HST310 Midterm

Galen of Pergamum

-*129-216 CE* -central figure in medicine from 129 until the Renaissance -wrote about Hippocratic medicine, which is how much of it survived -prolific→ wrote a ton and many works survived (important by quantity) -big braggart, huge ego, big debater, thought his word was the last on any topic -began medical studies at 16→ studied at Pergamum, Alexandria, and Smyrna; learned Alexandrian (anatomic) and Hippocratic (humoral) traditions of medicine -went to Rome in 162 and quickly developed big reputation amongst top minds -left for Pergamum and returned at the request of Emperor Marcus Aurelius (personal physician of three emperors)

[Third Stage of Translation] Constantinople

-*Burgundio (1110-1193)* -merchant from Piza that moved to Constantinople and spent free time doing translations -his renderings of Galen from Greek originals are more *accurate* than that of Gerard of Cremona and cover a wider, more generally *theoretical* set of writings

[Humoralism] Managing the Patient

-*Patient-oriented* #no discrete diseases→ two people might have same symptoms, but humoral balance is different so the causes are different and require different treatment regimens #never separate the disease from the sufferer #importance of environment→ illness seen as the product of a defective personal routine and the body's interaction with the wider world -*Holistic*→ look at patient as a whole, take thorough history -*Hippocratic Manner* #downplays supernatural causes, empirical approach based on evidence #consultation→ doctor very thoroughly questions patient to understand every aspect of their situation (lifestyle, occupation, diet, etc.) #combine information with results of comprehensive physical exam to form patient's treatment regimen

[Medieval Italy] The "Articella" or "Little Art of Medicine"

-*basis of medical teaching*; the go-to medical textbook from the 13th-16th century -collection of six medical treatises bound in one volume and used as a textbook/reference manual 1. "Liber ysagogarum" (Johannicus) 2. "Aphorisms and Prognostic" (Hippocrates) 3. "On Urines" (Galen) 4. "On Pulses" (Galen) 5. "Tegni" (Galen) 6. "On Regimen in Acute Diseases" (Hippocrates) -*differences from pre-Solerian texts→ theoretical rather than practical, mix of translations from both Greek and Arabic, confined to Galenic tradition* -majority are either Galen or influenced by Galen→ narrows the medical focus, makes Galen completely dominant, even Hippocratic texts included Galen's notes or were reconstructed based on his commentary -gives learned medicine the equivalent of its own bible #*from this moment forward, a proper doctor could be defined in terms of his knowledge of a series of books* #compounded by the rise of universities and renewed access to earlier learning via translation (books can now be circulated and taught)

Hellenistic Period

-*c. 323-30 BCE* -reign of Ptolemy→ see jump from animal to human dissection for a bit in Alexandria before it goes back to being taboo -Aristotle and followers embark on massive program of zoological and biological investigation -Diocles→ first book on dissection (animals) -Herophilus of Chalcedon (c. 330-260 BCE) and Erasistratus of Ceos (320-255 BCE)→ hippocratic physicians, skilled anatomists that investigate the human body in Alexandria, animal and possible human vivisection, people weren't into it

[Humoralism] Treating Disease

-*diet and regimen*→ step one of any treatment; includes food, drink, sleep, exercise, and lifestyle -need to *restore humoral balance*→ bloodletting, purging, regulating diet -poultices, ointments, pessaries, pills -cupping→ hot glass on cuts to pull humors out -scarification→ form of bloodletting -venesection→ bloodletting from inside the arm -cauterization -physical→ suture wounds, treat traumatic injuries, trephine the skull, artificial pneumothorax, infected wounds -*basic understanding of surface anatomy, played a minor role in practice*

[Galen] Differences in Humoralism

-*importance of anatomy* #animal dissections -*synthesis of philosophy and medicine* #Hippocratic Corpus #Plato→ three bodily systems #Aristotle→ practical investigation and scientific logic -*refines and codifies the important of external factors on the body/humors* #six non-naturals

[Galen] Diagnostics

-*the physician must explain the disease in terms of natural causes and that the disease must be understood in terms of humoralism* -examination of pulse and urine→ colorimetric urine chart alongside smell and taste -*hygiene* very important→ escaping disease required rigid adherence to hygiene and the continuous guide of a competent physician -very *individualized* approach to health -constant attention must be paid to the *Six Non-Naturals*

Pneumonic Plague

-100% mortality -Highly contagious and exceptionally lethal -Plague travels to lungs and becomes aerosolized, where it can be spread person to person by droplets of saliva -Neurologic symptoms, become incapacitated, hemoragges under the skin, lungs fill, patient basically suffocates and dies within days

The Rise of Leprosy

-11th and 12th Century -Not really well known in Europe before the fall of Rome, but it begins to slowly seep into the Mediterranean -Crusades→ military operations to the holy lands to assert dominance and reclaim Jerusalem #Created the perfect conditions for the spread of leprosy→ massive movements of people that carried infections back to new populations that had never been exposed -By the end of the 12th century, maybe 1 out of every 200 Europeans was infected with leprosy -Reaches its peak in the 13th century, but dissipates after that -Disappears from Europe after ~300 year period of being very prominent -Still endemic in certain parts of the world

Coming of the Black Death

-1347-1351 in Europe, maybe earlier -tracked from Central Asia→Crimia→Sicily→Genoa→Europe -trade and war were really good vectors -1347→ Mongol army besieges Kaffia in Crimea, hurled plague bodies into city, Italian trade ships brought it back where it spread to the rest of Europe -became endemic with erupting outbreaks for 3-4 centuries -spreads very quickly through interconnected trade routes once it got to Europe -cities→ ideal places for plague to spread, high death rates (sometimes 2/3+ of population

