1.1 Ideas about the causes of disease and illness

• What were people like in the Middle Ages? What was expected of them towards the Church? What was the role of the Church? What did the Church use to pay for the care of the community?

  People in medieval England were very religious. The vast majority of people in England followed the teachings of the Catholic Church. They attended services regularly and were expected to give a sum of money to the Church each month. This was known as atithe.

  The Church also owned large amounts of land in England, where it built churches, monasteries and convents. These became important centres of the community: as well as praying, monk and nuns of the Church provided basic medical care, looking for people who were not able to care for themselves. The Church used the tithes given by ordinary people to pay for the care of the community.
• What was a common illness during the Middle Ages?

  Why were the causes of disease and illness unknown?

  What did the Church use to answer the questions people had about disease and illness?

  Illness was not uncommon. Malnutrition, particularly in the times of famine, made people more likely to fall ill. A lack of scientific knowledge at this time meant that the causes of disease and illness were a mystery. The Church used religion to answer the questions people had about illness and disease.
• Where did ordinary people receive most of their teaching from? What did they learn? What did the Church teach about this?

  Ordinary people received most of their teaching from the Church, as they didn't receive any formal education. The majority of people at this time could not read or write. Instead, they learned from the stories they heard, or the paintings they saw on the wall of their church. One thing they learned was that sin was very dangerous. The Church taught that those who committed a sin could be punished by God. They also taught that the devil could send disease to test someone's faith.
• How did the Church explain famine and disease? What did this mean that the Church could do when people recovered? What did blaming sickness on God act as?

  The Church often explained famine by saying that God had sent it as a punishment for sin. Therefore, it was logical also to blame people's sins for their illnesses. This meant that, when people recovered, the Church was able to declare that a miracle had happened, thanks to the patient's prayers. Therefore, blaming sickness on God acted as 'proof of the divine': it provided evidence of God's existence. This explains why the Church supported the idea that God sent disease as a punishment.
• Although disease was mainly seen as a result of sin, what else did the Church teach about disease?

  Although disease was mainly seen as a result of sin, the Church also taught that disease was sent by God to cleanse one's soul of sin. If you became ill, God could be sending the illness to purify your soul, or to test your faith. Since they had learned that God controlled every aspect of the world, this was very believable to people at this time.
• What is a specific example of a disease that God sent as a punishment? What were the symptoms of leprosy?

  The Bible tells many stories of how God sent disease as a punishment- leprosy in particular was included in the Bible as an illustration of a punishment for sin.

  
  

  Leprosy usually began as a painful skin disease, followed by paralysis* and eventually death. Fingers and toes would fall off, body hair would drop out and ulcers would develop both inside and outside the body.
• Because there was no cure for leprosy, what were lepers made to do? If lepers were allowed to remain at home, what must they do?

  There was no cure for leprosy, so lepers were banished from their communities. They usually had to move to leper houses or to isolated island communities. If they were allowed to stay in their home towns, they had to wear a cloak and a ring a bell to announce their presence, and they were banned from going down narrow alleys, where it was impossible to avoid them.
• What was believed about the spread of leprosy?

  This was because it was believed their breath was contagious. Although this was not true (leprosy was spread only by very close contact with the infected), it does show that medieval people had some correct ideas about how some diseases were transmitted.
• What was open that helped people suffering from leprosy?


  Although there was no formal care for lepers, a fewlazarhouses did help people suffering from leprosy. Lazar houses were commonly known as leper colonies.
• What else was considered very important when diagnosing disease in the Middle Ages?

  Along with the role of God, the alignment of the planets and stars was also considered very important when diagnosingillness. A physicianwould consult star charts, looking at when the patient was born and when they fell ill, to help identify what was wrong.
• Why did the Church frown upon using astrology as a means of diagnosis?

  Traditionally, the Church frowned upon the idea of using astrology in diagnosing illness, as it seemed only one step away from predicting the future, or fortune telling. However, after the Black Death arrived, astrology became more popular and the Church became more acceptant of it. Many people believed the Black Death was caused by a bad alignment of the planets.
• What sort of cause for explanation of disease was astrology? Why was the impact of stars and planets on health considered important in the period c1250-1500?

  Astrology was asupernaturalexplanation for disease. During the period c1250-c1500, the impact of the stars and planets on health was considered important because of the influence of Hippocrates, who had been a leading physician from Ancient Greece.
• What was the idea behind the Theory of the Four Humours?

  The human body was believed make itself healthy by getting rid of excess of fluids. Staying healthy was by the balance of liquids.
• Who first put down the idea of The Theory of the Four Humours?

  What did the theory state?

  Ancient Greeks first put forwards the Theory of the Four Humours- a popular idea, that was an idea for a disease, different from supernatural or religious explanations. The theory stated that, as the universe was made up of four basic elements- fire, water, earth and air- the body must also be made up of four humours, which were all created by digesting different foods.
• What were the four Humours of the body?

