When the Roman Empire was invaded by the Barbarians, between the years 300 and 800, some of the religious orders during the Middle Ages collected and preserved a large part of Greco-Roman culture, namely countless medical manuscripts. This contributed toward the Church’s strong influence on the development of Medicine at that time. Monastic medicine was simple and popular. Monks not only used medicines extracted from medicinal plants grown in the monasteries’ gardens, but they also founded inns and small hospitals next to the monasteries where they could examine their patients.

One of the most prestigious monasteries was that of Monte Cassino, in Italy, founded in the 6th century by Benedict of Nursia, better known as Saint Benedict, giving rise to the Benedictine Order.

One of the most prestigious monasteries was that of Monte Cassino, in Italy, founded in the 6th century by Benedict of Nursia, better known as Saint Benedict, giving rise to the Benedictine Order.

The 10th century marked the founding of the Salerno School, the first lay school for teaching Medicine with the intention of electing the first faculty of medicine in the West. It was strongly influenced by Greek, Arab, Jewish medicines, Galenical and Hippocratic traditions, and the practice of surgery, while disregarding the practice of superstitions. It attempted to foster a new concept of teaching, a new medical literature, coming up with an outline of what university life should be, while chiefly having contributed towards developing medicine as a profession.

Given its immense fame, Salerno School was attended by countless students from a wide variety of countries. Teaching there was basically practical and allowed females students to attend. The vast majority of the books used were written by the school’s teachers, comprising educational features, annotations and comments along with translations of works originally written in Arabic. The medical study programme lasted five years, plus the requirement to attend preparatory studies; at the end, students were granted a licence to be able to practise the profession of physician.

The most famous physicians from Salerno School include Benevenuto Grasso, Gilles de Corbeil and Rogerius Frugardi.

Although Europe’s first physicians belonged to religious orders, from the 12th century monastic medicine began to decline (and was even prohibited in the following century), as church officials suspected that monks were too busy with their medical duties at the expenses of their religious duties.

The mid-12th century saw the founding of several universities throughout Europe, such as that of Bologna (one of the oldest European universities), Paris, Montpellier (which was notable early on as the centre of medical teaching in the Middle Ages), Oxford and Cambridge (the first English universities) and Padua (Italy’s second largest university, recognised in the early 13th century, which quickly became enormously successful, even more so than the University of Bologna).

From the 13th century, medical teaching was lectured at lay schools and universities, such as those of Paris or London. Hospitals were also created throughout Europe. Several universities were gradually founded in other European countries, such as Portugal, Spain, or Italy, totalling 16 educational institutions, in the late 13th century.

Just like throughout Western Europe, so, too, in Portugal medicine during the Middle Ages was taught at convents and monasteries, namely at Santa Cruz in Coimbra and in Alcobaça.

The vast majority of these institutions also comprised annexes, which were originally created to house patients, but were mostly used as accommodation for travellers, pilgrims and the poor.

Medicine, which had become quite a reputable profession at that time, was practised solely at convents and monasteries by members of the clergy, the most privileged social class and the only one endowed with knowledge. Along with these, there were charlatans and the curious, who sought to provide health care to the populace, despite not having training of any kind.

The low number of existing physicians merely provided care to the royal family and to those of the upper strata of society, while the general population would turn to traditional remedies recommended by healers and by Jewish doctors.

The first Portuguese university was founded in Lisbon in 1288, during the reign of King Dinis: it was originally called “General Study of Lisbon,” according to the Papal Bull issued by Pope Nicholas IV in 1290, which mentioned not only the University’s status, but also the various subjects that were to be lectured at that institution, including Physics (the name given to Medicine at that time).

Later on, the General Study was transferred five times between Coimbra and Lisbon, and was permanently established in Coimbra in 1537, in the reign of King John III. Only after the foundation of the Portuguese Republic in 1911 was the University of Lisbon itself founded.

Medical knowledge was conveyed by members of the religious orders, who had acquired such know-how at foreign universities such as Paris or Montpellier, through royal financial aid. For instance, we refer to canon Mendo Dias, regarded as the first lecturer of medicine in Portugal: after having attended the University of Paris, where he learned Theology and Medicine, while making use of a hospital (considered the “the first school hospital”) which, in the meantime, had been founded near Santa Cruz Monastery, he began to lecture medicine in the traditional manner, that is, by reading classical texts of Greco-Roman and Arab medicine, but also with practical applications thereof.

