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Medicine in the Renaissance

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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Medicine in the Renaissance

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

  10. Survival rates, pre-1750 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. M. R. Columbus, De re anatomica, Venice, 1559. Wellcome Trust

  29. 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

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

  40. Hieronymus Brunschwig, Das Buch der Cirurgia. Strassburg, 1497.Countway Library of Medicine, Harvard University

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

  42. First illustration of amputation.Feldtbuch der Wundartzney, Hans von Gerssdorff, 1517.

  43. Military surgery: removing an arrow.Possibly from Feldtbuch der Wundartzney, Hans von Gerssdorff, 1517

  44. Injuries soldiers could suffer on the battlefield."Wundenmann aus Eyn gut [well] artzney" ca. 1525

  45. Brain Surgery Buch der Cirurgia Hantwirckung der Wundartzny, Hieronymus Brunschwig, 1525

  46. Reduction of dislocated arm Hans von Gersdorf, Feldbuch der Wundartzney, Strassburg, 1530. Wellcome Trust Medical Photographic Library

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