Transcript Medicine in the Renaissance

Medicine in the Renaissance
Topics
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Contemporary view of health and illness
Illnesses, epidemics, infectious diseases
Learned Medicine
Knowledge of Anatomy and Physiology
Medical education
Surgeons and Surgery
Contemporary view of health and illness
• Hippocratic / Galenic tradition
– Hippocrates 450-370 BCE; Galen 129200 CE
– Tied disease to the environment
• Changes in air or water or planets
• Individual, not anatomical
Galen and
Hippocrates
Humoralism
Four humors:
– Black bile
– Yellow or red bile
– Blood
– Phlegm
• An imbalance caused sickness; the
environment could affect it
Sickness as Invasion
• Pollution of the body
• Immorality and vice
• To “cure”:
– Prayer, penance, exclusion
Medicine and the body
• Body not well understood
• Metaphorical terms:
– “Balance,” “sympathy,” “rhythms,”
– outward marks or signs of inner state
• Mental and physical intertwined
• Cures: transference, sympathy, purge
• Astrology
– stars influenced bodies and caused illness
– Treatment did not differ
Mortality
• Curve differs from that of today
• Infant mortality often quite high
• Most dangerous age of life:
– Infancy and early childhood
– 1 out of 4 or 5 did not survive 1st year
– 50% of mortality occurred before age 10
• Geographical and class divergence
• Debate over statistics for death in childbirth
Infant mortality, pre-1750
Area
England
France
Germany
Scandinavia
Spain
Switzerland
Number of deaths
/1000 live births
187
252
154
224
281
283
Michael W. Flinn, The European Demographic System, 1500-1820.
Brighton, 1981), 16-17. Cited in Lindemann.
Survival rates, pre-1750
Area
Number of survivors/1000 live births at age
England
1
799
5
668
10
624
15
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France
729
569
516
502
Switzerland
766
597
533
506
Michael W. Flinn, The European Demographic System, 1500-1820.
Brighton, 1981), 16-17. Cited in Lindemann.
Childhood illnesses
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Minor illnesses
Smallpox
Whooping cough
Infantile diarrheas
Tuberculosis
Plague
Typhus
Injuries that crippled or severely impaired
Worm infestations
Eye infections
Accidents
Social and environmental factors
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Not straightforward
Diet
Housing
Invasion and civil war; revolt
Some diseases attacked the strong (plague)
Lepers had a certain immunity to tuberculosis
Dyeing, bleaching, tanning, etching, hot
metals, fires of forges, butchers’ knives,
animals
Views of disease:
• Survival of childhood made one hardy and
resistant
• Religious views of pain, illness, deformity
• People knew life was fragile
Hans
Holbein the
Younger,
Dance of
Death.
Lyons, 1538
Disease and Epidemics
• Causes of disease:
– Macroparasites, such as worms:
– Microparasites: bacteria, protozoa, viruses
• Propagated by:
– Air, water, food
– Non-human vectors:
• Mosquitoes, ticks, fleas, lice
Most Important infectious
diseases in the period
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Plague: bacillus
Dysentery: bacillus
Influenza: virus
Smallpox: virus
Measles: virus
Tuberculosis: bacillus
Typhus: bacterium
Syphilis: bacterium
Malaria: protozoan parasites
Medical Education
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Learned Medicine
Medical universities
Clinics and clinical instruction
Medical students
Training surgeons
Midwifery and man-midwifery
Context: Galenic Medicine
• 13th c.: transmitted through Arabic sources
– significant parts missing
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An adaptable system
Not of Galen himself (129-200 CE)
Known by learned and lay people
Natural causes and non-supernatural cures
Rational and learned
Stressed philosophy
Renaissance Galenism
• Was rational and logical
• Reform took place over 3 centuries:
– 16th century anatomical revolution
– Paracelsus’ attack on medical ideas
– 17th century scientific revolution
– Rise of iatromechanical and iatrochemical
medicine
Paracelsus (1493/94-1541)
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Attacked established medical community
Rejected Galenic humoral theory
Relied on experience and practice
Traveled as an army surgeon
Father physician trained him in:
– botany, mineralogy, mining, natural philosophy
• Studied in Northern Italy?
