medicine

• The four humours

  The concept of illness involving the equal balance of 4 humours: blood, phlegm, yellow bile and black bile. Medieval doctors believed that when someone was ill, their humours were out of balance. The balance would be restored by reducing the one that was out of balance by bloodletting or purging.
• Hippocrates


  A greek doctor born around 460BCE and his ideas are still used today. Created the theory of the four humours. Hippocrates was also famous for his Hippocratic oath, an oath taken by new doctors as a promise to be ethical and not harm their patients.
• Galen


  Galen was a greek born in 129AD and was a follower of Hippocrates. He also believed in the concept of the four humours and recommended a good diet to stay healthy. Galen developed the idea of using opposites to balance humours. For example, if a patient has too much phlegm you should eat hot peppers to stop the cold. Galen also dissected animals such as pigs as he wanted to learn as much about the body as possible. However, because the anatomy of humans is very different to animals, he made mistakes that went unchallenged for years. Galen also discovered that the brain controlled speech and that arteries carry blood.
• Beliefs about causes of disease

  • Punishment- the most common belief was that God sent illnesses to punish people for their sins
  • Bad air- many believed that bad air, also known as miasma, caused disease. Miasma may come from human waste or corpses.
  • Four humours- Hippocrates and Galen spread the idea that illness was caused by unbalanced humours
  • Supernatural- Disease was thought to be caused by evil supernatural being like demons and witches. People believed some diseases could be caused by evil spirits living inside someone. Trepanning was used to drill a hole into the skull and let the demon out.
• Preventing illness

  • Astrology- belief that the movement of planets and stars caused disease. The Zodiac chart showed the doctor when and when not to treat each part of the body.
  • Herbal Remedies-most common remedies were made from herbs, minerals and animal parts. They also included prayers to say while collecting them to improve effectiveness.
  • Bleeding-people were bled regularly to avoid illness, done by a barber surgeon or a doctor.
• Christianity

  The Christian church believed in following the example of Jesus who healed the sick. God sent illness as a punishment or a test of faith so curing an illness would challenge God. Therefore the church was a place of care, rather than to cure. They made sure that scolars of medicine learned the works of Galen as his ideas fit with the christian belief that God created humans to be perfect. The church banned dissection meaning that medieval doctors couldn't discover human anatomy in depth, so they had to rely on Galen's ideas.
• Islam

  Believed that Allah has given a cure for every disease, so doctors were inspired to find them. Avicenna (980-1037) wrote 'canon of medicine', a great encyclopedia of ancient greek and islamic medicine. This was the most important way that classical ideas reached the western world. Ibn al-Nafis (1200) questioned Galen's ideas about the heart and suggested that blood flows from one side of the heart to the other via the lungs. However, his ideas were not read by the west. Muslim scientists were encouraged to discover cures and new drugs. They invented techniques such as distillation and sublimation, Like Christianity, dissection was not allowed.
• Medieval surgical processes

  • Albucasis was a muslim surgeon who wrote a 30 volume medical book 'Al Tasrif' (1000). He invented 26 new surgical instruments and procedures including ligatures and amputations. He also made cauterisation popular.
  • Hugh of Lucca and his son Theodoric (1267) criticised the common view that pus was needed for a wound to heal. They began to use wine on wounds to reduce the chance of infection. Their ideas opposed Galen's theories so they were unpopular.
  • John of Ardene was said to be the first english surgeon. He developed an anaesthetic from opium, bedlock and henbare which may have worked in careful doses but was very likely to kill.
  • Rhazes helped plan the building of a hospital in Baghdad, the first documented general hospital in the world. He wrote over 200 books
• Who treated diseases?


  • Physicians-only used by the wealthy as there were few trained doctors, so they were highly paid. Mainly treated by bleeding and the 4 humours.
  • Barber surgeons-medieveal surgery was very dangerous as there was no way to prevent blood loss, pain or infection. So barbers only did minor surgeries.
  • Apothecary-prepared and sold remedies. They were most accessible for those who could not afford physicians.
  • Wise women-gained information and knowledge passed through family. They shared their knowledge, prayers, sold remedies and were midwives. Like the apothecary, wise women were accessible to the poor.
• Towns


  Many towns didn't have clean water supplies or sewage systems, waste was chucked into streets and rivers instead. Sewage from latrines leaked into the ground and get into wells. Rivers were used for drinking water, for transport and to remove waste. Butchers slaughtered animals in the streets and left the waste. Cesspits were built near wells so were contaminated. However, hygiene levels were rising. York and London both banned people from dumping waste in the streets. Medieval town councils passed laws encouraging people to keep streets clean
• Monasteries


