Health Care and Social Status in the Middle Ages - Research Paper Example

Health Care and Social Status in the Middle Ages HERE) HERE) Life in the Middle Ages during the time of feudalism brought about a rigid social structure that left a wide division between those who held money and land, and those that worked that same land for little to no pay. Those of wealth and privilege could look forward to a good diet and a life of ease, while those that were of poor status could do little more than their daily work while praying for good health. Widely differing options were available for health care, and each was dependent on the status of a person in the hierarchy of feudalism. Through the use of books and the internet, this paper examines not only feudalism in general and the social structure that depended upon it, but the various diseases and options that were available to the different classes based upon their status for medical treatment, alongside common problems that were widespread in the Middle Ages and gave no thought to the same status that those who lived during that era held dear. Introduction The fall of the Roman Empire ushered in a new way of life for most of Europe that would last from 500 A.D. to 1500 A.D., allowing most of the country to adopt a structured hierarchy which bound all peoples of a society together in a system that became known as feudalism. The feudal system was implemented across much of Europe, from Germany and France to England and Italy (Nelson, 1999). Most often represented as a pyramid, with the king or ruler at the top and the common serf or peasant at the bottom, feudalism represented a vast economic and social network of nobles and aristocracy ranking near the top of the pyramid and the majority of the common men and women, known as serfs or peasants, at the bottom (Abels). The common connector among the levels of social structure was, quite simply, the land parcels that were handed out by the king to his most trusted noblemen, who divided it into smaller parcels amongst their own followers as well as employing serfs, or peasants, for various functions (Nelson, 1999). This ensured a system of complete and total loyalty, as those up and down the levels of social strata in feudalism made promises to one another. Those of lower social class, such as serfs, promised to work hard and serve their lord in exchange for a small hut and food; those that were of aristocratic class promised to protect the serfs at all costs (Abels). With such promises in place, there was virtually no need for anyone to enforce feudalism, as everyone simply knew where they belonged and what their duties were to each other. Feudalism was not a new concept to Europe. The Roman historian Tacitus wrote that the Germanic peoples, long considered a race of warriors, practiced a way of life in which the warrior class left all land holdings to the care and trust of others, while using their time to defend their lands or make war on others (Stephenson, 1956). Companions also traveled with the warriors, and in return for their service, expected little more than food, water, and a share of any winnings that may come from victorious conflicts (Stephenson, 1956). Though the beginnings were humble, feudalism soon rose to be a standard way of life throughout Europe in the Middle Ages, complete with rigid, even unbreakable social structures that affected almost every aspect of life during that time. In many ways, feudalism was seen as a benefit to all. Regional landowners held the power to enforce any laws, as well as to settle disputes (Quigley, 2003). Those of lower class were given the benefit of protection by lords, as well as knights in the employ of landowners, and could run into the castles or manor houses if an invasion took place (Quigley, 2003). The disparities of feudalism, however, cannot be argued, particularly in the vast distinction from rich to poor. The rich, namely landowners and aristocracy, were catered to and could expect a life of health and privilege, while the poor serfs and commoners who constituted a majority of the population were lucky to live to the age of thirty, or even past childhood (Alchin, 2012). While the benefits of a feudal system for all involved cannot be argued, it also cannot be denied that the social structure created by the feudal system of the Middle Ages directly affected the overall health and wellbeing of its society, particularly in the ways in which medicine, healing, and health care was available to treat the sick and dying. Health Care and Social Status in the Middle Ages Division between wealthy and poor The divisions between the wealthy, or nobility, and those of commoner (serf) status were vast in many ways, but none as great as when it came to the health care that was available. There were physicians in the Middle Ages; they were trained, respected gentlemen that were given a level of respect almost equal to that of a religious figure (Singman, 1999). Most often found in the houses of nobility or traveling from manor to manor, most physicians spent their time with