HSTCMP 410 A Medicine History Society From Medieval

HSTCMP 410 A: Medicine, History, & Society From Medieval to Enlightenment Medicine April 4, 2016 Laura Harkewicz, Ph. D. 1

Today’s Agenda Recap last week’s discussions Medicine in Dark Ages Medicine in Medieval & early modern era Anatomy Primary sources Enlightenment medicine Mechanism v. Vitalism Small pox 2

Recap last week’s lectures Black Death/ Great Plague (1347 - 51) – more on this today Humoral theory Hippocratic school (sensual) Humoral theory - Galen (theoretical) – prognosis = observation, logic, & experience Islamic contributions - hospitals and compendiums of Greek authors 3

Medicine in Dark Ages Civilization collapses Literate men & women confined to cloisters & monasteries Medicine preserved w/o expansion 4

West Reawakens Salerno at crossroads Salerno medical school Salernitan translations Regimen Sanitatis Salernitanum (The Salernitan Rule of Health) – stressed Galenic idea of 6 non-naturals. . . 5

The Salernitan Rule of Health = The Flower of Medicine Author unknown – usually attributed to John of Milan 6 non-naturals = food & drink, environment, sleep, exercise, evacuations [including sexual], and state of mind Regulate these = natural body balance = medical analogue to monastic life – all things (including body) have divine purpose

The Medieval Hospital Hospitals embodied Christian principles of charity or philanthropy (love of humanity) Offered spiritual care as much as material health Universities – began around 1200 – some were dominated by clerics, others were secular 7

Medicine in medieval and early modern Christendom Three separate spheres, in order of prestige: Physicians Apothecaries Surgeons Zodiac Man 8

Elite Medicine Learned profession Restricted Adherence to classical Greek authors 9

Medical practice Gentlemanly bedside manner Patient and doctors as equals Consultation based on detailed patient history Rudimentary physical examination Epistolary medicine 10

Surgery and apothecary = trades Apprenticeship Regulated by guild system Lower status than physicians Surgeons and apothecaries were like physician’s hands 11

Surgeons Performed amputations No anesthesia No antisepsis 12

Apothecaries Prepared drugs Drugs – herbs, emetics, laxatives Including oddities like coral, woodlice, earthworms Laudanum 13

Non-elite medicine Wise women and men in villages, Squire’s wife or the lady of the manor. These people might offer better care than elite doctors. 14

Apothecary’s Shop Physicians hold clinics in shops Like an early version of the doctor’s office 15

Epidemics of Plague & Leprosy The Great Plague of 1347 – 1351 Some considered disease as punishment from God for sins Pestilential atmosphere Constitutional imbalance 16

Treatment Costumes to protect themselves Thought plague caused by atmospheric putrefaction Stressed individual treatment Leprosaria and plague hospitals = quarantine (forcibly confine) 17

The Body Late Middle Ages - medical & Christian views cross-fertilized Body (rather than the soul) more imp. Soul’s incarnation in flesh Humanistic theology Artists - Greek ideals of human body 18

The Art of Anatomy “Anatomy” – from Greek “dissection” Visual forms of communication Johannes Gutenberg’s (1398 – 1468) movable type printing press, which was invented around 1439 19

Leonardo da Vinci (1452 – 1519) Dissected 19 human corpses, many animals Used a systematic approach Drawings at every stage of dissection. . . 20

. . . from outward appearance of body. . . Vitruvian Man 21

. . . to the musculature. . . 22

. . . the veins, arteries other parts of circulatory system. . . 23

. . . and, finally, the skeleton. 24

Da Vinci wrote: “living through the night hours in the company of quartered and flayed corpses [is] fearful to behold. ” 25

Renaissance anatomy 1520’s onward Padua, Italy Leiden, The Netherlands Medical students flock to cities Corpses of criminals Leiden University, 1597 26

Andreas Vesalius (1514 -64) Born Andreus van Wesel in Brussels Father was pharmacist to Emperor Charles V Trained as a physician in Paris Became interested in anatomy In 1537, he moved to Padua where corpses were plentiful 27

Pre-Vesalius Anatomy education Anatomy taught with animal dissections Maybe one human dissection per year Professor read from works of Galen While barbersurgeon performed dissection 28

Vesalius’s Contributions to Anatomy Education Used human Did own dissections Corrected Galen’s errors 29

