Extension Study


Before and After


  • Ancient Greeks had developed an explanation for ill health based on the idea it was an imbalance of the four humours
  • treatment could be based on changes in diet, encouraging the patient to get rest, and exercise
  • also based on bleeding or purging the patient due to excess humour
  • many people continued to rely on prayers and charms to protect and cure them
  • home made remedies were used from plants


  • in 1347 the Black Death arrived in Europe and 1/3 of the population died
  • the understanding of disease was limited
  • treatment was based on the ideas of Galen 
  • in the 16th and 17th century more understanding of the body
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Roman society, and medicine and public health

  • when the Romans conquered britain in 43ce they brought ideas about medicine and public health with them
  • the Romans adopted many of their ideas about disease and illness from the Greeks and there were few developments by the Romans about theories of illness
  • major improvements in public health
  • they were more interested in what they could do to improve health and less interested in what actually caused the illness
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How did Roman Society affect medicine and public h

  • Rome was crowded so they were aware of infectious disease
  • had skilled engineers who planned to build aqueducts to bring clean water to the cities and sewers to remove human waste
  • Romans were aware that hygiene linked to health but didnt know why
  • the government organised large scale projects and raised taxes to pay for them
  • Romans took on whatever attitudes and beliefs seemed to work
  • the importance of the army controlling the empire meant there was an emphasis on keeping soldiers healthy
  • many Greek doctors came to live and work in the Roman Empire bringing Greek ideas with them
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Public Health after the Romans

  • When the Romans left in 410CE there were huge changes
  • a number of local leaders took control
  • many towns and cities fell into decay
  • Britain was attacked by various invaders

As a result...

  • doctors continued to be trained according to Galens ideas as they fitted with the Christian teachings
  • Government became very weak 
  • knowledge was lost
  • christianity dominated society 
  • the church controlled society and resisted new ideas
  • christianity stressed the importance of caring for the sick rather than treating
  • traditional cures and remedies continued to be very important
  • no central organisation of armies or medical treatment for soldiers
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Hippocrates and Galen


  • believed illness had a physical rational basis and could therefore be treated
  • he said a doctor should respect all life and not try a treatment if it was risky
  • developed the theory of four humours as an explanation for illness
  • developed clinical observation


  • Greek doctor who worked in Rome
  • developed a way of balancing the humours in the body through the theory of opposites
  • had experience as a surgeon
  • carried out dissections
  • produced books which were studied for the next thousand years
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Roman ideas about disease

  • supernatural
  • miasma
  • an imbalance in four humours

there were very few doctors in Roman Britain

  • most illnesses were treated within the home by the father of the family using remedies
  • used herbs and plants
  • some treatments were purging or bloodletting
  • the Romans would often mix these practical remedies with prayers and offerings made to Salus the God of Health
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Public Health in Roman Britain

  • Roman Army hospitals were often well equippied and provided excellent training for surgeons and physicans
  • very few hospitals open to the public so this treatment would have little impact on ordinary people
  • Romans placed little emphasis on medical knowledge but did notice that disease increases if you live near marshes and swamps due to bad air (malaria)
  • stressed the need to provide access to clean water and remove sewage

Public Baths in Bath

  • the Roman Baths were part of a complex of facilities
  • admission was not free but cheap enough to attend
  • people would exercise before going in the baths
  • there were public toilets with a sewage system
  • there was also a steam room to remove dirt from the body
  • they would then get in a cool pool to be clean and relaxed
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Medicine and Treatment- The Middle Ages

  • The Romans left Britain in 410CE
  • no one took responsibility for maintaining the structures built by the Romans
  • Public Health Systems fell to ruins
  • apart from Galens theory of opposites the Romans showed little interest in developing their understanding of disease further
  • not a big change in medicine when Romans left Britain
  • they worked out many cures through trial and error
  • Honey was a common cure and it had antibiotic properties
  • onions garlic and wine were also often used