the wealthy aristocracy (Singman, 1999). A lord with more holdings than most could afford to even have a doctor as part of his regular household staff to attend to matters of health at his command (Quigley, 2003). Among the benefits of those with money, having a doctor in the household or nearby to be summoned instantly was something that was often taken for granted. Alongside being able to summon a doctor whenever necessary, those with money (nobility and landholders) looked forward to more benefits than others. While diet was limited to what could be produced and varied with the seasons, nobility could usually afford fresh meat at all times of the year alongside shellfish and other forms of protein, and ate bread made with refined flour (Singman, 1999). The biggest advantage that they held was that they never went without, unlike commoners, and could usually eat what they wanted, when they wanted, even if they were under threat (Singman, 1999). Also, they had limited means for better sanitation; unlike commoners, privies were installed in castles and manor houses that at least enabled waste to be left at a distance, and certainly no one of noble status would have had to touch or deal with such matters (Alchin, 2012). These factors, coupled with better living conditions, made the lives of the nobility far easier when it came to matters of health. For those without money, the services of a physician were nonexistent. They did have access to hospitals, mainly run by the clergy of the church, although they had little hope of regaining health there (Newman, 2001). Often required to share a bed with another sick person, hospitals often accommodated little more than fifty people (Newman, 2001). This was complicated by the fact that hospitals were few and far between, mostly used for those that fell ill on the road between towns and cities (Newman, 2001). Most serfs made do with herbal remedies given by local apothecaries or, in fact, their own households (Newman, 2001). Women, in particular, had to be knowledgeable about home-based healing remedies as well as childbirth, as part of the running of the household (Singman, 1999). Complicating these matters was the diet of a serf, which was rich in grain and lacking in fresh meat and vegetables, unless they raised these themselves with the permission of their lord (Alchin, 2012). Regardless of the methods available for healing, the serfs that made up the majority of the population in no way had access to the same medical treatment as those of nobility, mainly due to social status and land or money holdings. For those lacking money and status, beholden to a lord or landholder, the best treatment for illness was simply not to become sick. Population Increase = More Health Problems Though there was a rigid social structure in place during the Middle Ages due to feudalism, and the lives of many were filled with hardship, this did not prevent the population from increasing. Populations throughout Europe grew quite steadily in the Middle Ages, at least until the Black Death or bubonic plague (Newman, 2001). With this increase in population, however, came an increase in health problems, especially since life was not confined in any way to manors of the countryside, but also to cities such as London and Paris where, despite the rigid hierarchy of feudalism, populations continued to grow (Newman, 2001). Complicating matters was the lack of space, in that in the cities people lived far more closely together than in the countryside and thus quite innocently spread disease among themselves without even trying (Singman, 1999). Sanitation was a little-known concept in the Middle Ages. Hand-washing was, however, practiced regularly, though only with minimal soap and cold water, and then only in the houses of nobility, where hands were regularly washed before meals (Alchin, 2012). Common serfs had little to no defense against germs that were spread from hand-to-hand and person-to-person contact (Singman). Waste products, both human and animal, were left to fester in city streets or dumped in the castle moat (Alchin, 2012). The nobility did have some defense, as they employed a staff to keep their homes clean, and had the luxury of separate rooms for separate purposes, while serfs had but the room that they lived in, sometimes packing the family in as tightly as possible (Singman, 1999). Floors of both commoner and noble were covered in straw or “rushes”, which bred fleas and lice quite quickly (Alchin, 2012). Though bathing occasionally took place in simple wooden barrels, again, it was with cold water and a minimal amount of soap, which would not have helped most of the disease and pestilence of the Middle Ages (Alchin, 2012). Quite simply, between lack of hygiene and lack of sanitation, the germs of the Middle Ages had all but free reign on the entire population. Medicine in the Middle Ages Given the hygienic and sanitation standards of the time, it is not surprising that disease spread freely and unchecked throughout the population, differing little from nobility to common serf. Even