Vesalius and Galen

-1538→ Vesalius publicly challenges Galen (immediately denounced by Sylvius, big fight) -becomes more critical of Galen as his own anatomical knowledge grows and he discovers that Galen only dissected animals -anatomy can only be discovered through direct observation -holds giant demonstration where he shows how wrong Galen is #doesn't go over well with the hardcore Galenists who claim the body has just degenerated since classical times #called the Martin Luther of Physic

Arrival of Greek Medicine in Rome

-282-146 BCE→ increasing contact between Greek and Roman world -not smooth, Romans had their own ideas on medicine -Cato the Elder (234-149 BCE)→ complained that Greek medicine was foreign and damned it as deeply unRoman #believed in specific Roman healing based on herbs, chants, prayers, and charms; far more superstitious, much less rational -4th century BCE→ increased influx of Greek medical practices -80 BCE→ Roman medicine is Greek medicine

Erasistratus of Ceos

-320-255 BCE -radical anatomist in Hellenistic Alexandria -studied the pulse as a guide to illness (becomes one of the most important diagnostics going forth) -dissected the brain to figure out where sensation and movement are produced -described the body and its processes -challenged a lot of Hippocratic doctrines #thought humors existed and caused disease, but didn't animate the body #thought arteries contained *pneuma* (specialized air) #refined form of air produced in the heart #explained presence of blood in arteries as leakage or attraction to pneuma as air escapes a wound

Bubonic Plague

-50+% mortality in the absence of appropriate antibiotics -Even if you get plague today, you can still die→ need to get antibiotics immediately, if you wait long it will be too late -If the plague enters your body from the bite of an infected flea, you're going to get bubonic plague -Not everyone in household is going to get it, everyone has to be bitten -6 day incubation period -Symptoms #Chest pains, coughing, difficulty breathing, high fever #Then dark splotches on skin (where you get black death) #Most characteristic sign is the buboe, from which it gets its name→ hard, painful swelling near the lymph nodes in the groin, armpit, neck, or behind the ears #Followed by restlessness, headaches, anxiety, confusion, hallucinations #Finally coma and death

[Medieval] Surgeons

-Anyone could set up chop shop if people would go to it (undermined surgical influence and authority) #Paolo di Ricco (fl. 1422)→ combination blacksmith/doctor #Domenico de Dentibus (fl. 1352)→ dentist, specialist in pulling teeth #Giovanni di Bartolomeo (d. 1450)→ bookless physician (didn't go to university), executed for heresy and necromancy -Other surgeons saw people like this as a threat to the good name of surgery #*Jacopo da Prato (fl. 1361)*→ high-ranking surgeon, nterested in elevating the profession/name of surgery by giving it the weight of textual authority, wrote "On Manual Operations", teaches surgery at the University of Florence (one of few schools where you could get a degree in surgery) #*Guy de Chauliac (1300-1368)*→ worked in France, wrote the authoritative text on surgery ("Surgery"), cites 38 different works of Galen in it to make it credible -higher sophistication in surgical writing after 1170

The Medieval Hospital

-Begin to see the development of larger hospitals in bigger towns in Italy, Paris, and York -Ranged in size and levels of care -St. Leonard's in York (England)→ treating 225 sick and poor in 1287 (a lot of people), had actual doctors attending -Civic hospitals of Milan and Paris→ generally run by city instead of a monastery -Bury St. Edmunds #Domus Dei (God's House)→ cared for up to 7 destitute men #St. Saviours→ room for 12 poor men and 12 poor women -St. Bartholomew's (London) and St John's Hospital (Cambridge)→ still a hospital operating today, St. John's became a medical school -Hotel Dieu Hospital (Beaune, France est. 1492)→ big city hospital in Paris, very fancy, had doctors in attendance

Septicemic Plague

-Blood infection -Don't get the buboes -Get sick, rapidly weaken, and die within 1-3 days after original presentation of symptoms -Rarest presentation -Basically 100% mortality rate

[1st Stage of Translation] Salerno

-Constantine and Southern Italy -Greek and Arabic -Galen dominant -new vocabulary -begins a standardized way of medical thinking -texts→ "Articella"

Black Death Mortality

-Death rates top ¼ -⅓ of the European population -Europe: 20-25 million -Worldwide: over 42 million -40-60% of all people in Europe, the Middle East, and North Africa -Fundamentally changed society

Leprosy

-Demonstrates the difference between the biological nature of the illness and the things attributed to the sick individual -People thought it was a lot worse than it actually was, evoked an incredible fear and revulsion -Thought to be the most contagious of all things (actually pretty hard to catch) -Lepers were cast out of society -Now called Hansen's Disease -Chronic bacterial infection of the skin, mucous membranes, and nerves by Mycobacterium leprae -Goes away by end of 14th century→ not entirely sure why, likely changing patterns of commerce/warfare/pilgrimages

[Medieval] Dissection

-Dissection brought into curriculum -Salerno (late 12th century)→ begins to introduce animal dissections into courses -Mondino de Luzzi (c. 1275-1326)→ introduces dissection into the curriculum at University of Bologna #Served as anatomy lecturer at University of Bologna (1314-1324) #1315→ introduced dissection of human cadaver into curriculum -Newly translated Galenic texts emphasized the importance of anatomy -Lessening of taboo on mutilating human corpses -Begin seeing increasing reports of autopsy to determine cause of death in 1250 Italy -Cadavers tended to be bodies of executed criminals, non-locals, or those on the margins of society -Were less about learning more about the body and more confirming Galenic writings

