A great deal of medical treatment in the 14th century was based on ideas developed by the Greeks and Romans. The most important aspect of this was the theory of the four humours. It was argued that the body had four humours: blood, phlegm, yellow bile and black bile. These humours were associated with different parts of the body and had different qualities: blood (heart: hot and moist); phlegm (brain: cold and moist); yellow bile (liver: hot and dry) and black bile (spleen: cold and dry).
It was believed that when someone was ill, the four humours in the body were not evenly balanced. A patient was usually advised to rest to allow the body to restore its natural balance. If this was unsuccessful, the patient's diet was altered. For example, if the patient felt cold, he or she would be given hot food.
If the change in diet failed to achieve success, and the patient was fairly prosperous, a surgeon would be called in. If the patient did not have much money, a barber-surgeon (an untrained doctor who spent most of his time cutting hair) would be used instead.
The surgeon would examine the patient and if he or she were hotter than usual it would be claimed that there was too much blood in the body. The solution to this problem was to remove some of the blood by opening the patient's veins with a knife. As well as blood-letting, surgeons could also carry out minor operations and deal with simple bone fractures.
Death from disease was a constant fear of people living in the Middle Ages. Probably the disease that worried them most was leprosy. Although it did not always kill its victims, the consequences of leprosy were horrifying. Extremities and facial features slowly rotted away and the face eventually becoming terribly disfigured. People suffering from the disease were treated very badly. "They were forbidden all normal social contacts and became targets of shocking rites of exclusion. They could not marry, they were forced to dress distinctively and to sound a bell warning of their approach."
There were also hospitals in the early Middle Ages. However, they were mainly used to isolate rather than to cure the sick. When people went into a hospital, their property was given away as they were not expected to survive. One of the main ways of dealing with disease in the Middle Ages was by prayer. It was believed that people suffering from disease were probably being punished by God for sins they had committed in the past.
Doctors became aware that it was important to build up a body of knowledge about disease. Scholars obtained copies of books written by doctors in other countries and had them translated into English. This was an important development, as in the past medical books in England were only available in Latin, which restricted the number of people who could read them.
In this way information was passed on about the successful treatment of diseases. For example, the Hotel Dieu, a large hospital in Paris, pioneered a new approach to dealing with patients. The hospital was divided into wards. Each ward dealt with different problems. People with broken bones would be treated in one ward while another dealt with infectious diseases.
The Hotel Dieu took great care over hygiene. All patients were given clean gowns to wear and had regular baths. Like all hospitals, patients still slept three or four to a bed but the sheets were changed every week. The floors of the wards were kept clean and the walls were washed down with lime.
Information about the successful treatment of patients in the Hotel Dieu soon spread to other countries. It was not long before doctors began to introduce similar reforms to their hospitals.
Primary Sources
(Source 1) Manuscript painting of a leper (c. 1400)
(Source 2) Manuscript giving instructions for doctors (c. 1230)
During very hot weather phlebotomy (blood-letting) should not be undertaken because humours flow out quickly as the bad. Nor should phlebotomy be done in very cold weather, because the good humours are compacted in the body and difficult to draw out, and the good came out quicker than the bad... If the blood appears black, draw it off until it becomes red. If it is thick, until it thins out: if watery, until it becomes thick... Phlebotomy clears the mind, strengthens the memory, cleanses the stomach, sharpens the hearing, develops the senses, promotes digestion, produces a musical voice, feeds the blood, rids it of poisonous matter, and brings long life. It gets rid of diseases, cures pains, fevers and various sicknesses.
Leprosy became highly stigmatized. They were forbidden all normal social contacts and became targets of shocking rites of exclusion. They could not marry, they were forced to dress distinctively and to sound a bell warning of their approach.... They were segregated in special houses outside towns... Leprosy provided a prism for Christian thinking about disease. No less a religious than a medical diagnosis, it was associated with sin, particularly lust, reflecting the assumption it was spread by sex.
The knowledge of anatomy is acquired in two ways; one is by books... the second way is by dissecting dead bodies, namely, of those who have been recently beheaded or hanged. By this means we learn the anatomy of the internal organs, the muscles, skin, veins and sinews.
(Source 6) A Gest of Robin Hood (c. 1495)
She laid the blood-irons to Robin Hood's vein And pierced the vein, and let out the blood, And afterwards the thin, And well then knew that there was treason within.
(Source 7) Illustration from Gerrssdorf's Field Book of Surgery (1517)
(Source 8) Letter from Edward III to the Mayor of London (1357)
When passing along the Thames, we have seen dung and other filth piled up in several places. We have also noticed the fumes and other terrible stenches... To preserve the honour of the City, we command that you cause the banks of the river and the streets and lanes of the city to be cleansed of dung and other filth without delay. And public proclamation is to be made that no one shall place dung or filth in the streets and lanes.
So much dung and filth... as well as dead beasts... are in the ditches, rivers and other waters... the air is greatly corrupt... Many intolerable diseases do daily happen... to the great annoyance, damage and peril of the inhabitants, dwellers, repairers and travellers... All dung, garbage, entrails and other odour in ditches, rivers, waters... shall be removed and carried away... upon pain to lose and forfeit to our Lord the King £20.
All the streets of London are so badly paved that they get wet at the slightest quantity of water, and this happens very frequently... on account of the rain, of which there is a great deal in this island. Then a vast amount of evil-smelling mud is formed, which does not disappear quickly but lasts a long time, in fact nearly the whole year round.
Questions for Students
Question 1: Select a passage from the sources that help to explain how doctors developed ideas on how to treat their patients.
Question 2: Study sources from this unit that provide information on phlebotomy (blood-letting) and trephination (brain surgery). Explain how these treatments worked.
Question 3: What were the symptoms of leprosy? Why do historians believe source 1 shows a man suffering from leprosy?
Question 4: Select information from the sources to explain why the standard of public health in the 14th century was so poor.
Question 5: In 1159 John of Salisbury commented: "We (scholars) are like dwarfs sitting on the shoulders of giants. We see more, and things that are more distant, than they did, not because our sight is superior or because we are taller than they, but because they raise us up, and by their great stature add to ours." Use the example of the growth in medical knowledge during the Middle Ages to explain what he meant by this statement.
Answer Commentary
A commentary on these questions can be found here.
