1.2 Approaches to treatment and prevention

• What did the Church teach about disease? What was important as well as looking for medical treatment? What were some examples of religious treatment?

  As the Church taught that disease was sent by God as a punishment for sin, it followed that the cure should also involve the supernatural. As well as looking for medical treatment for disease, it was important to undergo a course of spiritual healing.

  
  

  Religious treatments included:

  · Healing prayers and incantations (spells)

  · Paying for a special mass* to be said

  · Fasting (going without food)
• What also became extremely popular? What actions could those with diseases undertake?

  Pilgrimages* to tombs of people noted for their healing powers also became extremely popular.

  
  

  Once the pilgrimage was complete, there were a few suggested actions those with diseases could take eg. touching holy relics, such as a piece of the 'true' cross on which Jesus was crucified, or the bones of a saint; presenting an offering at a shrine- usually an image of the body part to be healed, made from anything from wax to precious metals and jewels, depending on how wealthy you were; lighting a candle proportionately as tall as you (or as long as the body part you wanted to heal).
• Why were pilgrimages important, apart from bringing prosperity to the communities around holy sites? What was especially important for the local churchmen?

  As well as making the locals a lot of money, as the pilgrims brought with them money to spend in the towns of holy sites, the ability to heal the sick was also imortant to the local churchmen. In order to be declared a saint, the dead person had to be assosciated with a certain number of miracles; so, the more people who were 'healed' after touching the relics, the better.
• What other supernatural remedies were available if prayers and offerings did not work?

  If prayers and offerings did not work, there were other supernatural remedies available, although the Church did not approve of them. Chanting incantations and using charms or amulets to heal symptoms and ward off diseases were fairly common throughout this period.
• Why were the sick sometimes discouraged from seeking cures?

  Sometimes the sick were discouraged from seeking cures. After all, if God had sent the disease to purge the soul, it was important for the disease to run its course. Taking medicine to cure the disease might keep you alive, but it would mean that your soul would still be stained with sin. That meant risking not being admitted into heaven when you died.
• How did physicians consult star chars to prescribe treatments?

  Physicians consulted star charts when diagnosing illness. These were also important when prescribing treatment. Treatments varied according to the horoscope of the patient. The alignment of the planets was then checked at every stage of the treatment prescribed: herb gathering, bleeding, purging, operations and even cutting hair and nails all had to be done at the right time.
• How did medieval physicians treat patients?

  Medieval physicians treated symptoms rather than taking the modern approach of attacking the pathogen causing the symptoms. In the Middle Ages, each symptom was broken down and treated separately, as they believed each symptom represented an imbalance in the humours. Therefore, conflicting remedies might be provided.
• Blood-letting or Phlebotomy:

  
  

  What was the idea behind it?

  Who carried out phlebotomy and why?

  Phlebotomy, or blood-letting/bleeding, was the most common treatment for an imbalance in the humours. The idea behind it was that bad humours could be removed from the body by removing some of the blood.

  
  

  Phlebotomy was so common that most physicians didn't even bother to carry out the procedure themselves- and monks were forbidden from bleeding their patients. Instead, it ws usually done by barber surgeons and wise women. Demand was so high that even some people with no medical background offered the service.
• What were the three ways in which phlebotomy was carried out?

  1. Cutting a vein

  2. Leeches

  3. Cupping
• 1. Cutting a vein

  This involved cutting open a vein with a lancet or other sharp instrument. Blood was usually let from a vein near the elbow, because it was easy to access.

  
  

  The most straightforward method of bleeding. Phlebotomy charts like the vein man* were used to show points in the body where bleeding was recommended for specific ilnesses.
• 2. Leeches


  Freshwater leeches were collected, washes and kept hungry for a day before being placed on the skin. Bleeding might continue for up to 10 hours after the leech was full.

  
  

  Used for people whose age or condition made traditional bleeding too dangerous.
• 3. Cupping


  The skin was pierced with a knife or a pin, or even scratched with fingernails, until it was bleeding. A heated cup was placed over the cuts to create a vacuum. This drew out blood out of the skin.

  
  

  Used for women, children and the very old. People believed different areas treated different illnesses. For example, people believed that cupping on the back of the neck was good for eye trouble, bad breath and facial acne.
• What was a negative, common effect of blood-letting? What is an example of this?

  Sometimes patients were bled for too long and died as a result. Evidence suggests that this was quite common and it was probably seen as a necessary hazard. In 1278, court records from an inquest in London show that William le Paumer had collapsed and died due to a blood-letting procedure that had taken place the previous day. The court did not hold anybody responsible for the death, and didn't even name the person who had carried out the bleeding.
• Purging:

  
  

  Why was purging a method used to treat disease? What were the three ways in which this was done?

