Medieval English Health and Medicine ************************************ Health and medicine in Medieval England were very important aspects of life. For many peasants in Medieval England, disease and poor health were part of their daily life and medicines were both basic and often useless. Towns and cities were filthy and knowledge of hygiene was non-existent. Superstition and ignorance reigned during the Middle Ages, a time when characters we now consider to be simply from fairy tales; pixies, trolls, hobgoblins and so on, were thought to truly exist. Health was controlled by the stars, and affliction was a sign of impurity of the soul - a curse from God. Disease was a constant concern, as was infection from injuries. Hygiene was not always a priority, in fact it was not a consideration and medieval diets were lacking in vital nutrition. Medieval science progressed quite slowly, and treatments for the sick were quite often out of reach, especially for the poor. But little by little, doctors learned information that led to better cures, and understandings of how diseases were transmitted. Hospitals began to be constructed, and schools established for those wishing to practice medicine. Superstition often remained, and medieval science certainly did not have all the answers. Information lost from the burning of the library at Alexandria by Christian zealots was slowly being rediscovered. Early days ********** In the early stages, from the 5th to the 9th century, Medieval medicine was made by those who were still in touch with the old Greek writers. The first documents that we have in the genuine history of Medieval medicine are to be found in the directions provided in the rules of the religious orders for the care of the ailing, especially by St. Benedict (480 - 543), the founder of the monks of the West. One of the rules of St. Benedict required the Abbot to provide in the monastery an infirmary for the ailing, and to organize particular care of them as a special Christian duty. Some of the doctrine was founded on that of the Benedictines. They promoted the herbal medicine, by recommending to learn the nature of herbs, and study diligently the way to combine their various species for human health; but they advised to not place your entire hope on herbs, nor seek to restore health only by human counsels. Since medicine has been created by God, and since it is He who gives back health and restores life, turn to Him... The monasteries are thus seen to have been in touch with Greek medicine from the earliest medieval times. In Britain, most things linked to the Romans was destroyed, villas were covered up as the Ancient Britons believed that they contained ghosts and evil spirits. With this approach, it is not surprising that anything medical linked to the Romans fell into disuse in Britain. The church continued to be the provider of care for the poor and sick. Some monasteries had cottage hospitals attached to them. The monks who worked in these hospitals had basic medical knowledge but they were probably the best qualified people in Britain to help the poor and those who could not afford their own physician. By 1200, there may have been as many as 400 hospitals in England. By the 14th Century, universities had developed in Western Europe that could be classed as medical schools where students could study under a master physician. Dissections of human bodies were carried out in these universities so anyone wanting to study medicine in the Middle Ages was not totally ignorant of facts about the human body. Public debates were also encouraged about medical issues and it is known that some medical schools encouraged students to actually challenge the ideas of Galen and Hippocrates. As a result of this refusal to take what Galen and Hippocrates had stated at face value some progress was made in the medical world during this time. All this took it's time getting to Britain, but it slowly arrived during the 16c. However, 14c medicine became steeped in superstition and the Roman Catholic Church effectively dominated what direction the medical world took. Any views different from the established Roman Catholic Church view could veer towards heresy with the punishments that entailed. Therefore, when the Roman Catholic Church stated that illnesses were punishments from God and that those who were ill were so because they were sinners, few argued otherwise. The Black Death 1348 ******************** The Black Death (plagues) spread to England in 1348, and killed between a third and more than half of the nation's inhabitants between 1348 and 1350. Medieval cities fared worst of the black death. With their narrow streets making transmission of the disease much easier, nearly half of the populations of some larger cities perished from this epidemic. This disease was spread primarily through rats and fleas. The Church's stranglehold on society left many feeling that this was a plague from God, and that doctors would be of little use. Attempts to avoid the disease ranged from constant supplication to God, to eating fine meats, drinking fine wines, and filling the mind with thought of anything, other than death. Doctors tried to treat victims with everything from valerian root and moonwort to arsenic and brimstone, eating powdered emeralds, bathing in human urine, wearing of excrement, placing dead animals in the home, use of leeches or even drinking molten gold... People didnt know better than to believe that these cures worked. There was no source of medicine so really