Medieval Medicine Ideas

Why the wrong idea made sense

Around 400 BC on the Greek island of Kos, Hippocrates and his followers wrote down a rule that would govern medicine for two thousand years: illness has natural causes, and the doctor should observe the patient, record the symptoms and predict the course of the disease. The roughly sixty works of the Hippocratic Corpus explained the body as a balance of four liquids, blood, phlegm, yellow bile and black bile, each matched to a season and an element. A fever was too much blood in a hot season; a cold was too much phlegm in winter. Health was balance, illness was imbalance, and the cure was to restore the balance. Five hundred years later, in Rome, Galen of Pergamon turned that idea into a system. Roman law forbade human dissection, so he cut open pigs and Barbary apes and described what he found as though it were human; he added the Theory of Opposites, treating a cold with something hot, a wet chill with dry warmth; and he wrote around 350 works with a confidence that left nothing to argue with. When the Church came to teach medicine, it approved Galen, because he had written that the body showed the design of a single creator. To question him was to question the Church. The grade-9 point AQA is looking for is not that these ideas were wrong but why they were reasonable. Without a microscope nobody could see a germ; what could be seen was that fevers came with flushed skin and thick urine, that the sick vomited and sweated, that bleeding a red-faced patient calmed him. The humours explained all of that. The stars explained why an epidemic struck a whole town at once; sin explained why it struck the good and the bad alike. A medieval physician was not stupid; he was reasoning correctly from what he could observe. This module gives you the ideas, the training that carried them, and the AQA shapes that test them.

Five terms with their dates

Each definition carries the date and the detail that make it usable as evidence, because a bare definition earns nothing in a significance or factor answer.

The ideas in order

Put these six developments in the order they happened.

• Doctors on Kos begin writing that illness has natural causes
• A Greek physician in Rome dissects apes and writes the Theory of Opposites
• The first medical school in Christian Europe teaches Galen at Salerno
• The first recorded public dissection of a human body takes place at Bologna
• English physicians carry folding almanacs with a zodiac man
• Vesalius publishes an anatomy that corrects Galen from human bodies

Why did the humours last so long?

The Four Humours were wrong about the cause of every disease and were taught in English universities for four hundred years. Which explanation best accounts for their survival?

• They fitted what could be seen, since fevers really did bring flushed skin and dark urine and bleeding really did calm a patient, and nothing that could be observed without a microscope contradicted them; they carried the authority of Galen, whom the Church endorsed for his belief in a creator, so that to disagree was to risk heresy as well as a career; the universities taught medicine as the reading of Galen and Avicenna in Latin, with at most one dissection a year, so that a doctor was trained to explain the book rather than to look at the body; and they gave the physician a complete system of diagnosis, treatment and prognosis that worked often enough, because most patients recover from most illnesses whatever is done, to seem confirmed by experience.
• Medieval people were less intelligent than we are.
• The Church banned all study of the body.
• Nobody was ill enough to notice that the cures did not work.

Natural and supernatural, side by side

AQA asks for both approaches and the grade-9 habit is to show that each was a reasonable answer to something that could actually be observed. The right column gives the observation each idea explained, which is what turns a description into an explanation.

Question 1: how useful is the source?

Source A: a description of a folding almanac made in England around 1415, small enough to hang from a belt, of the kind carried by physicians. Its pages show a calendar of saints days, a table of the phases of the moon, a urine wheel with twenty shades of colour each labelled with the illness it shows, and a zodiac man, a naked figure with a ram drawn on his head, a bull on his neck, fish on his feet and each sign written beside the part of the body it governs, with a note warning against bleeding a part while the moon is in its sign. AQA Question 1 asks: How useful is Source A to a historian studying medieval ideas about the cause and treatment of illness? Tap the TWO details that make it most useful for that enquiry.

