Edexcel GCSE 9-1 History

Medicine in Britain, c1250 to present workbook

Key Topic 1

C1250-c1500: Medicine in Medieval England.

Name:

Medicine Key Topic 1: Medieval Medicine Key Words

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Medicine Key Topic 1: Medieval Medicine Key Words

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Medicine Key Topic 1: Medieval Medicine Key Words

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Medicine Key Topic 1: Medieval Medicine Key Words

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Key features of medieval life c.100-c.1500

The Church

The Christian Church, which was Catholic, was an organistion which spread all over Europe and was headed by the Pope. In England, the head of the Church was the Archbishop of Canterbury. Every region had a bishop and every village had a priest. This gave the Church great influence over everyone's ideas.

The King and his government

The King’s main task was to defend the people at wartime and to keep the country peaceful. Taxes were only raised to pay for wars. Keeping streets clean and towns healthy were the work of local councils but they had little money to pay for this.

Communication

Printing came to England in the 1470s but until then books had to be written out by hand. This meant there were not many books and knowledge was slow.

Work and Harvest

90% of people worked as farmers to grow the food everyone needed. This was hard back-breaking work. This constant hard work meant there was little time for education or reading. There were years when poor harvest meant that people went hungry.

Education

The Church controlled education, especially in the universities where physicians were trained. By the end of the 15th century up to 10% of people in large towns could read. The books most read were prayer books and other religious books.

Attitudes

People were taught to respect what was written in the Bible and other ancient books. They were not encouraged by the Church to think for themselves or challenge traditional ideas.

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Key features of medieval life c.100-c.1500

TASK: If this is the answer, what is the question:

1. 90% - ___________________________________________________________________________
2. 10% - __________________________________________________________________________
3. Every village had a priest. - ___________________________________________________________
4. Local councils - ____________________________________________________________________
5. People went hungry - _______________________________________________________________

TASK: Explain, using the information on the previous page, why progress in medicine was so slow. You must use all the sentence fragments below, They can be used at the start, middle or end of the sentence. Once you have used them, you need highlight them.

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

A. Supernatural and religious explanation of the cause of disease.

Religious Explanation of the Cause of Disease

The period of 1250—1500 is known as the Middle Ages or the medieval period and the majority of the people living at this time were extremely religious. Most of the people in England followed the teachings of the Catholic Church. They would attend services regularly and would be expected to give sums of money to the Church each month, this was called a tithe. The Church also owned large amounts of land in England where it built churches, monasteries and convents. These became important centres of the community: as well as praying, monks and nuns of the Church provided basic medical care, looking after people who were not able to care for themselves. The Church used the tithes to pay for the care of the community.

Illness was not uncommon. Malnutrition, particularly in times of famine, made people more likely to fall ill. A lack of scientific knowledge at this time meant that the causes of disease and illness were a mystery. The Church used religion to answer the questions people had about illness and disease.

Ordinary people received most of their teaching from the Church, as they didn’t receive any formal education. The majority of people at this time could not read or write, instead, they learned from the stories they heard, or the paintings they saw on the wall of their church. One thing they learned was that sin was very dangerous. The Church taught that those who committed a sin could be punished by God. They also taught that the devil could send disease to test someone’s faith.

The Church often explained famine by saying that God had sent it as a punishment for sin. Therefore, it was logical also to blame people’s sins for their illnesses. Blaming sickness on God acted as ‘proof of the divine’: it provided evidence of God’s existence.

TASK: Answer the following questions.

1. What was a tithe? ________________________________________________________________________________________________________________________________________________________________________________________
2. How did the Church help people with medicine? ________________________________________________________________________________________________________________________________________________________________________________________
3. Why was the cause of illness a mystery? ________________________________________________________________________________________________________________________________________________________________________________________
4. How did people learn in the Middle Ages? ________________________________________________________________________________________________________________________________________________________________________________________
5. How did the Church explain famine? ________________________________________________________________________________________________________________________________________________________________________________________

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

A. Supernatural and religious explanation of the cause of disease.

Leprosy

The Bible tells stories about how God sent disease as a punishment. One such disease that was mentioned was leprosy which is a painful skin disease that leads to paralysis and eventually death. There was no cure, so lepers were banished from communities. If they were allowed to stay, they had to wear a cloak and ring a bell to announce their presence. They were also banned from going down narrow alleys, where it was impossible to avoid them. This was because it was believed that their breath was contagious. Although this was not true, it does show that medieval people had some correct ideas about how some diseases were transmitted. Although there was no formal care for lepers, a few lazar houses did help people suffering from leprosy. Lazar houses were more commonly known as leper colonies.

TASK: How does the illustration the left connect to medicine and supernatural ideas.

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TASK: What evidence can you find from the above that even in the Middle Ages, people also looked for rational (scientific/logical) explanation of causes of disease.

