Medieval Medicine

• Many people thought that illness was God’s will. If someone did something bad (committed a sin), God could punish them with illness.
• Prayer and repentance were thought to be a way to make a person better after an illness/disease.
• To repent for bad deeds, many used prayers or flagellation (whipping yourself).
• Some people believed that supernatural spirits could live inside a person and cause illnesses.
  • Some people in the Church did “exorcisms” to get these spirits out of people's bodies.
• Witches were also thought to be responsible for some diseases spreading across a town.
• These supernatural reasons were based on astrology (how the stars and planets were aligned).
  • Astrology was first used in Arabic medicine but it was used in Europe after 1100.
• Doctors used star signs and an almanack (calendar showing planetary movements) to diagnose and treat diseases.

• The Church promoted the belief that illness was because of supernatural causes. Because of this, Christians believed that God would heal illness.
• Prayers were viewed as the most important kind of treatment.
• Christians would go on pilgrimages to relics or to the resting place of saints in the hope of miraculously recovering from illnesses.
• The Church only allowed dissections to happen on criminals that had been executed.
  • This meant that Galen’s mistaken beliefs about the anatomy (holes in the heart and blood being absorbed not circulated) could not be corrected.
• Here, religion and superstition slowed progress.
• Some historians have claimed that the Church’s encouragement of the Crusades diverted (moved) funds away from hospitals and health towards wars.
• However, the Crusades meant that Western Europeans met Muslim doctors.
  • This meant that ideas from the Islamic Empire could be used in Europe.
• Lots of Ancient Roman and Greek medical texts were lost when the Roman Empire fell.
  • Monks tried to copy and preserve medical texts.
• Dissent began to be caused by people questioning the Church’s reliance on old books.
  • For example, a monk called Roger Bacon was arrested for challenging the books in the 1200s.

• Hippocrates (born in 460 BC) lived in Ancient Greece.
  • He advocated (supported) using natural treatments to treat diseases and developed lots of theories about medicine.
• These included:
  • Clinical observation.
  • Hippocrates invented the idea of ‘clinical observation’.
  • This involved a doctor being objective (independent) and using observation and logic to deduce what was wrong with a patient.
    • A doctor should examine and monitor a patient’s symptoms to diagnose their disease or illness.
    • The Four Humours Theory.
    • Hippocrates also developed the theory of the four humours.
    • To be healthy, the Ancient Greeks believed that a person needed to have balanced humours. People got diseases if they had too much or too little of a humour.
    • Hippocratic oath.
    • Doctors today take the Hippocratic oath and this binds them to keep to a set of ethical standards to treat their patients well.

Yellow Bile

• Yellow bile was related to Summer and fire. The Ancient Greeks believed bile was produced in the spleen. Yellow bile was considered hot and dry.
• To remedy a yellow bile imbalance, doctors forced patients to throw up or change their diet.

Blood

• Blood was related to Spring and air. The Ancient Greeks believed blood was produced in the liver. Blood was considered hot and wet.
• To remedy a blood imbalance, doctors used bloodletting or suggested eating red meat and drinking red wine.

Phlegm

• Phlegm was related to Winter and water. The Ancient Greeks believed phlegm was produced in the brain and lungs. Phlegm was considered cold and wet.
• To remedy a phlegm imbalance, doctors suggested breathing steam or eating vegetables filled with water.

• Black bile

  • Black bile was related to autumn and earth. The Ancient Greeks believed black bile was produced in the gallbladder. Black bile was considered cold and dry.
  • To remedy a black bile imbalance, doctors gave laxatives and suggested eating more vegetables.

• Galen believed that imbalances in the four humours of the body caused diseases.
• He supported clinical observation and encouraged doctors to monitor a pulse or take a urine sample to find out what was wrong with a patient.
  • But Galen thought that blood was absorbed or taken in by the body, rather than pumped around it.
• Galen advanced the understanding of the humours through his Theory of Opposites.
• He thought that humours could be rebalanced by giving a patient something opposite to their symptoms.
  • For example, if you had an excess of blood (hot and wet), doctors should prescribe a treatment which was cold and dry.
• Although Galen lived in the Roman Empire he believed in monotheism (one single God).
  • Because of this, the Christian Church supported his ideas of medicine.
• As the Church put their weight behind Galen’s ideas of medicine, it was frowned upon to question Galen.
• The Miasma theory was also included in Galen’s thinking.
  • Miasma theory said that bad air made someone ill when they breathed it in.
  • It was very popular in medieval Britain and it was probably the most powerful theory of disease until late into the 1800s.

• Roman emperors and senators spent a lot of money on building aqueducts to bring clean water into Roman cities.
  • This is likely to be because they thought that unclean drinking water, sewage and dirt tended to make people ill.
• Ancient Romans built toilets, sewers and public baths that were used to take the waste out of buildings and people’s homes.
• Doctors in Ancient Rome were recommended herbs and plants as medicines and they often fitted with Galen’s Theory of Opposites.
• Bleeding was a common treatment but surgery was very rare.
• The Romans believed that Gods and supernatural things could affect health.
  • Aesculapius was the Roman god of Health and Medicine.
  • Carna was the Roman god who kept the heart and organs healthy.

Roman aqueducts and sewage systems were an improvement in health and medicine that have lasted to today.

• Clean water and dealing with sewage and dirt are important in societies today.
• Ancient Romans took a wide range of herbs and plants to heal them in keeping with Galen’s Theory of Opposites.
  • This continued the trend started in Ancient Egyptian society.
• The Roman Empire did a good job of providing lots of food, housing and infrastructure (sewage and water).
  • This society/civilisation helped provide the systems that helped society to function.
  • This showed the importance of government in improving the state of medicine and health.
• The diffusion (spreading) of Galen’s ideas show the importance of chance in history. His ideas became very popular partly because of the support of the Christian Church.
  • Without this, fewer people would have known about things like clinical observation.
• However, not all people in Ancient Rome benefited from these changes in society.
  • Diseases still spread and lots of poor people didn’t benefit from doctors, treatments and herbal remedies (treatments).

