Medieval Medicine

• Surgery left to barber surgeons and not professionals despite the fact that surger was constantly in demand.
• Wine was the first antiseptic.
• Most surgery was external.
• Didn't know dirt carried disease.
• Still a  lot of supernatural beliefs, for example, trepanning. This was when they tried to cure epilepsy by drilling a hole into the skull to release demons.
• Lots of warfare so surgey was used frequently.

• Bloodletting was used to restore equilibrium in the four humours; they would create a small cut on the inside of the arm where blood was aloud to run out.
• Amputation used to remove a damaged/ painful part of the body. It was a very common procedure. Successful in cases of breast cancer, bladder stones and haemorrhoids.
• Epilepsy was thought to be caused by demons inside of the body so would drill a hole into the patient's skull to let the demon out-trapanning.
• Most surgery took place on battlefields and was a last resort.
• Patients faced pain and shock during operations.
  
• Cauterisation was a very common method of burning the wound to stop the flow of blood; usually done with a heated iron and was immensely painful.
• A surgeon would have many different tools: saws for amputation, arrow pullers, cautery irons and bloodletting knives.
• Many medieval surgeons were barbers who combined hair cutting and small surgical procedures. Barber surgeons were lower class medical tradesmen.
• Surgeons learned their skill by being apprenticed to another surgeon, watching and copying.
• Some attempts made to put patients to sleep with natural substances such as opium, mandrake root and hemlock as anaesthetics but a strong dose could kill a patient so they often had to tie the patient down.

• Knowledge was dangerous and travelled slowly.
• Bad communication.
• No universities.
• Illiterate.
• Knowledge controlled by the Church.
• People believed what they were told.
• Christian God.
• Superstitious.
• Trade and communication develops.
• Knowledge about medicine stagnated- no improvements made.
• Islamic ideas- most influential development.
• Objection to any ideas risked execution.
• Church encouraged getting better by praying. 

• Knowledge was hard to access.
• Knowledge of Acient Greeks and Romans lost.
• Anatomy was basic.
• Galen enforced Hippocrates' idea of the four humours.
• Church didn't allow dissections.
• Believed combing hair helps the brain.
• Demons/ sins/ Jews/ stagnant water/ astrology caused disease.
• Challenged errors.
• Islamic ideas about medicine weren't well-known as there was tension between Islam and the Church.
• Didn't have scientific knowledge.

• When training as a medieval doctor, you would study fora bout 7 years at a university. The majority of learning was through listening to lectures and debating about what had been read in books.
• A fully qualified doctor could leave university without ever seeing an actual patient.
• You would learn the treatments of Galen and Hippocrates with knowledge of Musilm, Indian and Chinese worlds.
• There was studying from British textbooks like Gilbert Eagle's Compendium Medicine [c1230], based on Greek knowledge.
• Each part of the body was dealt with from the head downwards and brought medical theory, recipes, charms and Christian prayers together.

• Al-Razi [c1865-c925] stressed the need for careful observation of patients and distinguished measles from smallpox for the first time. Wrote over 150 books. Although a follower of Galen, he thought all students should improve on the work of their teacher.
• Ibn Sina [c980-c1037] wrote a great encyclopaedia of medicine known as the Canon of Medicine. Comprising over a millon words, covered all Greek and Islamic medical knowledge at the time. Listed medical properties of 760 different drugs, contained chapters on medical problems such as anorexia and obesity- it became the standard European textbook and used to teach doctors.
• Ibn al-Nafis concluded Galen was wrong about how the heart worked. Said blood circulated the body through the lungs. His books weren't read in the west so Galen's mistake was accepted until the 1600s.
• Although hospitals were rare in 12th century Britain, they were common in Islamic populated areas eg.Baghdad, which alone had 60 hospitals when Londoners were marvelling at their first.
• In Cairo, the Al-Mansur hospital was founded in 1283 and was one of the scientific wonders of the age; it had separate departments for sick patients with different diseases, a library and lecture halls where people trained to be doctors. Also had a kitchen to prepare special diets for patients and wards where convalescent (recovering) patients could stay.

• Trained doctors in the many hospitals available by making libraries, lecture halls,kitchens and wards.
• Spread knowledge by maintaining good libraries which students could use to keep up to date with medicine and Arab scholars translated the work of Galen and Hippocrates into Arabic so they could be studied by medical students.
• Arab doctors increased knowledge by learnining from Indian and Persian doctors.
• Helped by making sure public health was up to standard by opening many hospitals where they checked public health.
• Easily allowing use of lisenced healers, both men and women could become doctors and doctors weren't turned away as there were more hospitals.