  The four humours were:·Blood·Phlegm- the watery substance coughed up or sneezed out of the nose, or expelled in tears.·Black bile- not one particular substance in the body, but probably referred to clotted blood, visible in excrement or vomit.·Choler, or yellow bile- this appeared in pus or vomit.
• What must have happened to the humours if you fell ill? What was important to preserving a good health? What else was believed to combine and make one or two humours stronger than the rest?

  There was a belief that all the humours must be balanced and equal. If the mix became unbalanced, you became ill. Being careful to maintain a good balance of the humours was really important to preserving good health. However, people believed a combination of age, family traits and circumstances, such as the season in which someone was born, usually combined to make one or two of the humours stronger than the other.
• What was each humour linked to? Give two examples

  According to the theory, each humour was linked to certain characteristics that physicians would look for when carrying out their diagnosis.

  
  

  For example, a person suffering from a fever had a temperature, causing the skin to go hot and red because, physicians believed, they had too much blood. This was a hot and wet element.

  
  

  Meanwhile, a person suffering from a cold had too much phlegm, which was cold and wet. They would shiver and the excess phlegm would run out of their nose.
• What else were the humours linked to? Give two examples

  The humours were linked with the seasons. For example, in winter, which is cold and wet, it was thought that the body produces too much phlegm, causing coughs and colds as the patient tries to get rid of it.

  
  

  The star signs for each season were associated with its humour, too: Capricorn, Aquarius and Pisces were linked with the phlegm. Astrology was considered an important part of the Theory of the Four Humours, as the humours were connected with star signs and seasons, and each one had its own ruling planet.
• What personality traits was choler and black bile linked to?

  The humours were also linked with certain personality traits. For example, a quick tempered, argumentative person was said to have choleric characteristics, while an optimistic, calm person had cheerful tendencies (sanguine).

  
  

  What we would today recognise as depression was blamed on an excess of black bile (melancholic) in medieval times.
• Who created the Theory of the Four Humours and during what century?

  The Theory of the Four Humours was created by an Ancient Greek physician named Hippocrates in the 5thCentury BCE. The word 'humour' comes from the Greek word for fluid- humon. Hippocrates was very careful to observe all the symptoms of his patients and record them. The Theory of the Four Humours fitted with what he saw.
• Who supported and developed Hippocrates' theory further? (name and century)

  Galen, a physician in Ancient Rome during the 2nd century CE, liked the ideas of Hippocrates and developed them further. He had been a physician in a gladiator school and later became the personal physician of the Roman Emperor. This meant that he had lots of time to experiment, ponder philosophy and write.
• What did Galen develop the Theory of the Four Humours to include?

  What else did Galen theorise?

  Galen developed the Theory of the Four Humours to include the idea of balancing the humours by using the Theory of Opposites. For example, he suggested that too much phlegm, which was linked to water and the cold, could be cured by eating hot peppers; a fever, or an excess of blood, could be treated with cucumber, which would cool the patient down when eaten.

  
  

  Galen also theorised that the circulatory system circulated blood generates in the liver, and the blood was then distributed around the body.
• Why was the Theory of the Four Humours so popular?

  The Theory of the Four Humours was very detailed and could be used to explain away almost any kind of illness- physical or mental. It was important that the theory covered almost every type of illness that occurred, because there was no other scientific explanation for the cause of disease. Often, physicians twisted what they saw to fit with the logic of the theory.
• Although written in the time of Ancient Greece and Rome, when did Latin translations of their works begin to appear?

  Hippocrates and Galen were both very popular figures in medieval medicine. Although written in the time of Ancient Greece and Rome, Latin translations of their texts only started to appear in Europe from the 11thcentury- almost 800 years after they were written.
• Who copied these translations and where were they passed on to? Where was the first European medical school and what did it teach based on?

  These translations were copied and recopied by monks, who passed them on to new medical universities. The first European medical school had been established in Salerno in the 9th century, and taught students based on these texts, rather than practical experience.
• What examples of other classical works that were popular among physicians were there? What were physicians expected to have a good background in, before studying medicine?

  Other classical works were also popular among physicians and medical students, including those of the Greek thinker, Aristotle, and the Persian philosopher and physician, Avicenna. Physicians were expected to have a good background in the liberal arts, such as philosophy, before studying medicine.
• What were the three reasons why classical texts like Galen's continued to be influential in the Middle Ages?

  1. The influence of the Church

  2. The importance of book learning

  3. The lack of alternatives
• The influence of the Church:

  
  

  What did Galen write about the body and how did this fit in well with the ideas of the Church? What did the Church do as a result?

  Galen wrote that the body was clearly designed for a purpose and that the different parts of the body were meant to work together in BALANCE, as first proposed by Hippocrates. Galen also believed in the idea of the soul. This theory fitted in very well with the ideas of the Church, who believed that God created man in his image, and so they promoted Galen's teachings and, by extension, those of Hippocrates.

  
  

  Since books were produced in monasteries, and libraries were maintained by the Church, their choice of texts were the ones that were widely read, preached and believed. In the early Middle Ages, the Church controlled medical learning in universities, too.
• The importance of book learning:

  
  

  What was the educational situation like for people in the Middle Ages?

  What was a good physician considered to have done?

  The authority of the classical texts was so strong, so what was the result of this?

