Medicine Through Time (c1250-present)

• Who treated the sick?


  • Barber surgeons in towns (bloodletting & minor operations)
  • Wise women in villages (herbal remedies)
  • Monks in monasteries (herbs, prayer and rest)
  • Trained doctors (very expensive, used ideas of Hippocrates & Galen)
  • Apothecaries (prepared and sold treatments to the sick)
• What were the different methods used to treat illnesses?

  • Clinical observation (pulse & urine)
  • Balancing four humours; bloodletting, purging or vomiting
  • Some also checked the position of stars or recommended praying
  • Many people would resort to prayer, or even whip themselves
• What were the different methods used to prevent illnesses?

  • Hygiene was used by some, especially the richer citizens, which involved regular bathing
  • Keeping the air free of miasma by spreading around herbs such as lavender
• Key obstacles to medical progress during this period

  • Doctors lacked scientific knowledge to explain the causes of disease
  • Medical training involved reading Church-approved texts such as Galen
• The invention of the printing press around 1440 would lead to more rapid change during the Renaissance period
• Hippocrates


  Emphasises the importance of clinical observation; his Theory of the Four Humours and the need to balance them dominated medical thinking up to 1800
• Four Humours


  Blood, phlegm, black bile and yellow bile; when someone became ill, doctors thought these humours were out of balance
• Galen


  • Dissected animals to improve knowledge of human anatomy-since he believed in design theory (that God designed humans), the Medieval Church banned people from questioning his work
  • Used Four Humours theory and stressed the importance of listening to a patient's pulse
• Influence of the Church on medicine

  • Taught that illness (such as leprosy) was sent as a punishment by God for sinful behaviour
  • Controlled universities where doctors studied (with a clear focus on Hippocrates and Galen)
  • Banned human dissection, thereby restricting knowledge of anatomy
  • Recommended pilgrimages to visit shrines containing the relics of saints where hopefully miracle cures could be gained
  • Ensured over 700 hospitals were set up between 1000 and 1500
• Other explanations for disease (supernatural)

  • Alignment of the planets; star charts (map of the night sky) would be used by looking at when the patient was born and when they fell ill to help provide a diagnosis of what was wrong
  • The Church' teachings that disease was a punishment from God
• Other explanations for disease (rational)

  • Miasma was bad air that was believed to be harmful
  • Medieval beliefs suggested any rotting matter could transmit disease
  • Theory of Four Humours
• Function of hospitals in the Middle Ages

  • By 1500 there were over 1000 hospitals in Medieval England, with about 30% owned and run by the Church
  • Hospitals were mainly a place for people to rest and recover; if you were not suffering from a terminal disease their higher standards of hygiene probably meant they were quite successful
  • The vast majority of sick people continued to be treated at home, by female relatives using herbal-based remedies
• Typical medieval surgical procedures

  • Bloodletting
  • Amputation
  • Trepanning (drilling a hole into the skull for epilepsy, severe headaches or possession by an evil spirit)
  • Cauterisation (burning a wound to stop the flow of blood using a hot iron)
  • Anaesthetics involved mandrake root, oplum and hemlock, although too much could kill a patient
• Main public health problems in many Medieval towns

  • Poor sanitation (water supply and waste disposal)
  • Regulations tended to be very ineffective-it was not the job of the monarch, for example, to improve public health
  • Streets were very dirty and cesspits could overflow into roads and rivers
  • Both leather tanners and butchers dumped chemicals and waste blood & guts respectively into rivers
• The Black Death began in Asia and travelled along trade routes, reaching England in 1348
• Ideas put forward to explain the Black Death

  • It was a punishment from God
  • It was caused by astrology and the alignment of the planets
  • It was blamed on Jewish people poisoning water supplies
  • It was an imbalance of the Four Humours
  • It was caused by miasma
• Dirty streets encouraged rats, and there was insufficient waste disposal. There were very few regulations and ignorance of germs and the true causes of disease was widespread
• Prevention methods used to avoid the Black Death

  • The monarch ordered the Church to organise special services and processions asking for God's forgiveness
  • Ordinary people prayed for forgiveness
  • Flagellants whipped themselves to show they had repented their sins
  • In some towns, there were orders to clean up the streets and in some towns quarantine was attempted
  • People carried posies of herbs with them to prevent miasma being inhaled
• Treatments used for the Black Death

  • Bleeding was used to treat some victims
  • Other remedies included the use of herbs
  • Some drank mercury which was poisonous
  • People would pray and confess their sins
  • Fires would be lit to remove the bad air
• Miasma theory, religious explanations (especially during epidemics), & astrology (although astrology was becoming less popular, people continued to wear charms during epidemics) showed continuity in understanding about the causes of disease
• Fewer people began to think that God sent disease as a punishment, the Four Humours was discredited and not believed by physicians at the end of the 17C, doctors stopped analysing urine showed change in understanding about the causes of disease
• Thomas Sydenham


  Believed in closely observing symptoms of a patient and then looking for remedies rather than relying on medical books. He was called the 'English Hippocrates'. He made the first description of scarlet fever, among many others
• The printing press enabled medical ideas to spread more quickly & contributed to the decline of the Church; books appeared which criticised Galen whose popularity faded throughout the 1600s
• The Royal Society was founded in 1660 to discuss new scientific ideas including medicine; scientists and physicians
• Continuity in approaches to prevention, treatment and care

