Medical Practice Through History

“Medical Practice” has improved and changed through the centuries. Today, an unborn baby can survive outside of the womb and go on to live a healthy life. We are fighting cancer and winning! All through history, we have been interested in health and how we can live longer, curing ailments and surviving pandemics --- why, we’re even ‘fighting’ coronavirus today. So, what was “Medical Practices” like in the years gone by? What did the doctor do? (If you could afford one). What were the hospitals like? Where do we start?

Ancient Egypt is a good place to start. They used many natural things are medicine --- honey and the juice of pomegranates for example. In the ‘Ebers Papyrus’, there are over 800 remedies, some using ointments, wrappings and even ‘oral medication’ such as pills and mouth rinses. In Egypt, magic and medicine were often intertwined, and it is interesting to note that there are references to tumours and ‘instructions’ on how to remove certain tumours. Women’s ‘complaints’ were treated, including problems with contraception. The ‘Kahun Gynaecological Papyrus’ dates back to 1800 BC and is the oldest surviving medical text of any kind. The ‘Hearst Papyrus’ (1450 BC) and ‘Berlin papyrus’ (1200 BC) also provide valuable insight into ancient Egyptian medicine. These ancient ‘Healers’ used herbs and other natural remedies to sure ailments. One recipe to help with headaches was “inner-of-onion, fruit-of-the-am-tree, natron, setseft seeds, bone-on-the-sword-fish, cooked, redfish, cooked, skull-of-crayfish, cooked, honey and abra-ointment.” (I’m glad I don’t live back then!) Some ‘treatments’ made use of cannabis and incense. Along with plant extracts and fruits, they also used animal faeces and even some metals as treatments. These ‘treatments’ were measured out by volume and the ‘prescription’ was put together more like cooking than how Pharmacists do things today.

The ancient Egyptians had a ‘knowledge’ of human anatomy and one example of this is the classic Mummification process. They had a general idea of where the internal organs are and removed these organs through a small incision in the left groin. The ‘Physicians’ were aware of the existence of the pulse and how it is connected to the heart. “They developed their theory of “channels” that carried air, water and blood to the body by analogies with the River Nile; if it became blocked, crops became unhealthy. They applied this principle to the body: if a person was unwell, they would use laxatives to unblock the “channels.”” Many of these medical practices were effective and the physicians’ advice for staying healthy was to wash and shave the body, including under the arms, to prevent infections (also remember, how hot Egypt as a country is). Advice was given on diet and it was recommended to avoid certain foods such as raw fish and animals considered to be ‘unclean.’

Surgery was a common practice in ancient Egypt (no, I’m not going into detail!) and they used an assortment of ‘surgical tools.’ These Egyptians recognized 3 categories of injuries; treatable, contestable and untreatable ailments. Male circumcision was a normal practice (as stated by Herodotus in his “Histories”). Also, prosthetics (such as artificial toes and eyeballs) were used, although they served little more than decorative purposes. In preparation for burial, missing body parts would be replaced, but were not used before death.

As the ancient Egyptians had a structured society with tools (written language and mathematics) which enabled them to record and develop ideas, it meant that other cultures could learn from them.

We jump forward to the Middle Ages and see that the average life expectancy was 30-35 years of age and 1 in 5 children died at birth (1350). Most people lived in rural servitude and superstition had gripped the communities. These people could not read and write, and there was no type of ‘schooling.’ It was usually the very wealthy and monks who learnt to read and write, and learnt to have some ‘understanding’ of the sciences. Therefore, the ‘quality’ of medical practitioners was very poor, and the common people rarely saw a doctor, preferring to put their trust in the local wise woman (or witch) who provided herbs and incantations. Midwives helped with childbirth. As the Christian Church took foundation in England, these same people replaced spells and incantations with prayers and requests to saints, yet also with herbal remedies. They now believed in repentance of sins, practicing penance and going on pilgrimages (to touch the ‘relics of a saint’) and believed this would cure the ailments.

It was at this time that “The Theory of Humours” came about. This theory held that 4 different bodily fluids --- or humours --- influenced human health. These humours had to be in perfect balance or the person would soon become sick, physically or ‘in terms of personality’ (mentally). The imbalance could result from inhaling or absorbing vapours. These humours depended on what a person ate, drank, inhaled or did. An example of this was lung problems, which occurred when there was too much phlegm in the body. The body’s natural reaction was/is to cough it up. The doctor would treat the patient by blood-letting (using leeches) and advising him/her to take in a special diet and medicines. The doctor believed that this would ‘re-balance’ the patient. This “Theory of Humours” lasted for 2,000 years, until scientists finally discredited it.

