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This timeline of the Medical Industrial Complex focuses on more than five hundred years of violence and disregard that masks itself as care. It tells the truth about white supremacy, racial capitalism, ableism, trans- and homophobia, misogyny, and more. It is also a conversation regarding the role of Christian supremacy and colonization, anti-Black racism, and the violence of Indigenous disappearance as part of what has shaped the current structure of healthcare. This timeline is primarily focused on those nations in North America established by British imperialism, which means that it is also a timeline about the habits of Anglo Christian culture that became the cultural blueprint for both the United States and Canada. And finally, this is a story about a historical cycle of violence.

As abolitionists, we know that the work of taking down violent systems, to make space for connection and care, includes a deep understanding of the roots of the structure that causes harm, and the work needed to transform those roots. Without doing this, by only focusing on reform, we end up building bridges over a wound so that those who have access to the bridge can move across safely, while those who don’t have access continue to be harmed by what has not changed. This phenomenon is what makes it possible to have legal changes, such as those created through the Civil Rights Act and over 50 years later, see instances of higher percentages of racial segregation, in schools and neighborhoods, than before the Act’s passage. Transforming these injustices demands deep work at the roots of the conditions themselves.

For us, this includes interrogating the habits of isolation, targeting, objectification, surveillance, ownership, and control that have shaped the Medical Industrial Complex since it first emerged. As community curators, we’ve had a lot of conversations about how we can name the wounds that settlers brought to Turtle Island without centering white/European Christian histories. Our goal is to begin with the experiences of those most impacted by this system, particularly Black and Indigenous people, and to also see the wider impacts of emigration, immigration, and refugee experiences of people from the Global South who have been forcibly displaced and violently targeted as they arrived in North America. At the same time, we know that it is too easy to imagine that the violence forced upon Turtle Island (the indigenous name for North America) just emerged on this land without its own beginnings and evolution.

This is the story of a wound that turned itself into a weapon that is held in the guns, the politics, the cultural practices, and the bodies of the colonizers of Turtle Island for the British empire. As both practitioners and organizers, we know that anything can be a tool or a weapon, depending on how it is used. This includes Christianity, a faith that has been powerful and supportive for many people even as it became institutionalized into a system that violently destroyed many cultures and ways of being. For the purpose of this Story of the Colonial Wound, we will separate individual people’s faith from the formal systems and institutions of Christianity.

While the systems of care outlined in this story were evolving, multiple equally complex forms of care were emerging or continuing to deepen, after hundreds and sometimes thousands of years of practice. This is the story of the lineage lifted up by the American Medical Association in 1844 when it began to define what constituted “real” medicine versus “fake.”

For most of the time that the United States has existed, and certainly during the time when the systems that created the social order of the U.S. were emerging, “American” history has defined itself as evolving from cultural lineages that emerged from the Greek and Roman Empires, developed in Britain and other Northern European countries, and then “settled” and occupied the lands now called the United States. This history, while not the lineage of all people who live on Turtle Island, is the dominant history that has shaped the infrastructure of the United States, and by extension its medical system.

This story is intended to help explain how this structure was created out of colonization and slavery. There is no single story or single interpretation of an incident. As community historians, we offer this as just one story and one interpretation. We track several different arcs that weave together to form the structure of British Christian imperialism that shaped the majority of the colonization of the continent now known as North America and the nation now known as the United States. Other story arcs also offer pieces of this early history. This story is painted in broad strokes, with moments of historical clarity that show a pattern, and hundreds of years of action and inaction surrounding them. For every year, or period of five years, or generation written about on this timeline, assume a mix of chaos, control, and contradiction; resistance, extremism, and reclamation; all colliding to create the nuanced contexts in which these events took place.

Shaping of state control, private property and ownership

A map of now-Europe and Africa, centering the Mediterranean Sea, showcasing the trade networks of the Roman Empire (shaded in purple).

About 2200 years ago, the armies of the Roman Empire reached the Atlantic and crossed into what we now call England. While that island had been colonized and shaped by many other cultural forces, the Roman Empire’s strategies across Western Europe did not just focus on conquering and stealing but also on the forced Romanization of those it conquered.

As the Roman Empire reached the island of Great Britain, the concept of private property was being written into Roman law. Called dominium or proprietas, these terms referred to the rights, privileges, and powers that a “legal” person had over a thing. A “legal” person was a way to distinguish between a Roman and someone who was enslaved. This concept of private property or ownership was a legal assignation that helped the Romans determine who got to keep the resources of conquest. Over time, this legal concept kept expanding and getting more specific in stipulating about how materials, including bodies as objects, could be handed off to another person (such as the leases that we have in the present day for cars and motorcycles). Roman property law also outlined the inherent power that the “head of household” held, which applied a patriarchal structure to private ownership, concepts of inheritance, and more. All of these did not exist as legal or formal structures prior to this shift in Roman law. Instead, how objects were shared was tied to specific cultural rules that changed over time.