Religion and Superstition

  • the christian church became increasingly important
  • most priests could read and write
  • learning was preserved in the libraries of monastries and convents
  • monastries and convents often had an infirmarian who cared for the sick
  • people would say prayers and go on pilgrimage
  • many people would carry a lucky charm 
  • astrologers would be consulted in order to choose the right time to carry out an operation
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influence of Galen in the Middle Ages

  • in the towns richer people would consult a physican who was likely to use bloodletting or purging
  • treatments were based on the four humours
  • Galen was keen on bloodletting as a way of healing and preventing illness
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Medical Training from Roman Britain to 1350

  • in the roman period doctors were not respected
  • the romans felt that foreign doctors were trying to take advantage
  • many doctors hated Galen when he publicised his ideas because he was arrogant and criticised old methods
  • Alexandria in Egypt was the main centre of medical training because it allowed dissections
  • no requirement for doctors to be formally trained
  • most doctors trained by reading books such as the Hippocratic Collection
  • no organisation to check doctors were knowledgeable
  • anyone who wanted to be a doctor could
  • by the 12th century a seperate course developed and medical training was based on a set of texts called Ars Medicinae including some works written by Muslim scholars
  • by the 13th century most towns would not let a doctor set up a practise unless he could prove he had studied
  • education and training were controlled by the church and ideas were slow to change 
  • the church approved of Galen and his ideas
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Public Health in the Middle Ages

  • as towns grew bigger throughout the Middle Ages the problem with hygiene became more important
  • animal and human excrement was common in the streets
  • rubbish was not removed
  • butchers slaughtered animals and left the remains in the street
  • rats were common
  • laws only had limited effect
  • there were public toilets in London but people still used the streets


  • rich people often had good standards of hygiene 
  • many had a toilet built
  • monks and nuns lived simple lives but the standard of hygiene in monasteries and convents was high
  • there was fresh water piped to the building and human waste was removed
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  • over 1000 hospitals were established in England and Wales in the middle ages
  • many of them were founded through charitable donations e.g St Bartholomews
  • they were usually quite small and had 12 inmates in memory of Jesus' disciples
  • there were some large scale hospitals like St Leonards which could admit over 200 patients
  • hospitals were usually run by monks and nuns as part of their christian duties because Jesus said his followers should care for the sick
  • there was thought to be a strong link between illness and religion because illness was seen as a punishment for sins
  • it was felt that patients needed spiritual support more than medical treatment
  • care for the soul combined with rest warmth food and care that patients recieved meant some patients did get better
  • beds would be positioned so that the patients could see the altar, religious states, and stained windows to help them focus on religion to heal


  • almshouses began to set up in the 14th century to care for the deserving poor and old
  • the poor were expected to live according to strict rules about behaviour and prayer
  • the almshouse was not intended to be a hospital providing medical treatment although it did provide care


  • leper houses were set up
  • leprosy sufferers were expected to keep themselves away from others as it was infectious
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Factors affecting developments in medicine and pub


  • christianity was the main religion in Europe
  • when the Roman Empire collapsed the church was left as the only international organisation that could preserve and transmit knowledge
  • the church preserved the ideas of Galen
  • it was believed that the Kings touch could cure TB


  • after the Roman Empire the rulers in Britain were more concerned with protecting their people and trade from attack than improving medicine
  • medicine was not a priority
  • this was because the church controlled so much of medicine and there was little that the government could do
  • the government organised and funded the construction of a good system of public health but the standards of public health fell and local authorities faced problems trying to keep their towns clean
  • people understood that cleanliness could help to prevent disease from spreading
  • as towns grew and public health became more important the local authorities began to be more active


  • war was responsible for the Romans settling in Britain
  • war had a positive effect on medicine in Britain bringing knowledge from Europe
  • when Romans left Britain because of war in Europe society became much more fragmented and public works decayed
  • people were less likely to travel and exchange knowledge
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