• Didn't spread knowledge of anatomy and didn't always encourage new developments eg. wouldn't allow dissection of human bodies.
• Believed Qur'an contained everything so there was no point trying to make new discoveries.
• Their attitudes towards the Qur'an  meant they were unwilling to criticise other acient books such as the writings of Galen.
• Didn't explain disease because they thought they shouldn't dabble in trying to explain it but rather concentrationg more on theory. Even great doctors like Rhazes and Ibn Sinna thought doctors shouldn't dabble in surgery and alike. 

• Helped in aiding public health by purifying water.
• Opened medical universities where students would follow old manuscripts on the works of Galen.
• Cared for the sick in hospitals.
• Some medical infirmaries established (mostly in monasteries). Between 1000 and 1500, more than 700 hospitals started in England; they varied in size but the common capacity was 12 to reflect Jesus' 12 disciples. However, some larger hospitals did exist.
• Preserved works of Galen and Hippocrates which, although were inaccurate, were sinificantly better than supernatural ideas.

• Church controlled universities as that was where religion was studied and where Church leaders were trained. Medicine usually 2nd subject studied after religion. In Britain, Church controlled training of doctors in universities of Oxford and Cambridge. Taught medical ideas of acient Greeks and Romans to make old knowledge clear and understandable- not to discover new concepts so medical rpogress stagnated.
• Church approved of Galen's books because he believed in a single god; this fitted with Christian ideas, however, nobody could challenge anything Galen wrote as it was seen as a criticism of the Church. English monk, Roger Bacon, was arrested for suggesting doctors should do original research and not trust old books.
• Church saw the role of a doctor as not a healer but as someone who could predict the symptoms and te duration of an illness and provide reasosn why God might inflict illness on a person. Gave people comfort and allowed patients and their families to put affairs in order. Could die in peace but again, medical knowledge didn't advance as no-one was treated.
• Wouldn't search for effective treatments as they saw God as the healer.
• Wouldn't easily license healers; men could become qualified doctors but women couldn't. Midwives had to gain a license and follow apprenticeships. 
• Didn't explain diseases appropriately eg. God, four humours, astrology, bad smells,etc.
• Church sent Roger Bacon to prison for suggesting new ideas that contradicited Galen.
• Wouldn't expand knowledge on anatomy as priests had banned dissection until the 14th century.
• Wouldn't spread medical knowledge; believed in superstition, astrology, God etc. Told these were the causes when they had no proof/ evidence of this.

• Believed in following the example of Jesus who healed the sick so founded many hospitals.
• Strong belief that illness came from God so curing an illness would be questioning God's authority as he was the healer and hes sent it as a punishment/ test of faith, therefore, it was important to care for patients but not to necessarily cure them.
• Prayers to God were the most important treatment.
• Church also encouraged belief in miraculous healing. Many shrines filled with relics, bones, hair and other body parts of a holy person. Shrines were where people made pilgrimage for help with illnesses such as the shrine of Saint Thomas Becket at Canterbury.
• While Church valued prayers, also respected traditional  medical knowledge of the Acient World as it thought Hippocratic and Galenic ideas were correct. Monks preserved and studied these ideas; they copied out the books by hand as well as traditional medicine books like Pliny's Natural History, which was an encylopaedia of everyday family remedies.

They encouraged medical learning. The first hospitals were set up for people with mental illnesses and were treated with compassion for being victims of an unfortuante illness. In 805, Caliph al-Rashid set up a major hospital in Baghdad which had a medical school and a library. Treated patients rather than just caring unlike Christian hospitals. Bimaristans (hospitals where patients were welcomed and treated by qualified doctors)  built in many Islamic cities to provide medical care for everyone. Doctors were permanently present and students would train alongside them.

• Overcrowded and densely packed houses: easy for disease and fires to spread.
• 700 years ago, there was an epidemic of filth.
• Population had gone up by 500% in last 2 centuries.
• Wanted a strong, stable government that didn't interfere with their affairs- self governed.
• Tyrannical
• Floor covered with mud, animal excrement, animal entrails (carcasses), rotten fish, beer and their chamber pots.
• Smelly- especially in hot summary weather.
• Would drink beer all day as it was safer than water.
• Wooden overshoes to lift above dirt.
• No sanitation
• Home to deadliest pathogens such as salmonella and E.coli.
• Government more concerend with law and order, trade.
• Constantly looking down to avoid waste.
• Human filth rained on passengers below.
• Diverted waste pipe-pipe removed within 40 days.
• Sent it to rain water gutter but blocked it.
• Neighbours complaining.