Roman colonizers brought their enslavement practices and understanding of who counted as a legal person to what would become known as the British isles. Britain, the furthest western outpost of the Empire, became a primary market for enslavement. Enslavement during this period was not tied to a single race or ethnicity. People from all around the Mediterranean, across the Baltic states, into Russia and more were enslaved. The word “slave”’ itself came from the word for Slav, which meant someone from the area we now call Eastern Europe. Anyone could be enslaved, for their resistance to Christianity and Roman rule. The Roman colonizers used the same tactics that all colonial forces use: they replaced local cultural traditions and practices with Roman ones, used violence and other strategies to control the population, and extracted as many resources from the land as possible. Just as would happen later in the Americas, part of the strategy of Roman colonization was to use wine and other forms of alcohol as tools of control. The Celtic peoples had not previously used alcohol and therefore had a low tolerance for it; the wine weakened and overwhelmed those who were not accustomed to consuming it. Celtic cultures also did not use money. This meant that there had to be an incentive to move to a currency-based system rather than a trade-system. After the introduction of wine, alcohol addiction spread widely, and wine became a prized commodity that Romans used in the markets as currency. These markets traded more than barley and sheep; they traded people, who had been enslaved from across the Empire, including some who were native to the island. Trading one enslaved person for an amphora (about seven gallons) of wine, became known as a "Celtic bargain."

Illustrated map in pink of current-day England and Wales, with a geographical section colored in a darker red.

In Britain, as well as other lands, Romans established marketplaces and expanded trade routes that increased the island’s connection to the continent while also steering profits into the pockets of the Romans. And, as with all colonization, there was resistance. Within twenty years, the Iceni, an indigenous tribe, revolted against the Romans in Britain. The Iceni were one of the indigenous peoples of Britain who initially welcomed the Romans, in the hopes of building relationships and fostering trade. As Roman expansion continued, Boudicca, the leader of the Iceni (who also happened to be a woman), led a rebellion against the imperial forces by pulling together a collaboration of southern tribes. Although they were eventually defeated, Boudicca’s rebellion was the largest rebellion recorded against the Roman empire. The word recorded is important here. One of the primary reasons that Roman generals wrote about Boudicca was their surprise that she was a woman, and that she was successful for years in leading the rebellion of her people. Most large-scale resistance forces were not recorded, whether in England or on Turtle Island. The history that is written in books is, most often, the history of the people who won a battle, not of those who fought against the imperial power.

At this point in time, the leaders of the Roman Empire were not Christian. Christianity was still a marginalized sect of people who were either targeted as dangerous, and so attacked, or completely ignored. In the year 260, as the legal control of property expanded, the Church in Rome was granted the right to own property. This meant that the Christian Church was recognized as a legal and therefore “real” entity. The Roman emperor Gallienus made the legal change; he granted the Christian Church the right to own property and officially recognized the Church, ending its time as an outsider sect. This mattered for the role that the Christian (what later became identified as the Catholic) church played in colonization. It was the root for the Doctrine of Discovery which granted the Catholic Church the right to claim any lands it “discovered” as Christian, and therefore as its property.

Shortly after this, (Saint) Augustine asserted the concept of a “holy war” as the duty and obligation of Christianity. In its earliest origin, Christianity was a pacifist faith, focused more on alleviating poverty than missionizing and forcing others to become Christian. Augustine pushed against that, believing that Christianity needed to be spread as the “true” religion and that war was a part of life. He asserted that while war was always the result of “sin," war could also remedy “sin." He named violence as justified when it was used to protect the “innocent” from the “dangerous.” This concept of “holy war” defined the coming colonization of Christian lands, and later the Crusades, and later still was used as justification for the Christian colonization of the Americas. It also served as the justification for the shaping of eugenic policies.

A white marble stone carving of a head with European features of the liking of Roman Emperor Constantine I.

This all coalesced in 312, when Constantine became the first Roman Emperor to convert to Christianity. Constantine’s focus on the expansion of the Roman Empire included increasing Christian conversions. In agreement with Augustine, he saw Christianity as a missionizing faith, focused more on converting people to Christianity than on ending poverty and asserting pacifism in the face of war. This task of converting believers combined with the expansion of the Empire, and the two were viewed as one and the same: the Roman Empire became synonymous with the spread of Christianity. The shift was not immediate. It emerged gradually, like all practices and belief systems.