[Medieval] Bury St. Edmunds

-England, big monastic site, healing pilgrimage shrine -Six different hospitals were founded on the site from *1150-1260* -Catered to a variety of groups: lepers, pilgrims, sick, old -Co-existence of secular and religious healing -Sick monks of the abbey could pray to St. Edmund or take advantage of the doctors among their own numbers -Walter→ monk doctor at Bury St. Edmunds, very successful at what he did, made so much money that he was personally able to rebuild the Almonry (poor house) in 1197 -Great pilgrimage center -Chroniclers reported healing miracles performed at the shrine -Construction of all these local hospitals to deal with the pilgrims coming in looking for miracles

Public Health Measures for the Black Death

-Extend quarantine times -Shutting borders -1480→ Italy creates Health Passes, have to pay for pass to get to get into town; foreigners got very mad about it, thought it was a ploy to get money -Maintaining quality of food in local markets -Maintaining cleanliness of streets -Maintain hospitals and cemeteries -Set standards and guidance for physicians -Authority over beggars, prostitutes, Jews -Authority to execute people who violated public health measures

[Medieval] University Medicine

-Formal establishment of university education for the first time -First wave is in late 11th century into early 12th century #Salerno (10th century)→ medical masters congregated with other teachers and students and began to establish official relationships with both church and secular authorities #School is earliest known center for medical education #Big boom in the creation of hospitals 1200-1350 coincides with development of new universities in Italy, Spain, France, and England -Second wave in East Europe #Prague (1348)→ first school in German-speaking region #Heidelberg (1385)→ first school in area that would become Germany -Third wave in Northern Europe #Flanders, Scotland, and Scandinavia (15th century)

[Medieval] Sta. Maris Nuova (Florence)

-Founded 1288, can trace medicalization from founding through 16th century -Know it expands dramatically in this period -1288→ 12 beds for sick and poor -1350→ employed a physician and surgeon -1500→ 250 beds for sick-poor #No more stays for able-bodied poor, just sick #Medical staff of ten doctors, a pharmacist, and several experienced assistants #8 private rooms for wealthier classes #Acted as public dispensary (pharmacy) and medical lending library #Surgical outpatient clinic #Staff of nurses that would go visit the sick in their homes #Treated about 3000 males and unknown number of females (didn't record women) annually

Black Death and the Church

-Lower Clergy→ 50% of the parish priests died of the plague in the first year (1348-1349) #Best trained and most committed were the ones who went to visit plague victims and hold funeral rites, so they were the most likely to die #Hard to fill their ranks back up when quality individuals #Many writers complain about the lowering of the quality and morality of the clergy as the more qualified priests die and must be replaced -Higher Clergy→ archbishop/pope/cardinal, estimated 30% death rate -Pope's court at Avignon (France)→ mortality at papal court itself was 25% -In some areas, monasteries/churches/whole villages abandoned -Fear of death among everyone lead to an increase in bequests to the church #People are worried about their souls making it to heaven, so they leave all their belongings to the church #Not enough priests to go around and give everyone funeral rites (very important, don't want to die unshriven) #Pope Clement VI graciously granted absolution (forgiveness for sins) to plague victims who leave their earthly goods to the church in their wills

[Renaissance] Revival of Galen and Greek Medicine (16th Century)

-Makes no sense on the surface since it never went away -Mid-15th century forward, the love for all things Greek grows -Call for new translations based on the original Greek and not using intermediaries -Many felt that the Medieval translations were inaccurate -Johan Guinther von Anderach (1531)→ translator of Galen, praised the times he lived in, said that he is now living in a time when medicine has been raised from the dead and that Hippocrates and Galen who have been almost entirely corrupted have now been rescued from perpetual darkness and a silent night #Finally getting back to the authentic Hippocrates and Galen that haven't been corrupted like in previous times -Between 1500 and 1600 there were published around 590 different editions of the works of Galen (everyone has their own translations) and a corresponding retrieval of the works of Hippocrates

De Humani Corporis Fabrica

-On the Fabric of the Human Body by Vesalius (1543) -The one colored version was done by Vesalius himself and given to Charles V who he dedicated the work to -Marks a turning point in the medical view of the structure of the human body -An attempt to describe the human body as it really was without deferring to Galen -Based purely off of observation -First to systematically demonstrate the human body through dissection and to show Galen's mistake through comparative anatomy -Revolutionary because of its naturalistic yet technically precise drawings #Not just descriptions and a few small images, full of illustrations of the dissected body in lifelike poses #About 250 woodblocks painstakingly prepared for incorporation into the text #Vesalius provided detailed instructions about how they were supposed to be incorporated into the text

[Medieval] Medical Education

-Only matriculated men -Many would enter university at the age of 14 or 15 -To attend medical school, you must first obtain a bachelor of the 7 liberal arts (must be mastered in latin)→ grammar, rhetoric, logic, arithmetic, geometry, astronomy, music -Could then study to get a Bachelor of Medicine (MB) #Study texts attributed to Hippocrates and Galen #Depending on university, student may also hear lectures derived from the commentaries on the ancient authors, particularly those works of Arabic medicine like Avacenna #Teachers would lecture on their own ideas about Galen/Hippocrates/Avicenna -Once you have your bachelor, you could either start practicing or go on to MD -Medical Doctorate (MD)→ took another 4-7 years of study #Attend lectures, disputations, oral examinations #At some (like Bologna and Paris), would have to fulfill a period of supervised practiced under a physician (like a residency) for between 6 months to 2 years -Bologna (1300), Montpellier (1340), Padua (1465)→ university requirements demanded that students also attend the dissection of a human cadaver -Degree in medicine marks expertise of the ancient authors, the theories of disease causation, and physiology - but not actually being able to treat someone in clinical practice #Degree about ancient books and theoretical approaches to medicine, but not necessarily how to treat patients

