Medieval Medicine

Medieval Medicine

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Devran Karatas

For Year 10, Medicine Through Time, the Medieval section

Hippocrates and Galen

Let’s ‘humour’ their ideas

In this section, we aim to understand who Hippocrates and Galen are, the Theory Of The Four Humours, and why it was so popular in Medieval England.

What do you see in this photo?

This photo features a typical dissection of the time. Now, dissections were illegal by the church’s law– unless it was the body of a criminal (it was believed your body had to be whole for you to ascend into the afterlife).

A barber-surgeon will be carrying the dissection, while the physician will be away from the body, reading aloud books by Hippocrates and Galen.

Who was Hippocrates?

Hippocrates was a Greek doctor and teacher who created the Theory of the Four Humours in the 5th Century (BCE). ‘Humour’ comes from the Greek word ‘humon’, which means fluid.

Who was Galen?

Galen was another Greek doctor, but he worked in Rome in the 2nd Century (CE). He was the personal physician of the Roman Emperor. Galen liked the ideas of Hippocrates, and he built on them, writing and publishing more than 350 detailed (confidently incorrect) medical books.

What is the Theory of the Four Humours?

The Theory of the Four Humours proposed that the human body consisted of four liquids, or 'humours,' derived from the digestion of various foods.

These humours were:

⦁ Blood

⦁ Phlegm (watery substance expelled via coughing, sneezing, or crying)

⦁ Black bile (likely referring to clotted blood observed in excrement or vomit)

⦁ Yellow bile (present in pus or vomit)

Maintaining a healthy state requires a balance of these humours. An imbalance, with an excess or deficiency of one humour, would result in illness.

What if there was an imbalance?

The theory suggested that if there was an imbalance, the person with the imbalance had to get rid of excess Humour. If they had too much black bile, they would vomit dark liquid. If they had too much blood, they would have a nosebleed or cough up blood. If they had too much phlegm, they would sneeze or cough, and if they had too much yellow bile, they would throw up or remove it through pus.

Links to elements

The theory also connected each humour to specific elements: hot, cold, wet, and dry. For instance, a fever, characterized by hot, red skin, was attributed to an excess of blood, a hot and wet element. Conversely, a cold, caused by too much phlegm (a cold and wet element), resulted in shivering and a runny nose. The humours were also associated with the seasons. Winter, being cold and wet, was thought to cause an overproduction of phlegm, leading to coughs and colds. Even star signs were linked to humours, with Capricorn, Aquarius, and Pisces associated with phlegm. Furthermore, personality traits were believed to be influenced by the humour.

Galen’s Additions

Galen expanded the Theory of the Four Humours by introducing the Theory of Opposites, suggesting that imbalances could be corrected by applying opposing qualities. For instance, he proposed that a phlegm excess, associated with cold and water, could be counteracted by consuming hot peppers. Conversely, a fever, resulting from too much blood, could be treated with cooling cucumbers.

Popularity

The comprehensive nature of Hippocrates' and Galen's writings instilled in physicians a false sense of complete understanding. Their works, including Galen's meticulous documentation of plague symptoms in AD 167, offered the first detailed descriptions of ailments and treatments. Galen's intricate accounts of human and animal dissections further bolstered his credibility, making his theories difficult to refute. Moreover, the Church's endorsement of Galen's ideas, which aligned with their theological beliefs, solidified their acceptance. The Church's control over book production and libraries ensured the widespread dissemination of Galenic texts. Book learning was highly esteemed in medieval society, and physicians were trained primarily through studying these texts, rather than practical experience. This emphasis on theoretical knowledge, coupled with the lack of scientific evidence and the illegality of dissections, perpetuated Galen's influence. Even when dissections were performed, they served to reinforce Galen's ideas, as any discrepancies were attributed to the criminal nature of the cadavers. The apparent correlation between patients' symptoms and the Four Humours theory, along with the seemingly logical treatments derived from Galen's principles, further convinced people of their validity.

The Church

Pray it away

In this section, we’re aiming to understand the different ways that the Church impacted medicine, mostly (although not always) by hindering progress.

TIP: When writing about Medieval Medicine, you should always mention the church. The church had a monopoly on ideas around medicine.

Libraries and scribes

The Church hindered the progression of medical knowledge in Medieval England through its control over libraries and scribes. Since almost all libraries were in monasteries, and monks were responsible for copying books by hand, the Church had the power to select which medical texts were reproduced and circulated. This meant that texts challenging the Church's accepted medical views, such as those based on the Four Humours theory, were less likely to be copied and distributed, limiting access to alternative ideas and hindering medical progress.

Attitude to new ideas

The Church's conservative attitude towards new ideas posed a significant obstacle to the advancement of medical knowledge in medieval England. It actively discouraged and suppressed any medical theories or practices that contradicted its established beliefs, often labelling them as heresy. This created an environment of fear and censorship, where physicians and scholars were hesitant to explore new ideas or challenge the prevailing medical dogma. Consequently, innovative research and discoveries were stifled, hindering the development of medical science and perpetuating reliance on outdated and ineffective treatments.