While in 409 the Roman Empire formally retreated from England and the lands surrounding it, the slave trade did not. The slave trade was now a fully integrated part of the market economy. As Viking raiders began crossing into northern Europe and Russia, they established a slave trade that competed with the slave trades of southern Europe where the Roman Empire remained in power. Bristol, England and Dublin, Ireland had the largest slave markets during the 1100s and 1200s, with the enslaved primarily coming from across Western and Eastern Europe and the lands around the Mediterranean. These same ports eventually became the primary British ports of exit for the North Atlantic Slave Trade.

The Christianization of Europe continued, even after the Romans left. The Christian Church was fierce in its commitment to converting “souls” as a sign of its strength. The intensity of the European Christians’ fight to “win” souls, and the bodies that housed them, sounds to the contemporary mind like an expression of a cycle of violence. A cycle of violence is defined by a collective trauma response in which unhealed trauma gets passed down. When a community is exposed to high levels of continuous violence people either freeze, by becoming numb and shutting down, fight, often by turning on each other rather than on the source of the violence, or flee.

Old oak tree leans to the left, without leaves because of cold weather

Another strategy, later repeated on Turtle Island, was the strategy of “cleansing” the land of older traditions and cultural practices. In 601, Pope Gregory called for the “cleansing” of Celtic, Roman, and other sacred sites in England for Christian use. In particular, he called for the smashing of idols, naming them as “devil worship.” In 743, the Synod of Liftinae forbade the worship of trees and plants, including indigenous practices of being connected to land as a source of spirit and culture. Out of this Synod, or gathering, the Church banned those living in Catholic lands from honoring (“worshiping”) trees, stones, collecting herbs, decorating springs and wells, and practicing death rituals outside of the church. These practices were deemed “heathen.”

The movement to end “heathen” beliefs intensified as local people continued to follow their pre-Christian traditions. Charlemagne was the first Christian leader to build a strategy around forced conversion; previously, conversions had been manipulative but not forced at the end of the sword. In 773, King Charlemagne increased the destruction of sacred sites; his forces reached all of Western Europe, and were credited with uniting Europe, and defeating pagan tribes. Some of the pagan sacred sites were destroyed, and others were turned into Christian sites. There are churches all over Western Europe with stones in their walls that exhibit carvings and images from earlier belief systems. Charlemagne also directed his troops to decimate entire old growth forests, which were sacred to the local people, to provide lumber for his army and to build forts and churches.

By the year 1014, the institution of slavery was vast and spread over the entire British Isles. Enslavement was a deeply embedded part of the British economy and the emerging British Catholic Church. It is estimated that 1/10th of the entire population of what is now called Great Britain were enslaved during this period, rising to 1/5th in the west country of Somerset, Devon, Dorset and Cornwall. This intensified Christianization continued into 1061 when Pope Alexander II developed Christian recruitment strategies tied to religious conversions. Those captured in territorial battles and willing to convert to Christianity were promised freedom rather than enslavement, torture, or other forms of violence.

An illustrated castle with multiple floors depicts feudal society in medieval Europe, from the church and king to freemen and serfs.

In 1066, the Norman (French) conquest of Anglo-Saxon Britain prompted another cultural shift as the French invaders, aligned with the wealthy classes, established a new system for managing land: feudalism. The feudal system consolidated wealth among landowners and put the responsibility for labor on workers. Land ownership was granted through inheritance or royal decree. Workers could not buy property or accrue wealth. People had to be part of the owning class - or placed into the owners’ class by a royal in order to purchase land. This system was a European form of sharecropping. It was declared that royalty was granted by the Christian God, and the King was the voice of God throughout the land. Since the feudal system was believed to be established by God, it could not be changed.

Feudalism established the foundation of the British class system. This system contributed to the eventual land hunger of waves of settlers leaving the feudal structures of their home countries to gain their own land and “freedom” on Turtle Island.

This was not the only cultural shift happening across Western Europe. The destabilization of the Roman Empire and the Christian missionizing wave inspired multiple waves of resistance that showed heightened adherence to traditional ways as well as the emergence of new structures and belief systems. It was a time of significant religious and cultural revolution. There was movement in all directions, with a push down from the tribal people of the north against these incoming religious/economic/political beliefs, as well as resistance from the lands to the south and East.

Old map of the Roman empire with colored territories, depicted via the key the different Christian and Mohammedan Territories.