[Medieval Italy] Salerno

-city in Italy that becomes the center of medical learning and translation in medieval times -first medical school -Introduction of Arabic medicine→ very important -most of the credit goes to Constantine the Aferican #monk working in Salerno c. 1070-1097 to translate medical texts #translated previously unknown texts of Arabic and Greek medicine that had never been seen in the West before #these translations put the Latin-speaking world (Christian West) in touch with the tradition of Hippocratic learning as promoted by Galen #introduces new therapies and new technical vocabulary

Official Responses to Black Death

-city officials enacted public health measures since physicians couldn't -some Italian towns set up temporary committees to coordinate public health measures against the plague #Venice→ three nobles/no physicians, rules for burial, released debtors from overcrowded prisons, allowed surgeons to practice medicine, banned visibly ill from entering city #Milan→ council sealed up first three infected people and left them to die #Florence→ committee of eight with dictatorial power, cleared streets of rot #Pistoia→ banned all incomers, tightly controlled linen and woolen goods, tightened rules on food markets, limited mass gatherings -London→ not enough manpower for street cleaning and compose removal -learn to deal with it better as time progresses #refinement of first emergency measures (use Italy as model) #15th century→ Italian cities has sophisticated and detailed public health measures, permanent boards of health

[Medieval] Treatment

-continued dominance of Galen and Hippocrates -surgeons in charge of physical treatment (wounds, breaks, leprosy, cysts, cauterization, cupping, phlebotomy) -learned physicians focused on internal medicine and told patients what was wrong, then sent them to surgeons to fix it

Black Bile

-earth -spleen -autumn -cold and dry

[Galen] Liver System

-eat food → goes to stomach (turned into chile) → chile goes to *liver* (turned into blood) -blood suffused with the first pneuma→ *Pneuma Physicon (Natural or Physical Spirit)* -pneuma-infused blood travels up the *veins* to the organs -veins are two way street; once blood is depleted of pneuma, it goes back down the veins to the liver to get more -in the organs, pneuma-blood is responsible for the functions of *nutrition, growth, and reproduction*

[Galen] Six Non-Naturals

-factors that aren't innate to the individual (not part of body/humoral makeup) but could still cause disease -under the patient's control, must be utilized in moderation in terms of quantity, quality, time, and order *1. Air and Environment* *2. Food and Drink* #what and how much #diet still very important→ very literal "you are what you eat", could assume the qualities of the things you ate #related properties of food to the four humors (cooling, heating, drying, moistening) #if diet fails, turn to drugs or other kinds of intervention treatments *3. Motion and Rest*→ sleep, exercise, qualities of dreams *4. Sleep and Wake* *5. Excretions and Retentions*→ what's coming out of you and what's not *6. Passions of the Mind (Emotions)*→ activities of the mind upon the body (stress, lovesickness, grief)

Vesalius and Education

-father was imperial pharmacist to Holy Roman Emperor Charles V→ grew up in large court surrounded by medicine -taught himself anatomy by dissecting small animals -1530→ Bachelor of Arts from university at Louvain -1533→ enrolls in medical training in Paris, gains skills in dissection, assistant to prominent anatomist Jacobus Sylvius -1536→ flees to Louvain when war breaks out between Charles V and France -1537→ enrolls in Padua in fall, has full MD by December, immediately appointed professor of anatomy and surgery -1538→ "Tabulua Anatomic Sex", among the first anatomical tables designed for students, still seeing body through Galenic lens -1539→ very popular dissection lecturer, added 30 florins to 40 florin salary

Yellow Bile

-fire -liver -summer -hot and dry

Alcmaeon

-flourished *c. 470 BCE* -only pre-Hippocratic medical authority whose theories survived -rational approach to disease→ result of disturbance in body's equilibrium rather than curse from gods -health is dependent on the body's equilibrium (*Isonomia*) of the powers within -supremacy (*Monarchia*) of any one power would lead to disease -*everything about humoralism is based on his ideas of balance in the body*

[Fifth Stage of Translation] Niccolo da Reggio

-flourished between *1315 and 1348* -bilingual doctor and diplomat from kingdom of Naples -translated over 50 writings from Galen→ first for many of them, many only available in his translation for centuries -*remarkably accurate and claimed to neither add nor remove anything from the Greek originals* -influence is actually fairly small because the Galenic treatises he translated were relatively minor

[Galen] Dissections

-gave both anatomical and physiological accounts of disease -believed that anatomy was incredibly important→ departure from Hippocratic humoralism, only through dissection could one gain a proper understanding of the organization and workings of the body -dissections on many animals but not humans (outlawed)→ translated many animal features to human anatomy (dog cotyledons, sheep ligature, ape kidneys)

The Black Death (Bubonic Plague)

-global pandemic of bubonic plague from *1346-1351* -thought to be punishment from God, now attributed to vermin (rats, squirrels, gerbils, guinea pigs, and other rodents) -caused by now extinct strain of Yersinia pestsis -dependent on flea (Xenophylla cheopsis) activity to transmit plague -black rat (rattus rattus)→ main vector, made its way to Europe in Middle Ages, settled well in cities -three distinct presentations→ bubonic, pneumonic, and septicemic -eventually comes in fewer and fewer waves, disappears in Europe in 18th century

Asklepieion

-huge temple complex in Epidaurus -rules of cleanliness→ no child born there and no one could die there (don't want to ruin numbers or question their god) -priests carefully selected who was allowed inside to meet their claim that everyone who came to the temple was healed -incubation→ temple sleep to get divine guidance from god #patients underwent purification rites (bathing, sacrifices, fasting) then had miracle inscriptions read to them before sleeping #dreams helped by hallucinogenic smoke pumped in #dreams interpreted by priests