Like in the time of the ancient Egyptians, herbs played an important part in curing ailments, and that is why the monasteries had extensive herb gardens which produced every herb to resolve each imbalance of humour. Of course, the local wise woman (or witch) also used herbs. The “Red Book of Hergest” is the oldest known book of herbs and it was written in Welsh in around 1390 CE.

There were hospitals in the Middle Ages, of a kind. These places housed people who were sick, yes, but also the blind, pilgrims, travellers, orphans, people who had nowhere else to go and also the mentally ill. As Christianity spread through the country, the Christian teaching of hospitality made it necessary for these ‘hospitals’ to provide relief for those in need. Most of the common folk, however, preferred to be treated in their own homes of possible. The first of these hospitals was built in 937 CE, with St. Bartholomew’s of London being built in 1123 CE (this hospital is still a major hospital today, having been modernized over the years). ‘Barber-surgeons’ carried out the surgery back then, their ‘skill’ being used especially in the battlefields, where they removed arrow-heads and set broken bones. It was at this time that it was discovered that some plants had powerful antiseptic qualities. Wine and ointments were used to cauterize wounds. When pus oozed out, this was looked at as the body ridding itself of toxins in the blood. Back then, there still had been no connection between hygiene and the risks of infection, hence many wounds became fatal.

The medical practices of this time, we would call barbaric today. For example, a person with epilepsy would have a hole drilled into the skull “to let the demons out”, but this, unfortunately, left the patient mentally ‘scarred.’ Plagues, such as the Black Death, was well-known in the Middle Ages, at one point killing 25 million people over several countries (1340’s).

We now come into the Tudor Times. Great domestic buildings were being built, and the ‘sumptuous’ Court of King Henry VIII was filled with the learning of the new-style Renaissance courtiers. The life expectancy had risen to only 40 years of age, with a ‘Spartan’ attitude towards pain, plague and cruelty. At the start of the Tudor Times, there was no ‘profession of medicine’ and all practitioners of medicine were a kind of “free-lance.” The actual physician was a learned scholar who had studied for 14 years but who had very little practical ‘acquaintance’ with the diseases he had studied. The apothecary (or pharmacist) saw mainly to the needs of the common folk, and then there was the barber who ‘prescriptive right’ was all minor surgery and tooth-pulling (dentistry).There was the Guild or Fraternity of Master Surgeons who were the elite consultants of these days. It seemed that to become a ‘qualified’ doctor meant that you studied all the theory but has very little (if any) ‘practical or hands-on’ practice. There was no clinical bedside teaching until well into the 17th and 18th Centuries. As a Christian country, the main purpose of education back then was to train for service in the Church. It was much later on that there was a secular education for medicine. Strange how medicine and astrology were ‘intertwined’ in such a Christian country. The medical student was taught the therapeutic virtues of herbs and also to pluck them ‘under the right aspects’ (under a full moon, for example), being well aware of the influences of the planets and stars upon the bodies and labours of a man.

King Henry VIII, himself a student of medicine, established at the universities of Merton and St. John’s Colleges, the “Regius Chairs.” The Church still held control of all knowledge at this time though. In 1540, the union of the ‘Fellowship of Surgeons’ with the ‘Barbers’’ Company became the “United Company of Barber-Surgeons”, and so now a ‘surgeon’ had to have certain qualifications before attending to patients. One of the most practical ways of teaching anatomy then was the dissection of the cadaver (dead body) under the direction of the Reader (Teacher). I know they had to learn but this inspires me personally with no confidence at all with the doctors in these centuries! Medical practice had hardly moved from the Middle Ages.

Moving into the Victorian and Edwardian Eras, medical practices eventually started to change if very slowly. They had a clear understanding of anatomy --- but this was still only the experts --- the normal people had very little knowledge of the location and role of the internal organs (unlike today, when basic anatomy is taught to children in the senior schools in Biology class). It was gradually recognized that women were built differently to men and not “smaller versions of men, turned inside out.” Biochemistry and endocrinology were just in their infant stages. Intellectual study was said to ‘damage’ a woman’s reproductive health and the prescription for many ailments was --- rest. Now doctors were beginning to see the connection between bad-water and bad-air (or smells) and disease. However, they still hadn’t got it right as it was thought that Cholera was caused by putrid food, cold fruits such as cucumbers and melons, and by passionate fear or rage.