those with doctors at their disposal, such as the aristocrats and wealthy landowners, were at a disadvantage due to the thoughts of the time. In many ways, physicians of the Middle Ages did the same thing that doctors of today do; however, they had little idea of how the body worked and could therefore not treat disease adequately (Quigley, 2003). The teachings of medicine, as well as the foundation, was from the Greeks as well as the Roman empire, and while in the latter period of the Middle Ages some advances in medicine were made, medical knowledge was largely at a standstill (Quigley, 2003). Despite being trained, most physicians relied on methods that today would be seen as holistic at best and brutal quackery at worst. A formidable adversary in health care during the Middle Ages was that of the Church, which ruled the country with an iron fist. Bishops often had places on the city council, and even the king subjected himself to the rule of the pope in the far-off Vatican (Singman). Illness was often seen as a punishment from God and something that should be cared for by prayer, or possibly a pilgrimage (Quigley, 2003). People were also encouraged to pray to a saint as a special messenger, to carry their message to God and ask for forgiveness for whatever sin they had committed to cause their illness (Quigley, 2003). Members of the clergy such as monks or nuns were responsible for running charity hospitals, and some monks and priests went so far as to attend medical training at university (Newman, 2001). This, however, put them in direct conflict with the teachings of the Church, who viewed the body as something not to be disturbed, and therefore actions such as surgery or bloodletting were forbidden (Newman, 2001). Even though the clergy took active roles in treating illnesses, sometimes more so than that of physicians, medical remedies largely consisted of herbal remedies with a healthy dose of prayer. Remedies for Disease in the Middle Ages All levels of social class in feudalism, from the king to the lowliest serf, relied on remedies for disease that were more herbal in nature than anything else. Antibiotic medicine were unheard of during the Middle Ages, and diagnostic tools such as X-rays were hundreds of years away from being used (Newman, 2001). Methods such as potions and herbs, in addition to other practices such as using leeches or “bloodletting”, the opening of a vein to allow blood to escape, were common and everyday remedies (Quigley, 2003). Dill, for example, was used to help digestion as well as keep away any evil spirits, while other herbs such as hyssop were used as laxatives and fennel as a smelling-salt to revive the faint (Quigley, 2003). Mint was by far the most popular, believed to cure over forty ailments from headaches to poor memory (Quigley, 2003). With a ready cache of herbs available, people of the Middle Ages, including physicians, honestly believed that they were doing what was necessary to cure the ailments of others. As stated previously, however, physicians were only available to the wealthy. Those that could not be seen by one made do with non-medical personnel. Apothecaries and surgeons, who were regarded as tradesmen rather than given the lofty status that physicians were, nevertheless served their purpose for those that were high within the social structure of feudalism (Singman). People such as serfs, at the bottom of the structure, made do with those known as barbers, who in addition to shaving and cutting hair could be counted upon to pull out a tooth or set a broken bone when necessary (Singman, 1999). For those that were the poorest, even apothecaries were out of reach, and local knowledge of herbs was then employed in the hope that the sick person did not swallow the wrong plant, leading to death (Singman, 1999). When all else failed, serfs could turn to the comfort of their Church, who employed plenty of priests and nuns that would doubtlessly pray for them and intercede with God to heal their illness (Quigley, 2003). Diagnosis methods were primitive as well, with even the best physicians not knowing, truly, how the body worked. The main theories used at the time of the Middle Ages were that of the body being made of quintessentially the same elements as the universe (Newman, 2001). This theory, called the humoral theory, essentially believed that if the elements of the body were in balance, then a person would be and remain healthy (Newman, 2001). Fluids that resided within the body were seen to correspond to these elements, with blood, phlegm, black bile and yellow bile constantly needing to be set back into balance and thus cause a person to regain their health (Newman, 2001). Any excess or lack of one of the bodily fluids was said to make a person ill, either with a short-term or long-term illness; for example, yellow bile was said to make a person irritable and prone to anger, though it would help them with their appetite, as they would not each much and thus remain thin (Newman, 2001). Treatments revolved around methods that were known and available