The Impact of Translation

-important consequences for medicine -Introduced new words, concepts, and errors -carried forward Galenic medicine, frequently within an Arabized and Aristotelian framework -Five Stages 1. Salerno (~1070) 2. Spain (~1140s+) 3. Constantinople (~1110-1193) 4. Spain and Italy (~1280-1315) 5. Niccolò da Reggio (1315-1348)

The Black Death and Doctors

-lack of physicians (either dead or ran away, unclear) -scared of seeing patients → don't want to get sick, don't get paid if patient dies -no effective cure -could offer advice, but much was contradictory #abandon affected area if you can #create your own shelter→ lock up, don't go out, avoid people #reduce contact with tainted air (miasma)→ move slowly (don't breathe heavily), breathe though pomander -elaborate protective equipment→ plague doctor mask (leather with beak for pomander), long robes, heavy boots, thick gloves -tried to mature buboes then squeeze them out (cauterization, poultices, cutting) -basis of therapies was that plague was due to aerial putrefaction (excess heat and moisture in air) #humoral→ need dry and cool #fix environment with fumigation/fire/smoke; pomander close to nose to protect from miasma; theriac (air is poison) -Guy de Chauliac→ personal physician to Pope Clement VI, one of the physicians that stayed to help, contracted plague but in 50% that survived, admitted doctors felt useless and ashamed because there's nothing they can do to help -can give all the recommendations they want, but can't enforce anything

Medieval Medicine

-only real difference is a general increase in literacy and availability of manuscripts -most important advances from 7-11th century are happening in Middle East and Iberian Peninsula (Spain area, controlled by Arabs) -Christian West in Europe is kinda backwater at this point -both areas get the same medical knowledge from Greek and Roman antiquity, but how much they get and how they use it varies greatly -Arabic authors had access to more works of Galen with a philosophical component #also had access to Greek philosophy (especially Aristotle and Plato) #Aristotle (who also did works on practical medicine and anatomy) was unknown in the West until the 12th century #links between medicine and philosophy are much stronger in Arabic writings -12th century renaissance (1050-1225)→ occurs in Western Europe and really shakes things up; period of rapid development marked by increase in population, economic strength, urban organization and state administration, urban growth, and literacy

Leprosy Cures

-only useful medieval response was isolation -few leper cures reported from shrines -miraculous→ St. Lazarus and St. Erige -St. Erige (noted for curing lepers) -Bartolomeus Anglicus (fl. 1250)→ admitted that leprosy was difficult to cure except of course from interference by God #Recipe→ made from the flesh of black snake, cooked in earthenware pot (choice of vessel is important in these kinds of recipes) with pepper, salt, vinegar, oil, water, and a bouquet gardine (bundle of herbs) #Very expensive ingredients beyond the reach of most people (could literally buy a house with peppercorns, wars fought over salt for preservatives) #Black snake soup thought to be incredibly powerful #Warned that it might make you dizzy, cause the body to swell, need a theriac (also expensive) to counteract the worst of the side effects #Eventually and your hair would fall out, but these are minor problems that will go away and the leprosy will go with it -extreme cures→ gruesome, ranged from cannibalism (human gall bladder) to bathing in blood -many transient skin lesions mistaken for leprosy would fade on their own, leading people to believe the cures worked

Responses to the Black Death

-quarantine→ air was source of contagion, try to purify the air, remove bad smells to remove plague -ban potential carriers→ some more susceptible than others (better humoral balance) -religious→ acts of contrition, public confessions, praying, going to Mass, fasting (now know groups are bad and fasting makes you weak) -flagellants→ religious sect that publicly whipped themselves in repentance; denounced by church and Pope Clement VI

Renaissance Medicine

-rebirth of arts and sciences that takes place in Europe from 1300-1650 -new perspectives on anatomy and physiology (finally begin to overthrow Galen) -new technologies→ gunpowder (new wounds), compass (mass migration of people and thus disease), printing press (books widely available) -revival of Galen and Greek Medicine

Cult of Asclepius

-starts 5th century BCE, preeminent healing cult by 3rd century BCE -Asclepius→ Greek god of healing; sacred serpent -Asclepiads→ descendants of Asclepius, priests that served him -400+ temples built all over -Asklepieion→ huge temple complex in Epidaurus

Medieval Causes of Leprosy

-thought to be extremely contagious (presence, look, or leperous miasma) -associated with morality and biblical sin -medical authorities linked it to Lust #confirmed by idea that leprosy was spread sexually (friction of intercourse opened body to receive infectious miasma from partner) #could also be from improper acts or contact with a healthy woman who had contact with a leper #high level of leprosy among the "most pious" crusaders and pilgrims, big embarrassment for church so they had other causes -inherited from leperous ancestor -bite of poisonous worm -corrupted food (rotten mean, unclean wine, milk) -leperous wet nurse

[Medieval] Rise of Hospitals

-transforms the status of the healing art -tend to be associated with a monastery or church (not much secular healing at this point) -by the 11th century, some monasteries began training their own physicians (became some of the first medical schools) -supposed to uphold the Christianized ideals of mercy and charity, but weren't above charging high fees

[Galen] Theriac

-universal antidote, cure-all for everything -everyone looking for universal antivenom for poisons, plants, and venomous creatures (from rich to poor travelers) -typical ingredients→ herbs, minerals, animal parts/products, dried locusts, viper flesh -Galen's skill was trusted by three Roman emperors to make their theriac -Galen's prep had 77+ ingredients -very expensive and exclusive→ high quality ingredients; pounding, mixing, heating, stirring for final prep; 40 days to make one batch; must age for 5-12 years before thoroughly effective -important trade item during the Middle Ages for big cities

