Treating disease: medieval medicine to anaesthetics
Treatment Through the Ages
Treating illness has always been one of humanity’s most urgent concerns. From the herbal remedies of medieval apothecaries to the carbolic spray of Victorian operating theatres, the history of treatment shows both how medical practice changed and how long some ideas persisted. Two of the most important revolutions in treatment — anaesthetics and antiseptic surgery — came within two decades of each other in the mid-nineteenth century, transforming surgery from a desperate last resort into a viable medical option.
Medieval Treatments: Herbal Medicine and the Humours
Medieval physicians treated illness according to the theory of the four humours. If a patient had a fever (too much blood, in this system), a physician might prescribe bloodletting to remove the excess. Bloodletting was performed using leeches or by cutting a vein with a lancet. Herbal medicine was widely used alongside these approaches: plants such as garlic, sage and thyme were prescribed for various conditions, and many were genuinely mildly effective. Women healers and apothecaries often had considerable herbal knowledge, passed down through generations.
Medieval hospitals, often run by the Church, provided rest and nursing care but had little ability to cure disease. Barber surgeons occupied a lower social rank than physicians and performed manual procedures including tooth extraction, wound-setting, the lancing of abscesses and amputation. They had no understanding of infection and operated without anaesthetics or antiseptics, making surgery extremely dangerous. Death from infection after surgery was very common.
Medieval treatments included bloodletting (rebalancing the humours), herbal medicines (varying effectiveness), and surgery by barber surgeons (no anaesthetics, no antiseptics — high death rate from infection). The Church’s influence reinforced the idea that prayer and spiritual care were as important as physical treatment.
Between 1500 and 1700, treatment changed slowly. The work of Andreas Vesalius (1543) and William Harvey (1628) improved understanding of the body’s structure and circulation, but these insights filtered down to treatment only gradually. Herbal remedies remained central. The first London Pharmacopoeia — a standardised list of medicines — was published in 1618, reflecting attempts to systematise herbal treatment. Pharmacopoeia publications helped unify practice, but they still contained many ineffective or harmful remedies.
James Simpson and Anaesthetics, 1847
Before 1847, surgery was performed on conscious patients who had to be physically held down. Speed was the surgeon’s most valued skill; the fastest could amputate a limb in under two minutes. The pain and shock of surgery killed many patients even before the risk of infection. This changed when James Simpson, a Scottish obstetrician working in Edinburgh, began experimenting with anaesthetics.
Simpson had already been using ether to reduce pain during childbirth, but found it unpleasant to administer. In November 1847, he and colleagues experimented with chloroform at a dinner party, inhaling it themselves. They awoke on the floor, having lost consciousness. Simpson immediately recognised its potential. He began using chloroform in his obstetric practice and published his findings that same year. The medical establishment initially resisted, partly on the grounds that pain in childbirth was natural and biblically ordained. Opposition faded significantly when Queen Victoria accepted chloroform during the birth of Prince Leopold in 1853, lending royal approval to the new technique.
James Simpson first used chloroform as an anaesthetic in November 1847. Queen Victoria accepted chloroform during childbirth in 1853, giving royal endorsement to anaesthetics. Anaesthetics allowed longer, more complex surgery but initially increased infection deaths because operations took longer.
Even with anaesthetics, death rates after surgery remained high. In the 1860s, roughly half of surgical patients at major hospitals died from post-operative infection, which surgeons called ‘ward fever’. The solution came from Joseph Lister, a Glasgow surgeon who had read Pasteur’s germ theory. Lister reasoned that if germs caused decay in organic matter, they might also cause infection in wounds. In 1865, he began spraying carbolic acid — a chemical already used to treat sewage — onto wounds and surgical instruments, and soaking dressings in it.
The results were dramatic. In a series of eleven compound fracture cases, Lister lost only two patients; previously the death rate from such injuries had been very high. He published his findings in The Lancet in 1867. Surgeons gradually adopted antiseptic technique, though some resisted for years. By the 1890s, aseptic surgery — preventing germs from being present at all, rather than killing them after entry — was replacing Lister’s antiseptic approach as the standard of care.
The Combined Impact of Anaesthetics and Antiseptics
The combination of anaesthetics (1847) and antiseptic surgery (1865) transformed medicine. Surgeons could now perform longer, more complex operations with patients unconscious and without the previously near-inevitable risk of fatal infection. Death rates from surgery fell sharply in hospitals that adopted both techniques. The shift was not instant: Lister’s methods were resisted in Britain longer than in parts of Continental Europe and the United States. But by 1900, the basic framework of modern surgery — anaesthetised, sterile — was established. Both changes were dependent on advances in knowledge: anaesthetics on chemistry, antiseptics on germ theory.