  Monasteries were healthier than towns. They had cleaner water and systems for getting rid of sewage. Monks also had access to books on healing and they knew how to grow herbs and make herbal remedies. Monasteries separated clean and dirty water. They had one supply for cooking and drinking and one for drainage. Mose monasteries were built near rivers. If there was no river, man-made waterways were built to supply clean water. Sick monks were cared for in the infirmary. They normally had a kitchen and served good meals. Latrines were put in separate buildings which were often built over streams of running water that carried sewage away. Monasteries were wealthy and had small populations.
• The Black Death


  Began in Asia and travelled rapidly along the trade routes to western Europe. Bubonic plague was spread by bites of fleas from rats carried on ships. This caused headaches and high temperatures, followed by pus-filled swellings on the skin. Pneumonic plague was airborne and was spread by coughs and sneezes. It attacked the lungs leading to people coughing up blood. Believed causes included; punishment from god, bad air and astrology. One of the main reasons why the Black Death killed so many people was because people didn't know which hindered their prevention.
• Spread and Remedies


  • Spread- street cleaning was poor and dirty streets encouraged rats to breed. Animals dug up buried victims bodies quickly. Laws about hygiene were difficult to enforce. Ignorance of germs and causes of disease.
  • Remedies- the main remedy was prayer. Unusal remedies such as drinking mercury or shaving a chicken and strapping it with buboes. Moving away if they thought the plague was coming or avoiding contact with people that might be infected by quarantining.
• Societal impact of the Black Death

  There were far fewer workers around. This meant that they could demand higher wages from their employers. The cost of land also decreased, allowing peasants to buy land for the first time. This contributed to the peasants revolt of 1381 and eventually the collapse of the feudal system. Damage to the catholic church because experienced priests died and others had run away.
• The End of the Black Death

  By 1350, the Black death subsided but it never really died out. Further outbreaks of the plague occurred in intervals. This included the Great plague of 1665.
• The Renaissance


  The Renaissance is a time of continuity and change. It was a cultural movement that began in Florence, Italy in the late 1400s. It inspired old texts and searched for the most accurate ideas and it also caused a 'rebirth' of learning and belief.
• Consequences of the Renaissance

  • New lands - explorers and merchants used more accurate maps and discovered the Americas and brought back new food and medicine.
  • Printing - new ideas spread quickly as well as those of the ancient world. Invention of printing press in 1451
  • New learning - a more scientific approach to learning involving observation, hypothesis, experiment and questioning.
  • New inventions - technology such as gunpowder caused new types of wounds
• Andreas Vesalius


  Born in 1514, Vesalius was a medical professor at Padua University. Vesalius was able to perform dissections on criminals who had been executed. This let him study human anatomy more closely and in more depth. He wrote books based on his observations using accurate diagrams to illustrate his work. 'The Fabric of the Human Body' Published in 1543 encouraged others to question Galenic anatomy and pointed out his mistakes e.g. the breastbone of a human being has 3 parts not 7 like an ape. Reactions: He was criticised for opposing Galen. He transformed anatomical knowledge and although he did not have an immediate impact on diagnosis or treatment of disease; it was the basis for better treatments in the future.
• Ambroise Paré


  Paré was a French Barber-surgeon born in 1510. He became an army surgeon and treated many serious injuries caused by war. Gunshot wounds were previously treated with oil, however, during one battle in 1537, Paré ran out of oil, so he improvised and simply used a cool salve (ointment). To his surprise, his patients treated in this way recovered better than the ones scalded with oil. Paré also used Galen's methods of tying blood vessels with threat (ligatures) which was less painful than cauterisation, however it did increase the risk of infection. He improved treatment for ampuytations. Reactions: Paré's ideas were resisted by doctors who felt that a lowly surgeon should not be listened to.
• William Harvey


  William Harvey was a British doctor born in 1578. Harvey realised Galen's theory was wrong. From experiments, he calculated that too much blood was being pumped out of the heart if it was being used as fuel for the body. So he concluded that it must circulate. Harvey published his book 'De motu Cordis' in 1628. Reactions: Going against Galen's theories would be criticised as well as criticism of his challenging the idea of bloodletting to balance the humours.
• New vs Old treatments

  • Nicholas Culpeper wrote the complete herbal in 1653 and he used plants and astronomy in his treatments similar to medieval medicine. However, he was highly critical of bloodletting an purging.
  • Thomas Sydenham stressed careful observation of symptoms and was highly critical of quack medicine. However, he dismissed the value of dissection and ignored Harvey's discovery as he still used bleeding methods for treatment.
  • Quackery: Quack medicines made wild claims about their ability to prevent or cure illness and disease although they did not work. At best they were harmless, at worst they could be deadly. Quack medicine was sold by 'quacks'. These were travelling salesmen who would sell their wares and move on before the patient realised the medicine didn't work.
• Methods of treating diseases

  • Bloodletting and purging were still common treatments used to balance the four humours.
  • Herbal remedies were still used. An increase in travel brought new ingredients to England, such as rhubarb and tobacco, that were used to treat the sick.
  • Superstition and religious beliefs remained. For example, it was believed that being touched by the monarch could cure a skin disease called scrofula (also known as the 'king's evil'). The monarch was seen as God's representative on Earth, so being touched by them was the closest people could get to being touched by God.
• Similarities to the Black death

