England set the stage for medicine in the American colonies. Learn the hierarchy and structure of medicine going forward to America.

Medieval Medicine...

Medicine in the Middle Ages was essentially unchanged from the time of the ancient Greeks and Romans. Physicians of this time still followed the teachings of Hippocrates and Galan with very little new creative thought. What is interesting to note is the structure and politics of medicine during this period. The medical hierarchy was as follows: the Physician, surgeon, barber, midwife, and the wise woman. I wish to spend a little time explaining how this system worked as it does have relevance to early American medicine.

The Physician. The physician has always been a highly trained intellect and, for most of history, from the noble and wealthy classes. Even Hippocrates, the father of western medicine from 460 BC, attended school and learned medicine from his teacher Herodicus of Selymbria. Little changed in the Middle Ages (Middle Ages are roughly from the 5th century to 15th century) except politics.

Galen (129 ad) was one of the most influential teachers in history. He studied at the school of Alexandria established by Aristotle. Later he was the chief physician and surgeon to the gladiators which provided an excellent opportunity to study anatomy and wounds. He was then appointed to the court of Emperor Marcus Aurelius, which required him to abandon surgical treatment for “political reasons”. During this time he wrote 22 massive volumes of medicine representing over half the bulk of medical literature at that time. By the 16th century over 590 editions of Galen were published.

During this time the church (politics) influenced the lives of nearly everyone. Most physicians were Monks and were trained within the church. Laypersons, however, attended universities and consisted mainly of sons of the nobility. A typical education started at age 14 and spent 6 years studying liberal arts and two years of debate to obtain a bachelor of arts. Another year for a masters’ degree and then training in medicine. It took 10 years to become a physician in the 13th century.

The surgeon. The surgeon has always been second class to the physician. After all, in the days before antibiotics and anesthesia the odds of survival were slim and there were lawyers to file lawsuits even then. Hippocrates did not oppose surgery, but did not perform surgery, and said the only appropriate training for a surgeon was to find an army and follow it.

In 1215, Pope Innocent III issued the Fourth Lateran Council. This edict contained several directives which changed many aspects of medieval life including the forbidding of physicians from performing surgical procedures. The driving factor for this edict was political. In regards to surgery, the church was amassing great wealth and assets, and surgery, with dismal results, resulted in many lawsuits. As a result, the practice of surgery was relegated to craft status with training through apprenticeship, while highly trained physicians attended the wealthy.

Surgical training began at age 13 or 14 from lower-class yeomen or tradesmen and consisted of a 7-9 year apprenticeship. This provided him a first-stage qualification with a limited license to practice surgery “provided (he) does not exercise the art of medicine and does not style himself to be a physician.” Second stage training allowed designation of “Master of Anatomy and Surgery;” and advanced training received the “Bishop of London’s license.”

There were never very many physicians or surgeons. In the years 1350 – 1450, London consistently had around 10 physicians and up to 20 surgeons. This was fairly consistent for most of the major cities of Europe.

The barber. Yes the barber. The barber was always good with a blade. Through history the Buddhist monks used barbers as simple surgeons. Egyptian barbers examined teeth. Chinese barbers castrated eunuchs. The barber was beneath the surgeon and performed simple duties. Bloodletting, cupping therapy, pulling teeth, lance boils, and give enemas.

Even though the barber was of lesser status, they were able to establish a guild, the Barber’s Company, in London in 1308. The surgeons were not able to form a guild and became the Fellowship of Surgeons in 1365. As a result, prominent surgeons who held positions at court were also officers in the Barber Company. The Barber Company even claimed patronage and membership from Kings Edward IV and Richard III and received a royal charter in 1462.

Barbers and surgeons were rivals for prestige and patients. Alliances formed other trade guilds such as the Guild of Leeches and Brothmakers.

In 1540, King Henry VIII merged the separate barber guild and fellowship of surgeons into the Guild of Barbers and Surgeons of London, later to become the Royal College of Surgeons. By doing so there was a framework for surgical education within the guild system and surgical skills were legitimized through governmental recognition.

The surgeon slowly established itself as a profession and in 1745 the two professions were separated by King George II establishing the London College of Surgeons and by this time surgeons were university educated.

The Apothecary. This was the equivalent of the pharmacist today. The physician would write a prescription and the apothecarist would fill it. However, only the wealthy could afford a physician or even a surgeon. As a result, most people were diagnosed and treated by the apothecarist, especially in rural areas without a physician. Commonly a monk or priest would fill this role and the person would make a donation to the church for his services. Originally, the apothecary belonged the Grocers Guild formed in 1340. It was 1617 before they split and had their own The Worshipful Society of Apothecaries of London.

The midwife. During the early Middle Ages women practiced medicine as much as the men and were not limited to obstetrical cases and female patients. However, once university trained physicians began in 13th century, women were excluded from advanced medical education. No university educated and trained physician would deal with women’s issues and pregnancy, probably because of puritan modesty of the time. Women cared for women. A midwife had no guild and learned her trade by apprenticeship to other midwives or from fathers or husbands who were medical men.

The “wise women”. These women were lay healers and usually the first person contacted by poorer people. Rural areas and small towns usually didn’t have a doctor and so the wise women together with the midwife provided obstetrical and nearly all the primary care. They were women from low or high birth and nuns. The therapies consisted of herbs, home remedies, purges, bloodletting, and native intelligence. In the 13th century women were barred from the university and so these women healers began to face opposition. They were ineligible as healers and those that persisted faced harsh punishment. From around 1300 ad to 1700 ad, female healers became the target of witch-hunting. This was the power of the church and supported by civil authorities.

This is what constituted the medical framework of England and Europe up to the time of British colonization of the Americas in 1607 in Jamestown, Virginia. Now explore what medicine was like in America up to 1900s.