Ambroise Pare (1510-1590)

-unlettered (no medical school) barber surgeon that rises to prominence and shines a light on the field of surgery -able to rise from obscurity due to printing press→ printed popular surgical texts in the language/vernacular of the common people -surgical texts had vivid accounts of the horrors of war and the types of wounds caused by different weapons -said that the stench of rotting corpses poisoned the air and corrupted wounds (tracks with infection) -new treatment for gunshot wounds→ eggs/rose oil/turpentine, did better than boiling oil -skilled amputator→ brought back ligature (ancient technique of tying off blood vessels and bringing skin flap over instead of cauterizing) -worked for King Charles IX of France who challenged him to prove or disprove things #bezoar→ hairball in intestinal tract of hooved animals that could neutralize poisons (proved ineffective unless against very specific poisons) -argued against mummy powder (amoral) and unicorn horns (useless and nonexistent)

[Galen] Takeaways

-veins and arteries carry pneuma, not blood -heart→ site where blood and air mix, doesn't move blood -ideas aren't correct but are very pervasive because they have an answer for everything and a logical explanation that pulls together everything known at the time -sheer quantity of writings helped establish him as an authority -his model of human physiology becomes gospel for 1400 years (isn't challenged until 1500s Renaissance) -anatomy became gospel even though it's animal based→ physicians in Middle Ages concluded that the body had degenerated since the classical period rather than think Galen might be wrong

Leprosy Diagnosis

-very difficult to diagnose, even today -no reliable classification of skin diseases→ same symptoms could indicate several diseases -most doctors were aware that a leprosy misdiagnosis could ruin your life #coagulation of blood→ if the blood adheres to side of bowl, that's leprosy #leprosy damages nerve endings, tricked patients with the foot poke test -both medical and church authorities involved in the examination→ looking for incriminating signs (bright spots, sores, depigmentation patches, thickened skin)

[Galen] Bleeding

-very enthusiastic about bleeding; thought it was a treatment for nearly everything -great skill was necessary to determine how much blood to take and which vein should be cut -different locations for cutting solves different kinds of issues -for certain conditions, recommended two brisk bleedings a day→ first should be stopped just before patient faints, second bleeding until unconsciousness -wrote three treatises on venesection #believed that nature discharged excess blood to prevent disease #proof→ women were spared many diseases because extra blood was eliminated through menstruation

Greek Humoralism

-viewed illness as the result of disruption/imbalance in humors -enduring themes of *balance* and *moderation* -see humors in excretions of disease (pus, sweat, vomit, etc.)→ body's natural defense to get rid of corrupting factor /try to rebalance the humors -everything is *individualized* and *patient-centered*→ everyone has their own complexion of humors, doctor must tailor treatment to each patient -Alcmaeon's idea of balance combined with Empedocles' (*c. 500-430 BCE*) four element theory -powerful and persistent system of medicine because it had an answer for everything and treatment for any problem -*miasma*→ "bad air"

Phlegm

-water -brain -winter -cold and moist

[Galen] Heart System

-when pneuma physicon-blood reaches the heart, it gets mixed with air from the lungs and is transformed into *Pneuma Zotikon (Vital Spirit)* -travels from heart through the *arteries* -responsible for suffusing the body with *heat and life*

[Galen] Brain System

-when the Pneuma Zotikon reaches an organ called the retentions mirabile, it is transformed again in the brain into the highest order of pneuma→ *Pneuma Psychikon (Higher Animal/Physchical/Rational Spirit)* -rete mirabile→ network of nerves and vessels at the base of the brain in hooded animals (not humans) -Pneuma Psychikon travels through the *nerves* -responsible for the *brain, nerves, thinking, and feelings* -didn't believe that lower order animals had this highest order pneuma

[Galen] Galenicals

-wrote thousands of pages on pharmacology -very interested in investigating the properties of different plants -galenicals→ later complex drug mixtures named as a nod to Galen -/unguentum refrigerans/→ cold creams for youthfulness -some less pleasant ingredients→ bull bile, spider webs, snake skin, cooked fox, hyenas -believed it was the physician's role to detect fakers (ex: soldiers wanting to get out of military service) -theriacs

Miasma

-"bad air" -usually identified by smelling bad (swamp gas, trash pile, etc.) -big theory for the cause of disease until we get germ theory -ex: malaria→ didn't know about mosquitos, but did see that it got worse with the "bad night air" -/Epidemics/ and /Aira, Waters, Places/→ Hippocratic works that offered advice on where to build your house and analyzes the health of communities based on environmental factors like miasma -epidemics→ big link with disease and environment; humoralism emphasized personal susceptibility to miasma because it didn't quite fit

Hippocrates

-"father of medicine" -lived on island of Cos from *460-370 BCE* -don't know many concrete facts, much contradiction -learned medicine from studying the Iamata (descriptions of cures from Asclepius)

[2nd Stage of Translation] Spain

-*1140s onwards* -latin translations made from the Arabic, often through *Hebrew intermediaries*→ extra layer of translation, introduces errors and new ideas -texts of medicine, science, and philosophy (first introduction of Aristotle) -*Gerard of Cremona* #flourishes 1150-1187 at Toledo #translates some of Galen's works ("The Method of Healing") #Arabic practical texts→ "Liber ad Almansorem" (Rhazes); "Canon" (Avicenna) #*"Canon"*→ systemizes medicine and its role in the world, strongly philosophical but a logical framework -*Importance of Spanish Translations #Arabized medical vocabulary in Latin #Arabic and Aristotelian slant to Galenic medicine #philosophical and logical framework #formed basis for investigation into pharmacology, surgery, and practical medicine*

