continued from History of Public Health(part 2)
THE DARK AGES AND THE MEDIEVAL PERIOD
During the Dark Ages (about 500–1000 C.E.), Western Europe experienced a period of social and political disintegration. Large cities disappeared, replaced by small villages surrounding the castles of feudal chiefs. The only unifying force was Christianity, and it was in the monasteries that the learning and culture of the Greco-Roman world was preserved. Furthermore, in many of these institutions, piped water supplies, sanitary sewers, privies, bathing facilities, and heating and ventilation were provided. In addition, some monasteries constructed hospices to shelter travelers and sick persons, though the medical care provided in them was primitive at best. In Eastern Europe and Asia Minor, however, feudalism did not exist, and medicine advanced and became centered in major secular hospitals established in Byzantium, Baghdad, and Cairo.
The most important disease of the period was leprosy, manifested by a continent-wide epidemic beginning in the sixth century and lasting through the fifteenth. Lepers were excluded from communities and segregated. Elaborate rules and regulations were set up to diagnose the disease and isolate cases. Leper houses (leprosaria) were established, and it is estimated that by the end of the twelfth century there were 19,000 such houses throughout Europe. Isolation of cases of leprosy in medieval times represents the earliest application of a public health practice still in use.
By about 1000 C.E., the stagnation in the West gave way to change. Feudal fiefdoms were being consolidated into nation states, cities and towns were growing, education was beginning to be secularized, and the Crusades were bringing increased interaction between the Islamic East and the Christian West. As these changes occurred, the responsibility for communal functions was transferred from the feudal lords and ecclesiastic authorities to lay councils presided over by a hierarchy of hereditary or appointed officials. Public health activities, such as overseeing the water supply and sewerage, street cleaning, and supervision of the markets, fell under the jurisdiction of the councils.
The establishment, in Salerno, Italy, of the first organized medical school was indicative of the changes occurring in Western Europe. This institution, founded in the eleventh or twelfth century, was particularly remarkable for two reasons: It was a lay organization, independent of the church, and it welcomed students of any race or creed. Its faculty included women, who apparently dealt with obstetric issues, and the renowned peripatetic scholar, Constantine the African (1020–1087), who translated many important Arabic works into Latin. Its most prominent literary product was the Regimen Sanitatis Salernitanum, a lengthy poem, prescribing healthy habits from birth to old age. Drawing on the whole corpus of Greco-Roman and Arabian medical writings the Regimenemphasized personal hygiene, diet, exercise, and temperance. It was the first "health guide" for the masses.
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