at the time; in addition to herbal cures, people often underwent bloodletting, leeches, massages, hot baths, and rubbing themselves with strange oils (Alchin, 2012). When people were healthy, the humors were said to be in perfect balance, thus requiring no care whatsoever. Another method of diagnosis revolved heavily around astrology. For those schooled in the subject, it was easy to make the diagnosis that the stars were out of alignment, and thus that was why the patient was unhealthy (Newman, 2001). Often, conditions were blamed on the star patterns rather than focusing on the person themselves (Newman, 2001). Although useful in establishing some sort of order for otherwise chaotic lives in the Middle Ages, the charting of star patterns certainly had little effect on illness (Singman, 1999). It cannot be found surprising that people died regardless of their belief in the star patterns causing their illness, or even if their bodily fluids were brought back into balance, according to the humoral theory. Disease and Pestilence Without question, both the rich and the poor suffered from disease and pestilence in the Middle Ages. Viruses such as smallpox, typhoid fever, measles, and bubonic plague swept through all levels of the social structure without regard to whether a person was a member of nobility or a common serf (Alchin, 2012). Though these illnesses today would barely cause a person to miss a day of work, in the Middle Ages they were deadly and unwelcome. Even the daughter of the king was not immune to disease; Joan Plantagenet, daughter of King Edward III, left England to become married to King Pedro of Castille, but never made it farther than France, where she died of the disease (Alchin, 2012). Without question, the Plague that infected much of Europe was seen as the deadliest disease to ever ravage the country. The mortality rate was 30-40%, and people could be dead within hours of contracting the disease (Alchin, 2012). The Black Death, named for the buboes that appeared on the skin full of black, foul-smelling blood, was carried throughout Europe on trade ships that bore sick sailors and traders to various ports (Alchin, 2012). Often, by the time ships were turned away, it was too late, and a town was already infected (Alchin, 2012). No amount of prayer, however earnest by the priests of the church, could stop the disease from spreading unchecked (Alchin, 2012). As a result, the populations of various countries across Europe were decimated, and those that were left could only find solace in the fact that they had more to eat due to the decrease in population numbers (Alchin, 2012). However, the price was paid and the damage done, as people no longer trusted any kind of healing or medicine. The Black Death was not the only virus to visit Europe. Viruses such as dysentery caused by contaminated water, typhoid fever, and smallpox also made their way around the continent (Newman, 2001). Carried by fleas that were in turn carried by rats, viruses and disease had no trouble finding a home due to the poor sanitary conditions, especially in cities such as London, where 20,000 people died within two years due to the Black Death (Alchin, 2012). Still more died on a yearly basis due to regularly unsanitary conditions (Alchin, 2012). Overall, in times of sickness, it was far better to be rich than to be poor, though this was not always the case. Little to no protection was available against these diseases and viruses, particularly for the poor serf or commoner that lived in a city. Packed tightly together in the midst of animal waste and human waste/sewage, the very air that was breathed and water that was washed with was contaminated with filth and germs (Alchin, 2012). Given the close proximity of people to one another, especially in cities with high populations, it is not surprising that disease spread unchecked (Alchin, 2012). On manor farms and villages, though there was more space between people, the constant dealings with animal by-products and lack of clean water still had the same results of spreading disease, though possibly not as quickly (Singman, 1999). Though the nobility had slightly more protection than serfs against these viruses and diseases, given that they did not live in close proximity to one another, had better food than common serfs, and did not have a life of backbreaking work to wear them down, it did not always help even those with a physician in their household. There were no antibiotics available to treat the diseases adequately, and while herbal remedies made people comfortable, they surely could not always slow the progress of whatever virus happened to inhabit the body of a person (Singman 1999). For example, a treatment during the plague was to lance the boils before smearing them with butter, onion, and garlic poultices (Alchin, 2012). Other remedies such as rubbing dried toad or making a tincture of tea in which bark or roots were steeped were also available and used (Alchin, 2012). While at the time such treatments were thought to be the very best that medicine had to