  Because it was believed that the humours were created from the foods eaten, a common treatment was purging the digestive system to remove any leftover food. This was done by giving the patient either something to make them vomit (an emetic), or a laxative or enema to clear out anything left over in the body.
• Emetics:


  Emetics usually consisted of strong and bitter herbs like scammony, aniseed and parsley. Sometimes they contained poisons like black hellebore, so it was best to vomit them up quickly.
• Laxatives:


  Laxatives were very common. Some well-known examples included mallow leaves stewed in ale, and linseeds fried in hot fat. Linseeds are still used today as a digestive aid.
• Clyster/enema :

  
  

  Example of the use of an enema

  Sometimes people needed a bit more help to purge, and the physician would administer aclysteror enema. For example, John of Arderne, a famous English surgeon, mixed water with honey, oil, wheat bran, soap and herbs such as mallow and camomile. He would squirt it into the patient’s anus used a greased pipe fixed to a pig’s bladder, while the patient rubbed his stomach. This would clear out any stubborn blockages.
• Remedies:

  What herbs were commonly used in remedies in c1250-1500?

  Sick people in the period c1250-c1500 were also treated with remedies- usually herbal infusions to drink, sniff or bathe in.

  
  

  For example, aloe vera was prescribed to improve digestion. Other ingredients featured regularly included mint, camomile and rose oils, tamarind, almonds, saffron, butter, absinth, turpentine and corals. Sometimes the ingredients were expensive and difficult to find.
• What was the name of a common remedy mixture? What was it and what did it contain? What did Galen write about theriacas?

  A common remedy mixture and sold at this time wastheriaca. This was a spice-based mixture that could contain up to 70 ingredients, including quite common things like ginger, cardamom, pepper and saffron, but also some unusual ingredients like viper flesh and opium.

  Galen had written a book on theriacas, looking particularly at their use in treating snake bites and poisons. Over time, they became widely popular and were used for many different illnesses.
• Foods also prescribed to encourage the balance of the humours?

  What dish was recommended for medieval invalids?


  Different foods were prescribed to encourage the balance of the humours- remember that the humours were thought to be created from the digestion of food.

  A dish calledblanc mangier, made from chicken and almonds, was regularly recommended for medieval invalids because the ingredients were warm and moist.
• Why were warm baths regularly prescribed? What was also sometimes added to bathwater?

  Warm baths were regularly prescribed to help the body draw in heat to help dissolve blockages in the humours. This gave the body the opportunity to steam out impurities and ease aching joints. Herbal remedies could also be given this way.

  Various plants and herbs were added to the bath water to help. For example, people suffering from bladder stones were advised to stir in mallow and violets.
• What was a remedy based on superstition regarding bath water?

  Some of the remedies were less pleasant and were based purely on superstition: those suffering from paralysis were advised to boil a fox in water and then bathe in it. This was because it was thought that the quick and nimble properties of the fox would be transferred to the patient through the bath water.
• What was there a strong focus on to prevent getting sick in the first place? Why?

  Although a physician could expect to be paid a lot more money for providing treatments for disease, there was a strong focus on following various regimes to prevent getting sick in the first place. This was seen as a far safer plan of action, since cures and treatments were hit-and-miss in their effectiveness.
• The Church: What did the Church suggest was the best way of preventing disease in the first place?

  Most people believed that the best, and the most important, way of preventing disease was to lead a life free from sin. Regular prayers, confessions and offering tithes to the Church worked together to ensure that any minor sins were quickly forgiven.
• Regimen Sanitatis:

  
  

  What was the regimen sanitatis? Where did this first appear?

  Ideally, what would a physician do in regards to the regimen sanitatis? In practice, who was this usually mostly used by and why?

  The regimen sanitatis was a loose set of instructions provided by physicians to help a patient maintain good health. It first appeared in the work of Hippocrates, where it was later picked up by Galen and Arabic scholars like Avicenna. This meant that the advice was widespread and very common by 1250. A lot of the advice is familiar to us today.

  
  

  Ideally, a physician would provide a regime sanitatis written especially for their patient, taking into account their predominant humours and lifestyle. However, in practice, this service was only used by the very rich, because it took a long time to write such a detailed set of instructions for every patient.
• Bathing:

  
  

  Why was bathing used as a preventative measure? Who were warm baths used by? What was the downside of public baths? What did poorer people do to keep fresh?

  What did everyone do before and after every meal? Why (what did they believe?)?

  Bathing was an important treatment for disease. It was also used as a preventative measure: bad smells indicated a miasma. However, only the wealthy could afford a private bath of hot water. Public baths, or stewes, were available for a fee. Poorer people swam in rivers, where possible, to keep themselves fresh.

