Medieval Medicine (c1250-c1500)

Religious explanations for disease

* committed a sin from God (he was punishing you)
* blaming sickness on God added proof of the divine
* famine that caused malnutrition was because of God (if people recovered a miracle had taken place)
* church taught that disease was sent by God to cleanse one’s soul of sin

What is Leprosy

* it was included in the bible as an illustration of a punishment for sin
* began as a painful skin disease
* fingers and toes would fall off, body hair would drop out and ulcers would develop in and out of your body
* there was no cure, so lepers were banished from their communities

Astrology and supernatural explanations for disease

* alignments of planets and stars were considered important when diagnosing illness
* physicians would consult star charts, look for when the patient was born/fell ill to help identify what was wrong
* church frowned upon ideas of astrology
* astrology became more popular after the black death in 1348

What was the theory of the four humours

* Hippocrates idea
* thought everyone had a mix of four humours in their body
* people became ill when this mix was unbalanced
* to make people better they tried to put this balance right

What were the four humours

* blood
* phlegm
* black bile
* yellow bile

What did people think made some humours stronger than others

a combination of age, family traits and circumstances (season in which you were born), usually combined to make one or two of the humours stronger than the others

What was the theory of opposites

* Galen’s idea
* Galen developed the theory of the four humours further
* aimed to balance the humours by giving the patient the ‘opposite’ of their symptom
* e.g too much phlegm you should eat hot peppers (linked to water and cold)

What was miasma

* bad air that was believed to be filled with harmful fumes
* smells and vapours were also associated with God
* homes that smelt badly suggested sinful and corruption and, if a person was unwashed, other people would avoid them

What were urine charts

* physicians did not blame people’s urine for marking them ill but did carefully examine the urine in order to make their diagnosis
* it was thought to be one of the best ways to check the balance of the humours inside the body
* the physicians would carefully check the colour, thickness, smell and taste of the urine before making their diagnosis

How did the church influence ideas about the cause of disease

* the Church did not like change and wanted to keep things the way they were
* the Church controlled medical learning and it chose which books were copied and distribute
* church strongly discouraged anybody from criticising the Theory of the Four Humours

How did science and technology influence ideas about the cause of disease

* a lack of scientific understanding meant that new knowledge was limited
* physicians and medical students tried to make new discoveries fit into the old theories, rather than experimenting to explain the discoveries

How did attitudes in society influence ideas about the cause of disease

* medieval people had a strong belief in God and did not want to risk going to hell by being critical of the Church
* many people believed that, since medicine had always been done this way, there was no need to change it

How did individuals influence ideas about the cause of disease

* Galen and Hippocrates were important individuals in the Middle Ages
* Galen in particular was popular with the Church, which meant that his work was widely promoted

How did the government influence ideas about the cause of disease

did not spend any money on medicine, and therefore there was no money for medical breakthroughs

What were some religious treatments for disease

* healing prayers and incantations (spells)
* praying for a special mass to be said (bread and wine)
* fasting
* pilgrimages
* touching holy relics
* lighting a candle
* chanting incantations or using charms

What were some supernatural treatments for disease

* varied according to the horoscope of a patient
* alignment of planets checked at every stage of the treatment prescribed
* herb gathering, bleeding, purging, operations, cutting hair and nails at the right time

What was blood-letting (phlebotomy)

* humoural treatment
* most common treatment for imbalance in the humours
* the idea that bad humours could be removed from the body by removing some of the blood
* usually done by barber surgeons and wise women
* methods: vein cutting, leeches, cupping

What was purging

* a humoural treatment
* humours were created from the food eaten, a common treatment was purging the digestive system to remove any leftover food
* one method was vomiting which used emetics (strong bitter herbs)
* another method was using a laxative/enema to clear out anything left over in the body

What were the humoural remedies used to treat disease

* herbal infusions to drink, sniff or bathe in
* aloe vera was used to improve digestion
* theriaca - a spice based mixture containing up to 70 ingredients
* different foods prescribed to encourage the balance of humours
* a dish called blanc mangier was recommended for medieval invalids because the ingredients were warm and moist

Why was bathing used as a humoural treatment

* warm baths helped the body to draw in heat to dissolve blockages in the humours
* steam out impurities and ease aching joints
* for people with paralysis a fox was boiled in water and then the person would bathe in the water

How could the church prevent disease

* regular praying
* confessing
* paying tithes (1/10th of your wages to the church)

How could diet prevent disease

* since the humours were thought to be produced by digestion, so what and when you ate where considered important when preventing imbalance
* eating too much was strongly discouraged
* fear of digestive problems leading to death was so great that many people purged themselves (usually by vomiting or using laxatives) as a way of preventing disease and treating it

How could hygiene prevent disease

* they would follow a loose set of instructions called the regimen sanitatis which was provided by physicians to help a patient maintain good health
* included instructions such as: undertaking moderate exercise, not overeating, making sure you get a reasonable amount of sleep, regularly bathing, not having too much sex, and being friendly with your neighbours
* bathing was used as a prevention method as bad smells indicated miasma (only the wealthy could afford)

How could purifying the air prevent disease

* purifying the air by using sweet herbs such as lavender
* sometimes they may also carry a posy of flowers
* local authorities also tried to tackle miasma outside of the home putting into place measure to keep towns clean. For example not leaving rotting animals around

What medieval medics were there

* most people would have been treated at home by a female family member
* physicians
* apothecaries
* surgeons

