Medicine revision chronologically

The influence of Hippocrates on Roman medicine

Hippocrates Greek, believed in natural cause of illness, influenced the training of doctors

1. Hippocratic Oath a doctor should respect all life, if didnt know how to treat an illness, shouldnt try anything harmful

2. Developed the Theory of the Four Humours

3. Clinical Observation study a patients symptoms, make notes, use previous experience, once shown to be accurate, treat illness, preferably through diet, exercise or rest

4. Hippocratic Writings his ideas recoded, not necessarily by him

The Four Humours the Ancient Greeks identified four different liquids or humour in the body, blood, phlegm, yellow bile, black bile.

The Greeks believed everyone had their own mixture of humours and when they became unbalanced, you became ill. If you had a temperature, you were red because you had too much blood.

They also thought the these humours were linked to the seasons therefore in winter, which is linked to water, your body would produce too much phlegm and you have to sneeze and cough to get rid of it. The cures were to restore the four humours e.g. bloodletting. Hippocrates believed most treatment should be based on rest, diet and leaving the body to heal itself.

Galen and the Theory of Opposites - Galen a Roman doctor developed the Theory of the Four Humours. He believed in bloodletting as a treatment for most illnesses but also used the Theory of opposites ie too much phlegm (water and cold), eat chilli peppers, a temperature eat cucumber.

Galen produced over 350 texts about medicine and surgery, which summarised medical knowledge at the time, he said he had perfected the Ancient Greek ideas so no further study was necessary.

The influence of Galen on Roman medicine

Developed Hippocrates ideas, Theory of Opposites

Had experience as a surgeon to the gladiators

Carried out dissections on many animals (central nervous system on pig)

Produced a number of books that were studied for the next thousand years, summarized all medical knowledge at the time

Believed had perfected ideas

Roman ideas about disease

Gods/curse

Miasma

Four Humours

Treatment in Roman Britain

Few doctors in Britain

illness treated at home by father, passed down from his father, herbs, plants

used throughout Roman Empire

bloodletting

purging

prayers and offerings to Salus, god of health

Theory of Opposites

Celtic ideas replaced by Roman ideas, others used by Romans

Roman army hospitals well equipped and provided excellent training for surgeons and physicians, however few hospitals open to the public, so treatment and training little impact on ordinary people

Public Health in Roman Britain

Little emphasis on medical knowledge

but noted increased disease near marshes and swamps, towns away from them, because of bad air

link between hygiene and disease (couldnt explain) so clean water and removal of sewage

Public Health in Roman Britain

Little emphasis on medical knowledge

but noted increased disease near marshes and swamps, towns away from them, because of bad air

link between hygiene and disease (couldnt explain) so clean water and removal of sewage, fresh water via aqueducts to towns, water stored in reservoirs outside towns, pipes then to towns, fountains, public baths, houses of rich, toilets, sanitation important e.g. in York

Roman Public Baths e.g. at Bath, before bath exercise, hygiene, social, medical, public toilets in baths, fresh water to clean hands and rinse the shared sponge for wiping their bottoms, next to a series of warm rooms, then massaged with oil, then scraped off, finish with a dip in cold water

Roman system impressive helped people stay healthy, prevented some disease, but still many open drains, water supply meant water didnt always work properly

Roman Society made public health possible

1. Government central decisions, organized large scale plans, raised taxes and manpower

2. Army needed good standards of public health, ideas brought from soldiers from all over empire, during peacetime built roads, baths, sewers

3. Communication good roads made travel/communication easy and quick, central control from Rome and change of officials kept Britain up to date, (knowledge and ideas plants/herbs) spread

Collapse of the Roman Empire c400AD

Huge impact, no longer one country but fractured into smaller kingdoms, often at war

1. Loss of the Roman Army no one to maintain law and order, no engineers or builders to keep the public health systems running, no-one to stop invasions, Britain invaded by barbarian tribes Angles, Saxons and Jutes

2. Loss of one ruler/government no overall control to pay for public health services, priority of new rulers to keep and expand kingdoms, no time or money for public health

3. Wars and chaos led to destruction of libraries and books as well as towns, more dangerous to travel, ideas no longer spread, crops, livelihoods destroyed by conflict, poverty increased

Impact on medicine and public health

Biggest impact on public health systems which were destroyed by war, abandoned towns, so more unhygienic, more disease

Trained physicians almost disappeared because:

Books and libraries with medical knowledge destroyed

New rulers illiterate and not interested in educating doctors

Little travel so to obtain learning/training

Increased poverty meant nobody could afford a physician

Increasing importance of Christianity

Became increasingly important, especially after Norman Invasion, 1066

International organization important for communication

Most priests could read/write, senior churchmen kings advisors

Learning preserved in the libraries of monasteries/convents

Monasteries/convents had an infirmarian, who cared for the sick

Strong belief in religion, accepted the Churchs authority over their lives

Believed illness a punishment for sin, or test sent by God

Medicine and treatment in Anglo-Saxon Britain

public health collapsed after fall of Roman Empire

affected health and hygiene BUT not ideas about disease so collapse of Rome limited impact on the treatments used

cures through trial and error, repeated successful treatments but couldnt explain why worked eg honey

folk remedies passed down through word and mouth

knowledge of plants and heeling written in leechbooks (leech = healer), eg Leechbook of Bald unusual as gave specific quantities

Religion and Superstition

Christian Church increasingly important in Middle Ages

international organization important for communications

most priests literate, some kings advisors

learning preserved in monastic libraries

monasteries had infirmarian who cared for sick

strong belief in religion so Church obeyed

believed illness sign of sin or a test from God

medieval treatments included supernatural aspects eg prayer, offering, pilgrimage, also carried lucky charm, astrologers consulted about timing of an operation

Influence of Galen

In towns rich people consulted physicians used bloodletting/purging: based on Four Humours, Galen keen on bloodletting, also prescribed medicines based on ingredients eg plants, herbs, spices, bezoar stone

Public health in the Middle Ages

as towns grew in Middle Ages, hygiene more important, saw link between hygiene and disease

Why was London so smelly?

13th century city authorities laid lead pipes from the River Tyburn to provide water, leaks, contaminated, insufficient supply, water quality poor generally, few drank it

animal/human excrement in streets

rubbish not removed

animals slaughtered, remains left

rats common

Laws passed but little effect systems too underdeveloped

public toilets in London, Hull, Exeter but urinated in streets

suggests no progression, in fact regression

However:

Rich had good hygiene, had wooden bathing tub, privy (toilet) with waste taken away, water supply sometimes

Monks and nuns standard of hygiene high, fresh water piped in, latrines built over running water

Town councils recognised importance of public health eg Southampton improved water supply , London fresh water through pipes/conduits in city

Stewes large baths where people bathed together, for rich social occasion drank and ate but denounced by Church as leading to immoral behaviour

Medical training from Roman Britain to 1350

Doctors not respected in Roman period, treatments didnt work, many doctors in Rome Greek so foreign, felt doctors taking advantage of them, Galen hated as arrogant and critical and a foreigner!

Hippocrates (Ancient Greek), his ideas written down and had an influence on medical training Four Humours, Hippocratic Oath, clinical observation, Hippocratic Writings

Alexandria the main centre for medical training, allowed to dissect bodies (pre Christianity), held books from Greece, Egypt, India, no formal requirement for medical training, doctors trained by reading books such as the Hippocratic Collection, or by working with a doctor, no organization to check doctors knowledge or follow up complaints, anyone could set up as a doctor

Medicine part of a more holistic approach of the person and lifestyle ie body/humours in balance, medicine began to incoperate knowledge of plants a