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

A. Supernatural and religious explanation of the cause of disease.

Astrology

The alignment of the planets and stars was also considered very 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, as it seemed only one step away from predicting the future or fortune telling. However, after the Black Death arrived, astrology became more popular, and the Church became more accepting of it. Many people believed the Black Death was caused by a bad alignment of the planets.

TASK: Was astrology a rational or supernatural explanation for disease?

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TASK: Sentence Expansion: Below is a sample paragraph explaining the supernatural and religious explanation of the cause of disease. Some of the sentence are incomplete. You need to highlight the incomplete sentence and rewrite them in the space below.

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Life in Medieval England revolved around the Catholic Church. During this time, people in England. On top of this, the Church built churches, monasteries and convents which became important centres of the community that provided basic medical care and looked after the sick. The Church taught ideas about the cause of disease such as. Along with this, people were taught to respect what was written in the Bible and were not encouraged to think for themselves. Finally, the alignment of the planets and stars was considered important when diagnosing illness. A physician would.

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

The Theory of the Four Humours

The theory stated that as the universe was made up of the four basic elements – fire, water, earth and air – the body must also be made up of four humours, which were all created by digesting different foods. The four humours were:

Blood

People may cough blood.

Phlegm

The watery substance coughed up or sneezed out.

Black Bile -

Probably referred to clotted blood, visible in excrement or vomit.

Yellow Bile

Appeared in pus or vomit.

There was a belief that all the humours must be balanced and equal. If the mix became unbalanced, you became ill.

According to the theory, each humour was linked to certain characteristics that physicians would look for when carrying out their diagnosis. For example, a person suffering from a fever had a temperature, causing the skin to go hot and red, physicians believed, they had too much blood. This was a hot and wet element. Meanwhile, a person suffering from a cold had too much phlegm, which was cold and wet. They would shiver and the excess phlegm would run out their nose. The humours were linked with the seasons as seen in the table below. Along with this, the star signs for each season were associated with its humour. Astrology was considered an important part of the Theory of the Four Humours, as the humours related to star signs and seasons, and each one had its own ruling planet.

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

The Origins of the Theory

The Theory of the Four Humours was created by the Ancient Greek physician named Hippocrates in the 5^th century BC. The word “humour” comes from the Greek word for fluid- humon. Hippocrates was very careful to observe all the symptoms of his patients and record them. The Theory of the Four Humours fitted what he saw.

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Galen, a physician in Ancient Rome during the 2^nd century AD, liked the ideas of Hippocrates and developed them further. He had been a physician in a gladiator school and later became the personal physician of the Roman Emperor. This meant that he had lots of time to experiment, ponder philosophy and write. By the time he died, he left behind a very large body of work- more than 350 books.

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Galen developed the Theory of the Four Humours to include the idea of balancing the humours by using the Theory of Opposites. For example, he suggested that too much phlegm, which was linked to water and the cold, could be cured by eating hot peppers. Galen also theorised that the circulatory system circulated blood generated in the liver, and the blood was distributed around the body.

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The Theory of the Four Humours was very popular because it was very detailed and could be used to explain almost any kind of illness – physical or mental. It was important that the theory covered almost every type of illness that occurred, because there was no other scientific explanation for the cause of disease. Often physicians twisted what they saw to fit in with the logic of the theory.

Galen’s Influence

Classical texts like those of Galen continued to be very influential in the Middle Ages for three reasons: the influence of the Church, the importance of book learning and the lack of alternative theories.

The influence of the Church

Galen wrote that the body was clearly designed for a purpose and that the different parts of the body were meant to work together in balance, as first proposed by Hippocrates. Galen also believed in the idea of the soul. This theory fitted in very well with the ideas of the Church, who believed that God created man in his image, and so they promoted Galen’s teaching and, by extension, those of Hippocrates. Since books were produced in monasteries, and libraries were maintained by the Church, their choice of texts were the ones that were widely read, preached and believed. In the early Middle Ages, the church controlled medical learning in universities, too.

The importance of book learning

Many people could not read in the Middle Ages. This meant that being widely read was a sign of intelligence. A good physician was considered to be one who had read many books, rather than one who had treated a lot of patients. Having read the works of Hippocrates and Galen was proof that a physician was worth the money he was being paid. The authority of these

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

classical texts was so strong that people believed them even when there was actual, physical evidence that suggested they were wrong.

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The lack of alternatives

There was a lack of scientific evidence to support any other kind of theories of the causes of disease. Dissections were mostly illegal, because the church taught that the body needed to be buried whole in order for the soul to go to heaven. Very occasionally, physicians were able to dissect executed criminals, or criminals who had been sentenced to death by vivisection. When this happened, the physician would sit far away from the body, reading from the works of Galen, while the actual cutting and examining was done by a barber surgeon. This meant that Galen’s ideas were preserved: anything in the body that didn’t agree with Galen’s writings could be explained away, since the body was that of a criminal and therefore imperfect, and the physician himself never did any examinations.