– no record of A degree
• Turbulent life, followed a pattern
Paracelsus and medicine
Many kinds of patients from all strata of society
Firsts:
• Described miners’ diseases as occupational
• Distinguished congenital syphilis
• Noted mercury had to be in small doses to cure
syphilis
• Medical account of chorea (nervous disorder)
• Linked goiter and cretinism to thyroid
• Said disease has external cause (chemical or
mineral)
• Said disease was localized
• Sought proper chemical treatments
Paracelsus
“In this portrait Paracelsus
is shown surrounded by
various philosophical
symbols, including his
famous sword. From
Paracelsus: Etliche
Tractaten, zum ander Mal
in Truck auszgangen. Vom
Podagra und seinem
Speciebus (Coln, 1567).
Washington University
Collection.” Allen G.
Debus
E. Feynon, Der
Barmhertziger
Samariter
Renaissance instruction
in preparation of
chemicals. From
Annibal Barlet, Le Vray
et methodique cours de
Chymie (Paris, 1653)
New Anatomical Studies
• Galenic medicine still current
• Dissections of cadavers recent
• Vesalius (Belgian, humanistic, medical
studies in Paris and Padua)
• Published De Humani Corporis Fabrica
Libri Septem, 1543
• Woodcuts done by a student of Titian
• Corrected 200 errors of Galen
• Revolutionary
• Beginning of modern medicine
Andreas
Vesalius
(1514-1564)
Andreas
Vesalius, De
Humani
Corporis
Fabrica Libri
Septem, 1543
M. R.
Columbus, De
re anatomica,
Venice, 1559.
Wellcome Trust
Medical Education
• Universities trained physicians
• Lay physicians had no formal training
• Surgeons, midwives:
– Gained expertise through apprenticeships
• Some physicians were autodidacts
• Eventually there were hospitals and private
schools
Medical Universities
• 12th and 13th centuries in Italy, France,
England, Iberia,
• 14th century: Prague, Wittenberg
• In Italy:
– Salerno, Bologna, Padua, Ferrara
• In France:
– Paris, Montpellier
Basis of education
• Galen’s work fully known only in 15th century
• Pre-printing, MSS and texts were limited
• Professors lectured from the major texts:
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Articella: gathering of major Galenic and Hippocratic texts
Commentaries: on the major texts (by Professors)
Consilia: Case studies
All were studied in terms of solving differences of opinion
• Practice under supervision
• Attendance at public dissections
– first in Bologna, 1316
Renaissance Medical Education
• Drew on and changed Medieval education
• Relied on repetition of topics
• Post 15th-century:
– Medical texts for students
– Access to anatomical prints
– Physicians had libraries of medical texts
– By 18th century, more emphasis on bedside
practice
Clinical Education
• Arguments over the “birth of the clinic”
and rise of hospital medicine
• Protoclinics in the 16th and 17th centuries
• 1540s Padua
• 1630s Leiden
• 1720s Halle
• 1730s Strasbourg
• 1740s Edinburgh
• 1750s Vienna
Private Medical Education
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English universities: Oxford and Cambridge
Hospital at London
Modern medicine developed differently
Private lessons:
– In anatomy and dissection
– In medical education
• Private medical career more consumer
driven than on the continent
Medical Students
• Educational objectives:
– To produce physicians
– To maintain learnedness
– To separate them in social status from the
lower classes
• Recruited from families of:
– Bourgeoisie, lawyers, churchmen.
– Rarely from noble or poor families
– Poorer students usually had benefactors
Surgeons and their training
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Surgeons were not trained in universities
Trained as artisans within a guild system
Was there a strict hierarchy? In social status
Many physicians did not take courses but were
trained as apprentices
Some university-trained physicians never finished
their degrees
Surgical training could be as rigorous and complex
The difference: cultural status
Eventually, surgery and physic will merge
Surgeons and guilds
• Guilds as institutions
• Unique systems of education and
requirements for completion of training
• Licensed their candidates
• Sometimes included surgeons, barbersurgeons, and bathmasters: conflicts
• For a fee, the apprenticeship lasted 4 years
• Then, a longer Journeyman period
• Return home to be tested and licensed
• Drawn from families of surgeons, artisans,
pastors, apothecaries
• Not from prosperous families or poor families
Surgical treatments
• From 15th c: move to more active surgery
• Military revolution demanded new medical
techniques
• Ambroise Paré (1510-90).
