Chapter Four: Medical Awakening: The Renaissance
The word renaissance means an awakening, a rebirth, or a revival. In historical terms the period known as the Renaissance was a time of renewed political, economic, religious, artistic, and scientific inquiry and learning. It began in Italy in the late 1300s and spread throughout Europe over the next three hundred years.
The Renaissance was marked by a renewed interest in the classical literature of the Greeks and Romans, but with new interpretations of them based on rational thought and observable evidence. The revived interest in non-Christian literature did not mean that Renaissance thinkers rejected Christianity, but there was a shift away from total spiritual control over people's lives by the church and religious officials toward a more secular (nonreligious) and humanist view of life, which maintains that individuals can have control over their own lives. Early Renaissance writers such as Dante Alighieri (1265–1321) began to use more local languages, rather than just Latin, so that ordinary people could read and understand their work without relying on Latin-speaking church officials to interpret it. With the invention of the printing press in the mid-1400s, books, especially the Bible, became more easily accessible to more people.
In politics and government, there was renewed interest in the democratic, people-driven form of government created by the Greeks and Romans. In art the shift was reflected in the Renaissance artist's appreciation of the beauty and structure of the human form. Painters and sculptors like Leonardo da Vinci (1452–1519) and Michelangelo (1475–1564) produced a more realistic portrayal of the human body and its surroundings. Paintings lost the flat, cartoonish look of the early Middle Ages and took on a more natural, three-dimensional appearance.
As the cities regained their populations after the Black Death, society became more urbanized, with trade and commerce replacing the old economic system of peasants farming the land belonging to landlords. The wealthy merchants, bankers, and tradesmen of Europe got used to having luxuries such as gold, spices, and silk, which came from the Orient. The overland trade routes that brought such imports to Europe became restricted as Islam gained strength and Arabic tribes took control of the territory; thus the need arose to find new sea routes. This led to what is now called the age of discovery—an age of exploration that reached its highest point with the discovery of the North and South American continents—the New World.
Columbus, the New World, and Disease
According to historian Roy Porter, the arrival of Europeans in the New World set in motion a health crisis even worse than the Black Death of the fourteenth century. Porter explains:
The most momentous event for human health was Columbus's landfall in 1492 on Hispaniola (now the Dominican Republic and Haiti). The Europeans' discovery of America forged contact between two human populations isolated from each other for thousands of years, and the biological consequences were devastating, unleashing the worst health disaster there has ever been, and precipitating [leading to] the conquest of the New World by the Old World's diseases.26
Before the arrival of the Europeans, the native peoples of North and South America lived much as the hunter-gatherers of the last ice age had lived. Like those earlier peoples, individual tribes had little contact with each other, and they knew very little about disease. As Central and South American civilizations such as the Mayan, Incan, and Aztec grew, some diseases that go along with an increasing population, such as tuberculosis, occasionally appeared, but still the people were relatively free of illness. They had no experience with European diseases, and their bodies had no defense against them when they were brought by the Spaniards beginning in 1492.
The first serious illness brought to the New World was possibly influenza, thought to have been carried there by pigs on board Columbus's ships. It struck the native Arawak people of Hispaniola and Santo Domingo in 1493 and killed thousands of them (along with approximately twelve hundred Spaniards). The Catholic bishop Bartolome de las Casas wrote a detailed account of the effect of the illness on the population of the islands. “Hispaniola is depopulated, robbed and destroyed,” he wrote in 1516, “because in just four months, one third of the Indians… have died.”27 In another account written in 1552, he wrote:
On Saturday 29 March , the Admiral [Columbus] arrived at La Isabela and found the people of La Page 62 | Top of ArticleIsabela were in sad condition because few of them had escaped being sick or dying…. Don Bartholomew Columbus [Columbus's brother] in arriving in Isabela found that almost 300 [Spaniards] had died of different diseases. Witnessing the plight of the Indian every day was even worse. There was so much disease, death, and misery, that innumerable fathers, mothers, and children died…. Of the multitudes on this island in the year 1494, by 1506, it was thought that there were but one third of all of them left.28
Other Spanish conquerors and their diseases quickly followed. Smallpox arrived in the New World in 1518, followed by measles in 1519. These illnesses all but wiped out the Aztec of Mexico and the Inca of Peru. By 1600 typhus had killed an estimated 2 million people in Mexico. To replace the almost extinct native populations, the Spanish brought African slaves to fill the labor shortage. The slaves brought malaria and yellow fever to the New World. All of these diseases contributed significantly to the eventual conquest of Central and South America by the Spanish.
