Approaches to caring for the sick (Edexcel GCSE History): Revision Notes
Approaches to caring for the sick in mediaeval England (c1250-c1500)
Introduction
During the mediaeval period in England, caring for the sick involved a variety of different approaches and practitioners. Most people received treatment at home, while others sought help from various types of medical practitioners or, in some cases, stayed in hospitals. The quality and cost of care varied dramatically depending on which approach was taken.
Mediaeval healthcare was highly stratified by social class and wealth, with different levels of care available to different segments of society. Understanding these distinctions is crucial to appreciating how medical care functioned during this period.
Who treated the sick?
Mediaeval England had several different types of people who provided medical care, each with their own level of training, skills, and costs.
Barber-surgeons
Barber-surgeons were among the most accessible medical practitioners for ordinary people. These individuals had no formal medical training but performed a range of services beyond cutting hair. They carried out bloodletting, pulled teeth, and lanced boils as their main medical treatments. When necessary, they also performed basic surgery, including amputating limbs, though this had a very low success rate due to their lack of proper medical knowledge and the absence of antiseptics or anaesthetics.
The main advantage of barber-surgeons was their cost - they charged less than properly trained physicians, making them affordable for more people in society. However, the lack of medical training meant that their treatments were often ineffective or even dangerous.
While barber-surgeons were affordable and accessible, their lack of medical training made their treatments extremely risky. Many patients died from infections or complications following their procedures, as they had no understanding of hygiene or proper surgical techniques.
Apothecaries
Apothecaries occupied a middle ground in mediaeval healthcare. While they received some training in preparing medicines and treatments, they did not have formal medical qualifications like university-trained physicians. Their main role involved mixing medicines and ointments, either based on their own knowledge and experience or following directions provided by a physician.
These practitioners cost money to consult, but their fees were still less expensive than those charged by fully qualified physicians. This made them accessible to people who could afford more than a barber-surgeon but couldn't pay physician prices.
Physicians
Physicians represented the most elite level of medical care in mediaeval England. They were medically trained at universities and had to pass examinations to practice. Their main responsibilities included diagnosing illnesses and providing treatment plans, though they often sent patients to apothecaries or barber-surgeons for the actual treatments.
However, physician care was expensive and mainly available to wealthier people in society. There were very few physicians overall, and women physicians were incredibly rare during this period, reflecting the limited educational opportunities available to women.
The separation between diagnosis and treatment in mediaeval medicine meant that even wealthy patients who could afford a physician's consultation often ended up receiving their actual treatment from less qualified practitioners.
Care in the home
The most common form of healthcare for most people throughout this period took place in the home. The majority of ill people were treated at home by a woman relative who took on the role of family healer. In villages, there was often a 'wise woman' who had developed knowledge of herbal remedies and healing techniques. Sometimes the Lady of the Manor would also provide free medical care to people in their homes.
Herbal remedies formed the foundation of home-based treatment. These could be consumed as drinks, inhaled by sniffing, or used for bathing. They represented the most common form of treatment during the mediaeval period and were either purchased from apothecaries or mixed at home using traditional knowledge passed down through families.
What physicians did
When wealthy patients could afford to consult a physician, the diagnostic process followed specific steps that reflected mediaeval understanding of medicine and illness.
First, physicians would observe a patient's symptoms carefully and check their pulse, examine their skin colour, and inspect their urine. The urine examination was particularly important - they would check both its colour and taste as indicators of the patient's condition.
Next, physicians consulted urine charts contained in their vademecum (handbook). These charts helped them interpret what different colours and characteristics of urine might indicate about various illnesses.
The third step involved consulting zodiac charts to help diagnose the illness and determine the best time to treat the patient. This reflected the mediaeval belief that celestial bodies influenced health and that timing treatments according to astrological signs could improve their effectiveness.
Finally, physicians would either treat patients themselves (though this was rare) or send them to a barber-surgeon or apothecary for the actual treatment. This system meant that diagnosis and treatment were often separated, with the highly trained physician focusing on identifying the problem while less qualified practitioners carried out the actual treatments.
Worked Example: A Physician's Diagnostic Process
Step 1: Physical examination
- Check pulse and skin colour
- Examine and taste patient's urine
Step 2: Consult medical references
- Use urine charts in vademecum to interpret findings
- Compare symptoms to known conditions
Step 3: Astrological consultation
- Check zodiac charts for optimal treatment timing
- Consider celestial influences on the patient's condition
Step 4: Treatment recommendation
- Prescribe treatment plan
- Refer patient to apothecary for medicines or barber-surgeon for procedures
Hospitals
Mediaeval hospitals served a different purpose than modern hospitals. Rather than being places primarily focused on treating diseases, they functioned more as places of recuperation and rest for people who were already recovering or needed supportive care.
Many hospitals were strategically located where travellers and pilgrims stayed during their journeys, providing accommodation and basic care for people far from home. The number of hospitals increased significantly during the mediaeval period, reflecting growing recognition of the need for organised healthcare facilities.
Most hospitals were run by the Church, which meant that the emphasis was placed on healing souls as well as bodies. Religious communities, particularly monks and nuns, provided much of the actual care. They maintained very clean conditions for patients and their surroundings, which was important for preventing the spread of disease, even though mediaeval people didn't fully understand how infections spread.
Mediaeval hospitals were fundamentally different from modern hospitals. They focused on rest, nutrition, and spiritual care rather than active medical treatment. People with infectious diseases or incurable conditions were typically refused admission, as hospitals lacked the knowledge and resources to treat serious illnesses effectively.
Hospitals focused on providing patients with fresh food and plenty of rest, recognising that good nutrition and recovery time were essential for healing. However, people with infectious diseases or incurable conditions were typically not admitted, as hospitals lacked the knowledge and resources to treat serious illnesses effectively.
Some specialised hospitals were built specifically for certain infectious diseases, allowing for some degree of isolation and specialised care, though treatment options remained very limited.
Timeline of key developments
- c1250: Establishment of many church-run hospitals across England
- c1300: Growth in number of trained physicians, though still very few
- c1400: Increased use of herbal remedies and home-based care
- c1500: Continued reliance on traditional methods with gradual improvements in hospital care
Key Points to Remember:
- Most people received care at home from female relatives or village wise women using herbal remedies
- Four main types of carers existed: barber-surgeons (cheapest, no training), apothecaries (moderate cost, some training), physicians (expensive, university-trained), and home carers (often free)
- Physicians used specific diagnostic methods including urine charts, zodiac charts, and physical examination, but rarely provided treatment themselves
- Medieval hospitals focused on rest and recuperation rather than treating diseases, and were usually run by the Church
- Cost determined access to care - wealthier people could afford physicians while most relied on cheaper alternatives or home remedies