EPIDEMIOLOGY

4.2. MEDICINE IN THE MIDDLE AGES

THE PLAGUE IN CATALONIA

DESCRIPTION OF THE SYMPTOMS

HOW INFECTION OCCURS

INFECTION ROUTES

THE MICROSCOPE

MICROBES: BACTERIA

THE MARCH OF THE PLAGUE

MICROBIAL MEDICINE

THE SCIENTIFIC METHOD

FROM MAGIC TO MEDICINE

PENICILLIN AND ANTIBIOTICS


PEOPLE AND HEALTHCARE

Some people believed that diseases were a punishment from God. Others thought illnesses were linked to the positions of the stars and planets. Another theory was that there was an invisible poison in the air, which they called 'miasma'. Greek and Roman ideas about the four humours of the body still existed. Cities were dirty places to live in. There was no sewage system. Many people threw toilet waste into the street along with other rubbish. Rats were very common in cities and villages and helped to spread the Black Death.
People used pigs to eat what rubbish there was. Water was far from clean. The local river was polluted with toilet waste thrown into it from villages. As people used this as a source of water (they had no other choice) and because people knew little about health and hygiene, disease was common. Life for a poor person in a city or village was brutal and short. Peasants houses were filthy, usually no more than two rooms, with walls covered with a mixture of mud, straw and manure. People's diet was mainly pulses, nuts, black bread, and a few homegrown vegetables.

MEDIEVAL MEDICINE
Many people in the Middle Ages were less healthy than earlier people had been. The Romans had known that good buildings, clean water and sewers were important. But after the collapse of the Roman Empire many people lived in poorer and dirtier conditions. Many of the Romans' ideas about medicine were lost too.This was a time of little change in medicine. Medical knowledge and treatments stayed at the same low level for nearly a thousand years:
· Knowledge of public health was lost after the Roman Empire fell. Apart from the monasteries, people forgot about the importance of clean water.
· There was instability and war.
· Learning was lost as libraries and universities collapsed.
· Communications were poor so it was hard for doctors to learn or discuss ideas.
The Church controlled all learning. Trees, fruits, flowers, and vegetables were imported from one monastery in a country to another and the healing virtues of plants and minerals were studied and applied to alleviate the sufferings of the sick. As dissections were not allowed, knowledge of anatomy was poor.

MEDICAL SCIENCE AND HEALTHCARE
The most important sources of medical science were Arabic texts. The Islamic world was the centre of medical knowledge. Greek medical texts were translated into Arabic and augmented with pharmaceutical information. Arnau de Vilanova, the most outstanding physician of the age, translated medical texts from Arabic into Catalan.
In Medieval period the monasteries were practically the only place of
study and learning. The monks were the best-educated members of society - often they were the only educated members of society. Monasteries acted as
libraries for ancient manuscripts, and many monks were occupied with medicine
studies. Many theologians considered disease and injury to be the result of supernatural intervention and insisted that cures were only possible through prayer.
The monasteries were hospitals and places of refuge for the weak and homeless. The condition that qualified an individual for assistance was poverty, old age, or disease.

HOSPITALS AND PHYSICIANS IN CATALONIA
Until the fourteenth century, Catalan hospitals took care more than cured. As a consequence, most hospitals did not distinguish between the sick and the homeless. This sort of hospital sheltered pilgrims, invalids, and poors. Medical care was introduced into Catalan hospitals around the middle of the fourteenth century. Tortosa, asked in 1345 that the town physician, doctor, also visit and treat the sick in the municipal hospital. The Hospital of the Poor in Girona and the Hospital of Sant Feliu de Guixols had contracts with physicians. At Barcelona's Hospital of Sant Macià there were two physicians: Berenguer Banyeres and Francesc Pedralbes. In addition, the hospital had the services of certain apothecaries. King Pere ordered in 1336 to visit all who were ill in the city's hospitals free of charge. In the early fifteenth century, the new Hospital of Santa Creu in Barcelona had a barber and an apothecary. In some areas, Jews, who were less than one percent of the population, were almost fifty percent of the medical professionals. They were the doctors of kings and rich people.