Islam was also an emerging spiritual and political force that gained strength in many of the former lands of the Roman Empire. Communities fought to hold on to their traditional connections to land, culture, and spirit against both Christian and Islamic influences. In 1096, the Catholic Church even more forcefully asserted its commitment to the Holy War by calling for the First Crusades. The crusades were a series of Christian religious wars aimed at "reclaiming" the "Holy Land'' from Islam and for the Latin church. This militarized Christianity allowed no space for any beliefs or cultural practices other than Christianity. The Crusades instigated a rash of Christian ferocity resulting in anti-Jewish, anti-Muslim, and anti-pagan massacres across western Europe. Jews and Muslims were expelled from across the Christian empire. “Heathens” were forced to convert, killed, or driven from their traditional lands. Many of the knights who fought in the Crusades successfully were granted land upon return to England. These land grants became another layer in the emerging class system, as fighting for Christianity became one of the ways to move out of the status of worker and into the status of owner.

In 1147, there was a call by the Pope for the Second Crusades. This fight continued across the borders of Christian lands and carried the particular goal of Christianizing Jerusalem and seizing its surrounding lands. As with the First Crusade, successful knights were granted property upon returning to England.

In 1285, an English legal structure emerged that identified ownership of land and of other forms of property, as something that could be held by a private person rather than only given by the King to a private person. This meant that an individual could transfer ownership to another individual without the King’s approval. This shift was not immediate, but by the 1500s (likely in response to the encounter with Turtle Island) the right to own property and hand property over to descendants had stabilized into a standard legal principle.

These waves of struggle over culture and faith coalesced in 1515 as the Protestant Reformation swept through Europe. Much of the settlement of what became the United States began with the Protestant Reformation. The tension between Catholics and Protestants defined who migrated to the colonies and why. An incomplete version of this origin story is still handed down through Thanksgiving narratives and early history books, which portray the Pilgrims as people pursuing religious freedom. These stories generally simplify the complex history of cultural unsettling and generational feuds over what it meant to be [insert identity of tribe or nation].

A crowd stands behind a man writing on a door with a cartoonishly long feather. Some help him carry it. Other men kneel or gather elsewhere.

The Protestant Reformation, in its simplest form, fought for the right of the individual to have a private relationship with God rather than for the relationship to be determined by a priest. Just as private property was now something an individual could hold, rather than something that had to be granted by the King, a person’s spiritual life became individualized rather than primarily experienced through collective worship. Like all things, this cultural change became both a tool and a weapon. It pushed back against the profound corruption of the Catholic Church, removing the priest from having the power to determine whether a person was “innocent” or “dangerous;” it also functionally ended the collective nature of how faith, spirit, and culture were previously held in European communities. A person could now have a faith or a belief system of their own, not defined by their community. An individual could now determine, on their own, whether their actions were justified in the face of God. This shift was the latest in an evolution away from communal life to a more individualistic life.

This cultural shift gained even more traction with the invention of the printing press. Literacy increased and the primacy of the written word began to expand. This brought about change on multiple levels: both fostering independence movements, and increasing the centrality of the individual rather than the collective. Now non-clerical people could read the Bible and interpret it on their own.

Moving from care to control

Along with this shift away from the centrality of priests and kings came new systems of care that were not completely dependent on the King’s favor. In 1601, during a period of economic depression, large scale unemployment, and famine, the Elizabethan Poor Laws were passed. These laws created a system of social welfare that was then transplanted to the colonies. The laws normalized leveraging taxes to support the poor, and asserted a difference between the "deserving" and the "undeserving" poor. The laws identified three categories of people seeking relief: the vagrant, the involuntarily unemployed, and the helpless. Children who could not be supported by their parents were forced into apprenticeships where they received basic needs support in exchange for their labor. Any able-bodied person or “vagrant” who refused to work could be imprisoned and/or fined. Care systems, once headed by kings or priests, now began to move into the general population. What made a person “deserving” of care began to center around productivity and work, along with other cultural concepts such as being “healthy” or “unclean.”

These laws also broke up regions into settlement areas for the distribution of aid. Outdoor relief referred to care given in people's homes and in public spaces, while indoor relief referred to care given within institutions established for this purpose. Other poverty mitigation strategies included auctioning off poor people to rich families, who then provided care in exchange for their service, and placing poor and sick individuals with married couples who "volunteered" their care and support for those considered deserving. This “volunteering” sometimes included expectations of labor, often expectations that turned this “care” strategy into another form of indentured servitude. In 1662, this law was expanded to include the Law of Settlement and Removal. This law allowed the government to force any impoverished individual, or family, from a town back to their local parish. In this way, government aid was only given to those who were officially residents of a town and withheld from everyone else. These were some of the legal structures that enabled the British government to send unaccompanied children to the Colonies to work as laborers.