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TASK: Answer the following questions.

1. Who was Hippocrates? _________________________________________________________________
2. What are the 4 humours? ________________________________________________________________
3. How did Galen adapt this theory? ________________________________________________________
4. Why was Galen’s ideas so popular? _________________________________________________________

______________________________________________________________________________________

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TASK: Read through each statement carefully. 

• If it is a full sentence write S in the final column
• If it is a fragment write F in the final column

The first one has been done for you

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

TASK: Read back through the statements and complete the following tasks in the table below.

1. Repair and rewrite the sentences by adding capital letters and punctuation in the right places.
2. Convert the fragments into full sentences with capital letters and punctuation.

Miasma

A miasma (plural= miasmata) was bad _______ that was believed to be filled with harmful fumes. Hippocrates and ___________ both wrote about miasmata and suggested that swamps, corpses and other _____________ matter could transmit disease. Smells and vapours like miasmata were also, unsurprisingly, associated with God. A clean and sweet-smelling home was a sign of spiritual _______________ , and incense was burned in churches to purify the air. Homes that smelled badly suggested _________________ and corruption and, if a person was unwashed, other people would ___________ them, in case they breathed in the bad miasma and contracted a disease.

Urine charts

Although medieval physicians didn’t _________ people’s urine for making them ill, they did carefully examine the urine in order to make their _______________. It was thought to be one of the best ways to check on the balance of the _____________ inside the body. Samples of a patient’s urine could be sent to a physician, where it would be examined and compared with a urine ___________. The physician would carefully check the colour, thickness, smell and even __________ of the urine before making his diagnosis.

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

Influences about the causes of disease

The Middle Ages was a time when there was continuity in ideas about the causes of disease. There were only a few small changes. For example, the use of astrology became more widespread, which meant it was adopted by many people, but did not expand upon Galen’s original theories. Overall, ideas remained the same.

Individuals and the Church

The Church was very important in maintaining the status quo at this time. This means that they did not like change and wanted to keep things the way they were. The Church controlled medical learning and this training was not practical. They banned dissection meaning that knowledge of the human body remained limited. Furthermore, monks and nuns would copy books and as a result, the Church controlled what was an was not copied controlling the flow of information. The Church liked the Theory of the Four Humours because it fitted with their teachings, so it promoted this theory. The Church strongly discouraged anybody from criticising the theory.

Hippocrates and Galen were important individuals in the Middle Ages, Even though they lived many years before this time. Their books had been preserved by Arabic scholars and Latin translations were available in Europe by the Middle Ages. Galen, in particular, was popular with the Church, which meant that his work was widely promoted. Galen had not been a Christian, but he had said that the body had been created by one god who made all the parts of the body fit together perfectly. As the Church supported this idea, no Christian would dare to question Galen’s ideas as you would be accused of challenging the Church and God.

Science and Technology

During the Middle Ages, a lack of scientific understanding meant that new knowledge was limited. Physicians and medical students tried to make new discoveries fit into the old theories, rather than experimenting to explain the discoveries.

One important piece of technology invented near the end of the Middle Ages was the printing press. It was invented around 1440 by Johannes Gutenberg in what is now Germany. Although this was not directly related to advancing medieval medicine, it eventually led to much faster and easier sharing of medical texts. However, it did not have a huge impact during the medieval period.

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Attitudes in Society

Medieval people had a strong belief in God and did not want to risk going to hell by being critical of the Church. Physicians who did not follow the old ideas found it hard to get work, because everybody knew a ‘good’ physician would follow Theory of the Four Humours. Many people believed that , since medicine had always been done this way, there was no need to change it. Furthermore, as a result of the influence if the influence of the Church and of the way doctors were educated was that most people had great respect for the past and for traditional ideas. They wanted to keep everything as it was unless for a good reason. It was hard for ne ideas to spread because books were hand written. Also, doctors were not trained to challenge existing ideas resulting in a lack of change during this period.

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

Influences about the causes of disease

TASK: Add the correct appositive to the sentence.

1. Miasma, _________________________, was a popular idea about the cause of disease in the Middle Ages.
2. The Christian Church, _____________________________, controlled the education so therefore controlled what was taught.
3. Galen, __________________________________, was popular with the Church which meant his work was widely published.
4. Scientific knowledge was limited, __________________________________, so physicians tried to make new discoveries fit into old theories.

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TASK: Complete the sentences below.

1. Even though the printing press was invented in 1440, ______________________________________________________________________________________________________________________________________________________________________
2. Although physicians didn’t taste people’s urine ______________________________________________________________________________________________________________________________________________________________________
3. Attitudes in society meant that ideas stayed the same because ______________________________________________________________________________________________________________________________________________________________________

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

Explain why there was continuity in the idea about the cause of disease during the period 1250-1500

The following statements are pieces of evidence that you can use to answer this question. You need to choose 3 colours and place them in the correct fact to the correct factor.

