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6 – ‘The Roman withdrawal from Britain was a turning point in
medicine and public health’. Do you agree? Explain your answer.
When the Romans left Britain, some areas of medicine and public health declined,
some stayed the same and some improved. These will be discussed before an
overall conclusion about whether or not the Roman withdrawal was a turning point.
Many ideas about causes and cures for diseases which had been used in Roman
times continued into the Anglo-Saxon and Medieval periods and these included the
Theory of the 4 Humours and the Theory of Opposites. These two theories had
been used for many centuries and treatments were based on them. In the Roman
period Galen was very influential as he was the doctor to the Emperor Marcus
Aurelius and he had a great reputation. He strongly believed that diseases had
natural causes and he used Hippocrates’ Theory of the 4 Humours to diagnose and
treat his patients. This theory said that the human body was made up of 4 humours
or liquids and when a person is well, these liquids are balanced, but when a person
has a disease; one of these liquids is not balanced. Doctors observed one or more
of these liquids to be in excess as it was visibly coming out of the body eg when you
have a cold, water comes out through the nose and eyes. Therefore, cures were
based on natural treatments to re-balance the liquids, such as bleeding out a vein
when there is too much blood. Galen used this theory, especially the bleeding and
purging elements to re-balance the humours. He also adapted this theory to include
his own ideas, the Theory of Opposites, where he would prescribe a treatment
which was the opposite of what was wrong with the patient eg if a patient had a cold
and was shivering, Galen would advise hot foods such as peppers. There was also
an emphasis on natural, herbal remedies which could be used at home and this also
continued after the Romans left Britain. In the Middle Ages, Galen’s work was used
in the training of doctors and so his ideas about the cause and treatments of
diseases continued to be used, especially as his work was approved by the Church
whose influence over medicine and medical training was extremely important. This
shows that there wasn’t much change in the ideas about the causes and cures of
diseases and so the Roman withdrawal can’t be seen as a turning point.
Continuity between these periods is also shown in the belief that the supernatural
was both a cause and a cure for illnesses. In Roman times, people were very
superstitious and they would offer prayers and sacrifices to the Gods to keep them
safe from dangers and illnesses. Many would go to the Asclepion, the temple
complex dedicated to Asclepios, the God of Healing. Here people could pray, relax,
exercise and eat well before falling asleep and then being visited by the God who
would cure their illness during the night. For many, this ‘health spa’ offered time
away from pressures at home and work and they felt revived, so much so that they
truly believed they had been cured by a God. Many others continued to wear lucky
charms to keep them free from illnesses believing that the Gods had made them ill.
Some of these ideas were continued into the Middle Ages as many people believed
that God (the Christian God) also had the power to make them ill or to cure them.
They, too, would offer prayers and give money to the Church in order to be safe.
Many believed that touching a holy relic, such as a part of the holy cross, or a
pilgrimage to a holy shrine, would cure them of any illnesses. Most people relied on
a priest or friar rather than doctors when they were ill. They believed that God would
make them ill if they had sinned. Indeed, during the Black Death, a group of people
went around the country whipping themselves. They were called the ‘flagellants’
and they believed that if God could see that they were punishing themselves for
their sins, then God would stop punishing them and take away the disease. This
shows continuity between Roman times and the end of the Middle Ages again
showing that the Roman withdrawal was not a turning point.
In Roman times people believed that ‘bad air’ caused diseases and ensured that
camps, towns and cities were not sited near to stagnant, dirty water as this would
mean people could get ill. They also built aqueducts to bring fresh water into towns
so that people didn’t get ill drinking dirty water. In the Middle Ages people believed
that miasma cause diseases. Miasma was the bad smells caused by rotting rubbish
in the streets of the towns and villages. In order to avoid these smells, people would
carry posies of small, sweet-smelling flowers in the hope that they could breathe in
the good smells from the flowers and avoid the bad smells which could cause them
to get sick. Some people had birds flying around in their houses to try to keep the air
moving to prevent the smells and they even believed that lighting fires would destroy
the bad smells. Although in both the Roman period, Anglo-Saxon period and
through to the Middle Ages, people believed in the idea that miasma was a cause of
disease, people in the Middle Ages placed lesser emphasis on public health and so
disease such as the plague emerged and spread very quickly due to the unhygienic
conditions. The continued idea of miasma showed that the Roman withdrawal was
not a turning point.
However, the areas where the Roman withdrawal could be seen as a turning point
are in public health and in the care of the sick.
The Romans had brought their ideas of public health to Britain after the invasion of
43 AD. They built aqueducts and fountains to bring fresh water to army camps,
towns and cities. They encouraged people to keep themselves clean by building
public baths and to keep the streets clean by building toilets and sewers to take
away human waste. After the Romans left, many of these facilities fell into disrepair
and people in the Anglo-Saxon and Medieval periods had neither the skills,
knowledge nor funds to be able to maintain them. Many people left the towns and
cities during the Anglo-Saxon period due to the many invasions and wars between
different potential rulers and went to the countryside, where the population density
was less, and this meant that these areas were more hygienic as there was less
waste and the water was cleaner. When Britain became more settled, after 1066,
the population began to increase and people moved back into the towns and cities
and the problems associated with the lack of public health facilities were made very
clear when the Black Death arrived in 1348 such as the lack of clean water, rubbish
in the rivers and in the streets. This decline in public health from the Romans
through the Anglo-Saxon period to the Medieval period shows that the Roman
withdrawal was indeed a turning point for public health as everything got worse for
the majority of the population. There were some areas of the country where there
was hardly any decline in public health such as the continued use of the Roman
toilets at Lincoln and the baths at Bath, but the main areas were the religious
houses of the Christian Church (who provided the funding) such as monasteries
and nunneries. Here the monks and nuns often enjoyed a clean water supply,
toilets and baths, but this was not available to everyone and so can’t really count as
a public health system.
Another area where it can be seen that there was a turning point is in the caring of
the sick. In Roman times the father of the family was often the one who cared for the
sick in the family but by the Medieval period it was the mother or women in the
family who did this. Hospitals had existed in Roman times but these had been
restricted in their use to the soldiers and military personnel only, not for ordinary
people. This changed when the Romans left Britain as the care of the sick and the
building of hospitals was taken over by the Church which was the institution with
enough funds to build and maintain these structures. Indeed, the Church took over
a lot of the aspects associated with medicine and care of the sick. These hospitals
were often set up for people with specific diseases such as leprosy, but provided
some medical care as well as just looking after those who were isolated from
society. This can be seen as a positive turning point after the Romans left Britain as
it was a definite improvement on what had gone before.
Overall, some aspects of medicine and public health showed a negative turning
point after the Romans had withdrawn such as regression of the public health
system they had built: some aspects showed a positive turning point such as the
progress made in the care of the sick and the building of hospitals for all by the
Church; and some aspects showed no turning point at all as medical ideas and
knowledge didn’t change (it wasn’t likely to when all medical training was based on
the books of Hippocrates and Galen) and the treatments were based on these
ideas showing no progress at all.