At this point, some of the same strategies designed to organize and control populations in Europe began to shape what was happening in the Colonies. In 1625, the concept of “eminent domain” emerged. A Dutch lawyer, Hugo Grotius, coined the term “eminent domain” to refer to the right of the state to seize private property. This legal concept has since been used to justify everything from colonization, seizing of land for the state, to the building of hospitals and highways in poor neighborhoods, where land is forcibly taken by the state with some amount of compensation to the residents, through “treaties” or property buyouts.

A ground stone for John Locke reads

The final major shift in British legal theory which shaped colonization on Turtle Island took place in 1690 when John Locke asserted his theory of property rights. In his essay, The Second Treatise of Government, Locke asserted that all resources have been created for the common good but that a person can seize or appropriate those goods if he can prove that he has labored for them. This is different from other European theories that bestow the right to seize property on the merit of perceived superiority or strength. Locke adds this nuance of labor entitlement: the person who works the hardest is entitled to have the most. This idea significantly shapes British imperialism, and is used by thinkers in the United States and Canada to justify territorial expansion.

Understandings of healing and the body and ableism

Concepts of “healthy” and “unhealthy” have varied across culture and time but the roots of the English word “healthy” are theorized to be between 5500 and 6700 years ago. The earliest traceable origin of the word means “whole, uninjured, of good omen.” In future centuries, (especially the 19th and 20th centuries) the word health became aligned with concepts of purity, of having “good bones and genes,” and/or meaning a person who is impervious to disease. This concept of health was used to justify the eugenic practice of removing the genetic materials of people perceived as diseased and unfit, including disabled, Black, Indigenous, immigrants, queer, trans, and poor communities.

What we call “Western medicine” emerged out of a mix of older indigenous European belief systems which centered around plant medicine, touch- or body-work, various types of emergency physical repair, and other cultural healing practices. These combined with Greek and Roman approaches to care and medicine, which themselves emerged out of cross-Mediterranean culture, and knowledge exchange which emerged from conversations about health and well-being with communities in northern Africa and African lands further south. Western medicine, also called allopathic medicine or biomedical care, has multiple lineages that collided with 19th century understandings of germ theory to bring us to where we are today. Most of the original lineages of Western medicine have long been subsumed, within Western medicine which identifies itself as the most viable form of medicine, without recognition of the many traditions that shaped its practices.

Map of northern Africa from Libya and Egypt to Kenya and the Democratic Republic of the Congo that outlines the Nile river in a bold blue.

It matters that many of the care practices that Western Europeans learned from Egyptian leaders were previously learned by those Egyptians from cultural trade among those living in the Nile basin–the lands now named as Sudan, Tanzania, Burundi, Rwanda, Kenya, Uganda, Ethiopia, and the Democratic Republic of the Congo. It is not random that it is not the story that is shared in most medical history classes. Most Western medicine classes begin with the story of Hippocrates, as though there was nothing before him.

Hippocrates lived about 2600 years ago in Greece. As a physician, he was credited with applying an understanding of the “four humors”of the body to medicine. Humoral medicine, the understanding that the elements of air, fire, water, and earth are held in the body and respond to the environment around us, is older than Hippocrates. Its origins and practices showed up in the lands surrounding the Mediterranean, as well as further south along the Nile basin of Africa. Disease (literally dis-ease) was understood to be what happens when the elements of air, fire, water and earth are out of balance in the body. This means that disease results from how the conditions surrounding a body support or harm that body. This is what social medicine– the contemporary understanding that social and economic conditions directly impact health–has re-asserted 2400 years later. Hippocrates developed a medical practice to bring the elements back into balance. Similar medical practices, which shared some of the same roots, evolved elsewhere, and showed up as practices within Ayurvedic, African, and Asian medical systems.

Opening of book, with illustration of a bust of Hippocrates on left side and title page on right reading: “The aphorismes of Hippocrate”

Around the same time that conferred with his peers to develop his theories, others such as Plato and Aristotle began to conceptualize the body as a whole that is divided into parts. In particular, what emerged was the idea of a separation between the sarx (flesh) and the soma (embodiment). This divide moved from an interdependent understanding and relationship of the body (spirit animating tissue) to strictly separated categories, each with their own set of criteria and understanding. As the generations passed, there was increasing separation between these two states of being: flesh and the embodiment of the flesh, or the aliveness that animates that flesh. This aliveness is also sometimes called the life force or spirit or, in some traditions, the soul. Over time, the separation of these opened up space for the body to be treated like a machine rather than something sacred. Once the body was treated as a machine, or an object, it was possible to operate outside of consent, and to view bodies as having greater or lesser value, as valuable or disposable, rather than recognizing the sanctity and value of all life for the mere reason that it exists.