“How much has been attributed to Galen, easily leader of the professors of dissection, by those physicians and anatomists who have followed him, and often against reason!” 30

In 1543, Vesalius published the 7 -volume De humani corporis fabrica – “On the fabric of the human body” 31

Many of the woodcuts featured allegorical poses 32

Published the same year as Copernicus’s On the Revolutions De fabricus as important to anatomy & medicine as Copernicus’ text was for cosmology & metaphysics 33

Why Vesalius’s work as important as Copernicus’s? Suggested Galen might be wrong Laid groundwork for observation-based anatomy Program for the new medicine Frontispiece of Fabrica illustrates this program. . . 34

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Humanists Pursued & disseminated the study and understanding of the cultures of ancient Greece and Rome Emphasized secular, individualistic, and critical thought Used ancient texts for credibility Criticized these texts, but used them as the foundation for their own insights Foundation of Age of Enlightenment/Age of Reason 36

Ancients Truth revealed through violation of body Dissected female (left) and male (below) Idealized (Greek) male & female from Epitome in de Fabrica 37

Break 38

What is a primary source? 39

PRIMARY SOURCES: DEFINITIONS “is material -- a document or other evidence -- that was created during the period or the event” “historical raw materials” “the leavings, the shards, the remnants of people who once lived and don't live anymore”

TYPES OF PRIMARY SOURCES Written Visual Oral

Primary Sources & History Provide a glimpse into the past Personal connection to the past Primary sources are the evidence used by historians in their analysis/interpretation of the past

Evaluating Primary Sources 43

Questions to consider: Who is the author? What is her/his place in society? Might the author’s socioeconomic or cultural position bias their views in any way? Why did the author write the document? Who is the intended audience? What is the text trying to do? What arguments or concerns is the author responding to although not specifically stated? 44

Primary Sources: Enlightenment Medicine 45

Three texts central to this lecture (All primary sources) William Harvey’s, The Motion of the Heart and Circulation of the Blood , published in 1628 Rene Descartes’s, The Discourse on Method, published in 1637 Edward Jenner’s, three treatises on vaccination against smallpox, 1798 46

Anatomical knowledge difficult to make: Legal/theological constraints Bodies putrefied Comparative work difficult Galenic anatomical philosophy remained 47

Galenic Circulation Galenic physiology stressed 2 types of blood with 2 separate pathways: 1) venous blood originating in the liver, and which insured nourishment & growth throughout the body, and 2) arterial blood, which originated in the heart & spread vitality (vital spirits) throughout the body 48

Galenic Circulation Teleology = idea that all natural phenomena can be explained by design or purpose – linked to ideas of supreme being or something outside the body and its processes 3 systems in Galenic body corresponding to 3 dimensions of the soul: 1) Brain and nerves = reason 2) Heart and arteries = emotion 3) Liver and veins = appetite 49

Discoveries from 17 th c. Anatomy in Padua Veins did not originate in liver Fabricus – veins have little flaps “Valves” – Latin for “folding doors” 50

William Harvey (1578 – 1657) English merchant’s son Conducted hundreds of animal and human dissections He learned the little flaps (valves) opened in the wrong direction = blood in veins must flow towards the heart 51

His creed: “I do not profess to learn and teach Anatomy from the axioms of Philosophers, but from Dissections, and the fabrick of Nature” 52

What Harvey’s creed means Faith in own experiments Injecting water into heart of oxen Calculating amount of blood forced out of sheep’s heart = quantitative evidence of circulation 53

De Motu Cordis et sanguines in animalibus (On the motion of the heart and blood in animals) Published 1628 One of most celebrated texts in history of medicine Featured Harvey’s theory and evidence for circulation 54

Hypothesized blood moved in loop around the body outward from heart through veins and back through arteries Galenic circulation heart has “pulsative virtue” Harvey - heart worked as a pump with the ventricle contracting and expelling blood. Harvey’s understanding of circulation Notice the heart is at the CENTER 55

He could not SEE his theory, but he could TEST it: He assumed the existence of the fine vessels (the capillaries) connecting arteries to veins to complete the loop But by means of simple experiment, he proved their existence 56

The Experiment Ligated a forearm with a tourniquet so tightly no arterial blood could pass below Then he loosened the ligature enough so arterial blood – going away from the heart – could flow So, there had to be some undiscovered pathways – the capillaries – to pass blood from the arteries to the veins 57