Dissection and Education

The Church's stance against dissection and its control over education significantly hindered medical progress in medieval England. Dissection was largely prohibited, as the Church believed it desecrated the body, a vessel for the soul. This limited physicians' understanding of human anatomy and hindered the development of surgical techniques. Additionally, the Church heavily influenced medical education, often emphasizing religious doctrine and traditional texts over practical experience and scientific inquiry. This led to the perpetuation of outdated medical practices and resistance to new ideas and discoveries.

Explanations of disease

The Church's influence on the explanation of disease in medieval England significantly hindered medical progress. By attributing illness to sin, demonic possession, or divine punishment, the Church discouraged the pursuit of natural causes and scientific explanations. This discouraged physicians from seeking practical solutions and effective treatments, as they were more likely to focus on prayer, repentance, and other spiritual remedies. This reliance on supernatural explanations hindered the development of a rational and evidence-based approach to medicine, impeding advancements in the diagnosis, treatment, and prevention of diseases.

The promotion of pilgrimages in medieval England also inadvertently contributed to the spread of disease. Large groups of pilgrims from diverse regions would often travel and congregate in proximity, creating ideal conditions for the transmission of contagious illnesses. Additionally, the lack of sanitation and hygiene practices during these journeys further exacerbated the risk of disease outbreaks. As pilgrims returned to their communities, they could unknowingly carry and spread these diseases, contributing to epidemics and pandemics.

Hospitals

In medieval England, the Church's influence on hospitals significantly impacted the progression of medical knowledge. Early hospitals were primarily religious institutions, focused on providing care and comfort to the sick and poor, rather than medical treatment and research. The emphasis was on spiritual well-being and prayer, with limited attention to hygiene and sanitation. This environment often fostered the spread of disease, hindering medical advancements and contributing to high mortality rates. While the Church played a crucial role in providing charitable care and the acquisition of some medical knowledge and basic practices in hygiene, its priorities often conflicted with the development of a more scientific and evidence-based approach to medicine.

Other Causes

Something smells here

This is a short section on other beliefs on the causes of disease.

Disease was often attributed to a combination of factors beyond the prevailing humoral theory. People believed that astrological alignments could influence health and well-being, with the positions of celestial bodies impacting an individual's susceptibility to illness. Additionally, the Church's teachings fostered the notion that disease was a manifestation of sin or divine punishment for wrongdoing, leading to a focus on repentance and spiritual remedies. The miasma theory also played a significant role, proposing that "bad air" or foul odours emanating from decaying matter or other sources of pollution were responsible for causing diseases.

The Black Death

Uh-oh!

The Black Death, a devastating bubonic plague pandemic, ravaged Europe in the mid-14th century, including Medieval England. Its arrival brought widespread fear, panic, and a desperate search for explanations and remedies.

Handling the Plague

The lack of scientific understanding led to a range of ineffective and often harmful practices. People resorted to superstitious measures such as carrying charms, wearing protective amulets, and blaming marginalized groups like Jews and lepers. The church claimed it was divine punishment and organised mass gatherings for prayer (...). Others blamed astrology, as the planets were lined up unusually.

Treatment Attempts

Medieval physicians, relying on the humoral theory and other prevailing beliefs, employed various treatments with limited success. Bloodletting, purging, and applying herbal poultices were common practices, often exacerbating the patient's condition. Some resorted to prayer, penance, and flagellation, believing the plague was divine punishment.

Pilgrimages were encouraged, but you can see what went wrong there: the disease spread because of this.

Prevention Efforts

Due to the limited understanding of disease transmission, prevention efforts were largely ineffective. Miasma theory led to attempts to purify the air with fires and incense, while others believed avoiding contact with infected individuals and their possessions could prevent the plague. However, the flea-borne nature of the disease remained unknown, rendering these measures futile. Others tried changing their diets, and many just left the cities (which only spread it more).

Impact and Aftermath

The Black Death had a profound impact on Medieval England, causing widespread death, social disruption, and economic hardship. Entire villages were abandoned and people thought the world was ending. Despite this event, not much changed in the handling of the Great Plague of 1667.

Practitioners

We cut more than the hair

Barber-Surgeons

Barber surgeons were versatile individuals who combined the roles of barbers and surgeons. They provided essential services such as shaving, haircutting, and beard trimming, but their expertise extended to medical procedures as well. However, this did not mean they were automatically good at it. There were many risks, like infection, or incorrect procedures.

Some barber surgeons picked up anatomy, physiology, and surgical techniques. They learnt various medical procedures, including bloodletting (a widely practised treatment for numerous ailments), tooth extraction, wound repair, and abscess drainage.

Apothecaries

Apothecaries served as the pharmacists of the medieval era, preparing and dispensing medicinal herbs and drugs. There was no guild system back then, so some apothecaries were quacks and others were genuine. It was hard to tell.

Carers in the home

Carers in the home, primarily women, played a crucial role in providing healthcare within households. They lacked formal medical training but relied on customary remedies and folk medicine passed down through generations.

