1250-1500

• What was Medieval England like?


  - 90% of the population lived in the countryside.

  - Most people worked in the fields to grow and harvest crops for wealthy landowners.

  - Poor nutrition, especially at times of famine, and hard physical labour, meant that disease was never far away.

  - People who lived in towns did not fare better as crowded streets and lack of drains meant disease spread easily.

  - Homes were heated by open fires, and smoke exposure meant that lung diseases were common.

  - Half the population died before reaching adulthood.

  - People were very religious, people following the teachings of the Catholic Church. They attended Church regularly and gave money to the Church each month (a tithe).
• Supernatural explanations of disease

  - God sent disease (because He was angry,

  because He wanted to test peoples' faith, or the disease itself was sent to purify peoples' souls)

  - Astrology (misalignment of the planets) resulted in the creation of a miasma.
• Rational explanations of disease: The Four Humours

  Rational explanation = more scientific or logical

  Theory of the Four Humours was first put forward by Hippocrates.

  - It said that because the universe was made up of four basic elements - fire, water, earth and air - the body must be made up of four humours which were created by eating different foods.

  They were:

  - blood

  - phlegm

  - black bile

  - yellow bile

  - Illness related from humour imbalance, and the goal of medical treatment was to restore balance.
• Rational explanations of disease: The Theory of Opposites

  - Galen developed the Theory of the Four Humours further to include the idea of balancing humours by 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 could be treated with a cucumber to cool a patient down.
• Why was the Four Humours so dominant?

  - The Church taught it was correct - Galen was not a Christian, but he taught that a god had made all body parts fit together, which supported Christian teaching at the time.

  - It made sense on some level - e.g. when ill, you are often physically sick (so people thought the excess humours were actually being removed by vomiting etc!)

  - It was very complex, the idea of the four humours being reflected in the our seasons, the four elements, certain personality traits etc.
• Rational explanations of disease: Miasma

  - A miasma was bad air believed to be filled with harmful fumes.

  - Hippocrates and Galen both wrote about miasmata (the plural) and suggested that swamps, corpses and other rotting matter could transmit disease.

  - A clean smelling home was a sign of spiritual cleanliness. Homes that smelled bad suggested sinfulness and corruption.
• Religious and supernatural treatments

  Religious treatments included

  - healing prayers and incantations (spells)

  - paying for a special mass to be said

  - fasting (going without food)

  - pilgrimages to the tombs of people noted for their healing powers were also popular

  
  

  If prayer did not work, there were other supernatural remedies including

  - chanting incantations using charms and amulets

  
  

  Physicians also consulted star charts and varied their treatment according to the alignment of the planets and horoscope of the patient.
• Humoural treatments: blood letting

  Blood letting was the most common treatment of this type - idea was to remove bad humours by removing blood and was usually done by barber surgeons or wise women.

  
  

  Three different ways:

  - Cutting a vein

  - Leeches

  - Cupping

  
  

  Sometimes patients were bled for too long and died e.g. William le Paumer in 1278.
• Humoural Treatments: purging

  Purging made sense because it was believed the four humours were created from food eaten.

  - Patient would either be given an emetic (to make them vomit) or a laxative to clear out bodily systems.

  - Emetics were usually strong and bitter herbs like aniseed or parsley.

  - Laxatives included mallow leaves stewed in ale or linseeds fried in hot fat.
• Humoural treatments: remedies

  Herbal remedies were very common - people could drink, sniff or bathe them.

  - Common example could be aloe vera for improving digestion.

  - A theriaca was a common remedy mixed and sold which contained up to 70 ingredients. Galen had written a book supporting their use.

  - Warm baths (sometimes with plants and herbs added to the water) were recommended to help dissolve blockages in the humours.
• Preventing disease

  - Live a life free of sin and pray/confess your sins regularly.

  - The Regimen Sanitatis (a book written in rhyming couplets) provided common sense advice on maintaining bodily health. Advice included...

  - Take moderate exercise

  - Do not overreat

  - Bathe regularly

  - Avoid barking dogs, drunks and bandits which cause anxiety.

  - Purifying the air through spreading sweet herbs such as lavender. People might carry a bunch of flowers (called a posy) with them

  - Local authorities would try to keep air clean by making sure there were no rotting animals lying around.
• Medieval medics: physicians

  - New universities were being set up across Europe throughout this period e.g. Oxford, Cambridge, Padua.

  - Medical degree was completed at university and took between seven and ten years to complete.

  - Knew very little about anatomy because dissection was forbidden at universities, physicians just listened to readings of Hippocrates and Galen's works.

  - Main role of the physician was to diagnose illness and recommend a course of treatment, but rarely treated the patient themselves... it was up to lesser medics to do this.