[Medieval] Rules of St. Benedict

-c. 480-547 -St. Benedict laid out some very specific rules about healthcare -provided religious guidelines for the care of the sick -most medieval monasteries had infirmaries to treat the sick monks (internal, generally not for other people besides the occasional servant or pilgrim) -therapy is almost exclusively by diet

[Medieval] Healing Shrines

-General Saints→ prayed to for generalized help -St. Luke or St. Michael -Thriving gift shop-esque business #Reliquary→ kept bone of saint in #Flasks to take holy oil from the shrine to take back with them and anoint the sick -Also have specialized saints #St. Roch→ particularly effective against the plague #St. Blaise→ goiters #St. Radegund→ ulcers #More serious the illness, less options you have for healing #In France, those who suffered from fever had 108 saints to pray to; sufferers of dropsy (kidney failure) had 11; gangrene had 1 saint -Vary in size and influence -Often marketed and had their own souvenirs

The Decameron

-Giovanni Boccaccio (1313-1365)→ lived in Florence and got the Black Death but survived -Story about 10 men and women who flee Florence in an attempt to escape the plague -Florence very heavily hit (1348), some of the worst ravaging, become a city of corpses #Most died within three days of getting sick #The poor were the most potable, unable to escape to the countryside #The stench of the death took over the city #Forgot funeral rites #Famine followed the plague→ peasants were either dead or too weak/scared to care for the crops and animals #Healthy people abandoned the sick, including their own families and children #Criminal and immoral acts carried out with impunity because there was no one left to uphold the laws of man or god #Variety of responses→ flight (only for the wealthy), complete breakdown to all regulation morality and law

[Medieval Italy] "Liber ysagogarum"

-Introduction of Johannicus -organizes medical practice -structure for medical discourse→ how you talk about medicine; laid out rules for how to diagnose a patient and organize therapy (emphasis on diet) -emphasized the Six Non-Naturals (Galen) -Galenic-Humoral text→ increases Galen's authority; this foundational document is Galenic, which really influences the way that everything else goes forward

Life with Leprosy

-Isolation was the favored solution→ leper houses outside town #Lateran Council (1179)→ church council, codified isolation, ordered lepers cut off from society and unable to mix with others (in life, church, or burial); lepers were already serving their time in purgatory in life -Rites of Exclusion→ religious rites for the formal abandonment of the leper, made to stand in their own grave while the priests declares you dead to the world -special clothing→ bell/rattle/clapper to warn of your approach, gloves, long stick, not supposed to talk -man could divorce leperous wife, but a leperous husband could force healthy wife to still have sex with him -objects of religious charity→ massive increase in leper hospitals by 1300, only lepers legally allowed to beg for alms

Symptoms of Leprosy

-Leprosy was a vague term given to a variety of skin conditions #Includes real leprosy but also vitiligo, skin cancer, psoriasis -Physical manifestations→ scaly flesh, collapsed tissue, loss of extremities (fingers, nose), degeneration of bones -Thought to be a living death, decomposing while you're still alive (part of why people feared leprosy so much) -Visible in skeletal remains (bone degeneration)

[Renaissance] Art and Anatomy

-The study of human anatomy from bodies and books had not been entirely neglected since Galen's death, but medical humanists reject Mondino de Luzzi's (ca. 1275-1326) text Anatomy (1316) #Was the standard anatomy teaching book until the Renaissance, rejected it since it was from the Medieval times -Return to the original Galen: On the Use of the Parts, On Anatomical Procedures -Influence of artists #New and naturalistic approach to the human body, and as such are increasingly interested in anatomic knowledge #Development of perspective in an image, makes a difference in how we can represent the body realistically #Artists attended public anatomies and executions to see how the body worked (Da Vinci hung around morgues and executions frequently)

False Accusations of Leprosy

-Theoretically leper is supposed to turn themself in, but that's not going to happen -Closet lepers often exposed by their suspicious neighbors -Lepers were hard to identify, so false accusations could be used to get rid of people you don't like (get revenge, get rid of business rivals, etc.) -Now falls to you to defend yourself against the claim -Only way to combat claims was to be examined by both medical and church authorities -One widow in 14th Century Gorga (village in Valencia, Spain) had to go to the king of Spain to get letters instructing authorities to ignore accusations of leprosy against her since no one believed her even after she was cleared by physicians

Dates

-Third century BCE→ Cult of Asclepius was preeminent healing cult (began fifth century BCE) -c.500-430 BCE→ Empedocles -470 BCE→ Alcmaeon flourished -460-370 BCE→ Hippocrates lived -420-350 BCE→ Hippocratic Corpus written -c.323-282 BCE→ Hellenistic Period, reign of Ptolemy -*280 BCE→ Hippocratic Corpus compiled in Alexandria* -*129-216 CE→ Galen!* -600-1000s→ Medieval medicine, important advances in medicine -1000-1100s→ Rise of leprosy -1100s-1200s→ Formal establishment of university education -1179→ Lateran Council codified isolation for leprosy -*1300s→ Peak of leprosy* -1300-1650→ Renaissance -*1346-1351→ Black Death* -1347→ Mongol army besieges Kaffa in Crimea -1400s→ permanent boards of health with sophisticated public health measures -Mid-1400s→ Printing press invented -1460-1525→ John of Vigo + gunshot wounds -*1510-1590→ Ambroise Pare* -*1514-1564→ Andreas Vesalius* #1538→ Tabulae Anatomicae Sex #1543→ De Humani Corporis Fabrica

Printing Press

-Transformative in many ways -Invented in the mid-1400s -Meant for the first time that books could become widely available -Scholars don't have to travel long distances to consult what might be the only copy of a work -If all of Galen's work is printed, you can finally look at it all at the same time, and see that there might be a different story or that it comes together in a different way than expected

