History of medicine - Medieval 1200-1500

Hippocrates’ theory of the Four Humours

Hippocrates was a Greek doctor and teacher who proposed that the body contained four humours: black bile, yellow bile, blood and phlegm.

• If you are healthy, your humours are balanced

• If you are unhealthy, your humours are unbalanced

Hippocrates believed that you saw evidence of this when you were sick, and to cure an illness, you would need to remove the unbalanced humour

Galen (a Roman doctor) developed this by…

He suggested the ‘Theory of opposites’ which suggested that:

If you had too much of a humour, you needed to cure it with the opposite i.e. if you had too much phlegm, which is cold and wet, you were given something spicy which is hot and dry, to cure it

Short term impact of this theory

The church supported this theory and all physicians were taught about it when educated by the Church.

Physicians also used urine charts linked to the four humours to check the colour, smell and taste of urine to ascertain illness

Miasma theory

People blamed bad smelling air (known as miasma) for causing disease. They believed that dirt and waste from the streets poisoned the air and caused illness.

The Church supported this theory as it was supported by Hippocrates’ and Galen’s work. There was also the theory that miasma was sent as a punishment from God or caused by an alignment of the planets

God/Church

The Church taught that diseases were a punishment from God for sinning or was a way for God to test people’s faith. A common disease linked to sin was leprosy

Supernatural

In the Middle Ages, most people were superstitious. Physicians were taught astrology as part of their medical training as they believed that the alignment of the stars and planets affected your healthy and caused disease.

Other believed causes were witchcraft, bad luck or scapegoating of minority groups e.g Jews

Lack of progress

No progress was made towards the cause of disease. A respect for tradition, lack fo education and scientific progress, and the dominance of the Church created continuity in understanding the cause of disease.

Surgery in the Middle Ages

• Used wine as an antiseptic and natural substances as anaesthetics

• Surgical equipment was often dirty and carried infection because surgeons still had no idea that dirt carried disease

• Surgeons were not well trained and knew little about anatomy

• Surgeons could do some complex external surgery (e.g removing eye cataracts) and even drill holes in the brain

• Could not prevent infections or stop heavy bleeding, so this was a major cause of death after surgery

Religious treatments in the Middle Ages

• Pilgrimages to tombs and holy relics were popular - peoples would touch and pray to them - meant to cure you

• Flagellation - whipping yourself to purge yourself of sin

• Tithes - people gave tithes to the Church for priests to pray for them and cure them

Four humours treatments

• Bloodletting - most common way to remove bad humours/blood

• Leeching - using leeches to suck out bad blood

• Purging - swallowing a mixture of herbs and animal fats to make you sick or talking laxatives - to rebalance humours

• No progress as it followed ancient theories

Herbal treatments

• Very popular and given by women and apothecaries

• Many worked - aloe Vera for digestion, honey for fighting infection on wounds

Prevention

Strong focus in the middle ages on prevention. Many people thought only god could cure diseases so they aimed to prevent it firsy

Religious prevention

• Flagellants whipped themselves to beg God for forgiveness

• People fasted, mad offerings to God to show they were sorry for their Sind

• Many people followed a Christian lifestyle (praying, going to Church) and hoped not to get ill

Miasma prevention

• People attempted to solve miasma by removing dirt poisoning the air

• The rich could visit bath houses and hung sweet herbs

• People carried sweet smelling herbs to overpower bad air

Regimin sanitatis

• Physicians recommended this to patients to keep healthy

• Only used by the rich because it was expensive

• Included avoiding stress, exercising and eating a healthy diet

Public health

The wealthy spent a lot to improve this - the government only spent money to improve public health during the Black Death.

Cost of public health improvement was high, so the poor still lived in dirty conditions.

Public health: waste and litter

Streets were filled with litter and threw blood and human waste on it.

Solution: laws banned littering, public latrines (toilets) were built in london, butchers had to clean thrown waste out of towns

Public health: too many animals

Animals were butchered in the streets and horses left dung in the streets

Solution:12 rakers were employed to clean the streets of London by 1370. Cities like Newcastle paved their streets to make them easier to clean.

Public health: dirty water

Water supplies were polluted with human and industrial waste

Solution: In some cities, like Gloucester, they used lead pipes and aqueducts to bring in fresh water, however it was only for the rich

Public health: leaking latrines

Latrines and cesspits contaminated water supplies

Solution: laws on locations for private latrines. Cesspits built with stones to stop leaks.

