Medicine in the Renaissance. Topics Contemporary view of health and illness Illnesses, epidemics, infectious diseases Learned Medicine Knowledge of Anatomy.

Medicine in the Renaissance

Topics

• 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 129-

200 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 Number of deaths /1000 live births

England 187

France 252

Germany 154

Scandinavia 224

Spain 281

Switzerland 283Michael 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

1 5 10 15

England 799 668 624 --

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• 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• 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

• Plague: bacillus• Dysentery: bacillus• Influenza: virus• Smallpox: virus• Measles: virus• Tuberculosis: bacillus• Typhus: bacterium• Syphilis: bacterium• Malaria: protozoan parasites

Medical Education

• 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

• 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)

• 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 medicineMany kinds of patients from all strata of societyFirsts:• 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:

– 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

• 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• 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, barber-

surgeons, 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).

– 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 surgeryMilitary 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 barber-surgeons

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, 441-42

M. R. Columbus, De re anatomica, Venice, 1559. Wellcome Trust

From Paracelsus, Opus chyrurgicum ... und

Artzney Buch (Franckfurt am Mayn, 1565)

Midwifery• 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.