About 2200 years ago, this separation continued to evolve, showing up as a philosophers’ debate over the meaning of the "mind." This debate was mostly divided between dualists, those who believed the mind and soul are separate from the body, and materialists, those who believed all aspects of the self are found within the body. What both of these frameworks have done is completely separate the body from the contexts and conditions surrounding it: the environment, the social context, and the community. Dualism became the primary framework underpinning Western science. As Christianity developed it took on this dualistic framework. This meant the division between good and evil, and spirit and matter became so deeply integrated as “normal” that there was little space for any other perspective. And, in fact, other ways of understanding life, particularly anything that asserted the nonbinary expression of life, were perceived as a threat or as primitive. This dualistic framework was applied to everything, including people’s bodies. Other examples of this dualistic thinking include notions of purity and sin, sacred and profane, good and evil, and more. Within dualism, if you have good, then you must also have evil. If you have innocence then you must also have guilt, and so on.

We do not assume that before the rise of such dualistic thinking, everyone in a community was showered with love and acceptance regardless of what their body looked like, or how it existed. But we do know that the particular way that disability is understood in 21st century North American medical systems is rooted in the frameworks that developed during the time of emerging dualism. As Christianity continued to develop with its dualism of good and evil, a moral, or religious model of disability also emerged. We write more about this in the story on disability justice and ableism, but this framework defines disability as the result of immoral acts and conduct, using words like sin, shame, act of God, divine punishment, and so on, to explain the existence of disability. This is not about care so much as categorization, a way of assigning reasons for why a body is perceived to be “out of balance” with its environment rather than existing harmoniously, in its own way and with its own life, as part of an environment. Instead of reflecting on the environmental context, or the randomness of how bodies are shaped, the focus moved towards assigning blame, shame, responsibility, and expendability.

Around the year 400, not that long before the Roman Empire fell, Christian monasteries began the practice of caring for the poor in large wards. As with all periods of colonization, the local care and resource-sharing systems had been decimated or, at the very least, unsettled. There was also an increase in poverty, forced isolation, disconnection, and houselessness. The monastic wards were the first traceable form of institutional care for people without wealth. While vulnerable wealthy people were still cared for in their homes, everyone else was cared for in large open rooms.

In the 5th century, the Roman Empire fell. What followed has historically been described by European historians as the Dark Ages. By using this language, historians assert that for much of Western Europe, particularly the British Isles and Northern Europe, the retreat of the Roman military and social networks marked the end of a period of cultural exchange, which included conversations about medicine that were a synthesis of beliefs among Arabic, Jewish, Greek, and Roman thinkers. This happened at the same time as other systems of medicine and care were emerging across Asia and Africa.

After the fall of the Roman Empire, care practices in Western and Northern Europe largely reverted to European cultural healing traditions such as plant medicine, bloodletting, cupping, purging, and other forms of care. The study of anatomy and surgery fell by the wayside, and instead the apothecary, where remedies and advice were given on how to attend to illnesses and health struggles, became the center of medical care. Care work again became local, and based on the land and traditions held by that locality. While some of this was a re-establishment of cultural traditions, it also indicated a kind of fundamentalist fear of anything new or progressive.

This was true for over 500 years, even though individual healers carrying other traditions traveled across Western Europe and shared their trade. Around the year 1050, Constantine “the African” came to southern Italy. He was a physician and a teacher who settled in Salerno; he brought with him medical texts that had been developing in North Africa and Western Asia. While in Salerno, he translated scores of Arabic medical documents into Latin, and shared Greek medical documents that had been lost to Western and Northern Europe with the fall of the Roman Empire, but were still being used by Muslim doctors. He translated, taught, and built a school to keep sharing these practices. This introduced a new period of medicine-as-art that centered around the clinics in Salerno. Schola Medica Salernitana was the center of medical training on the northern side of the Mediterranean for about 300 years. After that, other universities also emerged across Europe, continuing the teaching and research.

While Schola Medica Salernitana did not remain at the forefront of medical education, it did not close its doors until 1811, 800 years after it was founded. From the beginning, the school had both female and male teachers, and taught female and male students. Students learned how to understand and treat people through the framework of the four humors, and also learned anatomy and surgery. Scholars came from all over, and brought this brand of medicine back to their homelands.

As the field of medicine grew, the separation of spirit from flesh and the understanding of the body as merely a structure of tissue and bone also grew. In 1163, the Council of Tours forbade priests from practicing medicine. The papacy stated that priests should be concerned with matters of the soul and not of the body, because these were now understood to be completely separate entities. Although priests and nuns could continue to make the medicine itself, this ended the practice of monastic medicine.