The Victorians treatments relied heavily on a change of air, which is why a trip to the coast was always recommended, but the doctors were still ‘bleeding by cup or leech’ in order to clear impurities within the body (a practice used in the Middle Ages). Also, prayer was still being ‘prescribed’ instead of medication. The fogs of the day, called pea-soupers, cause respiratory problems. Death rates for men were aggravated by occupational injury and toxic substances. For women, it was childbirth and violence.

The Victorian passion for “Taxonomy” now lead to a greater understanding between pollution and disease, and this lead to the appropriate environmental health changes. The connection between contaminated water and Cholera was finally discovered and now sewage systems and the removal of rubbish was set up. One major improvement was “improved housing” thus reducing overcrowding, reducing the risk of infections. The indoor toilet slowly replaced the outdoor privy (or water-closet). There was a new emphasis on rigorous hygiene and fresh air, and cleanliness (cleaning toilet seats and shared utensils, for example).

It was during this century that new inventions started to ‘help’ the medical profession. For example, the ‘Kymograph’ measured blood pressure and muscular contraction. Improved microscopes started to reveal micro-organisms. The ‘Stethoscope’ aided in the diagnosis of respiratory and cardiac disorders, and this new invention became the symbolic icon of the medical profession. The invention of anaesthesia led to advancement within surgery. Ether and Chloroform now came to the fore, especially when Queen Victoria used Chloroform when giving birth to her 8th child (1853). As well as anaesthesia, surgeons now had specialized surgical instruments and with this, came better techniques. These surgeons, though, still needed to learn about cleaning these surgical instruments. Carbolic acid (Phenol) was first used in 1869, thus starting the practice of sterilization of whole surgical theatres, as well as the instruments used. One successful operation was the appendicitis operation of King Edward VII, and now the way ahead was clear for the 20th Century Era of ‘heroic surgery.’ In 1895, the “X-Ray” was invented.

The British Medical Association was established in 1856, and from 1858, the General Medical Council (GMC) controlled entry into the medical profession through central registration. Medicine was still dominated by men, for example, in 1901, there were 22,698 physicians and surgeons (in England) with 212 being women. The number of dentists rose to 5,309 in the same year with 140 being women. It was in this century that many of the major hospitals (we have today) were built. The medical practices surrounding childbirth were improving but too slowly, and the high maternal mortality rate was a concern, even back then. Roughly one quarter of all children died in the first year of their lives.

The death rates started to fall in 1901 when public hygiene and a better ‘diet’ approached the common classes, thanks to an increase in wages. In 1889, aspirin was ‘invented’ and it replaced the traditional opiate pain-killers that had been used for years. Although there were ‘medicines’, most of these were not effective at all and so many conditions or ailments remained chronic and/or incurable. As only the wealthy could really afford a ‘qualified’ doctor, shamefully, many fraudsters took advantage of the poorer-classes, offering ‘useless’ medicines just to make a quick penny or two. These ‘alternative’ therapies were just as useless, some even being dangerous (“Galvanism” or electric therapy coming to mind, especially if in untrained hands).

“Psychiatry” was first established in 1846, and the term has been used to ‘denote the medical treatment of disabling mental conditions.’ A mental problem was thought to be hereditary back then. Those with mental problems were sent into the mental asylums which, by today’s standards, were cruel in their treatment of these sick patients. What they considered was the ‘modern’ way of treating someone with a mental problem, today we find ‘barbaric’ and backwards. The patients were “controlled” instead of cured, and solitary confinement and straight jackets were the norm. Overtime, however, doctors and scientists began to understand the workings of the mind, the brain and the nervous system. The progress was slow but sure! It was not until 1833 that the Madhouse Amendment Act came in which was responsible for the way patients were treated, and also the 1834 Poor Law had the same effect.

Thankfully, medicine and the study of human anatomy has improved to the Medical Practices that we have access to today. More women are living through childbirth, more children are living past their 5th birthday, and lives are being saved with open heart surgery and chemotherapy (to mention just 2 treatments). Medicine and research is improving all of the time. Even my life had been saved by modern practice! The surgeon operated, quickly, and I was put into Intensive Care for 7 days, an experience I shall never forget but one that saved my life and that I am eternally grateful for. If it had happened (say) 30 years ago, I may not have survived.

So rather than grumbling about waiting times, just be grateful to have been born in this century --- our chances of surviving as the human race have improved!

(My research comes from: Wikipedia / Medical News Today / Medical Education in the Tudor Period / the Victoria and Albert Museum)