• The urine wheel with twenty labelled shades, which shows that physicians diagnosed the imbalance of the humours from what could be seen in the patient rather than from examining the body
• It was small enough to hang from a belt.
• The zodiac man with a warning against bleeding under the wrong sign, which shows that natural treatment and astrological belief were used together by the same practitioner rather than being rival approaches
• It was made in England.
• It has a calendar of saints days.

Training the medieval doctor

Select the THREE statements that are accurate about how a physician was trained and how he worked.

• A physician trained for seven years or more at a university such as Salerno, Bologna, Montpellier, Paris or Oxford, reading Galen, Hippocrates and the Canon of Avicenna in Latin and disputing set questions, so that his qualification was in the authors rather than in the body.
• Human dissection was permitted at some universities from the early fourteenth century, the first recorded public one at Bologna in 1315, but usually once a year, on an executed criminal, with a professor reading Galen aloud while a barber cut, so that what was seen was used to illustrate the book rather than to test it.
• Trained physicians were few and expensive, so most people were treated by apothecaries, barber-surgeons, wise women and the monks and nuns of hospitals, who used the same humoral ideas, herbs and prayer without the Latin.
• Physicians qualified by treating patients successfully under supervision in a hospital.
• The universities forbade astrology as a superstition.
• Medical texts were written in English so that any healer could use them.

Question 1: the usefulness method

AQA Question 1 on Paper 2 gives one source and asks how useful it is to a historian studying a stated enquiry, for 8 marks. The marks come from three things used together: content, what the source shows about the enquiry; provenance, who made it, when, for whom and why, and what that does to its value; and own knowledge, used to test what the source shows against what else is known. For the almanac in Source A, the content shows the urine wheel, the moon tables and the zodiac man together on one belt, so that the natural and the supernatural were tools of the same physician. The provenance is its strength: it was made for a practitioner to use, around 1415, not for display or argument, so it shows what a physician actually consulted at the bedside. Its limit is that it was an expensive object for a university-trained doctor, so it shows the ideas of the few hundred physicians in England and not those of the barber-surgeon or the village healer who treated most of the population. Own knowledge tests it: the twenty-shade wheel matches the humoral belief that urine showed the excess humour, and the warning about the moon matches the university teaching of astrology after the Black Death. This meant that the source is very useful for the ideas of the physician and less useful for the ideas of the people, and a top-level answer says both, with the provenance explaining why.

At the bedside, 1400

You are a university-trained physician in Norwich in 1400, called to a merchant with a fever. Four decisions, each of which was a reasonable choice for the knowledge of the time. Choose what such a physician actually did.

• The merchant is hot to the touch, red in the face and sweating, and his servant has brought you a flask of his urine. How do you diagnose?
• You intend to bleed him. It is late April and your almanac tells you the moon is in Taurus, the sign that governs the neck and throat. Where and when do you cut?
• The bleeding has been done. Galen tells you to treat a hot, wet excess with its opposite. What do you prescribe?
• A week later the merchant has recovered, as most fever patients did whatever was done. His wife asks what cured him. What do you say?

From observation to belief

Because a fever brought a red face, sweating and dark urine, a theory of four liquids in and out of balance fitted what a physician could see, and bleeding a patient whose face was red seemed to work. Because Galen had written that the body showed the design of one _____, the Church approved his books and the universities taught them for some 1,300 years. Because human _____ was rare and used to illustrate the text, the five-lobed liver of the ape stayed in the books until 1543. Because epidemics struck a whole town in one season and no idea of _____ existed, the planets and the will of God were the only causes large enough to explain it. And because most patients recover from most illnesses whatever is done, every recovery seemed to _____ the treatment and every death could be blamed on _____.

The span of Galen

Galen died in about AD 216. The first anatomy to correct him from human bodies, by Vesalius, was published in 1543. For roughly how many years did his authority stand unchallenged?

Question 3: two similarities, marked

AQA Question 3 asks you to compare across periods, for 8 marks: Explain two ways in which ideas about the cause of illness in the medieval period and in the Renaissance of the sixteenth and seventeenth centuries were similar. Which answer reaches the top level?

