Medicine through time, c1250-present, Study Guides, Projects, Research of Medicine

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Medicine through time,

c1250-present

Key Topic 1: c1250–c1500: Medicine in medieval England

Key Topic 1.1 Ideas about the causes of disease and illness

Religious explanations  Committed a sin from God – he was punishing you  If there was a famine that caused malnutrition it was because of God. When people recovered it was because a miracle had taken place  Blaming sickness on God acted as proof of the divine  Leprosy was included in the Bible as an illustration of a punishment for sin. Leprosy began as a painful skin disease, followed by paralysis, and eventually death. Fingers and toes would fall off, body hair would drop out and ulcers would develop in and out of your body. There was no cure, so lepers were banished from their communities.  Disease was mainly seen as a result of sin, the Church also taught that disease was sent by God to cleanse one’s soul of sin.  Most of what ordinary people learned was taught by the Church. It was also the centre of formal learning; it set up and ran universities where physicians were trained. The Church also discouraged dissection. Astrology and supernatural explanations  Alignment of planets and stars considered important when diagnosing illness  A physician would consult star charts, looking at when the patient was born and when they fell ill, to help identify what was wrong  Traditionally, the Church frowned upon the idea of using astrology in diagnosing illness, seemed only step away from predicting the future/fortune telling  After the Black Death (1348), astrology became more popular  Astrology was a supernatural explanation for disease Rational explanations for disease  Still based on ideas from the Ancient world, in particular those of Hippocrates and Galen  The Theory of the Four Humours: Ancient Greeks thought everyone had a mix of four humours in their body. They believed people became ill when this mix was unbalanced, so to make people better they tried to put this balance right.  The Four Humours were – blood, phlegm, black bile and yellow bile. People believed that a combination of age, family traits, and circumstances (season in which you were born), usually combined to make one or two of the humours stronger than the others  Theory of Opposites: Galen developed the idea of the Four Humours further. This aimed to balance the humours by giving the patient the ‘opposite’ of their symptoms. For example, if you had too much phlegm (linked to water and cold), you should eat hot peppers  Theory was so popular as it was very detailed and could be used to explain almost every kind of illness – physical or mental  Ideas were supported by the Church and because the Church educated the majority of people, that is all they knew Other explanations  Miasma: bad air that was believed to be filled with harmful fumes. Galen and Hippocrates suggested that swamps, corpses and other rotting matter could transmit diseases. Smells and vapours were also associated with God. Homes that smelt badly suggested sinful and corruption and, if a person was unwashed, other people would avoid them.

Key Topic 1.2 Approaches to treatment and prevention 1250 - 1500

Treatments: Religious treatments: Healing prayers and incantations (spells) Praying for a special mass to be said (bread and wine) Fasting Pilgrimages Touching holy relics Lighting a candle Chanting incantations and using charms Supernatural treatments: Varied according to the horoscope of a patient Alignment of planets checked at every stage of the treatment prescribed – herb gathering, bleeding, purging, operations, cutting hair and nails at the right time Humoral treatments: Today, when we fall ill, doctors assess the symptoms, make a diagnosis, and treat the infection. If a patient catches a chest infection, the treatment prescribed will be to attack the germ, rather than to stop the patient from coughing. Medieval physicians broke down and treated each symptom separately, as they believed each symptom represented an imbalance in the humours. Conflicting remedies may be provided. Blood-letting (phlebotomy) Most common treatment for an imbalance in the humours. The idea behind it was that bad humours could be removed from the body by removing some of the blood. Usually done by barber surgeons and wise women.  Cut a vein with a lancet or other sharp instrument. Most straight forward. Phlebotomy charts like the vein man were used to show points in the body where bleeding was recommended for specific illnesses  Leeches: freshwater leeches were collected, washed and kept hungry for a day before being placed on the skin. Bleeding might continue for up to 10 hours after the leech was full. This was used for people whose age or condition made traditional bleeding too dangerous  Cupping: skin was pierced with a knife or a pin, or scratched with fingernails until it was bleeding. A heated cup was placed over the cuts to create a vacuum which drew blood out of the skin. This was used for women, children and the very old. People believed different areas treated different illnesses. People believed that cupping on the back of the neck was good for eye trouble Purging The Humours were created from the foods eaten, a common treatment was purging the digestive system to remove any leftover food. Done by vomiting (emetics) or a laxative/enema to clear out anything left over in the body Emetics consisted of strong bitter herbs (e.g. scammony or parsley). Laxatives common Sometimes people would need a bit more help to purge, and the physician would administer an enema. John of Arderne, a famous English surgeon, mixed water with honey, oil, wheat bran, soap and herbs. This would be squirted up into the patient’s anus using a greased pipe fixed to a pig’s bladder, while the patient rubbed his stomach