  
  

  Although only the wealthy bathed their whole bodies regularly, everybody- no matter how poor- washed their hands before and usually after every meal. They believed that cleanliness was next to godliness, so it was important to stay clean.
• How did people keep their homes clean and free of miasma?

  As well as keeping themselves clean, people also tried to make sure their homes smelled sweet and fresh, too. Floors were swept regularly and rushes wer laid down to soak up any mess. Sometimes sweet smelling herbs, like lavender, were spread with the rushes to keep the air free of miasmata.
• Purifying the air:

  
  

  How did medieval people purify the air?

  Medieval people attempted to keep air free from miasmata by purifying it. They did this by spreading sweet herbs, such as lavender. Sometimes this might be carried as a bunch of flowers (posy), or placed inside a decorative piece of jewellery called a pomander (a large locket, which would be worn around the waist).
• How did local authorities make sure that the towns were kept clear of miasma in the streets?

  Local authorities, usually under the direction of magistrates or noblemen also tried to tackel miasmata outside of the home, putting into place measures to keep towns clean. For example, they tried to make sure there were no rotting animals left lying around and pulled down or cleaned particularly smelly public toilets.
• Diet:

  
  

  What was considered important in preventing an imbalance? What was strongly discouraged and why?

  Since the humours were thought to be produced by digestion, what and when you ate were both considered very important in preventing an imbalance. Eating too much was strongly discouraged.

  
  

  According to the chroniclers of the time, several medieval kings died as a result of eating too much, or having too rich a diet. Edward I died of dysentery (very severe diarrhoea) for example.
• What did many people do to themselves out of a fear of digestive problems leading to death? What did Hippocrates recommend?

  Fear of digestive problems leading to death was so great that many people purged themselves, either by vomiting or usin laxatives, as a way of preventing disease as well as treating it. Hippocrates recommended using an emetic once a fortnight in the winter, and to use enemas in the summer.
• Most people in the Middle Ages would have been treated at home by a female family member. Women did most of the treatment at home, caring for the sick and mixing remedies themselves. Women also acted as midwives: evidence from medieval sources suggests that only women attended births.
• Asking for medical advice cost a lot of money. Since the treatments weren't guaranteed, most people were not willing to spend this money even if they had it. However, there were other treatment options for people willing to pay.
• Physicians:

  
  

  How did medicine change in the Middle Ages? How long did a medical degree take? Where did new universities open up?

  During the Middle Ages, new universities were set up across Europe, including Oxford, Cabridge, Paris, Bologna, Montpellier amd Padua. Medicine became more professional. A medical degree took between seven and ten years to complete, depending on the level and university.
• What was the main role of a physician?

  Medieval doctors were known as physicians- the word 'doctor' did not become common until the 17th century. The main role of a physician was to diagnose illness and recommend a course of treatment They rarely got involved in treating the patients themselves-this was left up to less educated midwives, apothecaries or barber surgeons.
• What was the consultation from physicians like?

  The consultation would follow three stages.

  1. The physician would look at a sample of the patient's urine, faeces and blood, all of which would be collected and sent to him.

  2. He would also consult the astrological charts under which the patient was born and at the same time they fell sick.

  3. Based on this, and the humoural tendencies of the patient (whether they were naturally sanguine, choleric, phlegmatic or melancholic), the physician would create a course of treatment.
• Who delivered the treatment after the physician made up the course of treatment? Why?

  It was then up to less trained and lower paid professionals to carry out the treatment. For most of this period, this was due to the fact that 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 also forbidden for clergymen.
• In Europe, where there were universities without religious sponsorship, what were the physicians able to do?

  
  

  Why were physicians expensive?

  During this time, new universities and centres for medical learning were set up in Europe without religious sponsorship. Foreign physicians who had no connection to the Church were able to both diagnose and treat their patients.

  Physicians were very expensive, because there weren't many of them. This was mainly due to the training taking a long time. Royalty and the very wealthy often employed a physician full time. Others paid for them when they needed them.
• Apothecaries:

  
  

  What was their role? Where did they get their good knowledge of herbs from?

  Apothecaries mainly mixed herbal remedies. They had a good knowledge of the healing power of herbs and plants thanks to studying herbal manuals such as the Materia Medica. They usually had a good amount of knowledge from their own experience, or passed down from family members.
• Since doctors were expensive apothecaries were seen as an alternative: What problems did this cause?

  Apothecaries were not considered as skilled or knowledgeable as physicians. Physicians prescribed the medication and apothecaries were just there to mix the remedy. However, since doctors were expensive and apothecaries were comparatively cheap, lots of people would see an apothecary as an alternative to a doctor. This meant that doctors saw them as a threat to their livelihood.