• One similarity is that both periods explained illness through the Four Humours: a medieval physician in 1400 diagnosed an excess of blood from urine and pulse and treated it by bleeding, and a physician in 1600 did the same, because even after Vesalius corrected the anatomy of Galen in 1543 and Harvey showed the circulation of the blood in 1628, nobody had found a better account of what caused disease, so bleeding remained the standard treatment into the eighteenth century. A second similarity is that both periods accepted supernatural causes alongside natural ones: the medieval Church taught that plague in 1348 was a punishment for sin and physicians consulted the zodiac, and in 1665 Londoners still prayed and fasted against the plague and the astrologer Lilly sold predictions, because an epidemic that struck a whole city at once still had no natural explanation that fitted.
• Both periods believed in the Four Humours.
• In the medieval period people believed in Galen, but in the Renaissance Vesalius proved him wrong.
• Both periods had humours, miasma, God, the stars, bleeding, purging and herbs.

Question 2: significance, marked

Question 2: Explain the significance of Galen for the development of medicine. At the time, Galen was significant because he turned the Hippocratic idea of natural causes into a complete working system. Between about AD 160 and his death around 216 he wrote some 350 works covering anatomy, diagnosis, treatment and prognosis, added the Theory of Opposites so that the humours prescribed a cure as well as an explanation, and proved by experiment on animals that arteries carried blood and that the brain and not the heart controlled speech, which corrected Aristotle. This meant that a physician anywhere in the Roman world had one authority to learn from instead of a scatter of rival schools. In the longer term his significance was larger still and mostly harmful: because he wrote that the body showed the design of a single creator, the Church endorsed him, the medical schools from Salerno in the eleventh century to Oxford taught medicine as the reading of his books, and his errors, the five-lobed liver, the two-part jaw, the pores in the wall of the heart, were copied for some 1,300 years, so that when Vesalius found the jaw in one piece in 1543 he was told the human body must have changed since Galen. The limit of that significance is that Galen never explained the cause of any disease correctly, and the treatments his system prescribed, bleeding above all, were at best useless; his significance lies in the authority his method gave to a wrong idea, not in progress. He matters most because to develop medicine after 1500 meant, first, to escape him. What earned the marks: significance at the time with dates and figures; significance in the longer term, distinguished from the first and explained through the Church and the universities; the limit of the significance stated plainly; and a closing judgement on what he matters most for. That three-part shape, at the time, longer term, limit, is what the 8-mark significance question rewards.

Question 4: the factor judgement

Has religion been the main factor holding back the development of ideas about the cause of illness in Britain? Explain your answer with reference to religion and other factors.

• Make the case for religion with evidence: the endorsement of Galen, the teaching of the universities, illness as punishment for sin, the Church control of hospitals and dissection
• Set other factors against it: the lack of instruments such as the microscope, the authority of the individual in Galen, the training that taught reading rather than observation, and the fact that the wrong ideas fitted what could be seen

Question 4: the judgement, tested

A student has argued that religion was the main factor holding back medieval medicine because the Church endorsed Galen, taught that illness was a punishment for sin and controlled the universities and hospitals. Which is the strongest point to set AGAINST that judgement, in the way the top level of Question 4 requires?

• The Church protected the wrong ideas but did not make them wrong: the humours and miasma were natural theories that fitted every observation available before the microscope, physicians in the Islamic world who worked outside the Church held the same Galenic ideas for the same centuries, and universities under the Church did dissect bodies from 1315 and taught the natural approach alongside prayer; so the deeper factor was the absence of the instruments and the method that would have produced a better theory, and religion mattered because it gave authority to a system that observation could not yet contradict, which is a reason to judge it the protector of the delay rather than its cause.
• The Church banned dissection, so religion must have been the main factor.
• Nothing held medicine back; medieval people simply did not care about it.
• Science and technology was the main factor because it was more important than religion.