How much progress was there with public health?

There was little progress (continuity) in the middle ages as a majority of prevention remained based on religious factors. However, the ideas of regimin sanitatis were healthy.

You could argue that public health improved with efforts to clean cities, however it was still not enough to improve health.

Treatment: wise women

• A local woman with experience, could be the ‘lady of the manor’

• They would use herbal remedies and some charms/spells to help cure local villages. They were cheap

• Often helped with childbirth and they could train to be a midwife with a bishop’s permission

• Not allowed to be physicians

Treatment: Apothecaries

• Like a pharmacist or chemist - cheaper than a physician

• Trained but had no medical qualifications, highly experienced

• Mixes various ingredients to produce medicines for physicians

Treatment: Physicians

• Medically trained at university for 7 years using Hippocrates and Galen, but without dissection so little anatomical knowledge

• Only 100 male physicians in England

• They would diagnose illness and suggest treatment by surgeries or apothecaries

• Took clinical observation (observed pulse and examined whole body)

• Very expensive, only rich could afford

Treatment: barber surgeons

• Untrained but experienced surgeon

• Used a wound man diagram for advice

• Could pull out teeth, let blood, lance boils and remove tumours

• Performed basic surgery such as amputating limbs

• Used no anaesthetic or antiseptic - very low success rate

• Cheapest surgery available

What were medieval hospitals like?

• The first hospital in England was created in 1123, St Bartholomew’s in London

• At first, hospitals were set up by monks who cared for older people, offering food, warmth and prayers

• Over time, smaller hospitals were set up by wealthy merchants to care and by 1400 there were over 500 in England

Management of medieval hospitals

• Majority run by Church

• Emphasis on God’s healing power

Medieval hospitals: patients

• Did not allow those with infectious diseases

• Mostly for the old and poor or travellers

Medieval hospitals: nurses and carers

Most did not have doctors but a priest with monks and nurses who ran the hospital

Medieval hospitals: treatments

• Focus on ‘care not cure’

• Patients given food and warmth to make them comfortable

• Monks believed it was up to god to cure you so they would offer prayer and you could go to mass 7 times a day

Medieval hospitals: conditions

• Kept very clean by monks

How much progress was there with care and treatment in the Middle Ages?

Despite growth of Churches there was little treatment with the focus on care and God’s healing. A majority of people were cared for at home by women and herbal remedies

What was the Black Death (1348-49)

• The Black Death first arrived in England in 1348

• By 1349, it had spread around the rest of England, killing 40% of the population

• At one point, 200 people a day were being buried in England

What were symptoms of the Black Death?

People who caught the disease developed painful swellings under their armpits. Blisters appeared all over follower by a high fever, severe headache, vomiting, fits, unconsciousness and a then death

What were ideas about the cause of the Black Death?

• The majority of people believed that it was caused by God as punishment for their sins

• It was blamed on the movement of the planets

• Many people believed that bad air (miasma) caused by poisonous fumes released by a volcano were to blame

• Jews, a religious scapegoat, were blamed for spreading the disease by poisoning the wells

• No one had an idea about the real cause of the disease (fleas spread by rats)

What were living conditions like in the 1340’s?

• Large cities were perfect for the spread of the Black Death as people lived so close to each other - 60% of Londoners died a

• Cities helped spread the disease and increase the number of rats/fleas because:

  • Horse waste was everywhere and the butchering of meat led to waste and blood on the streets

  • Medieval towns had no drainage, sewers or rubbish collections

  • The disposal of bodies was basic and unhygienic and helped to spread the disease still

What were treatments for the Black Death?

• Rubbing onions or herbs on boils

• Drinking vinegar or eating crushed up minerals, arsenic or mercury

• Physicians would pop the buboes to release the pressure or try bleeding or leaching

• Sitting close to a fire or in a sewer to drive out the fever

• Praying to God to hope that He would cure the illness

What public health measures were put in place during the Black Death?

• The government introduced a ‘quarantine’ to stop people moving around so much, whilst victims were stopped from leaving their houses. The hospitals would not accept sufferers either

• However, King Edward ordered the cleaning of the streets to stop, believing that the odour would drive away the miasma

• Usual advice was to carry a posy of flowers or herbs around their neck or bathe to avoid the corrupted air

What methods of prevention were used during the Black Death?