In North America the Indian population was also devastated by European diseases brought by the French and English. Having seen what disease had done in Mexico, the Caribbean, and South America, it was not unknown for the Europeans deliberately to infect blankets, clothing, and other goods with smallpox in order to weaken the native tribes. The Europeans often justified this behavior as divine providence, acceptable in the eyes of God. For example, the Reverend Increase Mather wrote in 1680, “The Indians began to be quarrelsome… but God ended the controversy by sending the smallpox among the Indians.”29
The spread of disease between Old World and New was not only one way, however. It is thought that when Columbus returned from the Americas, he and his sailors brought back with them the sexually transmitted disease syphilis, called the “great pox” to distinguish it from smallpox. Beginning in 1493 epidemics of syphilis raged throughout Europe for the next twenty years. Its symptoms were horrifying, with rashes, skin ulcers, and abscesses that destroyed bone and disfigured the face. It was often fatal. Treatment for syphilis included heating patients to make them sweat, applying an ointment made from mercury to the sores, and the ever-popular bloodletting. The mercury treatment caused excessive drooling and sweating and included severe side effects such as gum sores, tooth loss, and weakened bones. For many the treatment was almost as bad as the disease.
The discovery of the New World by Columbus soon led to more explorations to other parts of the world. Many of these explorations, like those of Columbus, were designed to find new trade routes and bring new wealth to Europe. Others had the goal of spreading
Christianity to native populations. Still others were done simply to learn more about the world. Vasco da Gama of Portugal found a new route to India by sailing around the southern tip of Africa. Ferdinand Magellan, also of Portugal, was the first to circumnavigate, or sail completely around, the world, which proved that the world was round, not flat as was previously believed. Spanish conquistadores (conquerors) such as Juan Ponce de León, Hernán Cortés, and Francisco Pizarro explored the inland areas of North and South America. The French, English, and Dutch all sent expeditions to the New
World and into the Pacific, discovering previously unknown lands such as Australia and the Hawaiian Islands.
Science, the Renaissance, and Medicine
The explorations during the age of discovery brought to Europe not only more economic wealth, but also a wealth of new knowledge about the geography of the world and the cultures of the people who lived in it. The new knowledge added to the desire to learn—a scientific spirit—that had already begun in the earlier years of the Renaissance. A scientific spirit leads to scientific inquiry, which means approaching learning with a fair and open mind, asking lots
of questions, considering all possibilities, and drawing conclusions from close observation, research, and testing.
In medicine scientific inquiry meant that if one were to decide that a particular disease had a particular cause, that cause must be tested to prove that it actually leads to the disease. The concept of the four humors remained strong during the Renaissance, and bloodletting to restore balance was still a common treatment for many illnesses, but many physicians questioned whether the four humors could really explain all maladies, especially new illnesses such as syphilis and the English “sweating sickness” (which killed thousands in the late 1400s and early 1500s and is thought by historians to be a strain of influenza). Waves of plague also continued to ravage Europe well into the 1700s; an especially severe one killed almost eighty thousand Londoners in 1665–66. New ideas about the causes and treatment of illness appeared. For example, in an idea that seems to predict the discovery of germs, the Italian physician Girolamo Fracastoro (1478–1553) explained contagious diseases in terms of invisible “disease seeds” that could infect people from a distance or by contact with articles such as clothing.
The Protestant Reformation and Medicine
In the early part of the Renaissance, medicine still remained largely under the control of the Christian Church. The church still held to the teachings of Galen, and few physicians questioned this. Also, the great majority of universities were founded and controlled by religious orders. As the Renaissance progressed, however, traditional thinking was coming into question within the church itself. One of the most important events affecting the evolution of medicine during the Renaissance was the Protestant Reformation.