  • Many treatments on the great plague were very similar including praying for the sick, wearing of magical or religious charms, herbal remedies such as posies and bloodletting and purging
  • Ideas about the cause of the plague had not changed since the Black Death. Most people still believed that: God controlled everything and sent the plague as a punishment for sin, an unusual alignment of the planets had caused bad air - miasma theory, rotten waste had caused miasma and the disease was spread from person to person
• Differences to the Black death

  • Methods of preventing the spread of the plague in 1665 were more carefully planned, and the Mayor of London did more to help.
  • During the Great Plague, residents were ordered to sweep the streets in front of their houses, making the environment cleaner.
  • When a person died, plague-searchers were sent to examine bodies and determine whether they had died from the plague. Their diagnosis was later confirmed by surgeons.
  • In 1665, doctors and scientists had better understanding of the connection between dirt and disease, although they couldn't explain it.
• Government actions to the Great Plague


  • Charles II and his government ordered days of public prayer and fasting to allow people to confess their sins. This was because they believed that God could have sent the illness.
  • The mayor of London also tried to prevent the spread with the following orders: Victims and their families were shut in their homes for 40 days and prevented from leaving so that they could not spread the illness by human contact. This was known as quarantine.
  • Barrels of tar and bonfires were lit in the streets to clean the air.
  • Animals were banned inside the city as it was thought they could spread the illness.
  • Events that attracted large crowds, such as plays and games, were banned to prevent the illness spreading through human contact.
  • However, these rules were difficult to enforce because there were very few authorities in London to check, and punish, the behaviour of individuals. This was before a police force was introduced in England. The mayor of London had to rely on people to follow his orders.
• Hospitals


  There was an increasing number of hospitals in the 17th and 18th centuries. The monasteries had been closed down by Henry VIII in the 1530s, so towns needed to open hospitals to take their place. St Bartholomew's Hospital in London had been a monastery. However, Henry VIII allowed the hospital part of the building to be taken on by the London authorities. Treatment in hospitals was usually based on the four humours, so bloodletting and purging were common. Hospitals received money from wealthy donors or royal endowments, so they could provide care for people who could not afford a physician.
• Treating the sick


  Physicians were doctors who had trained at university. They were considered to offer the best medical care. Most of the diagnoses and treatments they suggested were based on the works of Hippocrates and Galen, and the theory of the four humours. Physicians were expensive and therefore tended to treat richer people or royalty. Monarchs would have their own private physicians.
• Bonfires were lit in the streets to clean the air
• Animals were banned inside the city as it was thought they could spread the illness
• Events that attracted large crowds, such as plays and games, were banned to prevent the illness spreading through human contact
• These rules were difficult to enforce because there were very few authorities in London to check, and punish, the behaviour of individuals. This was before a police force was introduced in England. The mayor of London had to rely on people to follow his orders
• There was an increasing number of hospitals in the 17th and 18th centuries. The monasteries had been closed down by Henry VIII in the 1530s, so towns needed to open hospitals to take their place. St Bartholomew's Hospital in London had been a monastery. However, Henry VIII allowed the hospital part of the building to be taken on by the London authorities
• Treatment in hospitals was usually based on the four humours, so bloodletting and purging were common. Hospitals received money from wealthy donors or royal endowments, so they could provide care for people who could not afford a physician
• Physicians


  Doctors who had trained at university and were considered to offer the best medical care. Most of the diagnoses and treatments they suggested were based on the works of Hippocrates and Galen, and the theory of the four humours
• Physicians were expensive and therefore tended to treat richer people or royalty. Monarchs would have their own private physicians to treat them when they were ill
• Apothecary


  Similar to a modern chemist, they would sell remedies and medicines to surgeons and members of the public. The medicines they sold were often based on herbal remedies, passed down through the generations. An apothecary is usually trained as an apprentice, working with an experienced apothecary to learn the various treatments and mixtures that could be used
• As most people could not afford a physician, they had to look elsewhere for medical advice and treatments
• Quack doctors


  Unqualified and often claimed to be selling miracle cures. They sold potions that supposedly contained all kinds of mysterious ingredients, such as crushed unicorn horn. These remedies did nothing to help people recover, and in some cases could make symptoms worse
• Until Pasteur's germ theory, there was a lack of scientific knowledge to challenge these ideas
• John Hunter


  • Joined his brother William, a successful doctor at his anatomy school's teachings. He was present for 2000 dissections and developed an unrivalled knowledge of human anatomy
  • Demanded careful observation in surgery; experimented on himself in 1767 with gonorrhoea germs. He also tried radical surgery; in 1785 he saved a man's leg, by tying off blood vessels forcing blood to flow through the other vessel preventing amputation