Special Note: I am not, never was and most likely, never will be, a student of medicine. With this in mind, be prepared for a few errors in the article to follow. All facts are presented as being true and correct according to the research I conducted and the sources that I’ve read. I approach this mostly from a historical point of view, being a student of history, rather than from a medico-scientific view.

For centuries, mankind has feared all kinds of things. The natural (floods, storms, fires, blizzards and the yeti), the supernatural (ghosts, demons, Criss Angel), the physical (murderers, rapists, George W. Bush) and the imagined (clowns, vampires and Frankenstein’s Monster). But all of these horrific, scary, angering or terrifying things, pale in comparison with one of man’s greatest fears, one which has lasted for centuries and which will last for centuries still.

The fears of injury, disease and death.

This article will explore the history of disease, injury, medical theories and the advancements of medical science from the middle ages to the modern era. A warning to the squeamish that this article may contain various unsightly visual media. Those prone to fainting at the sight of blood might want to click that nice, and doubtless,increasingly inviting ‘Back’ button, right now.

Back in the Old…Old…OLD…Days

These days, we probably don’t think much of medicine. If we break a leg or get sick or get injured, we go to the hospital or visit the chemist’s shop to get ourselves treated and fixed up. We get a day or four off of school or work and then get on with life. Today, minor things seem pretty…minor. But that’s because today in the 21st century, we have things like antiseptics, antibiotics and effective medications to deal with our problems and predicaments.

Things were not always this safe. Antibiotics were only discovered less than a hundred years ago and antiseptics not much further back. Imagine living in a world before all these amazing medical inventions, and wondering what your life must’ve been like. How were injuries and illnesses treated? How did doctors deal with infections? How did they understand the workings of the human body? And how did they understand the workings (or lack, thereof) of the medicines which they prescribed?

A Totally Humourous Theory

Any person who has studied the history of medicine, either for university, for school or even because they were bored at the doctor’s office and picked up one of his magazines lying on the coffee-table, will probably know this first medical theory. It is the oldest theory in the books, almost literally.

The theory of the Four Humours (officially called “Humourism”) lasted a surprisingly long time, from its formulation in Ancient Greece, right up to the 17th century. Hold out your hands and start counting on your fingers to see how long that was.

The theory of the Four Humours was the belief that the human body was made up of four…humours. These humors were four different liquids, these liquids being, in no particular order: Blood. Black Bile. Yellow Bile. Phlegm. This theory came from the belief in the “four natural elements”, said elements being Earth. Air. Fire. Water. At the time, it was believed that everything on earth was made up of a combination of these four ‘elements’. So by that logic, man and woman were also made up of four elements: the four humours.

The theory of Humourism stated that when someone was feeling fine, their four humors were in perfect balance. If the person was sick, this was a sign that the four humours were imbalanced in some way. To cure the person, the correct action was to restore the balance of fluids in the body and to restore the person’s humours.

Have you ever heard of someone being described a melancholy, meaning that they’re feeling sad, depressed, listless and bored? This is probably the only holdover from the Humourism theory that still survives in the 21st century. Originally, to be ‘Melancholy’ meant to have an excess of black bile in the body, which caused a mood imbalance which was thought to cause sadness and listlessness.

Let it Flow

Since, to medieval minds, a person’s body was made up of the four humours, if the person was sick, this indicated an imbalance in the humours. To ‘cure’ the person, the correct action was to remove the offending and ‘bad’ fluid from the body. This was meant to restore the patient’s balance of humours and cure them. Enter the surgeon with his lancet and bowl.

This set of lancets from the 1700s shows just how long the practice of bloodletting survived

More often than not, the medieval way of curing disease was a barbaric and totally pointless practice which was known as ‘bloodletting’. Bloodletting was an incredibly popular remedy and it lasted right up to the 1800s! If the body was sick, the idea was that the blood had become ‘poisoned’. To cure the person, the blood had to be let out of the body to remove the ‘pestillence’ from the body and to restore its natural balance. This was done with a lancet and a bowl. Squeamish folks…turn away now.