Led by a monk named Martin Luther, the Reformation began in 1517 as an attempt to reform the Christian Church. The church had become corrupted by many clergy who used their positions in the church to gain power and wealth. Also, wide differences in opinion about religion had arisen among the clergy because of the new humanistic thinking about the role of religion in people's lives. These problems eventually led to a split in the church into Catholics and reformers. The reformers became known as Protestants (those who protested), and they completely rejected the authority of the Catholic Church. In some countries, such as Germany, Norway, Sweden, and Holland, Protestantism became the official religion, and their rulers closed Catholic institutions, including the hospitals. In England King Henry VIII also rejected the Catholic Church, and from 1536 to 1541, he closed the monasteries, seized church-owned lands and property, and drove out the monks and nuns who had cared for England's sick and poor.
Without Catholic hospitals, there was a severe shortage of people to care for the sick. Health care in these countries suffered, and health institutions became unsanitary, poorly staffed places where
care was provided mostly by untrained women who came from the lowest ranks of society. In response to this, new, nonreligious medical schools were built, paid for by wealthy patrons other than the church, such as King Henry VIII, who founded Trinity College in 1546.
Anatomy and Surgery
Like the artists and sculptors of the time, Renaissance physicians were very interested in the structure of the human body. As a result of the increased interest, anatomy as a science soon gained a larger place in the university medical schools. Dissection was the best way to learn about the inside structure of the human body, but the church had always frowned upon the procedure. In 1482, however, Pope Sixtus IV decreed that dissection of cadavers was acceptable as long as the person was a criminal and was given a Christian burial afterward. Men of various backgrounds, such as Leonardo da Vinci, an artist and sculptor, and Andreas Vesalius (1514–1564), a university-trained physician,
performed dissections of human cadavers (sometimes in public) and drew detailed anatomical diagrams of muscles, nerves, blood vessels, internal organs, and many other body parts.
Leonardo da Vinci, despite having no medical training at all, was not only a gifted artist but also a brilliant anatomist. In addition to studying the anatomical structure of all parts of the body, he also studied their function—how they move and work. He studied the development of the unborn baby in the womb and used hydrodynamics (the study of liquids in motion) to explain how the heart moves blood through the body. One of his acquaintances wrote of him:
This gentleman has written of anatomy with such wealth of detail, illustrating by his art both limbs and muscles, nerves, veins, and ligaments of the inward parts, and of all that may be demonstrated in the bodies of men and women, in a way that has never been equaled by anyone else. And this we have seen with our own eyes, and he has also told us that he has dissected more than thirty bodies of men and women of different ages.30
Andreas Vesalius, on the other hand, had extensive medical training in Italy and went on to teach in several Italian schools. He was the author of one of the most influential books on human anatomy, De Humani Corporis Fabrica (On the Fabric of the Human Body), in which he used what he learned through dissection to dispute almost everything Galen had written about anatomy. He is considered the founder of modern human anatomy because of his accurate, scientific approach to anatomy and the extensive work he did on almost every part of the human body.
