Medicine – Part Seven

The Medical Renaissance

As we saw previously the foundations for the Renaissance were laid during the Middle Ages. The Renaissance was a process, not an event, so it is hard to pin down exactly when it started. Some areas of Europe experienced it at different times and at different rates. Universities had been set up, some with the assistance and patronage of the church. Hospital systems were in evidence. The Crusades had reconnected the Christian East and West. Europeans once again gained access to ancient medical works, and translations of Islamic texts.

Jonathon Davies, Going Postal
Leonardo da Vinci, Studies of Embryos

During this period there was new interest in Ancient writers. Across many fields there was renewed interest in academic and practical learning and the sciences. There were a several individuals who delved in to numerous fields, from science, art, medicine, etc and became known as a Renaissance Man. One such example is Leonardo da Vinci. There was an improvement in and general spread of the printing press. Printing books meant ideas spread quickly and widely.

At the same time literacy was increasing and there were more schools. People had grown wealthier and spent more on luxuries and education. People had time and money to devote to the arts and learning. Skilful artists were employed to draw highly accurate pictures of the human body. While this was happening, old ideas such as Galen and the movement of the planets, was challenged. People tested out their new ideas and theories. As a result, some individuals made significant discoveries. Technology in general advanced, with new and better watches, clocks, pumps, instruments, etc. There were again numerous wars, which gave physicians practice. Dissection started to be allowed around the 15th Century in certain parts of Europe, such as the Italian city states. Doctors could perform autopsies to study the cause of death. This allowed greater knowledge of anatomy, which could be recorded by skilled artists, which could be disseminated by printing presses, which were then read widely.  Many of these factors are interlinked and combined to help boost progress in medicine.

Andreas Vesalius (31 December 1514 – 15 October 1564) was an anatomist, physician, and author of one of the most influential books on human anatomy, De humani corporis fabrica (On the Fabric of the Human Body). Vesalius is often referred to as the founder of modern human anatomy.“-Infogalactic

Andreas Vesalius was one noted individual. Born in Brussels, he studied at the Universities of Leuven, Paris and Padua (amazing what existed before the EU). Importantly, Vesalius carried out hands on dissections. He used this as a teaching tool at Padua. This is in contrast to past practice, which had relied on reading Galen. He had an artist, Johan van Calcar, illustrate his book “Tabulae Sex.” He started to challenge the works of Galen, after he found Galen had dissected animals such as pigs instead of humans. At the time this was akin to heresy.

One example of challenging Galen was the heart. Galen suggested that the lungs and brain were fed by the left ventricle and the right ventricle fed the other organs. Galen said there were holes between the two. Vesalius said that he could find no trace of these. He also showed the lower jaw bone to be one piece and not two. He later helped publish “De humani corpus fabrica.”  What was important about this was the quality of the anatomical pictures and that Vesalius corrected some of Galen’s mistakes. The work was a huge success. However, some errors still persisted, such as that a different type of blood went through veins as opposed to arteries.

Jonathon Davies, Going Postal
Vesalius, De humani corporis fabrica

Later Vesalius was invited to the court of the Emperor Charles V. He took up this position, where he encountered opposition to his findings and his methods. Other physicians still clung to the works of Galen with semi-religious reverence. They asked the Emperor to look in to his works, with particular reference to the religious implications of his methods e.g. dissections.

Jonathon Davies, Going Postal
Andreas Vesalius (1514–1564)

Vesalius made a numerous other discoveries. He made progress on the skeletal system, showing men had the same number of ribs as women. He was able to chart the make-up of the muscles in the body, as shown by the impressive illustrations in his books. He believed the brain was the centre of the mind and emotions, rather than the heart, which was an old Greek notion. He identified two chambers in the heart, and that taught his students to challenge their own findings, as well as his. He also favoured dissections of animals alongside humans to demonstrate the differences and point out Galen’s errors.

William Harvey (1 April 1578 – 3 June 1657) was an English physician who made seminal contributions in anatomy and physiology. He was the first known to describe completely and in detail the systemic circulation and properties of blood being pumped to the brain and body by the heart, though earlier writers, such as Miguel Servet (aka Michael Servetus, Michel de Villeneuve) in: ‘Restitutio Christianismi’, Paris, 1546, and Jacques Dubois, had provided precursors of the theory. After his death the William Harvey Hospital was constructed in the town of Ashford, several miles from his birthplace of Folkestone.“-Infogalactic

William Harvey also attended the University of Padua. He later returned to England and studied at Cambridge, and then lectured extensively on anatomy. He then went on to be a physician to Charles I and James I. Harvey made progress in circulation. He established that blood flow was continuous and only in one direction. He showed that the lungs were where arterial blood was transformed from venous, a clear break from Galen who believed the liver was the centre of circulation. Harvey explained how he believed the heart was a pump and backed this up with experiments and detailed writings on his findings.

