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Medicine in the Middle Ages AD 500 to 1400 This icon indicates that detailed teacher’s notes are available in the Notes Page. This icon indicates the slide contains activities created in Flash. These activities are not editable. For more detailed instructions, see the Getting Started presentation. 1 of 26 © Boardworks Ltd 2004 What happened when the Roman Empire collapsed? The Roman Empire grew too large to control its borders successfully. During the 5th century, neighbouring barbarian tribes swarmed in and overran and colonized the western part of the empire. By AD 500 Europe consisted of many small, feuding tribal kingdoms. There were frequent wars between these tribes, and in the process the benefits brought by the Romans were lost. Their buildings, public health systems, libraries and medical books were destroyed. It was now dangerous to travel, so communications were limited, and there were no longer opportunities for doctors to learn or train. Explain how war affected the progress of medicine at this time, in your Factors page. 2 of 26 © Boardworks Ltd 2004 Britain in the Dark Ages After the Romans left Britain in AD 410, society went back to its pre-Roman, uncultured ways. Villas were left to rot, and local people took bricks and stones to build their own homes. The bathhouses, toilets and sewage systems in towns fell into disrepair, and cleanliness became a thing of the past. Over the next 500 years, the time known as the Dark Ages, there were waves of invasions by barbarians such as the Saxons and Vikings. They took what they wanted and often destroyed what they did not. Many settled in Britain, bringing their own beliefs and cultures. Little is known of the state of medicine at this time, but what progress or regress would you expect to have seen? 3 of 26 © Boardworks Ltd 2004 Norman Britain Archaeological evidence has shown that the Normans built sewers and cesspits in towns like York and that there was some attempt at cleanliness again. For those at the top of the feudal system (lords, barons, knights) living standards improved with stone-built castles and manor houses. For the majority of the population (the peasants), however, home was a small timber house consisting of one room for the whole family, with a stall at one end for the owner’s cow or pig. Inside it was dark, smoke-filled (there was no chimney) and damp. Peasants worked from dawn till dusk for themselves and their lord, usually in the fields, in all weathers. What effects would the living conditions of a) the rich and b) the poor have on their health? 4 of 26 © Boardworks Ltd 2004 Britain in the later Middle Ages Life in Britain improved from about the time of the Norman conquest (from 1066). Travel and communications became safer and trade increased. Harvests improved and there was more money about. The church also became wealthier and stronger all over Europe. What benefits to medicine and health might these improvements have brought? 5 of 26 © Boardworks Ltd 2004 How the church helped medicine How the church hindered medicine Copy this chart into your books and use the information on the next five slides to complete it. 6 of 26 © Boardworks Ltd 2004 The medieval church The medieval church was a very strong force throughout Europe. Christianity had been brought by the Romans and remained after their decline. Religion played a greater part in medicine in the Middle Ages than at any other time: the church was at the centre of everybody’s lives the village priest controlled what people did and what they should believe. He preached that God punished people for their sins with diseases and death the pope in Rome refused to allow new ideas that might contradict the Bible the church controlled education. Only priests and monks could read or write and the monasteries banned books of which they disapproved. 7 of 26 © Boardworks Ltd 2004 Re-enter Galen! Most copies of Galen’s books were lost in the Dark Ages but some were discovered in the later Middle Ages. The church liked Galen’s writings – his idea of human anatomy being part of a great design matched the story of God’s creation. His works did not conflict with the Bible, instead they supported Christian teachings. Throughout the later Middle Ages, therefore, the church promoted Galen, and monasteries used his theories as the basis for training doctors. Anyone found questioning or criticizing Galen’s ideas was harshly treated. One 13th century priest, Roger Bacon, was imprisoned for encouraging doctors to carry out their own research instead of just believing Galen. 