Remedies: Herbal infusions to drink, sniff or bathe in Aloe vera was used to improve digestion Theriaca – spice-based mixture containing up to 70 ingredients Different foods prescribed to encourage the balance of humours – a dish called blanc mangier (chicken and almonds) recommended for medieval invalids because the ingredients were warm and moist Bathing: Warm baths helped the body to draw in heat to dissolve blockages in the humours Steam out impurities and ease aching joints For people with paralysis a fox was boiled in water and then the person would bathe in the water Preventing disease Although a physician could expect to be paid a lot more money for providing treatments for disease, there was a strong focus on following various regimes to prevent getting sick in the first place. This was seen as a far safer plan of action, since cures and treatments were hit-and-miss in their effectiveness The Church: Regular praying, confessing and paying tithes (1/10th of your wage to the Church). Diet: Since the humours were thought to be produced by digestion, what and when you ate were both considered very important in preventing an imbalance. Eating too much was strongly discouraged Fear of digestive problems leading to death was so great that many people purged themselves, either by vomiting or using laxatives, as a way of preventing disease as well as treating it Hippocrates recommended using an emetic once a fortnight in the winter, to use enemas in the summer Hygiene: Once your spiritual health was taken care of, it was important to concentrate on your bodily health Followed a loose set of instructions called the Regimen Sanitatis which was provided by physicians to help a patient maintain good health. Included instructions such as undertaking moderate exercise, not overeating, making sure you get a reasonable amount of sleep, regular bathing, not having too much sex, and being friendly with your neighbours. Bathing – used as a prevention method as bad smells indicated miasma. Only the wealthy could afford a private bath of hot water. Public baths or stews were available for a fee. Poorer people swam in rivers. No matter how rich or poor you were, everybody washed their hands before and after a meal. Purifying the air: Purify the air by using sweet herbs such as lavender. Sometimes they may also carry a posy of flowers Local authorities also tried to tackle miasma outside of the home putting into place measures to keep towns clean. For example, not leaving rotting animals lying around

donations could help to heal disease. Medieval hospitals were places to rest, recover and sleep. The space would have been kept clean and bed linen changed regularly. Patients would share beds Insane and pregnant patients were often rejected, though some hospitals had special beds, reserved for unmarried mothers