  Many people could not read in the Middle Ages. This meant that being widely read was a sign of intelligence. A good physician was considered to be one who had read many books, rather than one who had treated a lot of patients. Having read the works of Hippocrates and Galen was proof that a physician was worth the money he was being paid. The authority of these classical texts was so strong that people believed them even when there was actual, physical evidence that suggested they were wrong.
• The lack of alternatives:

  
  

  Why was there a lack of alternative scientific evidence to support any other theories of what caused disease?

  What were physicians allowed to do very occasionally? What happened during a vivisection? What did this mean about Galen's ideas and why?

  There was a lack of scientific evidence to support any other kind of theories of the causes of disease. Dissections were mostly illegal, because the Church taught that the body needed to be buried whole in order for the soul to go to heaven.

  
  

  Very occasionally, physicians were able to dissect executed criminals, or criminals who had been sentenced to death by vivisection.*

  
  

  When this happened, the physician would sit far away from the body reading from the works of Galen, while the actual cutting and examining was done by a barber surgeon.* This meant that Galen's ideas were preserved: anything in the body that didn't agree with Galen's writings could be explained away, since the body was that of a criminal and therefore imperfect, and the physician himself never did any of the examinations.
• Define vivisection:


  Criminals sentenced to death by vivisection had their bodies cut open (dissected) and examined by physicians and medical students.
• What was a miasma? What did both Hippocrates and Galen suggest about miasma?

  Amiasmawas bad air that was believed to be filled with harmful fumes. Hippocrates and Galen both wrote about miasmata (which is plural of miasma) and suggested that swamps, corpses and other rotting matter could transmit disease.
• How were smells and vapours associated with God? (what did a sweet-smelling home and what did a bad-smelling home suggest?) Why were unwashed people avoided?

  Smells and vapours like miasmata were also, unsurprisingly, associated with God. A clean and sweet-smelling home was a sign of spiritual cleanliness, and incense was burned in churches to purify the air. Homes that smelled badly suggested sinfulness and corruption and, if a person was unwashed, other people would avoid them, in case they breathed in the bad miasma and contracted a disease. This was also why people avoided lepers. Although many believed leprosy was a punishment from God, they also believed the disease was contagious.
• What else did medieval people examine in order to make a diagnosis? What would the physician exam the urine sample compared to?

  Although medieval physicians didn't blame people's urine for making them ill, they did carefully examine the urine in order to make their diagnosis. It was thought to be one of the best ways to check on the balance of the humours inside the body. Samples of a patient's urine could be sent to a physician, where it would be examined and compared with a urine chart.
• What would the physician check of the urine?

  The physician would carefully check the colour, thickness, smell and even taste of the urine before making his diagnosis. This was seen as a very important part of medieval medicine: Norwich Cathedral Priory, for example, employed a full-time physician to examine urine.
• Influences on ideas about the cause of disease:

  
  

  What were the only few small changes in ideas about the causes of disease?

  On the whole, was there much change or was it majorly continuative?

  The Middle Ages was a time when there wascontinuityin ideas about the cause of disease. There were only a few small changes. For example, the use of astrology became more widespread, which meant it was adopted by many people, but did not expand upon Galen’s original theories. On the whole, ideas remained the same.
• What were the three main factors to understanding change and continuity in early diagnosis of disease?

  1. Individuals and the Church

  2. Science and Technology

  3. Attitudes in society
• Individuals and the Church:

  
  

  What was the role of the Church during this period? Why did the Church like the Theory of the Four Humours? What did the Church do to anybody criticising the theory?

  
  

  Who were the important individuals during this time?

  The Church was very important in maintaining the status quo at this time. This means that they did not like change, and wanted to keep things the way they were. The Church controlled medical learning. It chose which books were copied and distrinuted. The Church liked the Theory of the Four Humours because it fitted with their teachings, so it promoted this theory. The Church strongly discouraged anybody from criticising the theory.

  
  

  Hippocrates and Galen were important individuals in the Middle Ages, even though they lived many years before this time. Their books had been preserved by Arabic scholars and Latin translations were available in Europe by the Middle Ages. Galen in particular was popular with the Church, which meant that his work was widely promoted.
• Science and Technology:

  
  

  What did a lack of scientific understanding mean about medicinal knowledge? What did physicians and medical students do to any of their new discoveries?

  
  

  What was an important invention near the end of the Middle Ages? When was it invented and by who? What did it allow to happen? However, was it hugely impactful?

  During the Middle Ages, 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.

  
  

  One imortant piece of technology invented near the end of the Middle Ages was theprinting press. It was invented in around 1440 by Johannes Gutenberg in what is now Germany. Although this was not directly related to advancing medieval medicine, it eventually led to much faster and easier sharing of medical texts. However, it did not have a huge impact during the medieval period.
• Why did medieval people not want to be critical of the Church and its teachings? What happened to physicians who did not follow the old ideas of the Theory of the Four Humours?


  Medieval people had a strong belief in God and did not want to risk going to hell by being critical of the Church. Physicians who did not follow the old ideas found it hard to get work, because everybody knew a 'good' physician would follow the Theory of the Four Humours.