Medieval England:

causes of disease in Medieval England were generally based on religious beliefs and not scientific knowledge as the majority of England’s population at the time was Christian.

supernatural and religious explanations: the Church was very influential and people followed the teachings of the Catholic Church. This therefore promoted the idea that God sent illness and disease as punishment or that the disease had been sent to them as a test of faith- either by God or the Devil.

astrology: physicians would use star charts to see when the patient had been born and when they had become ill to determine the illness they had. this method was also popular AFTER the BLACK DEATH [CASE STUDY]

miasma, or miasmata: a common idea was that illnesses or diseases were caused by poisoned air, which they also linked to God when they said that God was the one who had poisoned the air.

KEY INDIVIDUALS : GALEN AND HIPPOCRATES

Hippocrates (5th Century BC) had come up with the THEORY OF THE FOUR HUMORS, which stated that the body was made of four humours:

• blood

• phlegm

• black bile

• yellow bile or choler

it was believed that the four humours had to be in balance for good health, and if they became imbalanced they would cause disease.

Galen (2nd Century BC) had come up with the THEORY OF THE OPPOSITES, which further developed Hippocrates idea. Galen believed that his theory of opposites could balance the humours.

Galen’s ideas were heavily promoted by the Church because he believed in the soul and his ideas fit with the teachings of the Catholic Church. The Churches controlled universities and medical teaching, which led to the CONTINUITY of Galen’s ideas because all books were produced in monasteries and the majority of the population was illiterate.

ROGER BACON- a man who was arrested for questioning the ideas of Galen, and therefore questioning the ideas of the Church.

PREVENTIONS in Medieval England:

Religion- based:

• prayers, confession and offering tithes

• pilgrimages - a journey of religious significance

• fasting - showing you’re sorry for your sins

• self-flagellation - whipping yourself in public

• attending church services and processions

Miasma- based:

• carrying posies or sweet smelling flowers

• burning herbs to ‘clean the air’

• wearing pomanders

The public also followed a policy known as Regimen Sanitatis, a loose set of instructions provided by physicians to help a patient maintain good health.

TREATMENTS in Medieval England:

Humour based: blood letting using a phlebotomy chart by:

• using leeches

• cutting into a vein

• placing heated cups over cuts or scratches

purging: this was done through laxatives or emetics which caused people to throw up

Barber Surgeons: barbers would carry out basic surgeries, like blood letting or removing growths that were outside of the body.

Apothecaries: apothecaries mixed ingredients for herbal remedies; they did this for physicians and also mixed their own herbal treatments which they sold to the sick.

Hospital Care:

11,000 hospitals were around by 1500 and most of them were owned by the Church- this meant they were often linked to monasteries and convents.

hospitals didn’t necessarily treat the sick but offered a place for care so that any sick person could rest and recover there. patients were cared for by nuns and monks, and hospitals also offered places to stay for travellers who were going on pilgrimages. hospitals were kept clean- nuns and monks were tasked with ensuring the bedding was changed and washed regularly.

KEY NOTE: medieval hospitals provided CARE for patients, not CURES.

Leprosy: a skin disease that caused fingers, toes and hair falling out before eventually, the infected would die.

If someone caught leprosy, they were separated from the community and made to live in a ‘leper house’.[early ideas of quarantining]

Medical Staff:

physicians - physicians would train at a university for at least seven years, where they read and learnt from books from ancient physicians like Galen and Hippocrates. there job was to diagnose a patient with an illness and recommend treatment after close observation. physicians were very expensive and only the rich could afford them so most of the time, people were cared for by the female family members or women in the community.

CASE STUDY- THE BLACK DEATH (1348)

the Black Death, or the plague, was an infectious disease that infected many people, rich and poor.

the main symptoms were:

• buboes in the armpit or groin

• chest pains

• and a fever

most people who caught it died within a few days, and hardly anyone survived it.

causes of the black death (it was believed)

• miasma

• imbalance of the four humours

• alignment of the planets

• punishment from God

• earthquakes

When the Black Death arrived in England, it spread rapidly. Most people who caught it died within days and so there was not much time for treatment, but some were similar to regular treatments of disease:

• if it was sent by God, prayer and confession of sins

• if it was because you breathed in bad air, carrying sweet smelling flowers or herbs

• imbalance of the four humours, blood-letting or purging.

Herbal remedies were an important treatment for all types of illness, including the Black Death. People relied upon them because there was little knowledge of how disease was spread and what had caused a person to become unwell

preventions of the Black Death:

individuals- confession, prayer, fasting and carrying posies

attempt by authorities - quarantine laws for anyone new to the area; they had to quarantine for forty days | houses were put under quarantine where there had been an outbreak | marking the doors of infected households. strangers couldn’t enter villages. local authorities stopped cleaning the streets in hopes that the bad smell would ward off any bad air.