These carers used herbal teas, poultices, and simple treatments for minor injuries and illnesses. They also provided comfort, administered remedies, and monitored the condition of the sick, occasionally assisting with childbirth and post-partum care.

Physicians

Physicians held the highest standing among medieval medical practitioners, recognized as experts in their field. They received education at universities controlled by the church.

Physicians studied subjects such as anatomy and physiology, gaining a comprehensive understanding of medical theories and practices. They possessed a deep knowledge of ancient medical texts, particularly the works of Hippocrates and Galen.

Physicians were skilled in diagnosing and treating various diseases, employing methods such as pulse-taking, urinalysis, and physical examination.

Treatments

I’ll treat you

Medieval treatments were a diverse mix of practices. These treatments often reflected the limited understanding of disease and anatomy at the time and were administered by various practitioners, including physicians, bbbarberurgeons apothecaries, and lay healers.

Humoral-Based Therapies

Many treatments aimed to restore the balance of humours, as outlined by Hippocrates and Galen. Bloodletting, purging, and emetics were commonly employed to remove excess humours, while dietary adjustments and herbal remedies were used to rebalance them.

Herbal Remedies

Apothecaries played a crucial role in preparing and dispensing herbal concoctions, believed to possess healing properties for various ailments. These remedies, often based on traditional knowledge and folklore, were used to treat a wide range of conditions, from fevers and coughs to digestive problems and skin diseases.

Surgery

Barber surgeons performed a range of surgical procedures, including wound dressing, abscess drainage, and tooth extraction. However, due to the lack of anaesthesia and sterile techniques, surgery was often risky and painful, with high rates of complications and mortality.

Spiritual Healing

Religious beliefs heavily influenced medieval medicine, with prayer, pilgrimages, and the intercession of saints often sought as remedies for illness. Exorcisms were also performed to expel demons believed to possess the sick.

Superstitions and Folk Remedies

A variety of superstitious practices and folk remedies were prevalent, including the use of amulets, charms, and incantations. These practices often reflected a belief in supernatural forces and the power of magic to influence health and well-being.

While some medieval treatments, particularly those based on herbal remedies, had a degree of effectiveness, many were ineffective, harmful, or even dangerous. The lack of scientific understanding and reliance on tradition and superstition often hindered progress and contributed to the persistence of disease and suffering. However, these practices also laid the foundation for the development of modern medicine, as physicians and scholars gradually began to question traditional beliefs and explore new approaches based on observation and experimentation.

Medieval Hospitals

More about hospitality

In medieval England, hospitals largely functioned as almshouses, primarily providing shelter and sustenance to the poor, sick, and elderly rather than offering comprehensive medical treatment. These institutions were often established and funded by religious organizations, such as monasteries and cathedrals, driven by the Christian principles of charity and compassion.

Medieval hospitals typically consisted of a collection of buildings, including a chapel, a common hall for dining, and separate dormitories for men and women. They were often located within or near towns and cities, allowing easy access for those seeking assistance. While some hospitals might have had a physician or a surgeon on staff, medical knowledge and practices during this period were limited, and treatments were often rudimentary.

Medieval hospitals' primary focus was on providing basic care, including food, shelter, and spiritual comfort. Patients were typically admitted based on their needs and the availability of resources. Medical treatment, when available, was often limited to simple remedies and wound care. Physicians and surgeons, if present, were often itinerant practitioners who relied on traditional knowledge and practices passed down through generations.

The lack of advanced medical treatment in medieval hospitals was due to several factors. Firstly, scientific understanding of the human body and diseases was limited, and medical knowledge was largely based on ancient texts and traditional beliefs. Secondly, there was a shortage of trained medical professionals, as medical education was rudimentary, and few opportunities for formal training existed.

Medieval hospitals played a crucial role in providing social support and basic care to the most vulnerable members of society. While they lacked the medical advancements of modern hospitals, they were essential institutions that offered comfort, sustenance, and a sense of community for those in need. In addition, many hospitals were often run by religious organizations, which emphasized the importance of spiritual healing alongside physical care, further shaping the approach to treatment during this time.

In conclusion, Medieval Medicine represents a complex interplay of prevailing beliefs, institutional influences, and evolving practices. While prominently guided by the ancient texts of Hippocrates and Galen, medieval medical knowledge was also shaped by the Church's doctrines, which often constrained exploration and innovation. The reliance on the Theory of the Four Humours provided a structured but ultimately flawed understanding of health and disease. Furthermore, external factors such as the societal response to the Black Death revealed both the limitations and the resilience of medieval medical practitioners. Some practices upheld by tradition paved the way for future advancements, as gradual questioning of established norms led to transformative changes in medical science. Thus, the medieval period, characterized by its adherence to ancient theories and religious constraints, also laid the groundwork for the Renaissance and the eventual emergence of modern medical thought. The legacy of this era underscores the significance of continuous inquiry and adaptation in the face of changing knowledge about human health and disease.