The medieval period is normally not associated with advances in technology, nor with contributions that benefit society. Yet, our medicine today owes much of its development to physicians of that time. Medicine of that era was strongly influenced by superstition and the doctrine of the Christian church, and did not have much foundation for practical application.
The need for medicine in Middle Ages was certainly great, considering the extreme amounts of plague and disease prevalent during that time (Grigsby 2). Unfortunately, medical knowledge of that day was of very little help (Margotta 68). Physicians had no concept of disease causing bacteria or viruses. Unfortunately, it was thought in that day that illness was either due to old age, heredity, or immoderate living. Is was also believed that certain sins could affect one’s health (Grigsby 2).
Medical practice of the time revolved around a concept called the “doctrine of the four humors”. Diagnoses of illness almost solely relied upon the examination of the human body’s four humors- blood, phlegm, yellow bile, and black bile. Each of the four humors was associated with a specific body part and certain elemental qualities. Blood was associated with the heart, and air. Phlegm was associated with the brain and water. Yellow bile was associated with the liver and fire, and black bile was associated with the spleen and Earth. When one’s bodily humors were in equilibrium, that person was normally considered to be in good health. Sickness was thought to be a result of imbalance of the humors (Gottfried 106).
Diagnosis, except in the few rare cases, was usually based on the interpretation of the color and smell of the blood, the smell and the color of the phlegm and, most commonly, on the examination of the urine. There were countless methods of examinations, each explaining how a detailed diagnoses of all types of illnesses could be determined from the color and the odor of the urine and from the layers of sediment in the collecting flasks.
Cloudiness in the upper layer of the collecting flask indicated that the origin of illness was in the head, and lower level layers of cloudiness indicated declining conditions of the bladder or genital organs. The diagnosis was often optimistically simple (Margotta 66).
Medieval physicians had almost nothing more than their interpretations of a patient’s humors upon which to base their diagnosis. Their ultimate objective was to restore equilibrium of the humors to the sick patient. Physicians had a variety of ways to do this, yet they often attempted to purge the cause of the ailment from the body, by whatever means were deemed necessary (Gottfreid 106). Bloodletting was very common (Margotta 66).
Bloodletting therapy was based on the theory of opposites. Doctors believed diseases could be caused by excessive amounts of body fluids. For its alleviation, bloodletting was the main treatment. This procedure was thought to move the material causing one’s illness and make it pass from one organ to another, thereby making it easier to eliminate. When blood was taken from the side of the body opposite from where the disease was situated, it was supposed to relieve the patient’s plethora and pain.
Detailed directions were given regarding the most favorable days and hours for bloodletting, the correct veins to be tapped, the amount of blood to be taken, and the number of bleedings required. Blood was usually taken by opening a vein with a lancet, although bloodsucking leeches were regularly used (Margotta 66). Not all aspects of medieval medicine were as particularly brutal as bloodletting. Pharmacy, or the prescribing of drugs or herbs, was a major part of the medieval physician’s cure.
Apothecaries were the pharmacists of the day; however, their role in medicine extended further than simply the filling of prescribed drugs. In many cases the Apothecary would actually prescribe drugs and give treatment to a sick patient. Apothecaries usually had no training in the medical field except as herbalists. They had little knowledge of the workings of the human body or diseases that affected it. In fact, since the herbs that Apothecaries used to make their medicines were usually extremely expensive spices, most doubled as merchants (Gottfreid 108).
Physicians were the primary treatment practitioners during the middle ages, yet into the 13th century, numerous medical treatments were being conducted by a new and separate group of people known as barbers, barber-surgeons, and surgeons. These new groups increasingly took on the responsibilities of
many types of invasive and non-invasive procedures. These new groups did not receive their training from universities, but from a hierarchy of apprenticeships regulated by guilds. The contributions of their procedures however, were significant (Duin 26).
Only a few surgeons undertook complicated operations and then only for life-threatening or extremely painful conditions such as bladder stones, urinary obstruction and toothache. There were attempts at anesthesia to reduce pain: sponges were impregnated with opium or mandragora and placed in the mouth or nose. However it is unlikely that these worked very well, since contemporary illustrations show that it was necessary to restrain patients physically during operations. (Duin 27)
Barbers were very important in the medical community. By the end of the Medieval period, the barber surgeons had a distinguished place in society and were very well established (most because of the significantly lower rates they charged than the doctors) (Gottfreid 108) (Margotta 66). In time, the Faculty of Medicine in Paris established a course for barbers. Eventually barbers became closely associated with physicians (Margotta 66).
Besides Barbers, another contribution of the middle ages to medicine was the hospital. Hospitals of the 12th century were certainly not like the hospitals we know today. Hospitals of that era were primarily established to care for orphans, the blind, and the sick. Most hospitals were usually overcrowded and dirty. Doctors and nurses there could do little more than comfort patients before they died (Porter 7).
Hospitals can be dated back as early as ancient Greece. Most hospitals of the middle ages were products of the Christian churches and their principles of charity. The Middle Ages saw the founding of hundreds of hospitals throughout Europe and in the lands influenced by the Crusades. At the highest point of this growth, there were over two hundred hospitals in England and Scotland and more than two thousand hospitals in France (Margotta 69).
Most hospitals of the middle ages were established and operated by the church. Yet, as the 13th century approached, civil authorities began to assume responsibility of the hospitals. As a result, many great hospitals were born. Cities took great pride in their new hospitals and commonly commissioned many of the great architects of the day to design them. Great sums of monies were lavished upon these new buildings which attracted an association between art and medicine. This new patronage lead to the very foundation of the renaissance and many of its glories (Margotta 69).
As the Middle Ages came to a close new ideas in medicine that challenged the traditional ones began to emerge. Today, many medical practices such as bloodletting are no longer used. Modern doctors have almost no uses for these early practices. Yet, medicine today would not be as sophisticated as it is without the early experimentation and progress made during the Middle Ages.
Duin, Nancy. A History of Medicine. London: Barnes ; Nobel Inc, 1992. Gottfreied, Robert S. The Black Death. New York: The Free Press 1983. Margotta, Roberto. The History of Medicine. New York: Smithmark 1996. Porter, Roy. Medicine : a History of Healing. China: Barnes ; Nobel Books 1997. Grigsby, Byron. Medical Misconceptions. 17, December 1999 .