Bloodletting involved the doctor or surgeon taking the patient’s arm, leg or in desperate times, even the neck, and cutting into a vein with a razor-sharp implement known as a lancet. The cut having being made, blood was literally let out. That is, it was allowed to flow out of the cut in the limb (or if you were especially unfortunate…the neck) and the blood dripped or dribbled into the bowl which was held nearby. The point wasn’t to bleed the patient to death, but rather to systematically cure the patient of his ills. A pre-determined amount of blood (say, one quart) would be removed from the body. After this, the cut was bandaged and left to heal. Later, another quart…or two…might be removed from the body and again the limb would be left to heal. While this theory made perfect sense to medieval doctors, it actually has no practical benefit at all. Removing blood from an already infected body leaves it weaker and in an even worse state to fight the infection already in it. And using lancets and knives which probably hadn’t been washed properly and sterlised, meant that the doctor was probably introducing even more harmful bacteria into the body.

A late 18th century illustration, showing a doctor bloodletting a patient. Having made a cut into a vein in the arm, the doctor is now catching the blood that comes out of the open wound. The bowl isn’t just there to not make a mess of the floor, but to accurately measure the amount of blood removed

Medieval Medicines

Bloodletting was not the only thing that doctors and barber-surgeons did to try and save lives. They also had medicines to prescribe to their patients. But how beneficial they were was often a hit-and-miss affair. More often than not, though, the medicines probably missed the mark by a mile.

Medieval medicine was a jumble of natural remedies, hocus-pocus, quackery and religious balderdash. Very few medicines actually ever worked. Those which did, doctors were at a loss to explain. All they knew was that it worked, and that was good enough for them. So…what were some common Medieval medicines or drugs? Here are just a few things which medieval people used to treat themselves:

Honey.

Yep. Honey. Ordinary bees’ honey. Various types of natural bees’ honey have special chemicals and plant-material introduced into it by the bees when it is made. This means that honey was a very mild antiseptic. Medieval surgeons sometimes rubbed or spread honey onto a wound to try and clean it and remove the ‘pestillence’ from the patient.

Pearls and Cuttlefish Bones.

Not exactly a medicine, but these were two of the ingredients used in a rudimentary form of tooth-powder, the forerunner of modern toothpaste. Needless to say, it didn’t work very good. And with pearls as an ingredient, you can bet it was bloody expensive.

Stinging Nettles.

Although undoubtedly painful, stinging nettles did actually work. The nettle branches were slapped or struck across joints in the body (such as the wrists or knees) which were suffering from arthritis. Even today, nettle extracts are still used to treat arthritis and rheumatism.

Common Medieval Sickenesseseses…es

Due to the filthy conditions of several Medieval cities, you can imagine that disease was never far behind in the 1300s. Diseases which people feared particularly, included…

The Black Death

Recorded variously as the Plague, the Black Death, the Sickenesse (original Middle English spelling) and several other names, the Black Death was the king of all medieval diseases. The mere mention of its name literally sent people running for the lives. The Bubonic Plague was horrible, painful, unmerciful, indiscriminatory and lethal. Massive outbreaks of Plague throughout the centuries have become the stuff of legends.

Dysentery

Caused by bacteria in unclean food or water, dysentery was a massive killer in the medieval age. During great battles, when armies had to march for days and nights at a time, through filthy weather and on poor diets, dysentery could kill more knights, soldiers and archers than the enemy ever would.

Leporsy

One of the most famous diseases to come from the medieval (and indeed, the ancient) world is leporsy. Leprosy was a horrible disease: Physically deforming and disabling to the body, leprosy was feared almost as much as the plague. Medieval people believed that leprosy was contagious (it is, if the sufferer has not been treated), and lepers were often the most shunned people in society. It was the custom of benevolent noblemen to save the leftover food and trenchers (slices of bread which served as dinner-plates) from their lavish dinner-parties, and to give them to the poor and hungry in their communities. While noblemen would certainly give out food to starving beggars and peasants, they would not dare to approach a leper. Instead, food was thrown at the leper’s feet for him to pick up instead. Due to the deformities caused by the infection, lepers lived in isolated leper-colonies and if they headed out in public, lepers had to carry clappers or bells which they sounded or rang, to warn people of their presence so that they would have enough time to throw up their hands and run off, screaming in horror.

Punishment from Above

Apart from belief in the Four Humours, many medieval people believed that illness was due to punishment from God. Particularly nasty diseases such as Plague, were seen as evidence of God’s wrath upon his people. Some people believed that prayer helped their healing just as much as pills and potions did. If it wasn’t punishment from God that made one sick, then possession by demons, the devil and evil spirits was thought to be the cause of one’s ills. These were treated with crosses, bibles, holy water and exorcism. In particularly extreme cases of “possession”, the unfortunate victim (who was most likely just mentally ill), was subjected to the barbaric and pointless operation known as trepanning.

