Medicine in the Renaissance

1
Medicine in the Renaissance
2
Topics

• Contemporary view of health and illness
• Illnesses, epidemics, infectious diseases
• Learned Medicine
• Knowledge of Anatomy and Physiology
• Medical education
• Surgeons and Surgery

3
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

4
Galen and Hippocrates
5
Humoralism

• Four humors
• Black bile
• Yellow or red bile
• Blood
• Phlegm
• An imbalance caused sickness the environment
  could affect it

6
Sickness as Invasion

• Pollution of the body
• Immorality and vice
• To cure
• Prayer, penance, exclusion

7
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

8
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

9
Infant mortality, pre-1750
Area Number of deaths /1000 live births
England 187
France 252
Germany 154
Scandinavia 224
Spain 281
Switzerland 283
Michael W. Flinn, The European Demographic
System, 1500-1820. Brighton, 1981), 16-17. Cited
in Lindemann.
10
Survival rates, pre-1750
Area Number of survivors/1000 live births at age Number of survivors/1000 live births at age Number of survivors/1000 live births at age Number of survivors/1000 live births at age
Area 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.
11
Childhood illnesses

• Minor illnesses
• Smallpox
• Whooping cough
• Infantile diarrheas
• Tuberculosis
• Plague
• Typhus
• Injuries that crippled or severely impaired
• Worm infestations
• Eye infections
• Accidents

12
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

13
Views of disease

• Survival of childhood made one hardy and
  resistant
• Religious views of pain, illness, deformity
• People knew life was fragile

14
Hans Holbein the Younger, Dance of Death. Lyons,
1538
15
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

16
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

17
Medical Education

• Learned Medicine
• Medical universities
• Clinics and clinical instruction
• Medical students
• Training surgeons
• Midwifery and man-midwifery

18
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

19
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

20
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

21
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

22
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
23
E. Feynon, Der Barmhertziger Samariter
24
Renaissance instruction in preparation of
chemicals. From Annibal Barlet, Le Vray et
methodique cours de Chymie (Paris, 1653)
25
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

26
Andreas Vesalius (1514-1564)
27
Andreas Vesalius, De Humani Corporis Fabrica
Libri Septem, 1543
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
M. R. Columbus, De re anatomica, Venice, 1559.
Wellcome Trust
33
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

34
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

35
Basis of education

• Galens 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

36
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

37
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

38
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

39
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

40
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

41
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

42
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

43
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 barber-surgeons

44
Hieronymus Brunschwig, Das Buch der Cirurgia.
Strassburg, 1497. Countway Library of Medicine,
Harvard University
45
Leg surgery.Buch der Cirurgia Hantwirckung der
Wundartzny, Hieronymus Brunschwig, 1497. Major,
434
46
First illustration of amputation.Feldtbuch der
Wundartzney, Hans von Gerssdorff, 1517.
47
Military surgery removing an arrow.Possibly
from Feldtbuch der Wundartzney, Hans von
Gerssdorff, 1517
48
Injuries soldiers could suffer on the
battlefield."Wundenmann aus Eyn gut well
artzney" ca. 1525
49
Brain Surgery
Buch der Cirurgia Hantwirckung der Wundartzny,
Hieronymus Brunschwig, 1525
50
Reduction of dislocated arm
Hans von Gersdorf, Feldbuch der Wundartzney,
Strassburg, 1530. Wellcome Trust Medical
Photographic Library
51
Surgery on a Stomach Wound
Hans von Gersdorf, Feldbuch der Wundartzney,
Strassburg, 1540. Wellcome Trust Medical
Photographic Library
52
Surgical Instruments
Hans von Gersdorf, Feldbuch der Wundartzney,
Strassburg, 1540. Wellcome Trust Medical
Photographic Library
53
Cataract Surgery.Georg Bartisch, das ist
Augendienst, 1583. Major, 441-42
54
M. R. Columbus, De re anatomica, Venice, 1559.
Wellcome Trust
55
From Paracelsus, Opus chyrurgicum ... und Artzney
Buch (Franckfurt am Mayn, 1565)
56
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

57
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?.
58
Obstretics
59
Early Printed Medical Works
60
Herbolarium de virtutibus herbarum, Vincenza,
1491. Countway Library of Medicine, Harvard
University
61
Hortus sanitatis, Mainz, 1491. Countway Library
of Medicine, Harvard University
62
John de Ketham, Fasciculus medicinae. Lier,
Milan,1491. Wellcome Trust.
63
Chiromantia, Venice, 1493. Countway Library of
Medicine, Harvard
64
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.
65
 Jerome of Brunswick, The vertuose boke of
disyllacyon of the waters of all manere of
herbes, London, 1527.
66
Leonardo Fuchs, De historia stirpium commentarii,
1542. Poppy.
67
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
  Majors photographs.
• Wellcome Trust Medical Library. Images.