they had to just try lots of different things. When they thought something worked, somebody else with the same disease or sickness would try it but they would usually end up dead because it didnt. Royalty were lucky because they had enough money to buy expensive cures that they thought had a better chance of working but still, they didnt work. The rise of the Physicians ************************** During the outbreak of black death in 1349, Edward III complained to the Lord Mayor of London that the streets of the city were filthy: "Cause the human faeces and other filth lying in the streets and lanes in the city to be removed with all speed to places far distant, so that no greater cause of mortality may arise from such smells." The plague was thought to come from the smell, or 'vapours'. No one knew what caused diseases then. There was no knowledge of germs. Medieval peasants had been taught by the church that any illness was a punishment from God for sinful behaviour. Therefore, any illness was self-imposed, the result of an individual's behaviour. Other theories put forward for diseases included "humours". It was believed that the body had four humours (fluids) and if these became unbalanced you got ill. Doctors studied a patient's urine to detect if there was any unbalance. Astronomers blamed the planets going out of line. As important, nobody knew how diseases spread, the fact that people lived so close together in both villages and towns meant that contagious diseases could be rampant when they appeared, as happened with the Black Death. Physicians were seen as skilled people but their work was based on a very poor knowledge of the human anatomy. Experiments on dead bodies were unheard of in Medieval England and strictly forbidden. Physicians charged for their services and only the rich could afford them. Their cures could be bizarre though some cures, including bleeding and the use of herbs, had some logic to them even if it was very much a hit-or-miss approach. One of the most famous physicians was John Arderne who wrote "The Art of Medicine" and who treated royalty. He was considered a master in his field but his cure for kidney stones was a hot plaster smeared with honey and pigeon dung! Physicians would have had their own ideas as to what caused illnesses. Those who blamed bad smells developed a 'cure' to make the bad smells go away. Those who blamed bad luck would use prayers and superstitions. Those who blamed the body's four humours used bleeding, sweating and vomiting to restore the balance of the four humours. When by some luck, a patient got better or simply improved, this was a sure sign that a cure worked. It also meant that the 'cure' would be used over and over again. If it did not work on the next patient, this was the fault of the patient rather than of the cure. Operations were carried out by 'surgeons'. In fact, these men were unskilled and had other jobs such as butchers and barbers. The traditional red and white pole outside of a barber's shop today is a throwback to the days in Medieval England when barbers did operations. The red stood for blood and the white for the bandages used at the end of an operation. Operations could end in death as post-operative infections were common. Instruments used in an operation were not sterilised and as there was no knowledge of germs, there was no need to clean instruments used in operations. Patients might recover from small operations, such as a tooth extraction (though this could not be guaranteed), but operations that included a deep cut through the skin were very dangerous. Progress after the black death ****************************** The Black Death set the stage for more modern medicine and spurred changes in public health and hospital management. Frustrated with Black Death diagnoses that revolved around astrology and superstition, educators began placing greater emphasis on clinical medicine, based on physical science. While schools initially had to close for lack of educators, the plague eventually drove growth in higher education. New schools were established, sometimes specifically mentioning in their charters that they were trying to address the decay in learning and gaps in education left by the Black Death. People who survived the Black Death era generally suffered a communal crisis of faith. Rather than becoming more religious in thanksgiving to God for their survival, people harbored doubts. They had turned to the church for an answer to the plague, and the church had been able to offer no help. Additionally, priests, who, along with doctors, had the highest rate of contact with the diseased, also had one of the highest rates of fatalities. Several new heretical movements sprang up. For the survivors of the black death, death became the start of the personal reckoning but at the same time these catastrophes were regarded as forebodings of the coming apocalypse, and the great collective reckoning. The result was that the day of reckoning was no longer a great collective event that would fit into the great scheme, but was now a very personal experience that might arrive soon, at a very inconvenient time - maybe without giving you time to pay penance for all of your sins. Feeling, essentially, that God had turned his back on them, the people reacted to the end of the Black Death by turning their backs on him. They engaged in wild debauchery to celebrate being alive. They held gluttonous banquets, drank, wore extravagant clothing and gambled. It was clear through the art of