Trepanning, like the equally useless and damaging operation known as the lobotomy, was an attempt to cure someone of their mental illnesses. It involved drilling a hole into the skull, either to relieve pressure on the brain, or to release demons and evil spirits which were inhabiting the patient’s brain. The operation was carried out with a murderous looking instrument called a trephine…

First, a Y or X-shaped cut was made in the skull. The skin was peeled back and then the trephine was placed against the skull. With pressure placed against the bone, the trephine’s was turned around and around to operate the drill. The grinding of the metal teeth against the bone would’ve been very noisy to the patient and excruciatingly painful. Once the skull was successfully drilled through, the operation was considered a success, although some patients squirmed so much that a successful trephination wasn’t always possible.

There’s Something in the Air…It’s a Miasma!

Once the circulation of blood was discovered in the 1600s, the old understanding of the human body began to collapse. The foundation of medical colleges and hospitals allowed doctors and surgeons to examine bodies (usually the dead bodies of criminals), and this furthered the understanding of the makeup and operation of the human body. As the the Theory of Humourism began to lose favour, it was gradually replaced by another one: The Miasma theory, or the Maisamatic Theory of Disease.

A miasma (pronounced alternatively either ‘My-azz-ma’ or ‘Mee-azz-ma’), literally meant ‘bad air’, from the Greek words meaning ‘pollution’. This theory, which first took hold in the Early Modern Period (ca. 1500s) and which lasted right into the mid 19th century, purported that diseae was not due to the imbalance of bodily fluids. It had since been discovered that the body did not contain such fanciful fluids (except perhaps…blood. Lots and lots of blood). Instead, the Miasma Theory said, disease was spread by ‘bad air’. Bad air generally meant bad smells: noxious, foul-smelling stenches and strong odours. As strong odours often came from filth and rubbish and refuse and human waste, for the first time in history, the connection was made between filthy living conditions and disease.

With the miasma theory of disease in full swing by the 1700s and 1800s, real progress began to be made in the field of sanitation. People learnt that it was impossible to survive in filth due to the powerful and poisonous odours that were given off by the rotting garbage and other…refuse. Cities learnt the importance of proper waste and garbage management, which helped to keep down populations of bacteria and rats, which in the past, carried the fleas which transmitted the Plague to their unsuspecting and unfortunate victims. In medieval times, when refuse and the contents of chamberpots were literally just thrown out the window, rats and disease thrived causing incredible sickness. The rise of the Miasma Theory meant that people soon learnt that unhygienic conditions were life-threatening and had to be avoided at all costs. While the Miasma Theory has since been debunked, a remnant of its influence still exists in 21st century medicine today. The tropical, mosquito-carried disease malaria has its roots in words literally meaning “bad air” or “MALodorous AIR”.

Enlightened Thought

While medical theory advanced slightly in the 18th century, commonly called the Age of Enlightenment, medical fact was considerably further behind. A lot of the treatments and practices of decades and even centuries past, continued to be taught and administered by doctors and surgeons in the 18th century. Bleeding was still a common method of treatment, accompanied by the painful and thoroughly uncomfortable cupping-glasses.

A set of 18th century cupping-glasses

Cupping-glasses were little glass cups or bowls, which were heated up, either with the flame of a candle, or by burning a substance inside the cup. The hot cup was then placed over a certain part of the body (usually the limbs). The point of cupping-glasses was that the heat from the hot glass created a vacuum. This vacuum brought blood to the surface of the body, which allowed surgeons and doctors to let the blood more effectively. While cupping still exists today as an alternative therapy, modern medical societies have determined that cupping provides no relief and has no healing effect at all.

The 17th, 18th and 19th centuries were the periods when people really started experimenting with new and fantastic drugs. Mercury was used to treat syphillis, mustard patches were used to treat headaches, smoking tobacco was once thought to be a preventative against the Plague. Laudanum, a mixture of opium and alcohol, was used as a rudimentary painkiller during operations and amputations. In the days before antibiotics, when a patient’s limb became infected with gangrene, amputation was often the only way to save the patient’s life. Laudanum (or just plain whiskey) was used as a painkiller while the surgeon sawed off the patient’s infected limb with an amputation knife and hacksaw.