THE RENAISSANCE PERIOD - 1500-1700

context:

Henry VIII broke with Rome and dissolved the monasteries [to get money to fight wars in France] and because the monasteries provided medical care for the public, this created a hole in care for the sick. The Catholic Church had a decline in power [new forms of Christianity - Protestants - and a more secular society developing]

Renaissance- meaning rebirth, a new period in time in which old ideas were reconsidered and new ideas were created.

VERY LITTLE CHANGE IN THE PRACTICE OF MEDICINE- Some ideas about disease began to change, but the way doctors treated and prevented disease hardly changed at all.

CAUSES of disease:

God and Sin- where disease was seen as a punishment from God. this was still taught by the church, but many people began to recognise that God didn’t send disease.

The Four Humours - physicians stopped believing in the idea of unbalanced humours (it was disproved by 1700) but ordinary people continued to follow it and expected the physicians to use it.

Miasma- this was a continuing idea of causes and it was widely believed during the Renaissance period. it was especially popular during the epidemics of the Great Plague.

contagion: it was theorised that disease was caused by seeds spread in the air

TREATMENTS of disease:

Religion based - prayers, fasting. pilgrimages and relics had stopped due to them being Catholic, and this was the time when people had turned to Protestantism. people still believed in the King’s touch too.

Four humours based - purging: new chemical treatments were used such as Antimony, which caused sweating in small doses and vomiting in large doses. blood letting and herbal remedies (theriacs) were still used too.

PREVENTIONS of disease:

religion based - prayer, avoiding sin or repentance. no self flagellation as it was a Catholic practice

four humours based - there was a new idea of balanced lifestyles; this was done by avoiding draughts, strong alcohol and rich/fatty foods

miasma based - hygiene wise, people stopped bathing as syphilis was associated with public baths. regimen sanitatis was still around and the use of pomanders and hanging sweet smelling herbs around the house was still prevalent.

contagion based- moving away from an area

CHANGES IN IDEAS ABOUT DISEASE:

• astrology was less looked to for causes of disease after 1500

• people gradually stopped believing diet caused disease

KEY INDIVIDUALS:

Andreas Vesalius - most famous anatomist of the Renaissance

• his contribution to medicine showed a significant change in the importance of observation, leading to more of Galen’s ideas being challenged

• dissection was no longer banned due to the decline in the power of the Church but he was able to carry out a large number of dissections which allowed him to closely observe the internal parts of the body by completing various dissection procedures.

• he corrected over 300 of Galen’s mistakes: the human jaw has one bone, not two | the human breastbone was in three parts, not seven | blood didn’t flow into the heart through invisible holes in the septum but is ‘diffused’ through it.

• published ‘On the Fabric of the Human Body’ in 1543 which was used to train physicians all across Europe

William Harvey - doctor to Charles I

• he proved that Galen’s idea [that blood was made in the liver and then pumped around the body] was wrong

• he proved Vesalius’ theory that the veins of the body contained valves

• published ‘An Anatomical Account of the Motion of the Heart and Blood’ in 1628, allowing doctors to learn from his discovery

Thomas Sydenham - the English Hippocrates

• he didn’t follow the ideas of Galen and Hippocrates

• he believed that diseases came from outside the body

• refused to rely on medical books and instead closely observed symptoms

• treated diseases as a whole, rather than the symptoms individually.

• encouraged the use of remedies to treat disease, bring a more scientific approach to medicine.

he published ‘Observationes Medicae’ in 1676 and he was one of the first to differentiate measles and scarlet fever. he popularised the use of cinchoa bark to treat malaria, which is still used today.

Humanism - a way of thinking that basically meant encouraging experimentation and rejecting God and religious ideas

Care and treatment:

training of physicians - physicians continued to learn from the books of Galen and Hippocrates but after the invention of the printing press (Johannes Gutenberg, 1440), different ideas were becoming more available and towards the end of the Renaissance, the ideas of Galen were finally being challenged. training took a more scientific approach and dissections were happening more often. new technology (the microscope) was being used more to learn more.

CASE STUDY - THE GREAT PLAGUE (1665)

causes of the great plague:

• God, sending it as a cleanse or as a punishment

• unusual planet alignment, similar to the Black Death

• miasma, or rotting waste causing miasma

• people, as in the disease was being spread from person to person.

treatments for the great plague:

• transference, strapping live animals to buboes in the hopes of transferring it to the animal

• patients were wrapped in thick woolen clothes

• bloodletting/purging

• herbal remedies

preventions to the great plague:

• chewing tobacco

• praying, confessing sins

• pomanders or hanging herbs in doorways

Government actions taken to prevent the plague:

• victims and families would be shut in their houses for 40 days and were prevented from leaving to protect others (quarantine)

• barrels of tar or bonfires were lit on the corners of streets to ‘clean’ the air

• events with large crowds, such as the theatre, were banned to prevent the spread through human contact