Old drawing of two pairs of people, one treating the other, with plants of some kind of ailment with a small building in the background.

As scholars continued to flock from all over to visit the school in Salerno, and then brought their learning home, this field of medicine – as opposed to locally-held knowledge of plant medicine and other forms of care – grew in prominence. In 1240 the German Emperor Frederick II issued a set of laws calling for the professionalization of physicians and pharmacists. This was the first known set of laws in Western Europe that named medicine as a profession with a set of standards. Now no one was allowed to practice medicine without first studying for five years at a “reputable” school, taking a specific series of courses and undertaking a year of apprenticeship. This standardization slowly spread across Western Europe, and became law in England 400 years later. Also in the 1200s, Pope John XXII issued more religious rulings about medicine, prohibiting the practice of medicine by “illiterates,” “herbal healers” and “old women.” “Rustic healers,” the use of leeches, and the practices of midwives, were now illegal and liable for prosecution when found. This persecution would also later be extended to perceived witches through the witch hunts that spread across Europe in the 15th and 16th centuries. While this papal ruling impacted large urban areas with clergy who were deeply loyal to the Pope, it didn’t change much of the practice in rural areas, and communities further away from Rome, who were not under close surveillance by the church.

Interestingly enough, one of the cultural changes attributed to the spread of Christianity was a decrease in the use of water for washing the body. Rituals involving water or washing as a form or worship were forbidden by the Catholic Church, and seen as heathen. Instead of regular ritual washing, water became associated solely with baptism, a one-off event rather than a regular practice. By the Middle Ages, when water sources had become polluted due to high population density, deforestation, an increase in agriculture, and domesticated animals, washing with water moved from a traditional practice passed down by elders to something perceived to be dangerous. Hot water baths were thought to open a person's pores and allow illness to more easily enter the body.

This lack of association between water and cleanliness was brought to Turtle Island by European colonists who, in the early days, used Indigenous peoples’ practices of daily washing as reasons to dismiss them as naive and backward. European notions of “dirty” and “clean” were separated from the physical body and instead, tied to the state of a person’s soul; to be Christian was to be pure, and clean, everyone else was considered polluted, dirty, and dangerous. The meaning of these words shifted after they were brought to Turtle Island, their echoes remain and show up through the language of eugenics. Physical hygiene was eventually “discovered” by white settlers as one of the roots of what became understood as public health strategy as germ theory began to define Western medicine. The dualism of good and bad that was so entrenched in European Christian traditions shifted so that Indigenous people, Black people, and new immigrants were identified as “dirty” after white people “discovered” physical cleanliness as part of what it means to be healthy.

The increase in population density and the lack of sanitation and water infrastructures in Western Europe meant that a constant wave of epidemics and other forms of illness ebbed and flowed across the continent, starting with the plague of 542 and continuing forward. These epidemics raised interest in medical treatments and practitioners. In 1350, the largest epidemic of them all, the "Black Death," arrived in Europe. (We’ll take a moment here to acknowledge the significance of death as synonymous with Blackness in the name of this plague.) Over the next five years, at least one third of the population, and possibly more than half of Europe, died in this epidemic, leaving widespread trauma, and profoundly altering the social and political landscape of the continent.

Map of Europe, arrows point to trade routes. Dates at bottom read 1346-1353, signifying with colors the spread of Black Death.

Medical practice across Europe at this time largely relied on techniques like blood-letting and boil-lancing. Both practices can be dangerous and lead to further and faster spread of the disease. At this time there was no clear understanding of contagion and how disease spreads. There was, however, clarity that separating those who were sick from those who were well could slow the spread of disease. In 1377 the first quarantine policies were established in Italy in the attempt to stop the plague’s spread. Mandatory quarantine was first established for all incoming ships and trade caravans in the Adriatic port city of Ragusa (modern-day Dubrovnik) in order to screen incoming travelers for infection of plague. The plague spread beyond Western Europe all the way to China; it was brought by colonizers to other continents that they perceived as “disease-ridden,” impacting all ports and travel routes. Venice began tracking the spread of the plague as early as 1348, and other cities soon also followed Ragusa in setting up quarantines. The word "quarantine” itself comes from the Italian term quaranta giorni, or forty days, the length of time that suspected plague cases, and travelers, were kept in isolation.

The impact of the Black Death on European cultural and political practice lasted for generations after the epidemic itself had subsided. Hospitals of this era tended to weave together care for the body and care for a person’s spiritual wellness. They were seen as separate entities, but care work included attending to both, within the framework of Christianity. A person's attendance to their spiritual and moral nature was seen as essential to the healing of their body. Hospitals included visits from priests and nuns focused on supporting the spiritual health of the unwell. Within many other cultural traditions, the illness of the body and the illness of spirit are integrated. Attending to spiritual sickness is an integral part of many medicinal traditions that continue to recognize the profound impact of spirit on the wellness of bodies.