the time, though, that people still had death on their minds. The danse macabre, or dance of death, is an allegorical concept that was expressed in drama, poetry, music and visual art. This overwhelming fascination with death was still with britain in the 16c with Hans Holbein's woodcuts of 1526 entitled "The Dance of Death". The practice of alchemy as medicine, previously considered to be normal for most doctors, slowly began to wane as the citizenry began to realise that it seldom affected the progress of the epidemic and that some of the potions and "cures" used by many alchemists only served to worsen the condition of the sick. Distilled spirit, originally made by alchemists, was commonly applied as a remedy for the Black Death, and, as a result, the consumption of spirits in Europe rose dramatically after the plague. Although the Black Death highlighted the shortcomings of medical science in the medieval era, it also led to positive changes in the field of medicine. As described by David Herlihy in The Black Death and the Transformation of the West, more emphasis was placed on “anatomical investigations” following the Black Death. How individuals studied the human body notably changed, becoming a process that dealt more directly with the human body in varied states of sickness and health. Further, at this time, the importance of surgeons became more evident. In 16c Britain, there were only three small hospitals after 1550. Pelling and Webster estimate that in London in the 1580 to 1600 period, out of a population of nearly 200,000 people, there were about 500 medical practitioners. Nurses and midwives are not included. There were about 50 physicians, 100 licensed surgeons, 100 apothecaries, and 250 additional unlicensed practitioners. All across Britain - and indeed all of the world - the vast majority of the people in city, town or countryside depended for medical care on local amateurs with no professional training but with a reputation as wise healers who could diagnose problems and advise sick people what to do - and perhaps set broken bones, pull a tooth, give some traditional herbs or brews or perform a little magic to cure what ailed them. The Great Plague of 1665 ************************ In 1665 the 'Great Plague' hit the country - though it was Stuart London that took the worst of the plague. The plague was only finally brought under control in 1666 when the Great Fire of London burned down the areas most affected by plague - the city slums inhabited by the poor. This had the simple effect of killing a vast number of the rats that carried the plague, thus the new cases of plague were greatly reduced. Stuart England was never completely free from the plague, but 1665 saw the worst. 1665 had experienced a very hot summer. London’s population had continued to grow and many lived in squalor and poverty. The only way people had to get rid of rubbish was to throw it out into the streets. This would include normal household waste as well as human waste. As a result, London was filthy. This was a perfect breeding place for rats. A popular belief during the plague was that the disease was caused by dogs and cats. This was not so. The plague was caused by disease-carrying fleas carried on the bodies of rats. A pair of rats in the perfect environment could breed many off-spring. The filth found in the streets of London provided the perfect environment for rats. Once the disease took a hold it spread with frightening speed. Those who could, the wealthy, left London for the comparative safety of the countryside. No such option existed for those who lived in the slums. In fact, militiamen were paid by the city’s council to guard the parish boundaries of the area they lived in and to let no one out unless they had a certificate to leave from their local parish leader. Inevitably, very few of these certificates were issued. Any family that had one member infected by the plague was locked in their home for forty days and nights. A red cross was painted on the door to warn others of the plight of those in the house. Those who assessed whether someone had the plague or not were called plague doctors. None of these were qualified physicians as most real doctors had fled the city for their own safety. However, their decision was final and would result in your home being chained shut from the outside and the red cross being painted on your door. Londoners were also paid to kill dogs and cats as it was assumed that these spread the disease. Cures for the plague were numerous, dangerous and pointless but very much sought after if someone had the money to pay for them. Most did not, so suffered and died. Nathaniel Hodges believed that sweating out the disease was a sound approach and he encouraged those victims he came across to burn anything they could to create heat and smoke. In view of the fact that Londoners lived in wooden houses then, this was not particularly sound advice even from a proper doctor. However, many were desperate to try anything. Some of these cures were even published in medical books as effective cures. One of the most common methods to disinfect oneself, especially those who carried the dead, was smoking tobacco. This was approved by physicians and even children were encouraged to smoke often. Other dubious cures included Plague water (A cordial made with white wine & herbs), and various herbal cures for plague sickness were offered using many different ingredients and often had a good helping of wines and spirits. lucky or magic charms