Medieval doctors usually learned through word-of-mouth or through personal experience.

• They experimented with herbs, charms and learned from apothecaries (person who sold medicines), travelling healers and wise men/women.
• Barber-surgeons were people who had access to razors and did a lot of medical procedures.
  • Barber-surgeons did not get training.
• They could cut people’s hair, do bloodletting and even amputate peoples’ arms and legs.
• However, a lot of people died because their wounds were infected or they lost too much blood.
• The closest thing to our view of a modern-day doctor was a man/woman who had been trained in Hippocratic and Galenic methods.

• Doctors had some tools to treat patients.
• This included:
  • a book which recorded possible illnesses.
  • leeches to remove blood.
  • aromatic objects which could stop miasma (bad smells which were believed to cause disease).
  • a zodiac chart to predict future illnesses.
• Most doctors were in large towns and they were still rare.
  • Doctors were expensive and most people couldn’t afford to see them.
  • Some doctors began to observe (and treat) their patients on the battlefield (in wars).
• The poor could only receive medical treatment in hospitals set up by monasteries.

• • However, lots of people who were very ill were not treated, because people were scared that the disease could spread to other people.
• Apothecaries were people who sold herbal remedies in medieval times.
• Female apothecaries were called "wise women".
• Most people couldn't afford to pay doctors (physicians), so they used apothecaries.

• Surgery was excruciatingly (very very) painful.
• No anaesthetics existed and only natural anaesthetics (like hemlock or opium) existed to numb the pain.
• Natural anaesthetics were dangerous because high doses could kill the patient.
• There was a very limited understanding of what causes diseases and infections.
• Nobody had discovered the link between dirt and disease and many doctors believed that pus in wounds helped a patient to recover.
  • Many people died from infections after surgery.
• Patients often lost a lot of blood in surgery.
• There were no blood transfusions or anything similar.
• Blood loss could also be fatal.

• Bloodletting
• Amputation

An amputation was when a surgeon cut off a body part.

• Trepanning

• Trepanning was when a surgeon would make a drill hole into a human’s skull.

• Cauterisation

Cauterisation was when surgeons burned a wound to stop blood flow or close up an amputated wound

• In the 11th century, Albucasis, the Islamic physician wrote Al Tasrif, this was a 30-volume book on medicine. He also invented surgical instruments and popularised cauterisation.
• In the 13th century, Hugh of Lucca argued that pus was bad for a wound. He began to use wine to disinfect wounds. However, he did not succeed in overturning the dominant idea that pus was necessary for wounds to heal.
• In the 14th century, Mondino de Luzzi pioneered anatomy. He popularised dissection and wrote Anathomia which dominated medicine until the 16th century.
• Remembered as one of the most famous surgeons in Medieval England, John of Arderne established the ‘Guild of Surgeons’ in 1368. He based his book, Practica, on his experiences in the war with France and his knowledge of Ancient Greek and Arab medicine. Ardene created his own forms of painkillers from substances such as opium.

• The centralised organisation of Ancient Rome had vanished as regions fragmented. This contributed to worse public health standards
• The Thames became so dirty that the “Great Conduit” was built to bring drinking water into London. Wardens protected and repaired pipes to keep the supply clean.
• The city also tried to keep streets clean and to improve the sewage problems.
• The unsanitary conditions were partly because of population growth and urbanisation. More people lived in towns, so towns became crowded. People lived close together in houses made of wood and overcrowding meant that disease spread quickly.
• Towns were not clean because people did not know that dirt could cause disease and nobody understood germs or bacteria. Miasma (bad air) was still believed to be the cause of illness. Towns smelt bad, people then got ill so people thought the bad air (smells) made people ill.

• Rivers were used for sewage as well as for drinking water. This meant that there was a lack of clean water.
• Lots of towns didn’t have clean water or sewage systems. Often there weren’t the systems of aqueducts and sewage that the Romans had used.
• Cesspits were used for people to throw their liquid waste and sewage into.
• Houses were also used for business by butchers and barbers. Their waste and rubbish were often thrown in rivers and the street.

• The disease began in Asia and spread to Europe on merchant ships. At the time, people thought that the epidemic was caused by supernatural things like the position of the stars (or God’s wrath) or natural reasons such as miasmas or humour imbalances.
• It was actually caused by bacteria in fleas’ stomachs. These fleas passed on the disease to rats who passed it on to humans. As many people lived close to each other, the disease spread quickly.
• Suggested remedies for the Black Death included prayers to appease (satisfy) God. Some tried to use herbs to keep them safe from miasma. Others tried purging, vomiting and bloodletting to keep humours in balance. Others tried to move away or avoid those who had become infected.
• Some people thought that the plague was caught from dead bodies. Some towns, like Winchester tried to build cemeteries away from people's homes. Some towns like Gloucester tried to stop anyone outside the town entering but this did not succeed. 

• 30-45% of the British population are estimated to have died from the Black Death. Whole towns were killed by the Black Death. The Church was harmed because lots of experienced priests died. New clergymen demanded higher wages. The Black Death killed lots of workers.
• Peasants asked for higher wages and moved around to earn higher wages. The cost of buying land fell because of the lower population and this allowed some peasants to buy land. The 1349 Ordinance of Labourers tried to stop peasants moving around so much. Some historians think these kinds of measures and the Black Death contributed to the Peasants’ Revolt in 1381.
• The worst of the Black Death was over by 1350. But plagues continued for centuries. The worst example was the Great Plague of 1665.