offer, knowledge today tells us that once a boil is lanced, the infection spreads more rapidly, not only to the sick but to the healthy as well due to exposure. Thus, while the aristocracy and those that had money may have had more options available to them for health care, they in no way had a better chance of surviving because of it. Disease and viruses killed equally, without regard to money or social status. Ironically, in many ways it could be said that the nobility would have suffered more rather than the serfs. By having access to medical care, nobility would have had more options for a physician to try on a fatal disease. Serfs would have died without treatment, but the end would have come quickly. Diseases such as the Black Death came, conquered, and left the dead behind silently and quickly, especially in the poorer ranks; however, nobility would have lingered due to the remedies prescribed by their physicians. It is possible that they may have been in considerably more pain as well, as leeches and bloodletting were applied in a final attempt to get rid of the disease. Therefore, while the nobility led a life of privilege with ready access to medical care, the poor serf should by no means be pitied, for while their deaths were often unavoidable due to lack of medical care, they also came at a quicker rate due to the same lack of options available. In the end, though hygiene was found to be the culprit of the many diseases and viruses that were afflicting people, it was too late for most of the population, as the Black Death and swept through indiscriminate of status or land holdings, and the dead could not be brought back to life, as even kings and the pope lacked the power to raise the dead. Conclusion The health care given to those in the rigid hierarchy of the feudal system varied widely on basis of social status and location. Those that were wealthy, such as nobles and lords, had access to trained physicians and doctors virtually whenever the need required, while those that were poor made do with self-diagnoses, untrained personnel, or herbal remedies concocted from woodland plants. If those methods failed, their faith lay with the holy people of their church, who would doubtlessly pray to saints that could (hopefully) heal them of their afflictions. Treatments that today are regarded as alternative were nothing more than commonplace to the lords, vassals, and even the serfs of feudalism. In most cases, however, medical treatments of the Middle Ages benefitted no one; plagues and disease swept through towns, cities, and the countryside in between largely due to poor sanitation and ignorance, unable to be eradicated due to lack of proper medicine. Populations were decimated and children died often before they reached maturity, or even before they grew out of diapers. Those that were left could not stop working long enough to attain treatment even if they did fall ill. While the rigid class system of feudalism today seems barbaric and unfair, and the medical treatments of the Middle Ages looked upon as painful and obsolete, it cannot be said that the overall system of medical care was radically different from the health care that exists today in the United States of America. While medical advances have been made to allow for comfort and sterility of treatment, the type of health care received still depends greatly on income and status. Those that can provide health care are still available to everyone, but the best doctors command the highest salaries, and thus are available only to those that can afford their fees. While it is true that health insurance now exists, unlike the Middle Ages, and can offset some of those fees, again, the best insurance is available only to those that can pay for it or have it provided by an employer. Looking closely, it is not hard to imagine large corporations as manors and fiefs, taking care of those within them from top to bottom, yet providing the best benefits (including health care) to those at the top, while those at the bottom struggle to pay the bill for even a simple visit to their family provider. Though the days of the simple serf dropping dead of bubonic plague are long past, and the power of prayer no longer regarded as the only means of healing, the world still has much to learn about abolishing the income-status relationship associated with health care. References Alchin, L. K. (2012, September 20). The middle ages . Retrieved from www.middle-ages.org.uk. Abels, R. (n.d.). Feudalism. Retrieved from http://www.usna.edu/Users/history/abels/hh315/Feudal.htm Nelson, L. K. (1999). Lectures for a medieval survey: The rise of feudalism. Retrieved from http://the-orb.net/textbooks/nelson/feudalism.html Newman, P. B. (2001). Daily life in the middle ages. Jefferson, NC: McFarland and Company. Quigley, M. (2003). Understanding people of the past: The middle ages. Chicago, IL: Reed-Elsiever, Inc. Singman, J. L. (1999). Daily life in medieval Europe. Westport, CT: Greenwood Press. Stephenson, C. (1956). Medieval feudalism. Ithaca, NY: Cornell University Press. Read More