Who were physicians

* medieval doctors were called physicians
* they diagnosed illness and reccomended a course of treatment
* rarely got involved in treating the patients themselves, this was left up to less educated midwives, apothecaries or barber surgeons
* many physicians were clergymen who were forbidden from carrying out procedures such as bleeding
* from 1215 onwards, any operations likely to involve cutting the patient were forbidden by clergymen

What would a physician often do

1. look at a sample of the patient’s urine, faeces and blood (this was collected and sent to him)
2. consult the astrological charts under which the patient was born and at the time they fell sick
3. humoural tendencies of the patient would be used to create a course of treatment

What would apothecaries do

* they mainly mixed herbal remedies
* they have a good knowledge of the healing power of herbs and plants thanks to studying herbal manuals such as Materia Medica
* usually had a good amount of knowledge from their own experiences, or passed down from family members
* where cheaper than physicians
* also prescirbed poison which went against the idea of physicians (they should do no harm)

What would surgeons do

* barber surgeons were probably the least qualified medical professionals in England
* since good barbers had sharp knives and a steady hand, they regurarly perfromed small surgeries as well as teeth extractions
* a skilled surgeon could remove cataracts from the eyes

How were the sick cared for in hospitals

* by 1500, there were 1,100 hospitals ranging in size from a few beds to hundreds
* Bury St Edmunds had six hospitals
* many hospitals did not actually treat the sick - instead they offered hospitality to travellers and pilgrims
* 30% of hospitals were owned by the church - these were run by monks/nuns who lived in nearby monasteries
* medieval hospitals were places to rest, recover and sleep
* the space would have been kept clean and bed linen changed regularly
* patients would share beds
* insane and pregnant patients were often rejected (although some hospitals had special beds reserved for unmarried mothers)

How were the sick cared for at home

* vast majority of the sick were treated and cared for at home
* women would care for their relatives and dependents when needed
* the care would involve making the patient comfortable, preparing restorative foods, mixing herbal remedies

What did people believe were the religious & supernatural causes for the black death

* god had deserted mankind
* punishment for the sin of the world
* 1345 - unusual positioning of the planets - a sign of something that was going to happen
* part of god’s plan to make people less sinful, saving them from Hell

What religious and supernatural treatments were there for the black death

* confess sins
* praying for forgiveness
* inevitability - once you have it you were meant to get it
* go to church services once a day
* candle vigils
* pilgrimages
* praying in public

What were the religious and supernatural ways to prevent the black death

* pray
* fast
* pilgrimage
* whipping yourself to show you are sorry

What were believed to be the natural causes for the black death

impure air - miasma causing disruption to the humours (from poisonous fumes or filth in the streets)

What were believed to be natural treatments for the black death

* bleeding/purging (this actually caused more people to die!)
* strong smelling herbs
* bursting buboes
* tried treatments based on treatment by opposites

What were believed to be natural ways for preventing the black death

* escaping - running away from the foul air
* carrying flowers/fragrant herbs
* avoid breathing in miasma
* avoid bathing - they believed water would open your pores to the bad air

What common beliefs did people have for the causes of the black death

* Europe many people blamed Jewish people
* Jews had been expelled from Britain during the 17th century

What common beliefs did people have for treatments to the black death

* strong christian beliefs - confession and praying
* clear nobody could cure the disease
* lack of knowledge about what caused it, stopped people being able to cure it

What were common beliefs on how to prevent the black death

* listen to cheerful music
* avoid doing anything sad
* stop visiting family members who had the disease

What year did the black death arrive in england

* 1348
* it had spread from the far east along trade routes
* within months, it had spread the length and breadth of England, killing thousands of people
* those who caught it could expect to die within a matter of days

What actions did the government take against the black death

* local authorities attempted to take action to prevent the plague from spreading
* new quarantine laws put in place to try stop people from moving around too much
* people new to the area had to stay away from everybody else for 40 days to ensure they were not carrying the disease
* authorities started to quarantine houses where the plague had broken out
* considered banning preaching and religious processions to stop large crowds of people gathering but they could not enforce this
* local authorities stopped cleaning the streets - the belief that the foul stench of the rubbish and rotting bodies would drive off the miasma causing the plague

What factors prevented change in medical thinking c1250 - c1500

* the church
* education
* attitudes/respect for tradition
* individuals
* government

How did the church prevent change to medical thinking 1250 - 1500

* was very rich and powerful
* controlled education
* the bible said that God controlled every aspect of life so it was logical that God sent diseases
* believed that God also sent the Black Death as a punishment
* if anyone did dare challenge the Bible and the Church they were told they would go to Hell when they died
* the Church supported the ideas of Galen

How did education prevent change to medical thinking 1250 - 1500

* church controlled education, including how physicians were trained at universities
* doctors were taught to believe what Hippocrates and Galen said, meaning they were not encouraged to experiment or think for themselves

How did attitudes/respect for religion prevent change to medical thinking 1250 - 1500

* due to the church and the way physicians were educated most people had great respect for the past and for traditional ideas
* they wanted to keep everything as it was (conservative attitude)
* doctors were not trained to challenge existing ideas

How did individuals prevent change to medical thinking 1250 - 1500

* no individual made a breakthrough because education was very limited and controlled by the Church which did not encourage new ideas
* the key individuals were therefore Hippocrates and Galen who had died centuries before

How did the government prevent change to medical thinking 1250 - 1500

* the king’s government did not want to improve medicine 
* they did order for towns to be cleaned but they did not do this regularly
* no taxes were collected which meant there was no money for medical breakthroughs