1000 - 1500: medicine stands still

• medieval beliefs about causes of illnesses and disease

  *punishment from God

  *bad air

  *astrology

  *unbalanced humours
• medieval methods of preventing, diagnosing and treating illness

  *urine chart

  *zodiac

  *bleeding

  *cleaning the streets

  *herbal remedies
• urine chart


  *used to examine urine to define illness

  *judged the colour, smell and thickness of urine
• zodiac man


  *diagram used by medieval doctors to indicate which astrological formations were favourable for treating different parts of the body
• bleeding


  *thought to keep the body's humours in balance, but probably made patients even weaker
• cleaning the streets

  *in 1349, plague struck London and King Edward III ordered the Lord Mayor to remove all the filth lying in the streets

  *he said that filth from the houses was infecting the air and endangering people through sickness
• herbal remedies


  *products developed from plants that exhibit or are thought to exhibit some medicinal property

  *most women knew the recipes by heart, but they were also written down in books

  *saying prayers while collecting the ingredients was encouraged to increase the effectiveness of the remedy
• medieval health practitioners

  *physicians

  *women

  *surgeons
• physicians


  *highest ranking and paid doctors that only the rich could afford

  *treated kings, nobles and wealthy merchants

  *only 100 of them in in England the 1300s

  *treatments were based on the four humours and they advised patients to stay healthy with regular washing, cleaning teeth, combing hair, exceeding in the fresh air and bathing in hot water

  *trained at university
• women


  *for the majority of people who could not afford a physician

  *would have learned a wide range of remedies from their (grand)mothers and treated their families

  *there may have been a wise woman in the village to consult when treatment for an illness was not known

  *also acted as midwives
• surgeons


  *for those with little money and very worried about an illness

  *trained as apprentices to experienced surgeons
• preservation of knowledge


  *collapse of Roman Empire nearly destroyed all of the medical knowledge that had been built up by the Greeks and Romans

  *Christianity and Islam made sure all of the knowledge was not lost by saving many of the books and making copies
• education and training

  *Christian Church controlled the universities where physicians trained and made sure that they read and trusted the work of Galen, as his teachings supported the Christian idea that God created human beings

  *physician were discouraged from questioning Galenic teachings, as it insinuated questioning the Bible
• Roger Bacon


  *Franciscan monk, English philosopher, and scientist in the 1200s who advocated for a system of scientific experimentation in seeking truth rather than accepting without question traditional Church and ancient beliefs

  *this led to the development of the scientific method

  *he was imprisoned by Church leaders in 1277
• medieval beliefs of causes and treatment of disease

  *the Bible said that God controlled all aspect of life, so it was logical that God also sent disease

  *it was believed that disease was a punishment for sin, so being more religious, praying more and committing fewer sins was thought to be a cure

  *if God sent disease, this meant that there was no need to look for other causes - this was an important reason why ideas abut what caused disease did not change
• medieval hospitals


  *the Christian Church taught that the sick should be cared for, leading to many hospitals being founded in the Middle Ages

  *patients were usually those living in poverty or the elderly - those with infectious diseases or mental illnesses were not allowed to be admitted

  *nursing care was usually provided by nuns or elderly women to prevent patients being tempted into carnal sin

  *patients were given food and rest as well as herbal remedies - the most important treatment was still prayer, with priests saying mass every day and encouraging patients to confess their sins and seek forgiveness from God

  *by 1400, there were nearly 500 hospitals in England, most of which were very small with an average of about 10 patients

  *there were separate hospitals for those with mental illnesses and leprosy
• Islamic hospitals and medical education


  *Islamic teachings encouraged people to take care of their diet, exercise and hygiene as well as to take care if those who were sick or in need

  *the first Islamic hospital was founded in Baghdad around 805 and by the 1100s, every large town in the Islamic world had a hospital

  *hospitals and medical schools were funded by wealthy individuals and were open to all, organised into wards and provided nursing care for patients

  *physicians were trained at these hospitals

  *there were also specialised hospitals for mental/physical disorders, plus a surgery, pharmacy, library and lecture rooms for teaching
• Islamic medical texts


  *Islamic physicians built on the ideas of the Ancient Greeks and Romans

  *many Greek medical books were translated into Arabic by Islamic scholars and without these translations, many books by Galen and others may have been lost forever

  *Islamic doctors wrote multi-volume medical encyclopaedias that organised medical knowledge, including the work of Galen and others Greek medial writers

  *many of these books were translated from Arabic to Latin and were used in Europe so that European physicians learned more about the work of Galen and Arab doctors
• Al-Razi (865 - 925)

  *wrote over 50 books based on the ideas of Hippocrates and Galen, also including Chinese and Indian sources

  *his books were used for centuries after his death in 925

  *his books emphasised the importance of preventative medicine (e.g. diet and hygiene) and the physician carefully diagnosing the illness

  *described smallpox and measles accurately
• Al-Zahrawi (936 - 1013)

  *produced a book describing complex abdominal operations and showing illustrations of more than 200 surgical instruments
• Ibn-al-Nafis


  *argued against Galen's theorem that blood was produced in the liver and burnt up in the body as a nutrient but instead argued that blood circulated around the body
• Ibn Sina


  *encouraged observation and experimentation, as well as emphasising the importance of clean air and water