Harvey’s philosophy Although Harvey saw the heart as a pump, he did not believe the body was a machine He subscribed to microcosm/macrocosm idea – “the Sun deserves to be call’d the heart of the world” Like Aristotle, he believed the work of the body was dependent upon a separate soul 58

Rene Descartes & Mechanistic philosophy 1637 – Discourse on Method “I think therefore I am” Body substantial & quantifiable Mind (soul) insubstantial & immortal Only humans had minds or souls Only humans had consciousness Only humans could feel things like pain Rene Descartes (1596 – 1650) 59

The Body as Mechanism Inspired by Harvey but… Considered heart as engine imparting motion to rest of body All body’s actions had mechanical explanations Automata 60

Mechanism vs. Vitalism Mechanism – view that the entire universe including the body, is controlled only by mechanical forces Thomas Hobbes (1588 – 1679) - behaviors driven by self-preservation not supreme being Vitalism – doctrine that phenomena are only partly controlled by mechanical forces and are in some way self-determining 61

So what? Because mechanists/materialists believed that the body was like other aspects of science – it could be measured, its mechanical properties could be learned Medicine could be made scientific Meanwhile, vitalists believed the body was unique because it had a soul Some things could never be understood 62

Smallpox & Vaccination 63

Vaccination against smallpox Practice of inoculation was learned from old women in Turkey Transmitted to the West by the wife of a diplomat Refined by an English doctor Who had learned from milkmaids that smallpox was similar to a disease of cows 64

Smallpox Highly contagious viral disease causing fever and pus-filled bumps on skin Caused as many as 1 in 10 deaths in 17 th and 18 th c. If you didn’t die, you were scarred for life Mild case seemed to protect you 65

Lady Mary Wortley Montagu (1689 – 1762) Lady Mary Montagu in Turkish dress – artist has drawn her with eyelashes, but hers had been taken by smallpox Writer, feminist 1712 eloped with Edward Wortley 1715 contracted smallpox, ruined her looks 1717 husband became British Ambassador stationed in Ottoman Turkey 66

Today’s Reading Letter 1717: Described smallpox inoculation parties (Inoculate: to implant disease) 1721 – Wortleys return to England Lady Mary has own children inoculated Statistically, it was safer to be inoculated than not – recipients got a mild case of disease Only 2% died from it 67

Edward Jenner (1749 – 1823) “Father of Immunology” English country doctor Observed dairy maids acquired smallpox immunity from cowpox Began to use material from cowpox pustule for inoculation 1798 publishes book about this method Testament to new experimental approach 68

Experimental method Known : Smallpox is more dangerous than variolation (inoculation of smallpox in controlled manner) and cowpox is less dangerous than variolation Hypothesis: Infection with cowpox gives immunity to smallpox Test: If variolation after infection with cowpox fails to produce smallpox infection, immunity to smallpox has been achieved Consequence: Immunity to smallpox can be induced much more safely than variolation Results 16 d after variolation (L) and vaccination (R) 69

Results of Jenner’s Method Vaccination (to inoculate with a modified virus as prevention) supersedes variolation Jenner’s book ends with prediction this method will wipe smallpox off the face of the earth 1979 WHO declares smallpox eradicated Some smallpox samples remain in U. S. and Russian laboratories CDC Recent publications have claimed Jenner “saved more lives than the work of any other man” 70

Did Jenner’s work “save more lives than any other man”? Did HE eradicate smallpox from the face of the earth? Yes and No…

Smallpox eradication – the UW connection 1970 s - UW grad. William Foege, M. D. M. P. H developed campaign that led to global eradication of smallpox In 2012, Foege received Medal of Freedom for his work Bioengineering building named after him Was head of CDC Now senior fellow Bill & Melinda Gates foundation William Foege (1936 - ) 72

Surveillance & Containment Strategy Locate potential cases of disease Monitor to see if they develop disease Stop transmission by vaccinating contacts & contacts of contacts Judicious use of vaccine with minimal risks 73

Anti-vaccination campaigns 1896 – Anti-Vaccinator journal 1874 – National Anti-Compulsory Vaccination League 1880 – London Society for the Abolition of Compulsory Vaccination In US, anti-vaccination campaigns often led by those who followed homeopathic medicine Vaccination debates continue…. 74