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TASK: Because, but, so. Complete the sentences below.

There was continuity in the idea about the cause of disease because ____________________________________

______________________________________________________________________________________

There was continuity in the idea about the cause of disease, but _______________________________________

______________________________________________________________________________________

There was continuity in the idea about the cause of disease, so _______________________________________

______________________________________________________________________________________

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KT 1.1 – Ideas about the cause of disease and illness in the Middle Ages

B. Rational Explanation: Theory of the Four Humours

Explain why there was continuity in the idea about the cause of disease during the period 1250-1500

You may use the following information in your answer:

• The Church
• Galen

You must also use information of your own. 12 marks

For this question, you don’t need an introduction or a conclusion in this answer, you are just explaining why something happened.

TASK - Below is a sample paragraph. It is a good paragraph but there are 5 factual inaccuracies. You need to highlight them and correct the mistake in the margin.

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One reason why there was continuity in the ideas about the causes of disease between 1250-1500 was because of the Church. Even though the majority of people at this time were not religious, the Protestant Church held a lot of power and influence. For example, they controlled the education, and with the king, decided which books were copied and distributed. This led to continuity in the ideas of the cause of disease because even though the Church liked change, they discouraged anybody from criticising their beliefs. Furthermore, they only taught ideas that fitted their ideas, like Galen's Theory of Four Humours, which led to continuity as all medical professionals learnt from the Church’s teachings.

TASK: Highlighter marking.

Identify the following on the model paragraph:

• Point / Topic Sentence.
• Evidence
• Explaination

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Now lets plan out the last 2 paragraphs.

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KT 1.2 – Approaches to prevention and treatment

A. Approaches to prevention and treatment and their conneciton with ideas about disease and illness.

As the Church taught that disease was sent by God as a punishment for sin, it followed the that the cure should also involve the supernatural. As well as looking for medical treatment for disease, it was important to undergo a course of spiritual healing. Religious treatments included:

• Healing prayers and incantations (spells)
• Paying for a special mass to be said
• Fasting (going without food)

Pilgrimages to the tombs of people noted for their healing power also became extremely popular. Once the pilgrimage was complete, there were a few suggested actions with diseases could take. (see pictures below)

If prayers and offerings did not work, there were other supernatural remedies available, although the church did not approve of them. Chanting incantations and using charms or amulets to heal symptoms and ward off diseases were fairly common throughout this period.

Sometimes the sick were discouraged from seeking cures. After all, if God had sent the disease to purge the soul, it was important for the disease to run its course. Taking medicine to cure the disease might keep you alive, but it would mean that your soul would still be stained with sin. That meant risking not being admitted into heathen when you died.

Religious and supernatural treatments

Lighting a candle proportionately as tall as you (or as long as the body part you wanted to heal).

Praying to God to help heal your ailment (illness).

Touching holy relics, such as a piece of the ‘true’ cross on which Jesus was crucified or the bones of a saint

Presenting an offering at a shrine, usually an image of the body part to be healed.

Astrology

Physicians consulted star charts when diagnosing illness. These were also important when prescribing treatment. Treatments varied according to the horoscope of the patient. The alignment of the planets was then checked at every stage of the treatment prescribed: herb gathering, bleeding, purging, operations and even cutting hair and nails all had to be done at the right time.

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KT 1.2 – Approaches to prevention and treatment

A. Approaches to prevention and treatment and their conneciton with ideas about disease and illness.

Today, when we fall ill, doctors assess the symptoms, make a diagnosis and treat the infection. For example, if a patient catches a chest infection, the treatment prescribed will be to attach the germ, rather than to stop the patient from coughing. This is because modern medicine recognises that treating the cause of the illness will eventually treat the symptom.

Medieval physicians did not work in the same way. Each symptom was broken down and treated separately, as they believed each symptom represented an imbalance in the humours. Therefore, conflicting remedies might be provided.

Humoural Treatments

Blood-letting

Phlebotomy, or bloodletting/bleeding, was the 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. Phlebotomy was so common that most physicians didn’t even bother to carry out the procedure themselves and monks were forbidden from bleeding their patients. Instead, it was usually done by barber surgeons and wise women. Demand was so high that even some people with no medical background offered the service.

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Sometimes patients were bled for too long and died as a result. Evidence suggests that this was quite common and it was probably seen as a necessary hazard. Bleeding was carried out in several different ways as seen in the table below. .

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KT 1.2 – Approaches to prevention and treatment

A. Approaches to prevention and treatment and their conneciton with ideas about disease and illness.

Because it was believed that the humours were created from the foods eaten, a common treatment was purging the digestive system to remove any leftover food. This was done by giving the patient either something to make them vomit (an emetic), or a laxative or enema to clear out anything left over in the body.

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Emetics usually consisted of strong and bitter herbs like scammony, aniseed and parsley. Sometimes they contained poisons like black hellebore, so it was best to vomit them up quickly.