Christian assessments focused on looking for what was “good” and what was “evil,” a kind of religious diagnosis. As birth rates skyrocketed after the mass death of the plague, social shifts and changes looked towards preventing anything like the plague happening again. Blame was placed on non-Christians, and the Latin term “pagan,” a derogatory term for someone living in the country, similar to “hick” in English, started to be used to refer to those who still followed the old ways. “Pagans” were perceived as foolish, uneducated, simple people, and persecuted in an attempt to eradicate them.

Meanwhile, in the “higher” medicines, practiced by those who were trained and whose efforts were seen as closer to God, a growing number of hospitals were designed and built to provide care. Many of these hospitals were built in a cross-like design, with an altar in the middle and wards extending out in four directions, so patients could feel themselves connected to God. This hospital design often continues to be used into the present day, with the nurses station in the center.

Black and white engraving of large hospital with expansive lawn, and people in pathways.

Increasingly formal care strategies and structures continued to emerge over the following centuries. In 1403, the first psychiatric hospital opened in London. Although Bedlam Hospital was officially founded in 1247, it began accepting permanent patients for “confinement” in 1403. Founded by a former sheriff in London, Bedlam was one of the first models for the institutionalization of people living with mental illness. Isolation from the broader community was seen as essential for treatment. This strategy was designed to “protect” the broader population from those perceived as “dangerous” or “unhealthy” and to control them in isolation.

In 1474, the Indiculus Superstitionum et Paganiarum (small index of superstitions and paganisms) was published. This material was the outcome of Charlemagne’s campaign to Christianize Western Europe, combined with other materials collected by priests and soldiers. It names, categorizes, and pathologizes different cultural healing practices indigenous to Europe, including different types of plant medicine, cultural and sacred cycles of worship, stories of the land, and more. This document is similar to reports filed by anthropologists and “Indian agents” who were hired to document the cultural practices of Indigenous people at the same time as suppressing them. Most of the pages of the Indiculus were lost but the remaining pages are held in the Vatican.

It is during this period, as the colonization of Turtle Island began, that Western medicine began to emerge into something we can recognize today. Germ theory was not yet formulated, but many of the other practices and structures of medicine were already established. Physicians primarily focused on the biology of a person, making a diagnosis about that biology by assessing a person's body against a "normative" baseline, and suggesting largely isolated and individualized treatment based on that diagnosis. The baseline for normative was white, wealthy, Christian, male, and able-bodied. This approach, also called the medical model of disability, focuses on the idea of a "cure," meaning that with the right treatment an individual’s disability can disappear, leaving what is considered the norm: a body without disabilities.

As a “right” form of medicine and medical care was asserted, other models emerged and were categorized as good or bad. This included the growth of what would become called “quackery medicine.” The term "quackery" comes from a Dutch word, and means remedies that are suspect or of dubious origin. As Western medical science continued to develop, the concept of quackery was placed on all remedies (purveyed by white people) that did not fit into the growing medical canon. This was a different strategy than the one used to suppress the healing traditions of people of color, which were identified as primitive, simple, or ignorant. Instead, quackery created a kind of class system within white strategies of care. "Quacks" were negatively defined as unregulated physicians, usually poor people who could not afford a medical education. They were people who sold their goods on street corners and at markets, calling out information about their products. The word "quack" in both Dutch and English referred to the noises they made, supposedly like a bunch of quacking ducks or geese. "Quacks" typically targeted those that were vulnerable and marginalized within their communities.

Over the years, many things once defined as quackery, such as using sound waves to heal bones, eventually became part of the western medical canon. Some things, once defined as good medicine, such as bloodletting or using leeches and other strategies to decrease blood in contusions, have entered in and out of favor, or have been fully dismissed as effective forms of care. Contemporary power struggles over which forms of medicine are considered legitimate are inseparable from this history of cultural change, colonization, and shifting systems of power and control.

This piece has focused on the story of the colonial wound: the isolated practices and belief systems that developed in Europe and were at the root of what was forced onto Turtle Island by colonization. This context is important to understand how we have arrived at our current predicament. We know that as Western medicine developed, other traditional ways of healing were defined as primitive or fake in order to minimize or sever their strength and cultural connections. We don’t wish to contribute to the invisibilization of other care traditions as we tell this story. Please keep an eye out for future stories that will focus on forms of care that existed on Turtle Island, and around the world, before European colonization, as well as those that have continued to resist disappearance and dismissal.

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