Health, Wealth, and Welfare
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ted by way of the Arabs of North Africa and had reached Europe to-
gether with all the corruptions and additions they had picked up on the
way. For most people the practice of medicine meant following a small
number of traditional practices and remedies, which had been perpet-
uated through the Anglo-Saxon “leechdoms.”
2
Medieval people had no
concept of the nature of pathogens. They could not understand that
disease was the product of organisms that could be carried by vectors
from person to person, city to city. One might have expected that their
experience of the Great Plague and of the pragmatic value of quaran-
tine would have taught them something along these lines, but it did
not. As late as the mid-nineteenth century, the London cholera epi-
demic was overcome not by medical science, but by the chance associ-
ation of high mortality with the vicinity of a particular source of water.
The important breakthrough had to await the period of Pasteur
(1822–1895) and the discovery of pathogens. Medieval people talked
of malaria—“bad air,”—the exhalations of marshland, instead of realiz-
ing that the source of many of their ills lay in the stench of the cesspit
and the foul taste of polluted food, and they even supposed, with
Chaucer, that illnesses came from the heavenly bodies. There were doc-
tors whose fees were out of all proportion to the value of the services
they offered. In fact, any serious illness was likely to be fatal. Despite
the existence, at least during the late Middle Ages, of schools of med-
icine at Salerno, Montpellier, Paris, and elsewhere, medical knowledge
was compounded of superstition and folklore. Little was known of
human anatomy, and nothing of the nature of disease. The result was
a very high death rate generally, and highest in the cities. In no field
of medicine was this higher than in childbirth. For this there is no
quantitative evidence, but it is clear from documentary sources that the
death rate in childbirth was appallingly high and remained so into mod-
ern times. And in this, as in most other aspects of medicine, the rich
suffered as much as the poor.
The medieval town made as little provision for the education of its
citizens as it did for their health. Toward the end of the Middle Ages,
schools were established primarily for the teaching of “grammar,” which
meant, of course, Latin grammar. Only boys received this restricted edu-
cation, which they subsequently employed in the service of either the
merchant elite or the priesthood. Previously the only schools had been