• One of the most common methods was escaping the plague and avoiding people

• Seeking God’s forgiveness was also the most common way people avoided the Plague

• ‘Flagellants’ whipped themselves for forgiveness

• Daily church services, prayers and pilgrimages were common

How much change/progress was there there surrounding the cause of disease in the medieval period?

There was no progress on what caused disease during the Middle Ages

How much continuity was there on ideas on the cause of disease in the medieval period?

• Religious ideas - everyone believed that God caused disease and this was simply not challenged due to the power of religion. As the Church taught this there was zero progress put into finding the real cause of illness

• Miasma, supernatural and superstitious ideas - all these ideas were common throughout the Middle Ages but again, they offered no real cause of disease

• Four Humours - the idea that the cause of disease was based on the four humours (blood, black bile, yellow bile and phlegm) continued for over 100 years. Hippocrates and Galen’s ideas failed to clearly identify the case of disease

What progress was there on treatment in the medieval period?

• Hospitals - By 1400, there were over 500 hospitals across the country. However they were more for rich people.

• Surgery - made progress during a time of conflict, where barber surgeons gained experience. Their expertise developed and they could perform some external surgery or even removing eye cataracts. They also used basic anaesthetic (opium) and antiseptic (honey) to treat the wounded during and after surgery

• Herbal remedies - some remedies, used by wise women, worked (such as mint)

What continuity was there on treatment in the medieval period?

• Hospitals - the sole focus was on ‘care not cure’, those with contagious diseases were banned from entering and those monks providing care usually relied simply on God

• Surgery - 50% of patients dies due to infections and injuries. Surgeons did not clean equipment, could no clean wounds or stoop heavy bleeding. Very basic understanding of anatomy using ‘wound man’

• The four humours - most of the treatments suggested to treat the Four Humours did not work and often made patients worse (cupping, leeching, bleeding)

• Religious - pilgrimages and praying also failed to cure

What progress was there on prevention in the medieval period?

• Public health - efforts were made in some cities to improve public health. For example, in 1370 there were 12 rakers in London clearing the streets of waste. In hull aqueducts were built to bring in clean water and in 1352 Edward III passed a law banning littering in the streets

• Prevention - regimin sanitatis was a medieval common sense approach to the rich keeping healthy, through exercise and a balanced diet

What continuity was there on prevention in the medieval period?

• Public health - medieval towns were still filthy places. This is why the Black Death spread so quickly as there were rats. Also, the government did little to help improve public health, only when the Black Death was happening

• Prevention - people believed that hanging sweet-smelling herbs or wearing amulets/charms would prevent diseases like the Black Death - they didn’t

Factors affecting progress in medieval Britain: The Church

• The Catholic Church was extremely rich and powerful in the Middle Ages. It dominated most people’s lives

• The bible said that God sent diseases as punishment for sins and it was only he who could cure it. Therefore, there was no need to look for other causes or treatments. The Church said that anyone who dared challenge the Church would go so hell, therefore no one challenged them (English scientist Roger Bacon was even jailed for challenging the Church’s views on medicine

• The Church controlled all education and libraries, so all ideas were from the Church and no new ideas could spread. The Church trained all the physicians, who were taught the ideas of Galen and Hippocrates. If you challenged them, you were challenging God.

• Dissection was also banned by the Church so no inspecting of anatomy could happen to challenge Galen.

Factors affecting progress in medieval Britain: Hippocrates and Galen

• The ideas of Hippocrates and Galen (Four Humours theory) were well respected as they were over 1000 years old and seemingly logical

• Galen had written over 300 medical books, they were detailed and illustrated so doctors believed everything to be correct

• To medieval doctors, the four humours theory worked and you could see evidence

• All medieval training (from the Church) focused on the work of Hippocrates and Galen

• The physicians were taught that all they wrote was correct and no to challenge it - instead to prove how it worked

• This meant that these ideas were never challenged

Factors affecting progress in medieval Britain: a respect for tradition

• A majority of people had respect for the past - they wanted to keep everything as it was

• Without any access to new books or ideas, there was little opportunity for new ideas

• Physicians were not encouraged to challenge the past. The focus was on supporting old theories (four humours)

Factors affecting progress in medieval Britain: the king and government

• The majority of tasks for the King of England were to defend the country and keep it peaceful - he was not interested in public health

• The government did not talked any taxes to improve people’s health or medicine, so no money was spent to improve medicine

• Only during the Black Death did the government aim to tackle public health