stands still (Part 1)

• Hippocrates


   

  Greek Doctor born around 460BC and was so influential his ideas are still used today. His main idea was to observe patients carefully to work out what was wrong with them and write down what he saw. Today we call this clinical observation and some doctors in medieval times would have used this. Hippocrates is best remembered for the theory of the Four Humours and the Hippocratic Oath which was an oath taken by new doctors promising to be ethical and not harm their patients.

   
• The four humors were blood, phlegm, black bile and yellow bile.
• Blood - associated with heat and moisture. It controlled our emotions and if there was too much it could cause anger or love. If there wasn't enough then someone might become pale and weak. Too little blood caused depression.
• Phlegm - associated with coldness and moisture. This made us calm but also lazy. Too much phlegm meant that someone became lethargic and didn't want to do anything. Not enough phlegm meant that someone had no control over their temper.
• Black Bile - associated with dryness and coldness. This made us sad and depressed. Too much black bile meant that someone became melancholic and wouldn't talk to anyone. Not enough black bile meant that someone was happy all the time.
• Yellow Bile - associated with heat and dryness. This made us angry and aggressive. Too much yellow bile meant that someone became violent and attacked others. Not enough yellow bile meant that someone was very passive.
• The balance of the Four Humours could be restored by reducing whichever one was out of balance. This usually meant purging (being sick) or bleeding a patient (bloodletting)  using leeches or cutting to reduce their blood. This continued until the 19th century.
• Galen


  Greek but studied medicine in Egypt. He was a follower of Hippocrates and the most celebrated physician in the Roman Empire. He was the first doctor to encourage dissection even though it was illegal. As doctor to the gladiators in his hometown, he gained a lot of practical experience. He took the idea of the Four Humours further coming up with the Theory of Opposites. Both of these men are significant as they show a shift from supernatural causes of disease to natural causes within the body.
• Theory of opposites


  In the 2nd century CE, Galen took the idea of the Four Humours further. Besides bleeding and purging to reduce the excess humours, his theory aimed to restore the balance of the humours by giving the patient the ‘opposite’ of their symptoms. For example, if you had too much phlegm (water and cold) you should eat hot peppers.
• Natural approaches to disease

  • Apothecaries (medicine-makers) used herbs to make medicines.
  • Burning herbs to create a sweet smell to get rid of miasma (smells they believed caused diseases).
• Supernatural approaches to disease

  • Praying to God or Saints- they believed disease was punishment from God.
  • Flagellation (publicy whipping themselves)- to show they were sorry for their sins.
  • Astrology - people believed the stars and planets could be responisble for illness.
• Hippocrates and Galen

  • Most medieval doctors would have accepted Hippocrates’ Theory of the Four Humours and Galen’s Theory of Opposites without question.
  • Unfortunately these weren’t always useful and patients got worse.
  • Most doctors believed in supernatural causes for disease.
• Methods of treatment:

  Some doctors would carry a toolkit for treating people, including:

  • The vademecum (go-with-me) diagnosis book.
  • Leeches for balancing the humour of blood.
  • Posies and other highly smelling objects to ward of miasma (the smells they believed caused disease)
  • Herbs for mixing natural remedies.
  • A zodiac chart to predict illnesses and suggest cures.
• Training


  New universities of physicians were set up in places like Bologna and Padua. In Padua students had to visit sick people as part of their training. At these schools doctors debated the best treatments for diseases and even began to watch people dissect bodies to better understand how they worked. The medieval period also saw some licencing for doctors returning from the new medical schools. New books were being produced for them to read by scholars such as Rhazes.
• Observation

  Medieval approaches weren’t completely unscientific. Some doctors followed Hippocrates’ methods and clinically observed their patients in an effort to understand what's wrong with them. Doctors might try to work out what was wrong by taking their patient’s pulse or tasting their urine.
• Anatomy lecture, 1483

  Notice the professors stays in his chair and the student’s aren’t taking part in the dissection. Dissection would have been done by a low-paid employee. Doctors were encouraged to learn by reading the books of Hippocrates and Galen, not by hands-on activities like dissection and experimenting. 
• Education:


  11th century medical school set up at Salerno in Italy. Limited dissection allowed

  but still used ideas of Galen and Hippocrates. Doctors became more professional. Islamic

  education, improved Baghdad Hospital, Avicenna and Rhazes.
• Public Health:


  Government did little about unhealthy streets - no sewers, rubbish everywhere. Monasteries

  were clean and healthy, physic gardens and bath-houses. Church also ran hospitals e.g. St

  Barts in London, St Giles Norwich not all hospitals did surgery, ill people banned! Islamic

  hospitals Cairo, Baghdad, clean and observed illness.

  Some improvements: Muckrakers, fines for throwing waste, dunghills created.