8 of 26 © Boardworks Ltd 2004 Hildegard of Bingen (1098–1179), Abbess of Rupertsberg. Became an expert on cures using herbs, animals and stones following visions of God. “…the care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting on them…” rule from a Benedictine monastery. 9 of 26 Dissection was banned by the church until the 14th century © Boardworks Ltd 2004 “Write these words on the jaw of the patient: ‘In the name of the Father, Son and Holy Ghost, Amen + Res + Pax + Nax + In Christo Filio’. The pain will cease at once, as I have often seen.” English doctor, 1300s. “Healing shrines developed a great range of relics, pious images and souvenirs. The blood of St Thomas à Becket cured blindness, insanity, leprosy and deafness – and ensured Canterbury’s popularity.” Roy Porter, medical historian, 1997. 10 of 26 © Boardworks Ltd 2004 Hospitals The only hospitals in the Middle Ages were those run by monasteries. St Bartholomew’s and St Thomas’ in London date from 1123 and 1215. Medieval hospitals generally housed the poor, the elderly or pilgrims rather than offering medical care. About ten percent of hospitals actually looked after the sick. Inside, they were much like a church, with side chapels and altars at which monks would pray for the souls of the patients. Many people were excluded from hospitals: “We strictly ordain that sick and weak people should be admitted kindly and mercifully, except for pregnant women, lepers, the wounded, cripples and the insane.” From the rules of the Hospital of St John, Cambridge. Treatments consisted of herbal remedies, warmth, food, and a lot of prayers. 11 of 26 © Boardworks Ltd 2004 “There is no doubt that religion obstructed the progress of medicine in the Middle Ages.” Using the information in your chart discuss this statement. Make sure that you include as many different aspects as you can and try to compose a balanced argument. You should make it clear in your conclusion whether you think the church caused medicine to progress or regress. 12 of 26 © Boardworks Ltd 2004 The medical role of women in the Middle Ages Women could not train as doctors because only men could go to university. Most people were treated at home by their wife or mother. Few could afford doctors, and herbal remedies handed down from mother to daughter were probably as effective as any treatment. There were also ‘wise women’ in most villages who offered treatment, although the church disapproved and sometimes accused them of witchcraft. Women acted as midwives. Women could become surgeons as surgeons did not have to train at university. 13 of 26 © Boardworks Ltd 2004 How effective was herbal medicine? Herbal cures were often the only remedies available to sick people and were handed down by word of mouth from one generation to the next. We have seen that herbs have been used in healthcare throughout the history of medicine. As communications improved in the ancient civilizations, so new plants were discovered, and the range of herbal remedies expanded. Effective medicine or old wives’ tales? For herbs to have been used for so long, it is likely that they must have had some good effects. Modern scientific knowledge has proved that about fifty percent of old herbal cures were effective, although those using them would not have understood why. 14 of 26 © Boardworks Ltd 2004 True or false? Chew willow bark to cure a headache. True – willow trees contain a form of aspirin. Carrots help you see in the dark. True – Carrots contain high levels of vitamin A, which helps prevent deterioration of the eye. An infusion of hairy roots will prevent baldness. False. Use crushed garlic and onions to treat a boil. True – These ingredients can kill bacteria. 15 of 26 © Boardworks Ltd 2004 The Black Death In 1348–49 Britain faced the worst crisis in its history. A deadly disease arrived from Europe which appeared to kill people at random, and no one knew why. This disease was the bubonic plague. The symptoms were a fever, headache, tiredness and painful swellings (buboes) the size of an apple in the groin and armpits. Small, oozing red and black spots appeared all over the body, giving the disease the name the Black Death. Patients lasted just a few days before a painful death. The plague killed the rich and poor, priests and criminals. What really frightened people, however, was the speed with which the disease swept across Europe and the number it killed. Nearly forty percent of the English died. Never before or since has there been any disaster so horrific. 