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Laxatives were very common. Some well- known examples included mallow leaves stewed in ale, and linseeds fried in hot fat. Linseeds are still used today a s digestive aid. Sometimes people needed a bit more help to purge, and the physician would administer a clyster or enema.

Purging

TASK: Answer the following questions based on what you have just read.

1. Give 3 religious treatments
1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________
2. What would people do if prayers didn’t work? __________________________________________________________________________________
3. Why were the sick sometimes discouraged from seeking cures? ____________________________________________________________________________________________________________________________________________________________________
4. How did people use astrology in medicine? ____________________________________________________________________________________________________________________________________________________________________
5. What is phlebotomy? __________________________________________________________________________________
6. What are the 3 types of phlebotomy? ____________________________________________________________________________________________________________________________________________________________________
7. What were the methods of purging? ____________________________________________________________________________________________________________________________________________________________________

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KT 1.2 – Approaches to prevention and treatment

A. Approaches to prevention and treatment and their conneciton with ideas about disease and illness.

Sick people in the period c1250-c1500 were also treated with remedies - usually herbal infusions to drink, sniff or bathe in. Some of these are still in use today. For example, aloe vera was prescribed to improve digestion. Other ingredients featured regularly included mint, camomile and rose oils, tamarind, almonds, saffron, butter, absinth, turpentine and coral. Sometimes the ingredients were expensive and difficult to find.

A common remedy mixed and sold at this time was theriaca. This was a spice-based mixture that could contain up to 70 ingredients, including quite common things like ginger, cardamom, pepper and saffron, but also some unusual ingredients like viper flesh and opium. Galen had written a book on theriacas, looking particularly at their use in treating snake bites and poisons. Over time, they became widely popular and were used for many different illnesses.

Different foods were prescribed to encourage the balance of the humours-remember that the humours were thought to be created from the digestion of food. A dish called blanc mangier, made from chicken and almonds, was regularly recommended for medieval invalids because the ingredients were warm and moist.

Bathing

Warm baths were regularly prescribed to help the body draw in heat to help dissolve blockages in the humours. This gave the body the opportunity to steam out impurities and ease aching joints. Herbal remedies could also be given this way. Various plants and herbs were added to the bath water to help. For example, people suffering from bladder stones were advised to stir in mallow violets.

Some of the remedies were less pleasant and were based purely on superstition: those suffering from paralysis were advised to boil a fox in water and then bathe in it! This was because it was thought that the quick and nimble properties of the fox would be transferred to the patient through the bath water

Remedies

Add a title for each paragraph

Summarise each paragraph in 2-3 bullets.

Remedy Ingredients

Remedies were herbal.

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Drank, sniffed or bathed in.

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Mint, rose oils and almonds.

Highlight the key information

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Title:

Most people believed that the best, and most important, way of preventing disease was to lead a life free from sin. Regular prayers, confessions and offering tithes to the Church worked together to ensure that any minor sins were quickly forgiven.

Title:

Once your spiritual health was taken care of, it was important to concentrate on your bodily health, too. Guidance on doing this was contained in a set of instructions known as the regimen sanitatis.

Title:

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.

Title:

Medieval people attempted to keep the air free from miasmata by purifying it. They did this by spending sweet herbs, such as lavender. Sometimes this might be carried as a bunch of flowers, or placed inside a decorative piece of jewellery called a pomander (a large locket).

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Local authorities put measures in place to keep towns clean. For example, they tried to make sure there were no rotting animals left lying around and pulled down or cleaned smelly public toilets.

KT 1.2 – Approaches to prevention and treatment

A. Approaches to prevention and treatment and their conneciton with ideas about disease and illness.

TASK: Below there are paragraphs regarding what people did to prevent disease. You need to give each paragraph a title from the table below.

Preventing Disease

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Title:

The regimen sanitatis was a loose set of instructions provided by physicians to help a patient maintain good health. It first appeared in the work of Hippocrates, where it was later picked up by Galen and Arabic scholars like Avicenna. This meant that the advice was widespread and very common by 1250. Ideally, a physician would provide a regimen sanitatis written especially for their patient. However, in practice, this service was only used by the very rich, because it took a long time to write such a detailed set of instructions for a every patient.

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Bathing was an important treatment for disease. It was also used as a preventative measure: bad smells indicated a miasma. The wealthy could afford a private bath of hot water. Public baths were available for a fee. Poorer people swam in rivers where possible. They believed that cleanliness was next to godliness, so it was important to stay clean. People also tried to make sure their homes smelled sweet and fresh, too. Floors were swept regularly, and rushes were laid down to soak up any mess. Sometimes sweet-smelling herbs, like lavender, were spread with the rushes to keep air free of miasmata.

KT 1.2 – Approaches to prevention and treatment

A. Approaches to prevention and treatment and their conneciton with ideas about disease and illness.

TASK: Create a 1 sentence summary of each of the factors.