Andreas Vesalius (1514-1564)

-Transforms the Western concepts about the structure of the human body -Started out as a Galenist #First restores Galenic anatomy and then moves beyond Galen to correct it #Everyone's on board with restoring, correcting gets a bit tricky -Among the first generation of scholars that has access to the complete works of Galen #Through his observations, came to realize that *human anatomy needed to be read through the book of the body* #His fame would be assured by the publication of his massive tome *De Humani Corporis Fabrica* (On the Fabric of the Human Body) in 1543 -lays the groundwork for anatomy-based personal observations to become important in medicine

[Medieval] The Professional Pyramid

-University trained physician (learned physician) -University trained surgeon (so few, they don't really count) -The unlearned surgeons (barbers) -Unlearned healers #Often combined with other professions #Women who dispensed home remedies to neighbors

Blood

-air -heart -spring -hot and moist

[Fourth Stage of Translation] Spain and Italy

-another burst of translations about a century later -brings other major works of Arabic science into Latin -Sicily 1282→ "Continents" (All-Embracing Book) of Rhazes -Padua 1283→ "Colliget" (Book of Universals) of Avverroes (Ibn Rushd) -More works of Galen -Spain→ Arnald of Villanova (d. 1311) #Galen's "On Rigour" (1282) #Avicenna's "On the Properties of the Heart" (c. 1280) -Italy→ Pietro d'Abano (1257-1315) #Galen's "On the Use of Parts of the Body" → made directly from the Greek manuscripts (increased levels of accuracy) -Impact #utilization of this new material to review what had come before→ *review of Arabo-Latin Compendia through Galenic lens* (review of the first three stages of translations) #Galen's "On Bad Temperament"→ Arnald of Villanova makes a commentary in which he criticizes earlier views that Galen is always right; start to *use the Galen, not just accept the Galen* #Pietro d'Abano's *"Conciliator"* (The Reconciler of Differences between Philosophers and Doctors)→ exposition of the basic principles of Galenic and Aristotelian medical science; beginning to see *synthesis of information into a comprehensive medical doctrine, not just translating and circulating*

[Galen] Synthesis of Medicine

-based on Hippocratic Corpus, Plato, and Aristotle -practical investigation and scientific logic (Aristotle) -*Three Bodily Systems* (Plato) #body controlled by three organs: heart, liver, brain #Galen disagreed with Aristotle's belief that the heart was the primary organ in control of the body -agreed with Plato's belief that the liver was the primary organ -Plato→ heart, brain, and liver were the origins of three parallel (not interconnected) systems each controlled by a single organ; tripart division of the soul divided into each of the organ systems -provided means of dividing vital processes into three systems governed by three spirits

The Problems of Gunpowder

-begin seeing primitive cannons in Europe as early as 14th century -John of Vigo (1460-1525)→ argued that firearm wounds were poisonous, so use the standard treatment of cauterization #actual cautery→ application of red hot poker into hole #potential cautery→ pour something like boiling oil into hole -Pare→ preferred actual cautery over potential, came up with new wound dressing of eggs/rose oil/turpentine that did better (caustic but antiseptic) #also used raw onions + salt and puppy oil balm to treat burned flesh

[Galen] Pneuma

-believed in pneuma (spirits) rather than humors→ Platonic three-fold division of the soul -three spirits, principle organs, and types of vessels: 1. Vegetative spirit, liver, veins 2. Animal spirit, heart, arteries 3. Rational spirit, brain, nerves -animal life is only possible because of the existence of pneuma within the body #pneuma→ for the everyday functioning of the body #humors→ for the malfunctioning of the body

Four Humors

-blood, yellow bile, black bile, phlegm -each connected to an element, bodily organ, and season where the humor would dominate -bile and phlegm considered the most dangerous humors to have out of whack because they were only visible during illness -blood considered ok and natural, seen more often like in nosebleeds and menstruation -black bile was the worst, only visible in vomit and excrement, scarier and associated with more dangerous illnesses than blood

Hippocratic Corpus

-body of ~60 Greek medical works written from *420-350 BCE* -assembled in Alexandria in *280 BCE* -written by multiple people, not just Hippocrates -similarities→ connect to medicine, in same Ionic dialect, all rational/almost free of magic and superstition -*rational*→ causes and symptoms accounted for in purely natural terms -paved the way for medicine's future as a rational science -based on humoralism (not called that yet)

Hierarchy of Black Death Causes

1. Divine punishment→ God at the top, sent the plague to punish humanity for its sins -Even doctors believed God was the primary cause of the plague -Doctors in Paris said that you should probably pray to God, he's still responsible, but you should probably also listen to our medical advice 2. "Natural causes" -Atmospheric→ turned air hot, sticky, and putrid -Planetary→ astrological component to planet locations; bad conjunction of Saturn, mars, and Jupiter in 1345, so that's the cause -Miasmas→ hidden quality that poisoned the air, could emanate from caverns/swamps/breath of the infected/corpses/piles of dungs -Poisoned→ deliberate poisoning by outsiders, lepers/jews/muslims get blamed and accused of poisoning the wells to cause the pestilence -Idea of contagion→ did believe that it could pass from person to person, but by miasma/bad air

Rules for Lepers

1. No public gatherings (church, market, meetings) 2. Can't wash in any water source 3. Drink from your own cup 4. Use stick to buy things 5. No public houses/taverns 6. No relations with anyone but wife 7. No narrow streets or speaking too close while traveling 8. Touch nothing public without gloves 9. Touch no children 10. Can't eat or drink around non-lepers; buried at home