Medieval medicine

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A physician could have trained at Oxford or Cambridge. Wealthier students often went abroad to famous medical schools such as Montpellier, Paris or Salerno.

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Source A is useful to an historian studying the treatments used by medieval physicians because it shows that even the best-trained doctors used treatments with no scientific basis. Gaddesden recommends wrapping a smallpox patient in red cloth and hanging red cloth around the bed. This seems to rest on the idea that like attracts like, so that red would draw out the red spots. Physicians did not know what caused smallpox, so they relied on ideas like this alongside the treatments I know they took from the Four Humours, such as bleeding, purging and the Theory of Opposites.

The provenance increases its usefulness. Gaddesden had studied at Oxford and treated the royal family, so this is the medicine of the most educated physicians in England, not of quacks. His book was widely read and copied - Chaucer lists 'Gatesden' among the authorities his Doctor of Physic had read - so it shows the sort of treatments that physicians learned from books. It was written at the time, in about 1314.

However, the source has limitations. Gaddesden is describing his own success with a royal patient, which would build his reputation and attract rich patients, so he may exaggerate. He cannot show that the red cloth caused the prince's recovery; the prince may simply have survived the illness. The source also deals with one disease and one unusual treatment, and it tells us about the treatment of the very rich; most people relied on home remedies, wise women and barber-surgeons.

Overall, Source A is very useful for showing how far physicians' treatments were based on tradition and belief rather than evidence, but it is not reliable evidence that the treatment worked, and it shows only the medicine of the elite.

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One way in which ideas about the causes of illness were similar is that people in both centuries believed in supernatural causes. In the fourteenth century many people believed that illness was a punishment from God for sin, and when the Black Death arrived in 1348 it was explained as God's anger. Physicians also blamed the planets: the Paris medical faculty said the plague was caused by a conjunction of Saturn, Jupiter and Mars. In the seventeenth century these beliefs were still common. During the Great Plague of 1665 many people saw the disease as God's punishment for the sins of London, and there were days of prayer and fasting. A comet seen in the winter of 1664-65 was widely taken as a warning of disaster, and astrology was still used by many healers, such as Nicholas Culpeper.

A second similarity is that the main natural explanations were the same: the Four Humours and miasma. In both centuries physicians explained most illness as an imbalance of the four humours, as Hippocrates and Galen had taught, so they treated patients by bleeding and purging; in 1685 King Charles II was bled and purged by his physicians, just as a fourteenth-century physician would have done. In both centuries people also blamed miasma, bad air from rotting rubbish or the dead. In 1348 people carried sweet-smelling herbs to protect themselves, and in 1665 people carried posies and the authorities ordered fires to be lit in the streets of London to purify the air.

These ideas were similar because medical training in both centuries was still based on ancient texts and the Church was still influential, and because nobody could yet see germs. Neither century realised that plague was spread by fleas living on rats.

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Science and technology has been the main factor in the development of diagnosis, because almost every major change in how doctors identify illness has come from a new scientific instrument or test. However, technology did not develop on its own: individuals invented it, and government, especially through the NHS, made it available to everyone.

In the Middle Ages there was almost no technology for diagnosis, and this explains why it barely changed. A physician examined the patient's urine, comparing its colour, smell and sometimes taste with a urine chart, took the pulse and consulted star charts and the zodiac man. These methods were shaped by ideas and religion - the Four Humours of Hippocrates and Galen, and astrology - rather than by technology, and they stayed much the same for centuries. Chaucer's Doctor of Physic was 'grounded in astrology'.

From the nineteenth century, science and technology transformed diagnosis. In 1816 the French doctor Laennec invented the stethoscope, allowing doctors to listen to the heart and lungs. In 1867 Thomas Allbutt designed a short clinical thermometer that took a temperature in minutes. After Pasteur's germ theory and Koch's methods of staining bacteria, laboratory tests could identify the microbe causing a disease. In 1895 Röntgen discovered X-rays, and within months they were being used in British hospitals to find broken bones and bullets. In the twentieth century came blood tests, ECGs, ultrasound, developed by Ian Donald in Glasgow in the 1950s, and the CT scanner, invented by Godfrey Hounsfield, which scanned its first patient in London in 1971. Since the discovery of DNA in 1953 and the completion of the Human Genome Project in 2003, genetic tests can show whether a person is at risk of inherited illnesses.

Other factors were also important. Individuals such as Laennec, Röntgen and Hounsfield invented these technologies, so the role of the individual was closely linked to science. Chance played a part too: Röntgen discovered X-rays by accident while experimenting with cathode rays. War helped to spread new technology: in the First World War mobile X-ray units were used to find shrapnel in wounded soldiers.

Government has been vital in making diagnosis available. Before 1948 many people could not afford to see a doctor, let alone have an X-ray. The NHS made diagnosis free for everyone, and government introduced national breast and cervical screening programmes in 1988 to diagnose cancer early. Expensive machines such as CT and MRI scanners could only be bought by hospitals because of government funding.

In conclusion, science and technology has been the main factor in the development of diagnosis since c1000. In the Middle Ages, when there was no technology, diagnosis was shaped by ideas about the humours and astrology and hardly changed; once science and technology developed in the nineteenth and twentieth centuries, diagnosis was transformed. Individuals, chance and war contributed to particular inventions, and government made them available to all, but it was new technology that made accurate diagnosis possible.