History medicine through time

• Wars destroyed the Roman public health systems and medical libraries
• The rulers of the small kingdoms built up armies rather than improving medical skills or public health
• War disrupted trade so countries became poorer
• Travel became more dangerous, reducing the communication between doctors
• Training of doctors was abandoned. Copies of Galen's books were either lost, or hidden away for safety
• The church had set up universities where doctors could be trained
• Armies took trained doctors to war with them where they gained experience as surgeons
• Rulers were taken to clean up towns
• Merchants and scholars were once again travelling around Europe, sharing ideas
• Christian Church


  Grew stronger in the Middle Ages
• Monasteries


  • Controlled education, priests and monks were the only people who could read
  • Opened medical schools where the ideas of Galen were taught
  • Made an effort to provide clean running water and toilets
• The only libraries were in monasteries, church sometimes banned books they did not want people to read
• Medieval hospitals


  • Provided "hospitality" for visitors
  • Genuinely ill people were often turned away due to fear of disease spreading
• Galen's ideas were rediscovered
• Church leaders looked carefully at Galen's works and decided that they fitted in with Christian ideas because he referred to "the creator" in his works
• Doctors in the believed his ideas were correct and it was nearly impossible to improve his work
• Galen had great influence on the doctors in the Arabic world and in medieval Christian Europe
• Medical schools began to appear in Western Europe, starting with the one in Salerno, Italy. Translations of Galen's and Hippocrates' work were accepted as absolute truth in medical schools
• Arab Medicine


  Islamic scholars picked up and developed ideas from the Greeks whom they greatly admired
• Aristotle's four humours, Galen's treatment by opposites and Hippocrates' clinical observation lived on
• Books were written that brought together the ideas of Aristotle, Galen and Hippocrates. These books were important means by which these ideas got back to Western Europe
• The attitude of Muslims towards the Koran meant that they were unwilling to criticise the works of Galen
• Four humours theory


  Medieval doctors believed illness was caused by an imbalance of the four humours
• The theory developed into a more complex system, based on the position of the stars
• Although human dissection was carried out in medical schools, findings were interpreted as the theory of the four humours – although some later doctors began to challenge traditional understandings
• More schools sprang up and human dissection was allowed. There were some doubts about classical texts
• New techniques included diagnosis by urine sample. This is a good aid to diagnosis, which is done today!
• Doctors also believed the stars caused disease and relied on astrology when deciding on treatments
• Trained doctors were very expensive. Medicine practised amongst the most was provided by monasteries and housewife-physicians, using traditional cures and their experience
• Supernatural beliefs and treatments

  • The church believed that illness was a punishment for sins – they prayed to god if they became ill
  • Some believed that pilgrimages to holy shrines could cure illness
  • Doctors had superstitious beliefs, saying magical words when treating patients and consulting stars
• Surgery in the Middle Ages

  • There was great demand for surgery because of warfare
  • Surgery was held in such low regard that many procedures were often left to untrained barber-surgeons
  • Wine was first used as an antiseptic
  • Surgical treatments were still simple, as major surgery was risky
• Towns lacked the public health schemes of the Romans
• People relied on cesspits and wells. Waste was frequently disposed of into the street
• People found it healthier to drink beer, than to drink water
• Black Death - 1348


  • Spread by coughs and sneezes or by black rat flea bites – black rats were carried overseas by ships
  • Arrived in Britain in 1348. Its victims were struck down suddenly and most died
  • Symptoms included exhaustion, high temperatures, swellings and difficulty breathing
• Ships were made to wait 40 days before landing – they were quarantined
• What did people think caused the plague and how did they treat it?

  • Miasma – carried sweet smelling herbs, sat between two large fires
  • God – tried to appease god by praying, or becoming flagellants (whipping themselves as a punishment)
  • Humours out of balance – use of opposites, purging, vomiting and blood letting
  • Poisoned water – blamed the Jews
• Doctors followed the ideas of Galen. They believed illness was caused by an imbalance in humours
• Believed that God and the Devil influenced health. Disease was seen as God's punishment for sins
• Astrology became important. Doctors studied star charts because they believed that the movement of the planets affected people's health