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The Church: ____________________________________________________________________________

______________________________________________________________________________________

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Hygiene: _______________________________________________________________________________

______________________________________________________________________________________

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Diet: __________________________________________________________________________________

______________________________________________________________________________________

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Purifying the air: __________________________________________________________________________

______________________________________________________________________________________

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Regimen Sanitatis: ________________________________________________________________________

______________________________________________________________________________________

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KT 1.2 – Approaches to prevention and treatment

B. New and traditional approaches to hospital care in the thirteenth century.

Wise Women

Most people in the Middle Ages would have been treated at home by a female family member. Women did most of the treatment at home, caring for the sick and mixing remedies themselves. Women also acted as midwives: evidence from medieval sources suggests that only women attend births. Asking for medical advice cost a lot of money. Since the treatments weren’t guaranteed, most people were not willing to spend this money even if they had it. However, there were other treatment options for people willing to pay.

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Physicians

Medicine became more professional during the Middle Ages and a medical degree took between 7-10 years. Doctors were known as physicians - the word ‘doctor’ did not become common until the 17th century. The main role for of a physician was to diagnose illness and recommend treatment, they rarely got involved in treating the patients themselves.

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He would: 1. look at samples of the patient’s urine, faeces and blood. 2. Consult astrological charts under which the patient was born and at the time they fell sick. 3. Based on this, they would create a course of treatment.

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Treatment would be carried out by less trained and lower paid professionals as many physicians were clergymen and were forbidden from carrying out procedures such as bleeding. During this time however, new universities were established without religious sponsorships so foreign physicians who had no connection to the Church were able to both diagnose and treat patients. Physicians were very expensive because there weren’t many of them mainly due to the training being so long.

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Apothecaries

Apothecaries mainly mixed herbal remedies. They had a good knowledge of the healing power of herbs and plants thanks to studying herbal manuals such as Materia Medica. They usually had a good amount of knowledge from their own experience or passed down from family members.

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Apothecaries were not considered as skilled or knowledgeable as physicians. Physicians prescribed the medication and apothecaries were just there to mix the remedy. However, since doctors were expensive and apothecaries were comparatively cheap, lots of people would see an apothecary as an alternative to a doctor. This meant that doctors saw them as a threat to their livelihood.

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Apothecaries did not just create remedies, they also prescribed poison. This went against an idea fundamental to physicians - that they should do no harm. This rule went all the way back to Hippocrates and still exists today. Apothecaries were not bound by this rule, so they could not be trusted to do the best for their patient. Nor did they need to attend universities.

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Finally, many apothecaries also dabbled in alchemy and the supernatural, providing amulets and charms for patients who wanted something extra to cure a disease. This was frowned upon by the Church and, since many physicians were also priests, this meant that the gap between physicians and apothecaries became even wider.

How would you get treatment in the Middle Ages?

26

KT 1.2 – Approaches to prevention and treatment

B. New and traditional approaches to hospital care in the thirteenth century.

Barber Surgeons

Barber surgeons were probably the least qualified medical professionals in England. Since good barbers had sharp knives and a steady hand, they regularly performed small surgeries as well, such as pulling teeth and bleeding patients.

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Some surgeons were highly trained: in Europe, some physicians were encouraged to study surgery alongside medicine, so many learned their skills at university. In fact, the quality of surgery was arguably higher than the quality of medical advice, because it was usually based on experience rather than knowledge learned from books. In medieval England, a skilled surgeon could set a broken limb, remove an arrow or even successfully remove cataracts from the eyes.

TASK - Which of the Medieval ‘medic’ do these statements relate to?

I trained at a university for 10 years. _________________________

I mainly mixed herbal remedies. ________________________

I would consult astrological charts. ________________________

I do most the treatment at home. _________________________

I’m considered the least qualified medical professional. _________________________

I dabbled in the supernatural. _________________________________

TASK: Give 3 reasons why treatment in the Middle Ages was ineffective. Explain in full sentences.

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HOT: Give one way in which getting treatment in the Middle Ages was the same as today.

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KT 1.2 – Approaches to prevention and treatment

B. New and traditional approaches to hospital care in the thirteenth century.

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KT 1.2 – Approaches to prevention and treatment

B. New and traditional approaches to hospital care in the thirteenth century.

Hospitals

The number of hospitals in England was on the rise during the Middle Ages. By 1500, there were an estimated 1,100 hospitals, ranging in size from just a few beds to hundreds. Bury St Edmund’s, for example, had at last six hospitals to cater for lepers, the infirm and the old. The city had a shrine famous for its healing powers and therefore attracted a lot of sick people. However, many hospitals did not actually treat the sick. Instead, they offered hospitality to travellers and pilgrims, which is how hospitals got their name.

About 30% of the hospitals in England were owned and run by the Church in the Middle Ages. These were run by the monks and nuns who lived in nearby monasteries. The rest were funded by an endowment, where a wealthy person had left money in their will for the setting up of a hospital. Since charity was a foundation of religion and the Church taught that charitable donations could help to heal disease, it is not surprising that there were so many. The Church oversaw running many of the hospitals, too.