  *wrote on a wide range of topics, his most important books being 'The Book of Healing' and 'The Cannon of Medicine'

  *'The Cannon of Medicine' became the main medical textbook for physicians until the seventeenth century and it described over 700 drugs and medicines and their uses as well as how to diagnose diseases
• medieval surgery

  *most surgery was performed by barber-surgeons

  *surgery was limited as surgeons could not help with deep wounds as there was too little known about anatomy

  *natural substances were used for anaesthetics (e.g. mandrake root, opium or hemlock) but too much may kill patient

  *wine, vinegar or honey were used to clean wounds, but they could not prevent infections spreading

  *they had no idea dirt carried diseases and some believed it was good to cause pus in wounds

  *large cuts would be sewn up and often cauterised, but heavy bleeding could not be stopped

  *patients would often die from bleeding, shock or infection
• medieval surgery procedures


  *bloodletting (done to balance the humours)

  *amputation (successful in cases of breast cancer, bladder stones and haemorrhoids)

  *trepanning (epilepsy thought to be caused by demons in brain so hole drilled into skull to remove them)

  *cauterisation (burning wound with heated iron to stop flow of blood, very painful)
• John Bradmore (1403)


  *surgeon for Henry IV, who had an arrow pass through his cheek and lodged in the bottom of his skull

  *made metal forceps that would pass through the cheek wound and take hold of the arrowhead and remove it

  *for the next three weeks, he carefully dressed the wound with barely and honey - it eventually healed, free from any infection
• Henri de Mondeville (1260 - 1320)

  *medieval surgeon and teacher

  *challenged Galen's belief of pus carrying away poisoned blood that caused infection, so wounds would be more likely to heal if pus developed

  *taught his students to bathe and cleanse wounds then close them up quickly before pus could form
• medieval public health problems

  *water for drinking or cooking was collected from a river or a storage pit

  *cesspit for human waste were sometimes built near water supplies

  people threw rubbish (including human excrement) into the streets and rivers

  *cattle, sheep and geese roamed the streets - these animals left dung

  *open sewers or drains ran through the streets
• medieval public health improvements

  *night carts collected human waste from cesspits

  *rakers were sent to clean the streets

  *aqueducts were built to bring fresh water to the town

  *streets were paved to make them drier and easier to clean

  *cesspits were lined with brick or stone so they did not leak into water supplies

  *laws were passed to punish people for throwing human or butchers' waste into the streets
• public health in medieval monasteries

  *monasteries were wealthy as the rich gave them money in return for prayers: this wealth allowed monasteries to install water supplies and sanitation

  *monasteries were often close to rivers, built in isolated places where they drew fresh water

  *monks were expected to keep clean, so they washed their clothes regularly and some had a monthly bath
• the Black Death (1347 - 1351)

  *the epidemic form of bubonic plague experienced during the Middle Ages when it killed nearly half the people of western Europe after arriving from Asia fleas on rats

  *those with the disease felt cold and tired, coughed up blood, got painful swellings called buboes, had high fevers and severe headaches and then eventually died
• Black Death believed causes

  *God's punishment - the plague was part of God's plan to make people less sinful

  *miasma - bad, stinking air coming from rubbish in the streets spread disease

  *astrology - people became ill because a planet had moved int a new constellation of stars

  *four humours - people died because they were "stuffed with evil humours"

  *sometimes groups of people such as the Jews or nobility were said to be responsible
• Black Death methods of prevention

  *people stopped strangers entering their villages in cause they carried the plague

  *bishops ordered daily services and processions to pray for forgiveness and ask for God's help

  *King Edward III wrote to the Mayor of London, ordering him to clean the streets, claiming that the rubbish was creating "bad odours" that led to the disease spreading

  *butchers were punished for leaving the remains of slaughtered animals in the streets

  *people lit huge candles in church as offerings to God

  *people fasted to show that they were sorry for their sins

  *doors and windows were shut and sealed

  *people went on pilgrimages to pray for God's forgiveness at the tomb of saints

  *people carried sweet-smelling herbs or lit fires to overpower the bad air

  *people kept the air moving by ringing bells or keeping birds to around the house

  *activities that may have been insulting to God were ended

  *some people punished themselves in public and begged God for forgiveness
• Black Death methods of treatment

  *prayers for recovery

  *holy charms around the necks of sick people

  *cut open buboes to let the pus out

  *used leeches to bleed patients

  *treatments based on Galenic treatment with the theory of opposites: as the Black Death was a fever, cold foods and baths were used and people were told to avoid hot (strong) foods such are garlic and onions
• Black Death short term consequences

  *over one third of England's population had been killed

  *whole villages were wiped out

  *increase in persecution against minority groups

  *Peasants' Revolt in 1381, which tried to create more rights for peasants (the uprising was crushed)

  *the loss of so many workers led to food shortages, inflation of prices and higher wages

  *power of the Church was undermined because many priests had died with others running away
• Black Death long term consequences

  *survivors became better-off

  *the shortage of workers meant that employers had to pay higher wages to attract them

  *people had more money to spend on education, which meant that more people learned how to read and write and this meant that new ideas could be spread more quickly

  *Some people lost faith in the Church when religious activity had failed to prevent the spread of the disease