and wearing toads round your neck was popular, and money was placed in vinegar or running water as payment rather than hand to hand contact. The remedies for plague sores are by far the strangest, a very popular one of these was to pluck the feathers from a pigeon's tail to burst the sore then hold the pigeon to the sore to drain the poison until the pigeon dies (hens and chickens were also acceptable). Another was to hollow out an onion, put in a fig cut it small and add a little Venice treacle. Wrap it in wet paper and roast it in embers then, whilst still hot, apply it to the sore for three hours. Venice treacle or theriac is mentioned quite often in plague cures. It is an ancient compound of many ingredients mixed with honey and was believed to be an antidote for poison of many types. One lady in the plague village of Eyam was believed to have survived by drinking a large quantity of bacon fat... The plague was at its worst in September 1665 when the heat of the summer was at its peak. The resulting great fire devastated the filthy city areas where rats had prospered. The rebuilt London was more spacious and open. Central parts of London were rebuilt with wider streets to relieve crowding and better sewage systems to improve sanitation and coincidentally reducing the population of rats. London’s Privy Council issued new Plague Orders in May 1666, which banned the burial of future plague victims in parish churches and small churchyards, enforced the use of quicklime at designated burial sites, and strictly prohibited opening graves less than one year after interment as a safeguard against the spread of infection. After the Plague **************** Medicine did not really leap forward until a century later, but the London Dispensary opened in 1696, the first clinic in the British Empire to dispense medicines to poor sick people. The innovation was slow to catch on, but many new dispensaries were opened in the 1770s. In the colonies, small hospitals opened in Philadelphia in 1752, New York in 1771, and Boston in 1811. Guy's Hospital, the first great British hospital opened in 1721 in London, with funding from businessman Thomas Guy. In 1821 a bequest of £200,000 by William Hunt in 1829 funded expansion for an additional hundred beds. Samuel Sharp, a surgeon at Guy's Hospital from 1733 to 1757, was internationally famous; his "A Treatise on the Operations of Surgery" (1st ed., 1739), was the first British study focused exclusively on operative technique. English physician Thomas Percival (1740-1804) wrote a comprehensive system of medical conduct, Medical Ethics, or a Code of Institutes and Precepts, Adapted to the "Professional Conduct of Physicians and Surgeons" (1803) that set the standard for many medical textbooks. In the 19c the practice of medicine changed in the face of rapid advances in science, as well as new approaches by physicians. Hospital doctors began much more systematic analysis of patients' symptoms in diagnosis. Among the more powerful new techniques were anaesthesia, and the development of both antiseptic and aseptic operating theatres. Actual cures were developed for certain endemic infectious diseases. However the decline in many of the most lethal diseases was more due to improvements in public health and nutrition than to medicine. It was not until the 20th century that the application of the scientific method to medical research began to produce multiple important developments in medicine, with great advances in pharmacology and surgery. A few Medieval cures: ********************* For toothache: Take a candle and burn it close to the tooth. The worms that are gnawing the tooth will fall out into a cup of water held by the mouth. The cause of the Black Death according to Guy de Chauliac, a French doctor: Three great planets, Saturn, Jupiter and Mars, are all in close position. This took place in 1345. Such a coming together of planets is always a sign of wonderful, terrible or violent things to come. For evil spirits in the head: For this, surgeons used trepanning. This was where a surgeon cut a hole into the skull to release evil spirits trapped in the brain. The operation might also include cutting out the part of the brain that had been 'infected' with these evil spirits. Incredibly, people are known to have survived operations such as these as skulls have been found which show bone growth around the hole cut by a surgeon - a sign that someone did survive such an operation if only for awhile. For general illnesses: People were told that a pilgrimage to a holy shrine to show your love of God would cure them of illnesses especially if they had some holy water sold at the place of pilgrimage. After the death of Thomas Becket in 1170, Canterbury Cathedral became a place of pilgrimage which brought even more wealth to the city. However, more people coming to the city also increased the risk of disease being brought in. Blood letting: Barbers doubled as surgeons, and a good bleeding was often the cure prescribed. This was when blood was drained from a certain spot in your body. The idea behind this was similar to trepanning in that it released bad blood from your body. The use of leeches was common for this but dirty knives were also used which only increased the risk to the patient. Sources: www.medieval-spell.com www.dodedans.com ucblibraries.colorado.edu www.historylearningsite.co.uk www.medieval-life.net www.tellmehowto.net davidwball.com www.google.co.uk en.wikipedia.org www.npr.org digitalcommons.wayne.edu www.st-hughs.co.uk