Other books and essays on anatomy were being published all over Europe. Many of them addressed very specific body parts, such as the ears, the kidneys, or the valves in veins. One of the most important was English physician William Harvey's (1578–1657) book De Motu Cordis (On the Motion of the Heart and Blood). Harvey's work on the circulation of blood was very controversial at the time, because many physicians still believed strongly in Galen's work from fifteen hundred years earlier. Galen had written that the heart's function was to produce heat and that arteries carried air and cooled the blood, got rid of bad “vapors” through pores in the skin, and were part of a separate system from veins. Harvey directly contradicted what Galen had concluded, showing that blood circulates through vessels that are part of one system with the heart and that the heart is a simple pump for the blood. Surgery before the Renaissance was considered a lower class of healing art, and surgeons were not considered to be doctors at all but more like craftspeople, in the same class as barbers. In fact, many so-called barber-surgeons performed simple surgical procedures such as bloodletting, pulling teeth, and cutting the umbilical cord after
childbirth. (The traditional barbershop pole of red and white symbolizes blood and bandages.) In the 1700s educated physicians who wanted to perform surgery separated themselves from the uneducated barbers, created their own guilds, and gained more prestige. Expressing his belief that surgeons should be of higher character and skill than barbers, English surgeon John Halle wrote that “a [surgeon] should have three divers properties in his person, that is to say, a heart as the heart of a lion, his eye like the eyes of an hawk, and his hands as the hands of a woman.”31
Hippocrates said that “he who wishes to be a surgeon should go to war.”32 Just as in the time of the Greeks and Romans, much of what surgeons knew in the Renaissance was learned from treating war wounds on the battlefield, but the transition from the swords and arrows of antiquity to guns and cannons in the 1300s created a whole new set of injuries to deal with. Gunpowder weapons caused much more extensive injuries with greater loss of blood and body parts. New ways of treating these wounds were discovered. For example, renowned French surgeon Ambroise Paré (1510–1590) learned that a dressing made with egg whites, rose oil, and turpentine worked much better to prevent “corruption” (infections) in gunshot wounds than the traditional one made with scalding hot oil. He also developed the use of ligatures to tie off damaged blood vessels.
In the civilian community, surgeons dealt mostly with superficial problems such as broken bones, burns, shallow wounds, tumors, amputations, and skin ulcers. There was a wide variety of surgical instruments designed for specific purposes. Bleeding was controlled with cautery, chemicals called styptics, and pressure. In a time before anesthesia, blood transfusion, and antibiotics, surgery was an agonizing and dangerous experience.
Hospitals and Pharmacies
Hospital care in Renaissance England had suffered a major setback after the Protestant Reformation. Until the 1700s, London, with over two hundred thousand people, had only two general hospitals for the sick, one for orphans, one for the poor, and one for the mentally ill. Most people could not afford to go to these larger hospitals, however. As a result, physicians began providing advice about how people could safeguard their health by eating and drinking in moderation, taking regular exercise, and keeping the mind occupied with creative pursuits.
In the cities of Catholic countries such as Italy, Spain, and France, however, hospitals were still mostly run by religious communities and supported financially by wealthy families. As the population of these countries increased, hospitals there became increasingly specialized, with institutions and homes built specifically for children, the poor, the elderly, the mentally ill, and those with specific disabilities such as blindness or infectious diseases such as plague. In general, they were clean,
comfortable places where all patients, including the poor, abandoned women and children, and those with incurable illnesses, could receive quality health care. Most hospitals had their own vineyards as well as vegetable and flower gardens, and patients enjoyed fresh food and wine served daily. According to history professor John Henderson of the University of London, “The traditional image of pre-modern hospitals as hellholes where people were brought to die has been overturned. Hospitals in this period provided free treatment, a warm environment and specialized care, which they would not have found in the community.”33
The science of pharmacy also changed during the Renaissance. At this time pharmacy became a separate discipline from other areas of medical practice, and universities began to include pharmacy as a separate subject of study. Pharmacists, called apothecaries, became specialists in the preparation of medicines. Just as in other areas of Renaissance medicine, apothecaries approached their craft scientifically. They carefully weighed and measured the amounts of ingredients used in their
preparations. They clearly prescribed the length of time that the medicine was to be used. They closely observed and recorded the effectiveness of their medicines and changed the “recipes” as necessary to make them work better.
The great majority of medicinal treatments still were made from plant sources, and the European voyages of discovery added many new choices for the apothecary. From the New World, cocoa made from coca beans became not only a popular drink among Renaissance Europeans but was also used as a stimulant for constipation and a treatment for “wasting diseases” (cancers). Sarsaparilla and sassafras were used for skin problems, arthritis, and the sores of syphilis. Tobacco was introduced to Europe as a treatment for a multitude of symptoms. Quinine made from the cinchona tree was effective for treating malaria symptoms. The Spanish in the Caribbean learned from the native people that medicine made from the wood of the guaiac tree could be used to treat a mild form of syphilis. Considering the unpleasantness of the mercury treatment, the guaiac treatment caught on quickly, and it came to be called “holy wood.”
