Medieval to Renaissance Overview

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The Middle Ages

Regression and hindrance

Medicine regressed in the Middle Ages with the collapse of the Roman Empire. Tribes overran the western parts of the Empire; they destroyed buildings, health systems, and books, and had little to no education.

The Empire was replaced by lots of separate smaller kingdoms, and travel between these became dangerous. This reduced communication, and slowed down medical progress.

Leaders of these kingdoms believed it was more important to spend money on building up armies and defence, rather than medicine.

The Church was very powerful during this time, and banned any new ideas that challenged the Bible - they encouraged Galen's work, as Galen believed one god created the body. This stopped physicians making and sharing new discoveries. Dissection was banned by the Church until the 14th century, at which point lecturers would read from Galen's books to instruct a surgeon, when training students.

The Church also promoted belief in supernatural causes and treatments - people believed God, the devil, or the planets ruled their lives.

People believed in the Four Humours, so bloodletting continued. They also believed bad smells in the air were a cause of disease.

Treatments used were both natural (prayer, bleeding, herbs, honey) and supernatural (prayer, 'holy' remedies). Quack doctors would sell 'medicine' in the streets. Trephining was used as a 'cure' for epilepsy.

There were no public health systems. Towns did not have sewers, or water pipes, and people threw waste into the streets. Animals would also roam the streets. Houses were made of wood, mud, and dung. Bath houses were also brothels and restaurants.

Developments

Hospitals would take in the sick, but not people with diseases they knew were infectious (e.g. leprosy) - they also took in pregnant women, who would be cared for by midwives (which women had to go through training to become).

Frequent war also meant the skills of surgeons were in demand, and they were able to develop their knowledge. Wine was used as an antiseptic, and things like opium and hemlock were used as anaesthetics.

Monasteries introduced sewers and fresh water. They made bathing compulsory (but only 4 times a year), and no kitchens in monasteries would be close to towns.

Once STDs were realised to be infectious, checks were called on prostitutes.

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The Black Death

The epidemic began in China, then spread throughout India and Europe. It arrived in Britain in 1348. It was also known as the bubonic plague, or the pestilence.

It killed 30 - 50% of Britain's total populations. Rats and fleas spread the plague, but many theories were spread.

Guy de Chauliac was a French physician who believed that it was caused by blockages in the body, and the position of the planets (astrology).

In many countries, minorities were blamed (e.g. Germany believed Jews poisoned the water supplies, and had them burned).

John of Burgandy, a physician, believed those 'with evil humours' were killed by the plague; he had these ideas of humours from Galen.

Some believed it was caused by God, as a punishment for sins.

Some believed it was caused by bad smells in the air, which came from privy toilets, dead flesh, and water in ditches.

There were various treatments:

Flagellants walked through towns, whipping themselves; they believed God would not punish them, if they punished themselves.

Clinical observation was used as physicians would take the pulse of a victim, and examine the victim's urine.

Services were held daily, as ordered by the King. People would pray for forgiveness, and some made candles their own height and lit them as an offering to God.

John of Burgandy said to "avoid excess eating and drinking", "avoid baths which open the pores", "light fires in cold or raining weather" - he applied Galen's Theory of Opposites.

The King wrote to the Mayor of London to have the filth in the streets removed, as he believed bad smells infected the air.

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Christianity

Treatment of the sick

People went to monasteries to be treated.

Sick were healed through prayer.

Nuns fed and gave herbal remedies to the sick.

Mass was held several times a day.

Preserving knowledge

Monks copied out ancient books, such as those by Galen. However, they would have made mistakes as they had to copy and translate them by hand.

Galen's influence

Galen's books were used as the basis of medical education.

Christian Churches controlled universities, and believed that questioning Galen's work was equivalent to questioning them - people could be imprisoned or even killed for this.

Galen said that each part of the body was created by one god with a definite purpose; this fit the Church's belief.

Islam

Treatment of the sick

Arab hospitals were famous for the care they provided.

The first hospitals were founded in AD805, and by 1100 every large town had one.

These provided medical care, but also promoted prayer.

Preserving knowledge

Arab rulers believed education was important, and many Greek medical books were translated into Arabic by scholars.

Baghdad was the centre for collecting and translating medical books.

Without these translations and copies, many of these books would have been lost to European wars.

Galen's influence

Physicians wrote encyclopaedias which organised medical knowledge, including Galen's. These were later translated into Latin for European use.

Ibn Sina / Avicenna (980 - 1037) wrote the encyclopaedia 'The Canon' which was used to teach European physicians until the 1600s. He included his own methods, as well as those by Galen.

al-Razi (860 - 925) wrote over 200 books, and was influenced by 'the Ancients'.

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Renaissance

Dated from AD 1453, the Renaissance means the 'rebirth'. Both the arts and medical knowledge advanced.

Governments were strong and rich; with a booming economy, people were able to afford doctors.

Artists, particularly in Italy, revolutionised painting and began to study the body in more depth, which led to improved anatomical knowledge.

The invention of the printing press allowed for quick communication, and accurate copies of medical books.

The scientific method of conducting an experiment, collecting results, and coming to a conclusion, was introduced in universities. Experiments led to questioning of Ancient Greek and Roman ideas, and eventually proving them wrong.

The invention of new weapons meant soldiers got new wounds, and new treatments had to be developed.

However, many rejected these new developments, and doctors could still not develop new medicines as they did not have knowledge of germs.

Andreas Vesalius (1514 - 1564)

Vesalius was a Professor of Surgery in Italy, who revolutionised the study of anatomy. He criticised the traditional way of carrying out dissections in education; when giving his own lectures, he encouraged the students to touch and observe the body closely.