Key Topic 1.3 Case study: The Black Death, 1348- 1349

In 1348, a new disease reached the shores of England. It had spread from the Far East along trade routes, arriving in Sicily in 1347, quickly spreading across the whole of Europe. The Black Death, as it eventually came to be known, was a new plague that was unfamiliar to the ordinary people of England, as well as English physicians. Within months, it had spread the length and breadth of England, killing thousands of people. It did not matter if you were rich or poor, a city dweller or a country farmer, the plague did not discriminate. Those who caught it could expect to die within a matter of days. Causes Treatments Preventing Religious and supernatural God had deserted mankind Punishment for the sin of the world 1345 – unusual positioning of the planets – a sign of something that was going to happen Part of God’s plan to make people less sinful, saving them from Hell Confess sins Praying for forgiveness Inevitability – once you have it you were meant to get it Go to church services once a day Candle vigils Pilgrimages Praying in public Pray Fast Pilgrimage Whipping yourself to show you are sorry Natural Impure air – miasma causing disruption to the humours Impure air may have originated from poisonous fumes released by an earthquake/volcano Filth in the streets – the King ordered them to be cleaned Measures to stop dirty air Bleeding/purging – caused more people to die Strong smelling herbs Bursting buboes Tried treatments based on treatment by opposites Escaping – running away from the foul air Carrying flowers/fragrant herbs Avoid breathing in miasma Avoid bathing – water would open your pores to the bad air Common beliefs Europe many people blamed Jewish people Jews had been expelled from Britain during the 17th^ century Strong Christian beliefs – confession and praying Clear nobody could cure the disease Lack of knowledge about what caused it stopped people being able to cure it Listen to cheerful music Avoid doing anything sad Stop visiting family members who had the disease How did the government act?  Local authorities attempted to take action to prevent the plague from spreading  New quarantine laws put in place to try and stop people from moving around too much  People new to the area had to stay away from everybody else for 40 days to ensure they were not carrying the disease  Authorities started to quarantine houses where the plague had broken out  Considered banning preaching and religious processions to stop large crowds of people gathering but they could not enforce this  Local authorities stopped cleaning the streets – the belief that the foul stench of the rubbish and rotting bodies would drive off the miasma causing the plague

GOVERNMENT: In the Middle Ages, the King’s government did not want to improve medicine. Kings did order for towns to be cleaned but they did not do this regularly. No taxes were collected which meant there was no money for medical breakthroughs. Answer these quick fire questions to test your understanding

1. Who came up with the Four Humours theory?
2. What were the Four Humours?
3. How would you treat somebody that had a temperature because of too much blood?
4. Arguably, what was the most important institution in the medieval period?
5. How did they use religion to explain the causes of disease and illness?
6. How would a physician use star charts to explain the causes of disease and illness?
7. How did bad air (miasma) explain the causes of disease and illness?
8. What did physicians do with urine samples?
9. What disease was talked about in the Bible?
10. Where did most people’s education come from during the Middle Ages?
11. Who controlled education during the Middle Ages?
12. Why did the Church lead to little change in medicine c1250-c1500?
13. What would happen if you challenged the Church’s teaching?
14. Whose ideas did the Church support?
15. What was the main part of doctors’ training?
16. What does it mean to have ‘conservative’ ideas?

17. Why was there no medical breakthroughs during the Middle Ages?
18. Why were Galen’s ideas followed more than Hippocrates during the Middle Ages? What did Galen say needed to happen in order to have an understanding of the body?
19. What year did the Black Death hit Britain?
20. Give three causes of the Black Death
21. Give two treatments of the Black Death
22. How did people try and prevent the Black Death?
23. What role did the government play in helping with the Black Death?

2. THOMAS SYDENHAM: Known as the English Hippocrates. His work moved medicine in Britain away from the classical ideas of Galen and Hippocrates. He refused to rely on medical books when diagnosing a patient, instead, observing the symptoms and treating the disease causing them. Plants and animals could be organised into different groups. He encouraged medical students to observe their patients, note down their symptoms in detailed descriptions, and then look for remedies to tackle the disease. The nature of the patient had little to do with disease. This was a very modern idea and laid the foundation for a more scientific approach to medicine from the 18th^ century onwards. Sydenham was not able to isolate and identify the various microorganisms that caused the disease that he was observing. He did, however, identify that measles and scarlet fever were separate diseases.
3. PRINTING PRESS: In 1440 a German goldsmith created the first printing press (machine for printing text/pictures). Allowed for numerous copies of the same thing to be printed. Information could be spread quickly and accurately, Scientists could publish their work and share it across Europe. This also meant that there was a much wider variety of subjects written about. The Church was no longer able to prevent ideas they disproved of, being published.
4. THE ROYAL SOCIETY: “Take nobody’s word for it”. The desire to explain the world in secular terms led to a big increase in the number of experiments being carried out. Scientists wanted to talk to each other about their new discoveries and share their ideas which led to the Royal Society being set up. The monarch, Charles II, issued a Royal Charter (a right/power to a particular group). Due to the King supporting them, they Royal Society gained in credibility. If the King approved of them, they were surely doing something right. More people therefore sent their work in to be published. In 1665 they published Philosophical Transactions – the world’s first scientific journal – still published today. The book provided a vitally important platform from which scientists could share their work – which contributed to the spread of new ideas. They offered funding for translations of European Scientific txts encouraging its members to write their reports in English instead of Latin, making them more accessible.