• Monasteries often situatedin isolated places but still near rivers as water was such an important research for the monks so would even redirect rivers to ensure a reliable supply eg. at Rievaulx Abbey in Yorkshire. Did this to supply mills, bakeries and brew houses with pure water.
• Had elaborate systems of pipes to deliver the water to wash basins. Filtering sstems installed to remove impurities by allowing dirt to settle out of te water.
• Had excellent facilities for washing- had a room called a lavatorium where water could be emptied into the river. Had toilets/ privies which sometimes contained potties to collect urine (which was used for bleaching cloth in monks' wool trade). Toilets emptied into a pit, waste dug out and carted as manure.
• Monks had religious routines of cleanliness which helped them to be healthy. Baths were rare luxuries for the rich but monks were ordered to use them as cleanliness was a sign of piety and celibacy. Some monks had a baths once a month; Benedictine monks allowed to each year at Christmas and Easter. Benedictine monks washed clothes regularly as well as their heads, faces and feet which were washed in religious ceremony twice a week.
• Monasteries were very wealty. many people gave money in return for prayers. Allowed monks to build sanitation facilities. Had access to medical books and manuscripts in their monastic libraries, as well as infirmaries where monks were trained to use herbs to heal. Monks also learned from the Acient World that a basic principle of good sanitation was to separate the supply of clean water from the wastewater that came from the toilets and wash places. Had infirmaries with good supply of water; a few had leeching houses where patients could be bled.

• Initially, the black rats, which came from Asia during the 1320s, carried the fleas which regurgitated diseased blood into people's bloodstreams.The rats were transported through trade, therefore, the fleas were also and this trade route was known as the Silk Road. Plague started in Bristol (a port) which proves that trade was involved.
• People of the time thought it was caused by movement of the planets (astrology), a punishment from God, bad smells/ corrupt air and enemies who poisoned the wells (Jews). They thought these were true due to a lack of scientific knowledge.
• The symptoms were: sweating/fever, death and black swellings (buboes) where the glands were. Exposure could lead to contracting the disease within a week and so many people died, they had to be buried in mass graves. It could take only 4-7 days to contract the illness and die. There was also a 70% chance of death.
• In Britain, 1/3-1/2 of the population died. In some villages, 80-90% of people died. In London, around 25,000 died (1/2). In Europe, 25-50% of population died. In the world, there was a total of 75-100 million deaths.
• The Black Death didn't really impact those in highland areas.

• Social: About 33% of Wales and England's population died. It took250 years for the population to recover. The feudal system collapsed- peasants could leave their village to find work, land and freedom elsewhere. Women had new job opportunities. Some villages, like Wharram Percy, never recovered and were left abandoned. Poor people's clothing and diet improved. Medical knowledge improved as doctors were allowed to study the corpses and began to understand how the human body worked. Harsh laws tried to stop the freedom and improvements of the peasants' lives. Officials slowly realised towns and cities had to be clean.
• Religious: New religious groups were set up eg. the Lollards who criticised the Catholic Church. Many Churches closed down- it was hard to find people to take over the jobs of priests. Peasants' attitude changed- they believed they could stand up to authortiy because God had spared them.
• Economic: Wages increased by 400% after the disease as workers could demand more when fewer of them were alive. Lords saw the value of their land decrease. Less tax meant kings had to think twice when going to war as it was too expensive so tax increased a lot.
• Cultural: Creative works (paintings, murals, etc) became morbid- images of death were everywhere. New medical discoveries and artistic ideas would later bring about a rebirth of culture. Some people thought disease could return any day so lived a wild life- drank, threw parties and lived carelessly.

Similarities:

• Bloodletting still used.
• Still diagnose people.
• Urine still used as an indicator, even though it isn't smelled or tasted, colour still recorded.
• Still record heart rate.
• Laxatives still used.
• Alternative therapy.

Differences:

• No belief in four humours.
• Not as many natural remedies used nowadays.
• Diagnosis mainly based on symptoms.
• Less reliance on religion, specifically Chrisitanity.
• Antibiotics used.

The four humours were what most doctors believed to be the cause of illness. The humours were four liquids (phlegm, black bile, yellow bile and blood) which made a person ill if there was a loss of equilibrium so to cure a patient, a doctor would have to restore the balance with treatments such as blodletting. This theory fitted with what medieval doctors were able to observe.

• Yellow bile= summer, as a cure, made to vomit or change diet eg. eat cheese.
• Black bile= autumn, as a cure, given laxatives or had to eat more vegetables.
• Blood= spring, as a cure, had to eat red meat or drink red wine and bloodletting.
• Phlegm= winter, as a cure, had to breathe in steam or eat fleshy vegetables like cucumber.