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Sunday, December 27, 1998 Published at 05:56 GMT


A millennium of health improvement

Surgery took place in the Middle Ages

In the modern world there is a feeling that medical science can achieve anything. In the medieval world, there was a belief that only miracles were so powerful.

But although it was easy to die in the Middle Ages, the quality of life could be tolerable and some basic principles of health care were exactly the same as they are now.

The main hurdle to living a full and healthy life for men was making it through early childhood. For women, it was making it past childbearing age.

The average life expectancy for a male child born in the UK between 1276 and 1300 was 31.3 years. In 1998, it is 76.

However, by the time the 13th-Century boy had reached 20 he could hope to live to 45, and if he made it to 30 he had a good chance of making it into his fifties.

The main threats lay in early childhood, as the child's immune system was coming to terms with the threats posed by a disease-ridden environment.

Dirty living

Lack of sanitation meant germs that are now easily dealt with lived everywhere.

Thatch roofs were common in the countryside (where 85-90% of the population lived) and they attracted insects and rodents.

They carried bacteria, which they deposited either on the inhabitants or the food they would eat.

[ image: Most care consisted of attention and prayer]
Most care consisted of attention and prayer
There was no plumbing, so human waste was deposited outside - but not too far from - the house. Such material produced a breeding ground for the biggest killers of the period, cholera and typhoid, which were caused by unsanitary living conditions.

Meanwhile, typhus was spread by body lice living on infected people.

Additionally, young men were generally involved in manual labour and this led to an increased risk of death as a result of accidents at work.

This also meant that any man who reached the end of his working life (at around 40) would have a good chance of living to a decent age.

Bath time

Cleanliness was recognised as essential for good health, even if medieval people did not understand the scientific reasons for it.

It was noblemen who were most successful at keeping themselves clean, and they surrounded themselves with well-scrubbed servants.

Unsurprisingly, they were also more successful at making it into adulthood, although their pastimes of hunting and warfare helped reduce their life expectancy.

For women it was different. On average, they had a 10% better chance of surviving their first 10 years than men.

But between the ages of 14 and 40 - the years of having children - a woman's life expectancy was half that of a man's.

One reason offered for this is that having babies in the middle ages was more dangerous than going to war.

Antenatal care was certainly less efficient that it is now. Childbirth was less sanitary, and put the mother at a high risk of fatal infection.

Complications in the birth were more frequently fatal too, as, although midwives existed, they had little medical knowledge and their hygiene was poor.

Women did take the lead - again, by 10% - in life expectancy after the age of 40.


This trend has lasted to the present day, with the UK Office of National Statistics placing a woman's life expectancy at birth at 81 years, an advantage maintained at all ages now that childbirth is less risky.

There were other health threats too. One really could catch their death of cold in an environment where pneumonia was not uncommon and would have a permanent effect on one's quality of life.

Food storage was also primitive, with no refrigeration except in winter, and consumers showed a tolerance of slightly rancid goods because there was a general shortage of food.

Although there were no antibiotics or vaccines, there were numerous folk remedies.

Some of these were surprisingly effective, although there is nothing quite as effective as an antibiotic for tackling pneumonia, leprosy, or bubonic plague.

There were, however, formally trained, and self-trained medical "experts". The best of these could diagnose many conditions, and prescribe useful treatment in many cases.

Broken bones could be treated well and cuts were treated with some awareness of the threat of infection, albeit without a scientific understanding of why it would occur.

Surgery was not unheard of during the period.

Healthier life

Some diseases were less prevalent than they are now, however, and environmental health risks such as industrial pollution or passive smoking simply did not exist.

Cancer, for example, was largely a disease of the elderly, a small group in the early centuries of this millennium.

Most of the time care was delivered in the form of a good bedside manner and attention, while relatives of the afflicted prayed for miracles.

Scientists now know that at least one medieval remedy worked - chicken soup was then used to treat colds and fevers, and its chemical composition hot vapour have been found to speed recovery from colds.

Heart disease, now the biggest killer in the developed world, was unheard of.

Diseases' progress

But in the modern developing world, a major disease can have as devastating an effect as it did in medieval Britain.

[ image: Education is used to combat Aids in Uganda]
Education is used to combat Aids in Uganda
Tuberculosis, until recently forgotten in the UK and US, is the biggest killer in the rest of the world.

Another stark example of this is Aids. According to a recent study in the British Medical Journal, the disease is responsible for reducing the average life expectancy in parts of Uganda.

The study found that it had dropped from 58.3 years to 42.5 years as a result of the Aids epidemic in parts of Africa.

As we approach the last year of the present millennium, it is clear that medicine has advanced over a thousand years, but so disease has done a pretty good job of keeping up.

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