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Apprenticed as a barber-surgeon
Army surgeon in Habsburg-Valois conflicts
Wrote on treatment of gunshot wounds
Wrote on vascular ligature
Wrote on how to correct breach position in childbirth
1564: Book on general surgery
Rise in surgery
Military surgery had civilian applications
• 1549-99: Skin grafting introduced –
Branca family secret
• 1620s: Forceps – Chamberlen family
secret
• mid 16th c: lithotomy, Colot family secret
• 16th c: Cataract surgery
• 18th c: surgery separated from barbersurgeons
Hieronymus
Brunschwig,
Das Buch der
Cirurgia.
Strassburg,
1497. Countway
Library of Medicine,
Harvard University
Leg surgery.
Buch der
Cirurgia
Hantwirckung
der Wundartzny,
Hieronymus
Brunschwig,
1497. Major,
434
First illustration of
amputation.
Feldtbuch der
Wundartzney, Hans
von Gerssdorff,
1517.
Military surgery:
removing an
arrow.
Possibly from
Feldtbuch der
Wundartzney,
Hans von
Gerssdorff, 1517
Injuries soldiers
could suffer on
the battlefield.
"Wundenmann aus
Eyn gut [well]
artzney" ca. 1525
Brain Surgery
Buch der Cirurgia Hantwirckung der Wundartzny, Hieronymus
Brunschwig, 1525
Reduction of dislocated arm
Hans von Gersdorf, Feldbuch der Wundartzney, Strassburg,
1530. Wellcome Trust Medical Photographic Library
Surgery on a Stomach Wound
Hans von Gersdorf, Feldbuch der Wundartzney, Strassburg,
1540. Wellcome Trust Medical Photographic Library
Surgical
Instruments
Hans von Gersdorf,
Feldbuch der
Wundartzney,
Strassburg, 1540.
Wellcome Trust
Medical
Photographic
Library
Cataract
Surgery.
Georg Bartisch,
das ist
Augendienst,
1583. Major, 44142
M. R.
Columbus, De
re anatomica,
Venice, 1559.
Wellcome Trust
From Paracelsus, Opus chyrurgicum ... und
Artzney Buch (Franckfurt am Mayn, 1565)
Midwifery
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Midwives delivered most babies: 20th c.
Spprentice system
Experience desirable; midwife families
In early 16th century,
– some had to attend public dissections
– or be instructed by physicians or surgeons
• Some produced manuals of instruction
• Some cities held courses for men and
women midwives; men after 1700
• Surgeons often helped with difficult births
Midwife
Aiding at a
Birth.
Wellcome Trust
Medical
Photographic
Collection
A seated woman giving birth aided by a midwife and two
other attendants, in the background two men are looking
at the stars and plotting a horoscope. Woodcut, 1583[?].
Obstretics
Early Printed Medical Works
Herbolarium
de virtutibus
herbarum,
Vincenza,
1491. Countway
Library of Medicine,
Harvard University
Hortus
sanitatis,
Mainz, 1491.
Countway Library of Medicine,
Harvard University
John de
Ketham,
Fasciculus
medicinae.
Lier,
Milan,1491.
Wellcome Trust.
Chiromantia,
Venice,
1493.
Countway Library of
Medicine, Harvard
Joseph
Grünpeck,
Ein hubshcer Tractat
von dem Ursprung
des Bösen Franzos
(A fine treatise on
the Origin of the
French Evil
[syphilis]), Nuremburg,
Caspar Hochfeder, c.
1497.
Countway Library of
Medicine, Harvard Univ.
Jerome of
Brunswick, The
vertuose boke of
disyllacyon of the
waters of all manere
of herbes, London,
1527.
Leonardo
Fuchs, De
historia stirpium
commentarii,
1542. Poppy.
Sources
• Mary Lindemann, Medicine and Society in Early
Modern Europe (Cambridge: Cambridge University
Press, 1999). Some text slides
• Nancy G. Siraisi, Medieval and Early Renaissance
Medicine: An Introduction to Knowledge and Practice
(Chicago: University of Chicago Press, 1990).
Summary of text, images
• Mario Biagioli, Harvard University, History of Science
161: The Scientific Revolution. Notes on Paracelsus
• National Library of Medicine: Exhibit on Paracelsus:
Five Hundred Years.
• From Homer to Vesalius: Exhibit at Univ. of Virginia
Medical School. Images.
• University of Kansas Medical School. Ralph Major’s
photographs.
• Wellcome Trust Medical Library. Images.