Medieval hospitals that did treat the sick were not the same as the hospitals we have today.

Medieval hospitals were good places to rest and recover The space would have been kept very clean and the bed linens and clothing of the patients changed regularly. It was a large part of the nuns’ duties to do the washing and make sure everywhere was kept clean. This is meant that, for people not suffering from terminal disease, hospitals were probably quite successful.

How would you get treatment in the Middle Ages?

How many hospitals were there in the Middle Ages?

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Hospitals didn’t treat the sick, what did they do?

How many hospitals were owned by the Church?

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Who ran these churches and how were they funded?

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What is an endowment?

What were hospitals a good place for?

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How were hospitals maintained?

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What did this mean for those not suffering terminal illness?

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KT 1.2 – Approaches to prevention and treatment

B. New and traditional approaches to hospital care in the thirteenth century.

Naturally, this is what the Church wanted: a recovery was further proof of the existence of God and the importance of prayer. Many European hospitals employed physicians and surgeons, but there is not evidence to suggest that English hospitals did the same. Since religious men were forbidden from cutting into the body, treatment was very limited. Infectious or terminal patients were often rejected from hospitals, as prayer and penance could do nothing for these people. However, patients who had a chance of recovery were able to see the altar and even participate in Church services from their beds, to help with the healing of their souls.

The Home

Although many hospitals were established in medieval England, the vast majority of sick people were cared for at home. It was expected that women that women would care for their relatives and dependents when needed. This care would have involved making the patient comfortable preparing restorative foods and mixing herbal remedies. Women would also be responsible for the garden, in which they were expected to grow various plants known for their healing properties, such as marigolds and clover. Some historical sources hint that women in the home were well-respected for their healing skills.

Women likely had many more healing skills than just mixing herbal remedies and keeping the patient clean, warm and well-fed. There is some suggestion that they carried out minor surgeries and bleedings – however, records are very patchy. This might be because it was taken for granted that women cared for the sick, so nobody bothered to record it when it happened.

Why did the Church want patients to recover?

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Why was treatment limited?

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What happened if you had a terminal illness?

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Where were most people treated?

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What type of care would they have been given?

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What would women grow in their gardens?

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What other kinds of treatment did women perform?

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Why are the records patchy?

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30

KT 1.2 – Approaches to prevention and treatment

B. New and traditional approaches to hospital care in the thirteenth century.

‘The main reason why medical care and treatment was ineffective during the medieval period, c1250-c1500, was because medical knowledge was based on Galen’s ideas.’

How far do you agree? Explain your answer. 16 marks

You may use the following in your answer:

• Theory of Opposites
• Hospitals

You must also use information of your own.

TASK: Lets plan an answer, what pieces of factual information are you going to add to this answer?

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31

KT 1.3 – Case Study: The Black Death, 1348-49

A. Dealing with the Black Death. Approaches to treatment and attempts to prevent it’s spread.

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 became known, was 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 was absolutely devastating it didn’t matter if you were rich, 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.

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The Black Death was an outbreak of the bubonic plague. The bacteria were carried in the digestive system of fleas who arrived in England on rats carried by merchant ships. It was probably spread by flea bites, although some recent evidence suggests that it was also spread in the air. The main symptom was buboes, which was swelling in the armpit or groin, filled with pus.

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Once caught, it was unlikely that you would survive the disease. It usually killed its victims in three to five days. At its height in London, 200 people were being buried every day. Contemporary accounts estimate that a third of the population of England died. Where the plague spread, it was common for more than half of a population of a town or city to die.

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The Black Death is the name given by Victorian historians to the particular outbreak of the plague in 1348. After this, the plague returned every 10-20 years, although it killed fewer people with each subsequent outbreak.

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People applied the same knowledge they had about the causes of disease and illness to the plague. New treatments appeared and advice on how to avoid catching the disease spread quickly.

The Black Death

Symptoms of the Black Death

Fever

Chest pains and breathing troubles

Boils and black buboes appearing in the groin and armpits

Sneezing and coughing up blood.

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KT 1.3 – Case Study: The Black Death, 1348-49

A. Dealing with the Black Death. Approaches to treatment and attempts to prevent it’s spread.

Religious and supernatural

Many believed that the Black Death was the result of God deserting mankind - that is, the Black Death was a punishment for the sin in the world. In 1345, there was an unusual positioning of the planets Mars, Jupiter and Saturn, which astrologers interpreted as a sign that something wonderful or terrible was about to happen.

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Natural causes

The main natural cause attributed to the Black Death was impure air. Breathing in this miasma caused corruption to the body’s humours. People believed that this impure air may have originated from poisonous fumes released by an earthquake or a volcano.