He studied the human body in depth, carrying out as many dissections as possible (in Padua, dissection was encouraged). As a student, he once stole the corpse of a criminal in the gallows to dissect. Through this, he discovered many of Galen's mistakes (e.g. Galen believed the human jaw had two bones, when it only has one). He also liked to compare Greek medical books with their Arabic translations, and wrote his thesis on al-Razi.

Vesalius wrote and published 'The Fabric of the Human Body' in 1543. It explained anatomy in depth, and featured realistic diagrams from the Italian artists of the time, whom were interested in dissection as it improved their own work. Accurate copies of his book were created and spread quickly throughout Europe, as the press print had been invented at this point.

During the 1550s, Vesalius left anatomical research and became physician to Emperor Charles V and his son.

William Harvey (1578 - 1657)

Harvey studied at Cambridge and Padua universities, and became doctor to King James I and King Charles I. He relied solely on experimentation, and liked to test his own belief in the likes of Galen through experimentation.

In 1616, he announced his discovery of the circulation of blood around the body. Blood did not flow through holes in walls of the heart, like Galen had believed, but was delivered by veins (deoxygenated) and carried to the rest of the body by the arteries (oxygenated).

In 1628, he published the 'Anatomical Account of the Motion of the Heart and Blood', which detailed scientific experiments which proved the circulation of the blood. It also explained that blood flowed in only one direction, and back flow was prevented by valves in the veins, and that Harvey believed the heart to be a muscular pump.

Harvey did not discover how the arteries and veins were connected, as capillaries are tiny and microscopes had not yet been invented. He also made mistakes regarding fertilisation, likely to not having access to microscopes.

Harvey's experiments included:

dissecting cold-blooded animals, as their hearts beat slowly, so he could clearly see what was going on.

dissecting human bodies to fully understand the heart.

measuring the blood moved in each heart beat, thus being able to work out how much blood is in the body.

Ambroise Paré (1510 - 1590)

Paré served as royal surgeon for a number of French kings. He initially apprenticed as a barber, and joined the army in 1536 - he spent the next 30 years serving as an army surgeon.

In 1536, he discovered that wounds healed better when treated with a 'healing digestive' of yolks, turpentine, and rose oil; he had run out of cauterising oil, and developed the concoction as an alternative. Paré also rejected cauterising oil to use after amputations, and instead tied off blood vessels using ligatures (silk threads) - this was less painful, but could cause infection and death, so were not readily adopted by other surgeons. In 1575, he wrote and published 'Apology and Treatise', which advocated change in the way wounds and amputations were treated.

Prior to Paré, boiling oil was poured onto bullet wounds as it was belied the bullet fragments were poisonous; hot iron was also placed onto amputations to stop the bleeding ('cauterising').

Paré also developed instruments and artificial limbs, as well as introducing new ideas in obstetrics.

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The Great Plague (1665 - 1666)

Very similar to the Black Death in the 1300s, and people thought the same things about its cause.

It was more effectively dealt with than the Black Death, because:

people infected with the Plague were kept in their houses, and had their doors marked with a red cross.

a constable was stationed outside the house of the infected, not letting anyone in or out.

the government insisted upon cleaning the streets, and encouraged people to clean their homes - this would attract fewer rats, although they did not know that was the cause.

bodies were buried during the night in mass graves, and no mourners were allowed to attend.

stray animals were killed.

surgeons were appointed to examine the dead.

Smallpox

Inoculation in Britain (1721)

In inoculation, the arm was cut, and a small amount of smallpox matter was put into the cut. This small dose protected them from a stronger form of disease, if they survived the initial infection. This method was brought to England when Lady Mary Wortley Montague observed it in Turkey, and had her children inoculated when she returned to England. She knew many doctors in England and shared the method with them. Upon seeing the success of the method in her children, the method was adopted throughout England. However, some died from this small dosage, and others became carriers of the disease.

Edward Jenner (1749 - 1823)

Jenner was a country doctor who noticed local milkmaids, who had been previously infected with cowpox, did not get infected with smallpox - he theorised that cowpox must protect against smallpox.

In 1796, he conducted an experiment on a young boy, James Phillip. He inserted pus from a cowpox pustule into an incision on the boy's arm. Phillip became immune to smallpox, and thus Jenner's theory was proved to be correct.

He submitted a paper to Royal Society in 1797, detailing the experiment - he was told his ideas were too revolutionary, and that he needed more proof. Jenner carried out the experiment on several more children, and in 1798, his results were finally published, and Jenner coined the term 'vaccine'.

In 1803, the method of vaccination was adopted in America. In 1853, it was made compulsory by the British government.

However, Jenner faced a lot of opposition:

Doctors charged a lot for inoculation, and stood to lose a lot of money with the introduction of the vaccine.

Some doctors were careless and accidentally infected patients with smallpox, rather than cowpox - so, some saw vaccinations as dangerous, as some people died as a result.

Jenner had no explanation as to why the vaccination worked, as there was no knowledge of pathogens, antibodies, or antigens, so many mocked him.

People thought it was unnatural to infect humans with an animal disease - it was seen as going against God.

Many were angry when the vaccine was made compulsory as this was against personal liberty.

Jenner is so important to the history of medicine because he was the first to make deliberate use of the knowledge that recovery from a mild disease could protect them against a more severe form. His vaccination made progress towards the eradication of smallpox (in 1980). This hugely influenced future physicians and encouraged others to discover ways to fight disease.