Jonathon Davies, Going Postal
William Harvey (1578–1657)

In 1628 Harvey published “Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus.” Here he writes “…in embryos, whilst the lungs are in a state of inaction, performing no function, subject to no movement any more than if they had not been present, Nature uses the two ventricles of the heart as if they formed but one for the transmission of the blood.” Galen believed that blood passed between the ventricles by means of invisible pores. According to Galen’s views, the venous system was quite separate from the arterial system, except when they came in contact through the unseen pores. Harvey’s discoveries inevitably and historically came into conflict with Galen’s teachings and the publication of his treatise De Motu Cordis incited considerable controversy within the medical community. Some doctors affirmed they would “rather err with Galen than proclaim the truth with Harvey.

Harvey’s rules on medical practice can be summed up as:

  • “That none be taken into the Hospital but such as be curable, or but a certain number of such as are curable.
  • That none lurk here for relief only or for slight causes.
  • That the Chirurgions, in all difficult cases or where inward physic may be necessary, shall consult with the Doctor, at the times he sitteth once in the week and then the Surgeon himself relate to the Doctor what he conceiveth of the cure and what he hath done therein.
  • That no Chirurgion or his man do trepan the head, pierce the body, dismember, or do any great operation on the body of any but with the approbation and the direction of the Doctor…”-Infogalactic

Harvey was involved in witchcraft trials, examining the women who were accused. A number were found innocent after Harvey reported on them, he was very sceptical of the idea. There is an account of him dissecting a toad and proclaiming it normal and not supernatural, after a woman was accused of being a witch and keeping a familiar. He also published “Exercitationes de generatione animalium, In which he explained that embryos formed inside the egg and were not present beforehand as tiny miniatures. Harvey’s lasting legacy was his work on the heart and circulation, along with his focus on proving your findings and rules on medical practice.

Ambroise Paré (c. 1510 – 20 December 1590) was a French barber surgeon who served in that role for kings Henry IIFrancis IICharles IX and Henry III. He is considered one of the fathers of surgery and modern forensic pathology and a pioneer in surgical techniques and battlefield medicine, especially in the treatment of wounds. He was also an anatomist and invented several surgical instruments. He was also part of the Parisian Barber Surgeon guild.

The numerous wars of the period were mentioned earlier. Surgeons got plenty of practice, and armies kept finding new and inventive ways to kill and dismember each other. War actually became a driver of medical progress. Paré observed soldiers being treated after wounds.  Paré would have seen stab and slash wounds, as well as gunshot wounds in the early modern period. He saw that those who has been treated with traditional cauterisation, which was burning of wounds and veins to seal them. He also used an old Roman remedy, using egg whites, oil of roses and turpentine, reputedly when he ran out of oil. Later he saw that those with cauterised wounds were in pain and not doing as well as those that had the alternative treatment. Unknown to him, turpentine has antiseptic properties, so wounds were not becoming infected. they were also in less pain. This shows the influence of regaining ancient knowledge. From then on Paré stopped using cauterisation.

Jonathon Davies, Going Postal
Ambroise Paré (1510–1590)

Paré also reintroduced the ligature of arteries (first used by Galen) instead of cauterization during amputation. The usual method of sealing wounds by searing with a red-hot iron often failed to arrest the bleeding and caused patients to die of shock. For the ligature technique he designed the “Bec de Corbin” (“crow’s beak”), a predecessor to modern haemostats. Although ligatures often spread infection, it was still an important breakthrough in surgical practice. Paré detailed the technique of using ligatures to prevent haemorrhaging during amputation in his 1564 book Treatise on Surgery. During his work with injured soldiers, Paré documented the pain experienced by amputees which they perceive as sensation in the ‘phantom’ amputated limb. Paré believed that phantom pains occur in the brain (the consensus of the medical community today) and not in remnants of the limb.“-Infogalactic

As well as these advances and others, there was also continuity with the past. Galen’s ideas continued in many areas, such as he four humours, but also some of his good ideas and teachings were brought back from the past. Those who challenged it received condemnation, even when they could prove it. However, little by little they gained acceptance as they could repeatedly be proved true in reproducible experiments. The foundations for modern medicine were taking shape. Alongside this ran supernatural beliefs. Plague returned, for example to England in 1665. The same beliefs as to causes seen previously were still there, such as it being a punishment from God.  The industrial revolution was about to bring more change.
 

© Jonathon Davies 2018
 

Audio file