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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

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Topics
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
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



Humoralism
Humoralism

Four humors:

  • Black bile

  • Yellow or red bile

  • Blood

  • Phlegm

  • An imbalance caused sickness; the environment could affect it


  • Sickness as invasion
    Sickness as Invasion

    • Pollution of the body

    • Immorality and vice

    • To “cure”:

      • Prayer, penance, exclusion


    Medicine and the body
    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
    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
    Infant mortality, pre-1750

    Michael W. Flinn, The European Demographic System, 1500-1820. Brighton, 1981), 16-17. Cited in Lindemann.


    Survival rates pre 1750
    Survival rates, pre-1750

    Michael W. Flinn, The European Demographic System, 1500-1820.

    Brighton, 1981), 16-17. Cited in Lindemann.


    Childhood illnesses
    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
    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
    Views of disease:

    • Survival of childhood made one hardy and resistant

    • Religious views of pain, illness, deformity

    • People knew life was fragile



    Disease and epidemics
    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
    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
    Medical Education

    • Learned Medicine

    • Medical universities

    • Clinics and clinical instruction

    • Medical students

    • Training surgeons

    • Midwifery and man-midwifery


    Context galenic medicine
    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
    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
    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 medicine
    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
    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
    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
    New Anatomical Studies Annibal Barlet,

    • 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 ( Annibal Barlet, 1514-1564)


    Andreas vesalius de humani corporis fabrica libri septem 1543
    Andreas Vesalius, Annibal Barlet, De Humani Corporis Fabrica Libri Septem, 1543


    M r columbus de re anatomica venice 1559 wellcome trust
    M. R. Columbus, Annibal Barlet, De re anatomica, Venice, 1559. Wellcome Trust


    Medical education1
    Medical Education Annibal Barlet,

    • 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
    Medical Universities Annibal Barlet,

    • 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
    Basis of education Annibal Barlet,

    • 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
    Renaissance Medical Education Annibal Barlet,

    • 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
    Clinical Education Annibal Barlet,

    • 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
    Private Medical Education Annibal Barlet,

    • 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
    Medical Students Annibal Barlet,

    • 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 and their training Annibal Barlet,

    • 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
    Surgeons and guilds Annibal Barlet,

    • 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
    Surgical treatments Annibal Barlet,

    • 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 surgery
    Rise in surgery Annibal Barlet,

    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


    Hieronymus Brunschwig, Annibal Barlet, 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
    Leg surgery. Annibal Barlet, Buch der Cirurgia Hantwirckung der Wundartzny, Hieronymus Brunschwig, 1497. Major, 434


    First illustration of amputation feldtbuch der wundartzney hans von gerssdorff 1517
    First illustration of amputation. Annibal Barlet, Feldtbuch der Wundartzney, Hans von Gerssdorff, 1517.


    Military surgery removing an arrow possibly from feldtbuch der wundartzney hans von gerssdorff 1517
    Military surgery: removing an arrow. Annibal Barlet, Possibly from Feldtbuch der Wundartzney, Hans von Gerssdorff, 1517


    Injuries soldiers could suffer on the battlefield wundenmann aus eyn gut well artzney ca 1525
    Injuries soldiers could suffer on the battlefield. Annibal Barlet, "Wundenmann aus Eyn gut [well] artzney" ca. 1525


    Brain surgery
    Brain Surgery Annibal Barlet,

    Buch der Cirurgia Hantwirckung der Wundartzny, Hieronymus Brunschwig, 1525


    Reduction of dislocated arm
    Reduction of dislocated arm Annibal Barlet,

    Hans von Gersdorf, Feldbuch der Wundartzney, Strassburg, 1530. Wellcome Trust Medical Photographic Library


    Surgery on a stomach wound
    Surgery on a Stomach Wound Annibal Barlet,

    Hans von Gersdorf, Feldbuch der Wundartzney, Strassburg, 1540. Wellcome Trust Medical Photographic Library


    Surgical instruments
    Surgical Instruments Annibal Barlet,

    Hans von Gersdorf, Feldbuch der Wundartzney, Strassburg, 1540. Wellcome Trust Medical Photographic Library


    Cataract surgery georg bartisch das ist augendienst 1583 major 441 42
    Cataract Surgery. Annibal Barlet, Georg Bartisch, das ist Augendienst, 1583. Major, 441-42


    M r columbus de re anatomica venice 1559 wellcome trust1
    M. R. Columbus, Annibal Barlet, De re anatomica, Venice, 1559. Wellcome Trust


    From paracelsus opus chyrurgicum und artzney buch franckfurt am mayn 1565
    From Paracelsus, Annibal Barlet, Opus chyrurgicum ... und Artzney Buch (Franckfurt am Mayn, 1565)


    Midwifery
    Midwifery Annibal Barlet,

    • 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
    Midwife Aiding at a Birth. Annibal Barlet, 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
    Obstretics Annibal Barlet,



    Herbolarium de virtutibus herbarum vincenza 1491 countway library of medicine harvard university
    Herbolarium de virtutibus herbarum Annibal Barlet, , Vincenza, 1491. Countway Library of Medicine, Harvard University


    Hortus sanitatis mainz 1491 countway library of medicine harvard university
    Hortus sanitatis, Mainz, 1491. Annibal Barlet, Countway Library of Medicine, Harvard University


    John de ketham fasciculus medicinae lier milan 1491 wellcome trust
    John de Ketham, Annibal Barlet, Fasciculus medicinae. Lier, Milan,1491. Wellcome Trust.


    Chiromantia venice 1493 countway library of medicine harvard
    Chiromantia Annibal Barlet, , Venice, 1493. Countway Library of Medicine, Harvard


    Joseph Grünpeck Annibal Barlet, ,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, Annibal Barlet, The vertuose boke of disyllacyon of the waters of all manere of herbes, London, 1527.


    Leonardo fuchs de historia stirpium commentarii 1542 poppy
    Leonardo Fuchs, Annibal Barlet, De historia stirpium commentarii, 1542. Poppy.


    Sources
    Sources Annibal Barlet,

    • 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.


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