2.2. Approaches to prevention and treatment 1500- 1700

Treatment Change from the Medieval period Continuity from the Medieval period Transference – illness/disease could be transferred to something else. People believed if you rubbed an object on an ailment, the disease transferred to the object New herbs started to appear from other countries. Appearance of new remedies opened up a huge number of possibilities for treatments and cures. Sydenham popularised the use of cinchona bark from Peru in treating malaria. Growth of alchemy meant that people began to look for chemical cures for diseases instead of relying on herbs and blood-letting. New science was known as iatrochemistry (medical chemistry) Pharmacopoeia Londinensis was published by the College of Physicians in 1618 as a manual of remedies were 122 different chemical preparations including mercury and antimony – promotes sweating so cools the body down. Belief in humoral treatments persisted. Old treatments aimed at rebalancing the humours continued. Bleeding, purging and sweating were all popular ways of removing too much of a particular humour Herbal remedies continued to be popular. 1500- 1700 remedies were chosen because of their colour/shape. For example, saffron used to treat jaundice Prevention Change from the Medieval period Continuity from the Medieval period No change in preventing disease – only way to avoid dying was to avoid catching the disease Condition at birth was important – if you were born small then it could be used to explain death from an illness Cleanliness was still important in the home and the body Still practiced the regimen sanitas Bathing had become less fashionable since the spread of syphilis – people believed that bathing led to diseases. More likely to now keep themselves clean by rubbing themselves down with linen and changing clothes regularly Certain weather conditions or surrounding atmosphere spread disease. More steps were taken to remove miasma – punishment given to minor criminals (picking up rubbish from the streets) Medical care Change from the Medieval period Continuity from the Medieval period Education increased considerably. Wars were being fought with new technology, new wounds on battlefields meant more surgery was needed. Introduction of iatrochemistry introduced new ingredients into the stores of the apothecaries. Now Apothecaries continued to mix remedies and surgeons carried out simple operations. Surgeons and apothecaries continued to provide a service for those unable to afford physicians. Physicians continued to be trained at universities –

 1543 ‘ On the Fabric of the Human Body’ he had been able to carry out a large number of dissections, thanks to a local magistrate allowing him to use the bodies of executed criminals.  Noted that Galen had made errors in his original theory on the human body. Galen had dissected animals instead of humans. Found 300 mistakes in Galen’s work: o Lower jaw in 1 part, not 2 parts o Vena Cava (vein leading out of the heart) was not next to the liver o Men and women had the same number of ribs o Human liver did not have five separate lobes  Vesalius encouraged other doctors to base their work on dissection  Dissections were vital – this laid the foundation for others to investigate the anatomy of the body in more detail  Included pictures hoping to present the ideal version of the human body – dissected corpses  Important as he made the study of anatomy fashionable  Laid the foundations for future discoveries e.g. Harvey What was the impact of Vesalius?  Anatomy became the central part of the study of medicine and doctors were encouraged to carry out dissections for themselves  His work was heavily copied and appeared in other medical texts  Work inspired others  BUT… caused a lot of controversies because he had challenged the ideas of Galen. This angered traditional physicians who argued that the human body had not changed since the ideas of Galen William Harvey  Harvey made one of the most important breakthroughs in medical history – blood circulates around the body  Harvey had a keen interest in dissection and observing the human body, he carried out public dissections, teaching students that it was important to observe the body and believe what they saw  Idea also followed by Sydenham  Born in 1578, studied medicine at Cambridge  1618 – became a royal doctor  Harvey had been taught that the veins of the body contained valves – proof that the blood in those veins flowed towards the heard. He used dissected bodies to prove this  Harvey looked at more detail at the old Galenic theory  Harvey then cut up cold-blooded animals (slower heartbeat) to observe the movement of their blood whilst still alive. This proved that arteries and veins were linked together in one system  He tied a tight chord around somebodies arm and cut off the blood flow in the artery leading into the arm. The artery in the arm is deeper than the veins, loosening the cord allowed the blood to flow into the arm, stopped it flowing out meant the veins swelled with blood  Harvey concluded that blood must pass from arteries to veins through tiny passages – blood vessels – capillaries  Proved that the heart acted as a pump thanks to the fire engine pumps How could Harvey make his discovery?