  - Physicians would diagnose patients by looking at samples of a patient's blood, urine or faeces, consult astrological charts and also ask the patient about their humoural tendencies.
• Medieval medics: apothecaries

  - Mainly mixed herbal remedies and had a good knowledge of the healing power of herbs and plants thanks to their study of herbal manuals such as Materia Medica

  - Sometimes would offer a prayer alongside a remedy

  - Not as skilled or knowledgable as physicians, with knowledge mainly passed down through the generations.

  - Did not require a licence or formal training.
• Medieval medics: barber surgeons

  - Probably least qualified as barbers would perform surgery with little more than a sharp knife and a steady hand... no licence or formal training required (although skilled surgeons such as the royal surgeons did exist).

  - Would perform surgeries including removal of surface tumours, sewing up wounds or amputations.

  - Most common job was blood letting - until 1307 bowls of blood were kept in surgeons' windows to advertise their practice.
• Caring for the sick: Hospitals


  - 1,100 hospitals in England by 1500, this number having risen during the Middle Ages.

  - Offered hospitality (care not cure) to travellers, pilgrims and the elderly.

  - Usually run by the church

  - Good places to rest and recover as the space would have been kept very clean, with bed linens and patient clothing being changed regularly.

  - If you were suffering from an infectious disease, however, this would be a bad place to recover as patients usually shared a bed.
• Caring for the sick: home


  - Most people received care at home in this period, with women providing care for their relatives and dependents.

  - Women made patients comfortable, prepared restorative foods and mixed herbal remedies.

  - Women were also responsible for the garden, in which they were expected to grow healing plants e.g. marigold or clover
• The Black Death


  - Terrible plague (referred to by Medieval People as the pestilence) which hit English shores in 1348.

  - Mix of bubonic, septicemic and pneumonic plagues

  - Spread from the Far East via trade routes.

  - Up to 40% of the European population died

  - Symptoms included black buboes (bubonic plague), sneezing and coughing up blood, fever and chest pains.
• The Black Death: causes

  People believed that the Black Death came because...

  - God had deserted mankind as a punishment for sin

  - There had been an unusual positioning of the planets Mars, Jupiter and Saturn which astrologers interpreted as an omen

  - Natural cause thought to be breathing in miasma, thus corrupting the body's humours.

  - In Europe, many blamed the Jews for poisoning water supplies

  - Some rich patients relied on humoural explanations.
• Black Death: treatments


  Main recommendation was to confess your sin and ask God for forgiveness through prayer

  - Initially, physicians tried bleeding and purging, but this did not work.

  - Physicians recommended strong smelling herbs like aloe and myrrh.

  - Physicians and surgeons sometimes lanced buboes
• Black Death: prevention


  Supernatural means:

  - pray to God and fast

  - go on pilgrimage and make offerings to God

  - show God how sorry you are by self-flagellation (whipping yourself)

  
  

  Natural means:

  - escaping the plague. Guy de Chauliac (physician to the Pope) advised people to 'go quickly, go far, and return slowly.'

  - carry a posy of flowers or fragrant herbs and hold it to your nose.

  
  

  Common beliefs:

  - Doing joyful things like listening to cheerful music

  - Stop visiting family members who had the plague

  
  

  Governments implemented new quarantine laws... e.g. people new to an area had to stay away from an area for 40 days to ensure they wren't carrying the disease.
• Why no change? The Church

  The Church made it difficult for new medical ideas to develop for three main reasons

  1) The Church had a major influence on people's ideas about what caused disease.

  2) The Pope, bishops and priests told people that everything in the Bible was true. If anybody questioned or challenged these ideas, they were told they would go to Hell.

  3) The Church supported the ideas of Galen.
• Why no change? Education

  - Strongly linked to the influence of the Church because the Church controlled education, including how physicians were trained at universities.

  - The main part of doctors' training was reading the books of Hippocrates and Galen. Doctors were taught to believe that Hippocrates and especially Galen were correct about every detail.

  - Trust in Galen was demonstrated by doctors attending the dissections of human bodies (as Galen had recommended) but they were not trying to make new discoveries, they just watched a surgeon dissect a body whilst someone read Galen's work out loud.
• Why no change? Respect for tradition

  The result of the influence of the Church and of the way doctors were educated meant that people had great respect for the past and traditional ideas.

  When English scientist Roger Bacon (1214-92) suggested doctors do their own research and experiments, the Church leaders threw him in prison
• Why no change? Government

  In the Middle Ages the king's government took a laissez faire attitude. The king's major jobs were to defend the country in war and keep the country peaceful. Occasionally kings would order towns to be cleaned (e.g. Edward III during the Black Death of 1349), but this was only in exceptional circumstances. No taxes were collected by the king's government to improve people's health or medicine.