16 of 26 © Boardworks Ltd 2004 Areas affected by the Black Death The Black Death came from China. The increase in trade meant many boats were travelling from port to port. 17 of 26 © Boardworks Ltd 2004 What was believed to cause the Black Death? It was not until 1894 that it was discovered that the bubonic plague was caused by germs, carried by the fleas which live on black rats. Back in 1349 people had very different ideas about the cause of the disease. Look at the list of the causes people believed in and the evidence on the next two slides. Which beliefs have we seen already in prehistoric medicine? Which beliefs are new? Why do you think no one suspected the fleas? 18 of 26 © Boardworks Ltd 2004 Breathing bad air (miasma) – medieval towns were very smelly and the smell was supposed to contain diseases Touching a victim The position of the planets – the relationship of the planets and the movement of the Sun affected health 19 of 26 Annoying God – the plague was his punishment What did people believe caused the Black Death? An imbalance of the body’s four humours – Galen can’t be wrong! Looking at a victim – the disease was spread by eye contact Drinking from poisoned wells – Germans believed the Jews were poisoning drinking water to kill off nonJews © Boardworks Ltd 2004 Were any of these ideas correct? 20 of 26 © Boardworks Ltd 2004 Sources about the Black Death The sources on this slide and the next were written in the 14th century. “The cause was the close position of Saturn, Jupiter and Mars on 24th March 1345. Such coming together of planets is always a sign of wonderful, terrible or violent things to come.” Guy de Chauliac, a French doctor. “It was thought that the whole area was infected through the foul blast of wind that came from the south.” de Smet. 21 of 26 © Boardworks Ltd 2004 “[A person] rose and read a letter out loud. In it, the angel said that Christ was displeased by the wickedness of the world and named many sins: not observing Sunday, not fasting on Friday, blasphemy, money-lending and adultery.” Matthew of Neuenberg. “The plague spread because of contagion; if a healthy man visited a plague victim, he usually died himself. It spread invisibly from house to house and finally from person to person.” Jean de Venette. 22 of 26 © Boardworks Ltd 2004 How did people try to prevent or cure the Plague? People in the Middle Ages had little idea of how to cure illnesses. When it came to the Plague they didn’t stand a chance. Terrified and desperate, they went to extreme lengths to escape its horrors. Look at the treatments they tried on the next slide. Which of these might have helped prevent the Plague? What do their ideas on causes and treatments tell us about their knowledge about medicine? 23 of 26 © Boardworks Ltd 2004 Strap a live chicken (shaved) to the Plague sore Sit in a sewer – the bad air of the Plague will be driven away by the worse air of the drains Let the blood out of the patient Eat crushed emeralds 24 of 26 Eat arsenic powder Run for the hills How to prevent the Black Death Put herbs on the fire to make the air smell sweet Kill all the dogs and cats in town Drink 10-yearold treacle Go from town to town flogging yourself with a whip © Boardworks Ltd 2004 The effect of Arab medicine on the West The Dark Ages might have been a time of chaos for Europe, but further east a new, Islamic civilization was developing the ancient Greek ideas. The Arabs admired the writings of Hippocrates and Galen. Medical students studied them carefully. New discoveries were made, some of which challenged Galen’s ideas. The Muslims believed, however, that the Koran, their holy book, held all the knowledge needed and did not encourage the search for new discoveries. The Koran also taught them to look after the sick, and many large hospitals were built. When Europeans went on crusades to the Holy Land in the 12th and 13th centuries, their doctors gained firsthand knowledge of Arab medicine, which was advanced by Western standards. 25 of 26 © Boardworks Ltd 2004 The Middle Ages – progress or regress? Ordinary people Wealthy people There was little change. They had not had access to Roman doctors or public health systems. Their medical care declined and they lost access to baths and toilets. Some benefited from the hospitals of the later Middle Ages, but there were not many of them. By the later Middle Ages the rich could visit doctors who followed the ideas of Galen. Most treatments were herbal remedies. Most treatments were based on the Four Humours. Life expectancy remained much Life expectancy fell during the the same as in the Roman Dark Ages, but was about the period. same as in the Roman period by the end of the Middle Ages. 26 of 26 © Boardworks Ltd 2004