1. INDIVIDUALS AND INSTITUTIONS: Vesalius had proved some of Galen’s work wrong which made it easier for other scientists and physicians to do the same. Harvey was employed by Charles I which gave him credibility. More people heard of Harvey’s work. Due to the Church declining in power, Harvey became more critical of Galen’s teachings

2. SCIENCE AND TECHNOLOGY: fire engines had mechanical pumps to provide water to put out fires, which inspired Harvey to look at how the heart worked. He used modern scientific methods, reading about other scientists work, carrying out experiments and observing the results
3. ATTITUDES IN SOCIETY: More of an interest in science and in solving some of the puzzles of the human body. People began to search for a rational explanation for things. Harvey also wanted to improve Galen’s ideas.
4. COMMUNICATION: Harvey had read the work of earlier doctors and used their work to build up his theory What was the impact of Harvey?  Beginning of modern physiology  Encouraged others to experiment  BUT… understanding the circulation of the blood which had little practical use in medical treatment  Most doctors ignored/criticised him  Work only appeared in universities from 1673  Did not make anybody better

2.3 Case study: the Great Plague, London, 1665

1. Who came up with the Four Humours theory?
2. What were the Four Humours?
3. Who controlled education during the Middle Ages?
4. Why did the Church lead to little change in medicine c1250-c1500?
5. What would happen if you challenged the Church’s teaching?
6. Whose ideas did the Church support?
7. What was the main part of doctors’ training?
8. What does it mean to have ‘conservative’ ideas?
9. Why was there no medical breakthroughs during the Middle Ages?
10. Why were Galen’s ideas followed more than Hippocrates during the Middle Ages? What did Galen say needed to happen in order to have an understanding of the body?
11. What is meant by the Renaissance period?
12. Give 2 key ideas that changed from the Middle Ages to the Renaissance period
13. Give 1 key idea that stayed the same from the Middle Ages to the Renaissance period
14. What was the name given to the earliest form of chemistry?
15. What does it mean to have humanist ideas?
16. Who was Thomas Sydenham and how did he change the way of thinking with regards to how diseases and illnesses spread?
17. What was created in 1440 that led to information spreading more quickly and accurately?
18. Who were the Royal Society and how did their work gain credibility?
19. How were more steps taken to remove miasma during the Renaissance period? What started happening for the first time?

20. Why did training improve for doctors and medical professions? What did they have much greater access too?
21. What would happen if you challenged the Church’s teaching?
22. Whose ideas did the Church support?
23. What was the main part of doctors’ training?
24. What does it mean to have ‘conservative’ ideas?
25. Why was there no medical breakthroughs during the Middle Ages?
26. Why were Galen’s ideas followed more than Hippocrates during the Middle Ages? What did Galen say needed to happen in order to have an understanding of the body?
27. What is meant by the Renaissance period?
28. Give 2 key ideas that changed from the Middle Ages to the Renaissance period
29. Give 1 key idea that stayed the same from the Middle Ages to the Renaissance period
30. What was the name given to the earliest form of chemistry?
31. What does it mean to have humanist ideas?
32. Who was Thomas Sydenham and how did he change the way of thinking with regards to how diseases and illnesses spread?
33. What was created in 1440 that led to information spreading more quickly and accurately?
34. Who were the Royal Society and how did their work gain credibility?
35. How were more steps taken to remove miasma during the Renaissance period? What started happening for the first time?
36. Why did training improve for doctors and medical professions? What did they have much greater access too?
37. What year did the Plague hit London?
38. How many people roughly died (%)?