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Common Beliefs

For the everyday people living in the cities and countryside, the spread of the black Death was terrifying, and they would have heard many conflicting ideas about what cause it. In Europe, many people blamed the Jewish population, but the Jews had been expelled from England in the 13th century, so this was not the case in England.

Ideas behind the causes of the Black Death

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TASK: Reduce each cause/factor to 15-20 words.

TASK: Answer the following questions about the cause of disease.

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Which ideas about the causes of the Black Death are similar to the causes we have already studied?

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Which ideas about the cause of the Black Death are specific to the Black Death?

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KT 1.3 – Case Study: The Black Death, 1348-49

A. Dealing with the Black Death. Approaches to treatment and attempts to prevent it’s spread.

Supernatural

The main recommendation to treat the Black Death was to confess your sins and ask God for forgiveness through prayer. However, there was an air of inevitability about the disease: once caught, people believed it was clearly God’s will; if it was his will that the patient should die, there was no cure that would work.

Natural

To begin with, physicians tried bleeding and purging - the same things they would usually do to correct a humoral imbalance. Unfortunately, that didn't work and, in fact, seemed to make people die more quickly. As well as this, physicians recommended strong-smelling herbs like aloe and myrrh, which were believed to have cleansing properties. They often prescribed theriaca, as it was believed to work for lots of ailments. Lighting a fire and boiling vinegar could also drive off the bad air. Physicians or surgeons sometimes lanced the buboes - occasionally, people whose buboes burst survived.

Common Beliefs

Everyday people were willing to try anything to survive the Black Death. They held strong Christian beliefs, and so would have gone to confession and prayed, as well as seeking traditional cures like bleeding. However, it quickly became clear that neither priests nor physicians could cure the disease. Apothecaries sold remedies and herbs were mixed in the home, based on old recipes, but they had uncertain and unpredictable results. Nobody produced a cure that worked in all cases.

The lack of medical knowledge about what caused the disease meant it was impossible to know how to cure it.

Treatments of the Black Death

Supernatural means

The main advice given by priests was for people to:

• Pray to God and fast.
• Go on a pilgrimage and make offerings to God.
• Show God how sorry you are by self-flagellation (whipping yourself). Large groups of flagellants wandered the streets of London, chanting whipping themselves.

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Natural Means

Escaping the plague was the best advice for prevention. Guy de Chauliac, who was the physician to the Pope, advised people to: ‘Go quickly, go far, and return slowly’. It was essential to escape the foul air to stay healthy. If this kind of movement was impossible, people believed it was essential to carry a posy of flowers or fragrant herbs and hold it to your nose. This helped to avoid breathing in the miasma. Unlike the usual advice on preventing disease, people were advised to avoid bathing. It was believed that water would open the skin’s pores to the corrupted air.

Preventing the Black Death

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KT 1.3 – Case Study: The Black Death, 1348-49

A. Dealing with the Black Death. Approaches to treatment and attempts to prevent it’s spread.

Common Beliefs

One physician in Italy recommended doing joyful things, listening to cheerful music and avoiding anything sad as a protection against the disease. This is a clue as to just how desperate most physicians felt - they were willing to suggest anything to prevent their patients from catching the disease. Much like the physicians, people did not know how to prevent the disease. However, they did stop visiting family members who had caught the plague - the common belief of the need to avoid those with the disease was so great that even their houses were avoided.

Government Action

Local authorities attempted to take action to prevent the plague from spreading. New quarantine laws were put in place to try to stop people from moving around too much. People new to an area had to stay away from everybody else for 40 days, to ensure they were not carrying the disease. Authorities also started to quarantine houses where the plague had broken out. They considered banning preaching and religious processions, to stop large crowds of people gathering.

TASK: Answer the following questions.

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Give 2 supernatural treatments of the Black Death. ________________________________________________

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What was the problem with bleeding and purging? _________________________________________________

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What strong smelling herbs were recommended and why these? _______________________________________

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What did apothecaries sell to treat the Black Death? _______________________________________________

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Why was it impossible to cure the Black Death? ___________________________________________________

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The King of England has asked you to make a poster showing people how to prevent getting the Black Death. Create your poster on the next page using specific detail.

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KT 1.3 – Case Study: The Black Death, 1348-49

A. Dealing with the Black Death. Approaches to treatment and attempts to prevent it’s spread.

TASK: Using the information you have learned about the Black Death, complete the table below.

TASK: You need to understand the role that factors had on the medieval ideas about the cause of disease and the treatments and preventions that they used. Look at the concentric circles, rank order the factors from page 49 in the box that explain the ideas that existed about cause, treatment and prevention, beginning with the most important in the middle to the least important on the outside. Explain your decisions by annotating the diagram.

For example, if you believe that the religious ideas about cause, treatment and prevention were the most influential, write ‘The Church’ in the centre circle. You can then annotate this with details of the religious ideas, such as it was believed that God sent the black Death as a punishment for sins.

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Middle Ages Medicine Review

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Notes

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