As mentioned previously, technology and cultures can regress over time as well as progress. The Roman Empire in the west fell, whether quickly or gradually is debateable. What isn’t is that Rome ceased to be a power. In some areas there were tribal groups underneath the Roman structure who assumed power. In others there was something of a vacuum. Various different tribes made power plays for territory, such as the Visigoths in Spain. In areas like Britain there were numerous invasion. Angles, Saxons, Jutes, Vikings and Normans all came in, adding to the vibrancy and diversity (lots of people got killed, robbed, enslaved or subjugated). As you can imagine this wasn’t conducive to keeping up all the old Roman engineering and public health facilities. Warfare, declining infrastructure and the rise of Islam had cut off the West from the Christian Roman East. One thing that was on the rise was the Church.
Christianity influenced medieval medicine in a number of ways. One way was the role of the church in society. There was a Christian concept of charity, caring for others and looking after the poor. This meant things like a poor box in churches for donations. Monasteries took on the role of caring for people and providing treatment for the sick. This could be for pilgrims, travellers and the local populace. Treatments ranged from the spiritual, for example saying prayers, to herbal remedies.
Monks and nuns kept gardens, and a herb garden would be among them. Another feature of monastic life was that monks and nuns were literate, where the vast majority of the population was not. As well as copying out religious texts, they would often write texts on herbal treatment. This allowed ideas to be recorded, preserved and spread between Abbeys. There are records of monks sending for rare herbs and texts, and given the relative wealth of monasteries this was within their means. Later the religious orders helped to set up universities, such as Oxford. These then became important centres of medical learning, and continued in to the Renaissance period, laying the foundations for future advances. After the Norman invasion in 1066 many hospitals were built. These too lay the foundation for what were to become recognisable as hospital later on. During the Crusades the Knights Hospitaller were formed to care for the sick and pilgrims in the Holy Land. The Crusades also meant that Islamic and ancient Greek and Roman medical texts were spread to the west, where they were translated. This too helped to launch the coming Renaissance period.
Thinking on the causes of illness was influenced by Christian beliefs. There was the idea that God sent some illnesses as a punishments for sins, or as some kind of test. In line with this, acts of repentance and penance were encouraged as a means to heal. People would go on pilgrimages to holy sites in order to obtain healing. While on a pilgrimage the pilgrim would be expected to behave in a spiritually pure manner. Probably the most famous example is the pilgrimage to Lourdes, in France. There was also the idea of Satan, who would visit harm on people. linked in to this was the idea of witchcraft. Many illnesses and misfortunes were put down to witchcraft, and these beliefs persisted in to the 1600s. It is fair to say that a number of women who practiced local herbal healing may have been caught up in this, but not exclusively. Mental illness in some cases was put down to possession, and exorcisms performed, but these were not very widespread and certainly not as common as most people believe.
These local “wise women” as they were often known were another source of medical treatment. Many would keep a herb garden, and often knowledge was passed on through families. However much would not be written down due to illiteracy. Some texts were available, but not in common circulation. Most often they herbal remedies focused on treating symptoms rather than worrying about what might cause a disease. In towns there may have been an apothecary, fulfilling a similar function by mixing and providing herbal remedies. These can be seen as something of a forerunner to the more modern pharmacies.
Most medical theory still revolved around the four humours, covered in Greek medicine. The patient would be observed and a judgement made on which humours were out of balance. Factors included, diet, climate, even star sign. Treatment would then be recommended on this. As mentioned in Roman medicine, the works of Galen were held in reverential awe and were thought by many to be unquestionable. This included Galen’s work on anatomy, which was good but had key flaws, and his theory of opposites. In the newly founded universities that sprang up in the Middle Ages, doctors would need to be literate to read and learn these works.
Based on humourism, treatments such as bloodletting and urology were used. Bloodletting was draining the patient of blood, thought to be a humour. This was not a new practice and dated back to Greece and Rome. It was also partly based on Galen’s flawed idea that blood could stagnate in parts of the body. Quite often it was carried out by a barber surgeon, who also carried out a variety of other minor surgeries. Often found in towns, the traditional red and white pole was a sign of their trade. While minor treatments could be successful, surgical mortality was very high due to infection and a lack of understanding about what caused disease.