From the East, opium became popular as a painkiller and treatment for dysentery and lung problems. Chinese rhubarb, ginseng, aloe, camphor oil, ginger, and cinnamon from the Orient all had medicinal benefits.
In addition to plants and the substances made from them, the Renaissance apothecary also used chemical substances as medicines. For example, mercury was used to treat venereal diseases such as syphilis. Antimony, a highly toxic substance in large amounts, caused vomiting and diarrhea in order to restore healthful balance in the body. Salt was used to treat skin diseases and digestion problems, and also worked like antimony to restore balance. Sulfur was effective for treating infections (just as sulfur-based antibiotics are today). Theriacs, first made by the ancient Greeks as an antidote to poisons, were combination drugs made with as many as sixty different plant, animal, and chemical ingredients. Collecting and preparing all of its ingredients could take weeks or months. The “recipe” varied, depending on who made it and what it was being used for. Besides treating poisoning, theriacs were used to clear blocked intestines, clear up skin ailments, improve strength, promote sleep, cool fevers, and many others. They were also tried as a treatment for plague during the Black Death of the mid-1300s.
Renaissance Medicine Moves Toward the Modern Age
In the sixteenth century religion had already undergone an upheaval with the Protestant reformation. At the same time, “medical protestants” began to offer new and rather controversial ways of thinking about medicine. One of the earliest and most influential of these was named Paracelsus.
Paracelsus, meaning “greater than Celsus” (referring to the Roman Celsus, who wrote about medicine in the first century A.D.), was the name adopted by Theo-phrastus Philippus Aureolus Bombastus von Hohenheim (1493–1541). Paracelsus, a Swiss botanist, physician, and astrologer, was a strong believer in astrology and the occult and believed that invisible forces intervened between man and God. Nature was the most important thing to him; he believed that observation, experimentation, and experience with nature was the source of all truth and that nature was unknowable to bookish university-educated professors.
Paracelsus infuriated most physicians of his time with statements such as “When I saw that nothing resulted from [doctors'] practice but killing and laming, I determined to abandon such a miserable art and seek truth elsewhere.”34 He ridiculed textbooks and dismissed dissection as a waste of time because it showed nothing about the workings of the living human body. His contempt for traditional classical thinking came out in his writing: “Let me tell you this, every hair on my neck knows more than you and all your scribes, and my shoe buckles are more learned than your Galen and Avicenna, and my beard has more experience than all your high colleges.”35 He publicly burned a copy of
Avicenna's Canon of Medicine and other traditional Galenic texts.
Paracelsus believed in the idea of the four humors, but felt that it was inferior to his own idea of three “spiritual” substances—mercury, sulfur, and salt—which he called the tria prima. He thought of these not as actual chemicals, but as qualities of objects as well as people. Sulfur represented the soul and emotions, salt represented the physical body, and mercury represented the spirit and morality. The physician had to understand the interaction of the tria prima in order to cure disease. More than other physicians, Paracelsus included in his treatments chemicals such as iron, arsenic, lead, mercury, and copper. He created the pain-killing laudanum, made from opium, and gave the metal zinc its name.
As controversial as Paracelsus was, his work had great influence on the scientific thinkers who followed him. His rejection of traditional thinking led others to publish their own nontraditional ideas about science and medicine. For example, two years after the death of Paracelsus, Andreas Vesalius published his work on anatomy in De Humani Corporis Fabrica, and Nicolaus Copernicus (1473–1543) published his revolutionary work on the solar system. Thanks to Paracelsus, medical chemistry, or alchemy, became widely adopted by physicians all over Europe as another option for treatment.
By the end of the seventeenth century, medical thought was undergoing a major transformation. Enlightened thinkers began to cast off the ancient Hippocratic and Galenic ideas of the past, which had no support from the observations physicians were making through experimentation, dissection, and the aid of the recently invented microscope. The next two centuries, often referred to as the age of reason or the age of enlightenment, brought radical changes to medicine, as scientific inquiry led to many important new discoveries.