  • Bloodletting, purging & sweating, herbal remedies, regimen sanitatis, removal of bad air, treatment by apothecaries and barber surgeons for those who could not afford a physician, women cared for the sick at home
• Changes in approaches to prevention, treatment and care

  • Belief in transference, looking for chemical cures (as opposed to bloodletting and herbs), hospitals began to treat people with wounds and curable diseases such as fevers
• Poorer people continued to buy treatments form quacks who travelled the country making profits form false treatments. Most people continued to be treated by female family members or local wise women. Both groups used herbal remedies and traditional treatments
• In some hospitals such as St Bart's London, some of their training actually took place on the wards; the writings of Vesalius and Harvey were being studied, training emphasised the importance of a scientific approach; dissection was permitted; and new equipment was being used such as microscopes and thermometers
• Explanations for the cause of the Great Plague of 1665

  • It was a punishment from God
  • It was caused by astrology and the alignment of the planets
  • It was spread person to person by touch (transference)
  • It was an imbalance of the Four Humours
  • It was caused by miasma
• Prevention and treatment methods used to avoid the Great Plague


  • People prayed for forgiveness
  • Plague victims were quarantined for 28 days with a red cross painted on their door
  • People carried a pomander to drive away bad air
  • People fasted and some smoked tobacco to ward off miasma
  • Local authorities banned most public gatherings leg. fairs), theatres were closed, streets swept clean, burning barrels of tar, dogs and cats killed, and searchers appointed to monitor the spread of the disease
  • Doctors wore special clothing to ward off the plague including wearing a bird-like mask with herbs inside
• It was observed that death rates were higher in poorer, dirtier places (thus promoting cleaning of streets), and watchmen prevented people entering and leaving infected houses to try and stop the infection from spreading. Gatherings of crowds were banned; fires were it to try to remove the poisons that were thought to be in the air
• Improvements to medical training

  • Wars were being fought with new technology which led to new wounds which required more surgery
  • The increase in available chemicals led to new ingredients being available for apothecaries
  • Dissection was legalised although there was always the problems of insufficient corpses to work on
  • The printing press allowed new ideas to spread more easily
  • Physicians were inspired to challenge the ideas of Galen and investigate for themselves
• Vesalius


  The most famous anatomist of this period- he was a lecturer in surgery at the University of Padua. In 1543 he published his most famous book On the Fabric of the Human Body-he had been able to dissect a large number of criminals. He worked with skilled artists to ensure his findings were accurately recorded and easy for others to learn from
• He dissected humans not animals, allowing him to prove Galen wrong in a number of ways, e.g a human breastbone has three parts, not seven as in apes; the human lower jaw has one bone, not two
• Impact of Vesalius


  • Anatomy became central to the study of medicine; medical students were encouraged to learn from dissections, not reading from books
  • His work was heavily copied and appeared in many other texts. He inspired other anatomists such as Fabricius who discovered valves in human veins; it was Fabricius who later shared this discovery with William Harvey
  • Yet Vesalius had limited impact on treatments-doctors still did not know about the cause of illness. Others criticised him for questioning Galen
• William Harvey


  • He worked as a doctor in England and held important posts incl. being doctor to both James I and Charles (including experience on the battlefield]; he was thus in a strong position to influence others
  • He discovered and proved that veins in the body had valves and that blood was pumped around the body by the heart beating constantly-he may have been inspired by mechanical water pumps being used in London
• Impact of Harvey's discovery

  • His theory challenged Galen who taught the liver produced blood; Harvey thus challenged the popular treatment of bleeding
  • Harvey's work was not immediately useful-transfusions did not happen until 1901 when blood groups were discovered
  • His work was rejected by conservative doctors who supported Galen and refused to accept the use of experiments in medicine. Some refused to accept his ideas since they were unable to see capillaries - it would be another 60 years before they could by using a good enough microscope. The capillaries showed how blood moved between the veins and arteries
  • He published 'On the Mation of the Heart' in 1628-not all were convinced, including some of his own patients who refused to be treated by him
  • Yet his theory encouraged other scientists to experiment on actual bodies
• People still believed in the Four Humours and miasma, but such theories were declining in popularity. Due to microscopes becoming more powerful, scientists began to develop the theory of spontaneous generation in the early C18th, arguing that microbes were the product of decay rather than the cause of it
• Louis Pasteur


  • Known as the "father of microbiology, he pioneered "Germ Theory-the idea that disease is caused by tiny organisms he called germs
  • This discovery, in 1861, led him to the theory that germs might cause disease in the human body
  • He invented the process of pasteurisation, named after him, to preserve liquids and stop them spoiling
• Impact of Pasteur's discovery


  • Little immediate impact since doctors and surgeons could not see Pasteur's microbes; there was some impact on the work of Joseph Lister who inked Germ Theory to infection in his patients (although he could not prove this). Since scientists could see microbes in the guts of healthy people, many were sceptical. However in the longer term Pasteur's discovery led to changes in preventing disease with vaccinations and the introduction of antiseptic and aseptic surgery