In organisational and programming terms, we know very little about how Medicine was taught at that time in this country; however, we suppose it was based on Hippocratic works and on the Greco-Roman school that had been compiled and commented on by the Arabs, even though the latter had disregarded some of the classical knowledge passed on, perhaps due to religious prejudice.

After attending the study programme for five years, which we accept occurred via a scholarship created in 1291, the student was granted the graduate degree, when professors deemed them to be credible to practise and lecture Medicine.

In view of the existing serious situation in Portugal regarding the medical profession and the teaching of medicine, namely with regard to the clergy’s reliance on foreign universities or to the high costs of sending students to study abroad, kings decided to undertake various reforms in order to change that situation.

And so, in 1357 King Pedro I created a tax for those wishing to study abroad and, later on, was against lecturing medicine outside the university, as there were students external to the institution. In 1377, King Fernando decided to hire various foreign professors. Likewise, King John I implemented several modifications and directives in lecturing medicine, among others, that the training of students seeking to obtain the doctoral degree should culminate with a scientific exam.

In the reign of King Manuel I, the lecturing of Medicine was organised into two chairs (“Prima” and “Véspera”) and we are aware of the existence of three academic degrees: bachelor’s, graduate and doctoral. Medical candidates had to have a bachelor of Arts. It was decided on the colour yellow to characterise the doctoral insignias in medicine, as well as for the protocols of academic actions and the conditions for earning said degrees.

As was the case in previous centuries, the lecturing of medicine was still based solely on listening to ancient texts in Latin, but with no practical experience, whereas the teaching of surgery was lectured outside the university via barbers and other resourceful individuals.

In the 15th and 16th centuries, existing physicians on the Iberian Peninsula were, for the most part, Jews, who had obtained their training outside educational systems. Despite it being forbidden for them to practise their profession, they were enormously important throughout Europe, where they became protected and favoured by several monarchs.

Perhaps due to the incompetence of existing graduates at the time, King John II not only lent continuity to the provisions enacted by King John I, but he also decreed that physicians, surgeons, whether Jews or from other origins, could be considered health professionals only after having been undergone an exam by the head physician or head surgeon and having been bestowed the royal seal.

From 1492, there was enormous development in the lecturing of medicine and in the medical profession, with the founding of the All Saints Royal Hospital, also in the reign of King John II, followed, later on, by the founding of the confraternity of “Nossa Senhora da Misericórdia” (Our Lady of Mercy).

Likewise, King Manuel I, with his visionary character, ordered that the teaching of surgery, hitherto separate from the lecturing of medicine, should become part of medical training and that it should be lectured at that hospital.

Kings John II and Manuel I are credited with the profound changes that were undertaken with regard to organising health care for the populace. This is why the old inns were replaced with new hospital institutions.

Faced with the refusal of Medicine chair holders regarding the transfer of the University of Lisbon to Coimbra, following King John III’s decision in 1537, the king availed himself of the opportunity to introduce another reform that would dignify the lecturing of medicine, by calling for the training and hiring of foreign professors. Later on, there was a large number of university lecturers of great merit in the teaching of medicine in Portugal, as, from the outset, this king favoured the teaching of theology and, afterwards, Anatomy and Surgery.

The Medicine study programme, which was only lectured in Coimbra, lasting six years plus two years of occupational practice, required possible candidates to hold the bachelor of Arts degree. The lecturing of medicine was based on the conveyance of classical knowledge chiefly in the comments and interpretations of classical texts, particularly those of Galen and Hippocrates as well as empirical knowledge (observation of the human body) via clinical practice, where students came in contact with the hospital’s internal patients and those outside the hospital, with the nature of illnesses and their treatments.

At that time, the lecturing of medicine in Spain was quite reputable, particularly in Barcelona and Salamanca. In the 16th and 17th centuries, several Spanish physicians came to Portugal to lecture; there is also information showing that Portuguese physicians lectured at various universities, among them Salamanca.