Much of the surgeons skill was required for and often learned treating the military. There was no shortage of wars across Europe in this period. Keeping experienced soldiers alive and able to fight was a prized asset. Surgeons most often treated arrow wounds, blade and knife wounds, broken bones and burns. Surgeons would become practiced at arrow head removal, and stitching and bandaging of stab ad slash wounds. If these wound became infected it was often necessary to amputate limbs. Broken bones were treated with splints, and burns with different types of ointments, often herbal based.
One of the major developments in medieval medicine was urology. This was the practice of diagnosing illness by examining a sample of their urine (literally taking the piss). It was tested by the physician for colour, smell and even taste. The results were compared to a chart and a diagnosis made. This is important as there are a number of illnesses and conditions that can be diagnosed from urine. Most people will have at some point given a urine sample to be tested at some point in their lives. While not highly accurate it was progress.
The plague hit Europe in the 14th Century. We now know this was caused by bacteria, and resulted in three types of plague, the bubonic, septicimic and pneumonic which was airborne. This explains the high death rates experienced across Europe, ranging from 20% to 70%, with densely populated urban areas being affected more. Transmission could be from fleas on rodents to people, through droplets in the air, coughing and sneezing, physical contact and contaminated water sources. Plague could also be used as a weapon, and there are records of Turks besieging a town in Crimea, and flinging plague infected corpses over the walls. Symptoms ranged from swollen lymph glands, parts of the body turning back from necrosis, coughing, sneezing and vomiting among others.
As stated previously, bacteria were unknown at the time and so the real causes of disease were not known. The plague gave rise to various reactions. Many thought that it was a punishment from God, sent due to people committing sins and not being devout enough in their faith. Cults of flagellants sprang up across Europe. People would whip themselves and live austere lifestyles in order to try and purify themselves. Some claimed that just marching with them purged sins. The numbers of people involved became alarming to the church and authorities, so much so that it was banned in many countries. Some Popes declared them heretics, the inquisition cracked down upon them and many were imprisoned or burned.
In some areas Jews were blamed, with accusations of poisoning wells or water supplies. Despite this being untrue many Jews were killed, for example in Strasbourg and Mainz. Others such as beggars, lepers and those with skin complaints were singled out. Others looked to astrology. There was a belief among some that the alignment of the planets was the cause. Others referred back to Galen and claimed that the patients humours were out of balance. In some towns and cites cats and dogs were killed as possible carriers of disease. Cures ranged from strapping a chicken on your head, to placing frogs on the swellings until they burst. softening the swellings with cooked figs and onions, and cutting the swelling open. this was alongside the more regular bloodletting.
One of the more popular theories was that the plague was spread by bad air. In some towns and cities rubbish was burned to drive out the bad air. Other moved out of the towns and cities to get away from it. This may have worked for some, as they were no longer in the generally dirtier and densely populated town where sewage was dumped in the streets or in rivers. However, the exodus would also have spread the plague if anyone was infected.
Related to the idea of bad air was the plague doctor, with his iconic costume. This consisted of a waxed overcoat, a mask with glass, a beak shaped nose full of spices and herbs to prevent him breathing bad air. Often he had a stick so he did not have to touch patients. In a break with tradition there were allowed to carry out dissections on the dead to try and find a cure for the plague.
“A plague doctor was a medical physician who treated people who had the plague. They were specifically hired by towns that had many patients with the plague in times of epidemics. Since the city was paying their salary, they treated everyone: both the wealthy and the poor. However, some plague doctors were known to charge patients and their families additional fees for special treatments and/or false cures. Typically they were not professionally trained nor experienced physicians or surgeons, but rather they were often either second-rate doctors unable to otherwise run a successful medical practice or young physicians seeking to establish themselves. These doctors rarely cured their patients; rather, they served to record a count of the number of people contaminated for demographic purposes.“-Infogalactic
To sum up the medieval period in Western Europe, the ideas of Galen and Hippocrates were continued where available, but not challenged. Many of the treatments were a continuation from classical Rome. There were strands of supernatural and rational beliefs on the causes and treatments of disease. Some progress was made, and the church took a lead in some areas. The crusades restored the link to the East and allowed old and new ideas to flow from the Eastern Roman Empire and the Muslim world. This helped set the stage for the Renaissance…
© Jonathon Davies 2018