Medicines continued to be developed throughout the 18th and 19th centuries, some of which we wouldn’t dare think of using today. Apart from mercury, poisonous substances such as lead, arsenic, strychnine and turpentine were also used in the treatment of various diseases and conditions. Opiate drugs such as opium and heroin were also used for their calming and anti-depressent affects.

Safe Surgery

From the barber-surgeon of the Middle Ages to the ship’s surgeon of Napoleonic times and the civilian surgeons who worked in hospitals in the 18th and 19th centuries, one major obstacle in their profession made many operations futile.

Infection.

Even though the surgery performed might have been highly successful (although what was considered a ‘success’ varied from surgeon to surgeon), one major problem was that wounds that were left open too long, or which were attended to with unclean hands or instruments, were very susceptable to infection. For centuries, surgeons puzzled over this problem, unable to find a solution. While the Miasma Theory meant that hospitals were now nice and clean, there was little pressure on doctors and surgeons to clean their hands or the instruments that they used, due to the belief that disease was transmitted through the air, not by tiny, invisible bacteria.

While patient comfort during surgery was gradually improving, with the discovery of anesthetics such as ether and chloroform (although until the early 20th century, these were still largely in the experimental stages), infection and how to treat and more importantly, prevent it, was still a mystery.

Until a man named Joseph Lister started messing around in hospitals.

Joseph Lister, 1st Baron Lister (1827-1912), was an English surgeon who revolutionised safe surgery. Through observing the cleaning of sewers, Lister saw that sanitation workers sprayed carbolic acid in the air to clear and clean it. Lister also saw that midwives, who washed their hands regularly between delivering babies, had fewer fatalities than surgeons in busy hospitals, who often rushed from one patient to another without washing their hands. Because of these obserations, Lister drew the conclusion that tiny, microscopic things, invisible to the human eye, were causing disease, and not miasmas, as was previously thought.

Lister and the Germs

When Lister was a young man in the second half of the 1800s, the Germ Theory of Disease was still pretty new. Despite evidence from research conducted by such pioneers as Dr. John Snow (who successfully and correctly determined that cholera was waterborne, which proved that disease could be spread in ways other than through the air), most people still believed in the old Miasma Theory, which had survived since the 1600s. Men such as Louis Pasteur (after whom the process of pasteurisation is named), also theorised that disease was spread in ways other than through the air. Bit by bit, doctors, scientists and surgeons formed a new theory of how disease was spread and how the body contracted disease as the 19th century progressed.

Lister experimented with carbolic acid. By spraying a carbolic acid solution around his surgery and by spraying and cleaning his hands and instruments in carbolic acid, Lister discovered that incidents of post-operative infection began to decline. Sure that he was on to something here, Lister gave instructions to all the surgeons under his leadership at the hospitals where he worked, that they wear gloves whenever possible and that, when this was not possible, that they wash their hands in a carbolic acid solution. Washing instruments in carbolic acid was made mandatory and gradually, instances of post-operative infections due to germs entering the body through unclean instruments and hands, began to drop.

As the 19th century progressed, the Germ Theory became more and more accepted by the medical and scientific community. Soon, hospitals everywhere were obliged to keep their rooms, hallways, instruments and the hands which used those instruments, as sterile as possible, so as to best aid the people being served. Lister soon gained immense fame, and was even rewarded with a baronetcy, for introducing the world to safe antiseptic surgery. Lister’s name lives on today in a rather unusual manner…the popular mouthwash-liquid…Listerine…was named after him, in 1879.

Listerine, named after Joseph Lister, was invented in 1879 as a general-purpose antiseptic wash, but is remembered today as everyone’s favourite mouthwash

Lister’s fame and skill and innovations in surgery meant that in 1902, when Lister was well into his seventies, he was still considered one of the leading experts on safe, antiseptic surgery. Why 1902? Because in that year, the year of the coronation of King Edward VII, Queen Victoria’s son, his Majesty suffered terrible appendicitis. The king received the best surgeons and doctors available, but they did not dare proceed with the operation without the personal direction of Baron Lister, who was now a creaking, rattling seventy-four years old! Under Lister’s instructions, the operation was a success. Once the king had recovered from his operation, he told Lister that “I know that if it had not been for you and your work, I wouldn’t be sitting here today.”