Following the reform introduced by King John III, the lecturing of medicine comprised a duration and a degree of difficulty that were much greater compared to the teaching at Spanish universities. This led Portuguese students to prefer attending university there, as they would later only sit for Portugal’s equivalence exam before the head physician.

Despite the occurrence of a certain scientific development in the 16th century in Portugal, after the lecturing of medicine once again returned to Hippocratic medicine, the medical field suffered an enormous setback due to the expulsion of the Jews (who were considered the part of society with the largest and most advanced percentage of Portuguese physicians and surgeons), the establishment of the Inquisition and the considerable influence of the Jesuits in every area of teaching in this country.

These factors gave rise to an enormous crisis as a result of the established system.

Despite the continued existence of a significant lack of physicians and surgeons, and because a few students were able to study abroad, the opportunity to lecture in hospitals also arose.

By that time, equal rights were granted to both professionals who had attended the University of Coimbra, those who had earned their degree at foreign universities, and those who knew only some of the basics of medicine, even if they had never attended a study programme. All that the latter needed was to bring forth witnesses who would approve their skills. These were known as idiots or “mata-sanos” (incompetent doctors).

They could all practise medicine with the consent of the head physician, which was allowed with enormous dexterity.

From 1608, the head physician’s authorisation, which was granted only to candidates taught at hospitals, was valid only in towns where there were no physicians that graduated from the University of Coimbra. After countless complaints against the power of the head physician, the evaluation mission and approval of external candidates were permanently transferred and made equivalent to a high-end position in the university career.

Due to the deficient knowledge, political and social instability, it is believed that not even the holders of a bachelor’s degree had appropriate clinical knowledge, and not even the “mata-sanos” were altogether unnecessary in towns located far away from major centres.

In opposition to the reform undertaken by King John III, which sought to bring about improved quality of medical teaching nationwide, the medical career started to be regarded with enormous unbelief and disfavour, as it was deemed to be made up of people unfit for practising the profession, as a result of a loss of independence, a large number of members who were unskilled but authorised to practise the medical profession, to the existence of a large number of skilled doctors at Spanish universities and the expulsion of Jewish physicians.

We should also point out the discrimination, which existed in the 16th century, regarding race or religion, which contributed toward prohibiting access to the lecturing of medicine and to medical practice and making these dependent on the Inquisition, despite the low number of professionals in this field.

In 1568, in order to support medical studies for “old” Christians, King Sebastian determined that they should be granted an annual pension that students in pharmaceutical studies would later benefit from.

In the 16th century, we should highlight a few Portuguese physicians who contributed to achieving international recognition for Portuguese Medicine

Garcia de Orta (1501-1568) conducted studies in medicine, anatomy and botany based on direct observation and systematising of results, according to analyses and therapeutic uses of the Indian flora that he conducted in India (where he died) and which gave rise to the published work Colóquios dos Simples e Drogas he cousas Medicinais da India… first published in 1563.

Amato Lusitano, (1511-1568) whose real name was João Rodrigues de Castelo Branco, a physician of Jewish origin.

Amato Lusitano was an anatomist and clinician, along with having conducted major studies in the fields of surgery and botany. His main written work is entitled “Centúrias e Curas Médicas.”

Rodrigo Castro, (c.1546-1627/29?), a Jewish physician, regarded as the pioneer of Portuguese gynaecology thanks to his work “A Medicina Geral da Mulher,” divided into two parts in an eight-volume set.

Antonio Luis, professor at the University of Coimbra, profoundly knowledgeable in Greek and Latin, published the book “Problematum libri,” where he condensed into 5 volumes every document translated and commented on from the originals by Galen as well as the texts attributed to Hippocrates.

Henrique Jorge Henriques (1545? – 1622) precursor of food hygiene, also distinguished himself in deontology and medical ethics. In his work published in 1595, entitled “No Retrato del perfecto medico,” he reports on the procedures that needed to be observed in the medical profession.

From the 17th century, we begin to notice a certain discrepancy between Portugal and other European countries regarding scientific development. We notice that teaching and the medical profession in this country began to decline in that century, compared to the previous century, due to political and religious factors, despite efforts by several kings to implement some reforms, as well as the international recognition of some Portuguese physicians.

Lurdes Barata

Library and Information Area

Editorial Team