1500-1700

• What was the Renaissance?

  - French word which means rebirth

  - Medical Renaissance refers to the period when new ideas were beginning to influence medicine

  - New ideas emerged and began to break down old beliefs, the dominance of the Catholic Church being challenged by Protestantism and the rise of Humanist ideas.

  - Despite new ideas, impact on treatment was minimal as people were reluctant to let go of their old, trusted beliefs

  - Period of laying the foundations to come.
• Causes of illness: Continuity


  - People still believed in miasmata (the idea that disease was spread by bad smells and evil fumes)

  - Whilst few physicians believed in the four humours by 1700, it was still used for patients because it was all they understood.
• Causes of illness: change

  - Paracelsus was a Swiss scientist who was the first to reject the Theory of the Four Humours, instead seeing disease as something separate from the body which needed to be attacked

  - Girolamo Fracastoro, an Italian physician, released a new text called On Contagion in 1546 which theorised disease was spread by seeds in the air

  - William Harvey published a new theory in 1628 that blood was circulated around the body, rather than being produced in the liver (as Galen had said)

  - Thomas Sydenham published Observationes Medicae in 1676 which theorised illness was caused by external factors, not the four humours.
• Thomas Sydenham


  Humanism = prioritising scientific or rational explanations over religious ones. Thomas Sydenham was a key humanist thinker.

  
  

  Important to medicine because:

  - Developed new treatments e.g. cinchona bark for malaria

  - Refused to rely on medical books, but made a point of closely observing patient symptoms - gained the nickname the English Hippocrates for this reason.

  - Published Observationes Medicae in 1676 which talked about the importance of categorising diseases in the same way you'd categorise a plant - laid the foundations for a more scientific approach to medicine.
• The Printing Press


  - Invented by Johanes Gutenberg in 1440

  - Took medical learning out of the hands of the Church for the first time. Previously monks had transcribed all book by hand and so no books which opposed the Church's ideas were allowed.

  - Allowed mass, cheap production of books for the first time so that information could be spread accurately and quickly.
• The Royal Society


  Organisation who wanted to explain the world in secular/rational terms...

  - Founded in 1660 and received a royal charter from Charles II in 1662, which gave their work credibility.

  - Motto = Nullius in Verba (Take nobody's word for it).

  - Published a journal called Philosophical Transactions from 1665, which provided a platform from which scientists could share their ideas.

  - Offered funding for translations of European scientific texts and encouraged their members to write reports in English instead of Latin.
• Treatment: continuity


  - Old treatments aimed at rebalancing humours continued. Bleeding, purging and sweating all continued to be popular methods.

  - Herbal remedies remained popular, although their use changed slightly.
• Treatment: change


  - Theory of Transference was the new idea that an illness could be transferred to something else. E.g. people believed if you rubbed an onion on a boil, the disease would transfer.

  - Herbal remedies were now chosen based on their colour an shape. e.g. yellow herbs such as saffron were used to treat jaundice or small pox, which has a red rash was treated with the 'red cure' - drinking red wine and eating red foods.

  - New herbal remedies started to appear from the New World and were often more effective - e.g. cichona bark.

  - Rise of chemical cures: a new science called iatrochemistry or medical chemistry became extremely popular - metals such as antimony would be used to purge the body. The Pharmacopoeia Londinensis published a manual on this in 1618.
• Prevention: Continuity

  - Preventing a disease was still the best way to avoid dying from it

  - Continuation of Regimen Sanitatis (e.g. practising moderation by avoiding rich and fatty foods, being too lazy etc)

  - Cleanliness remained important (both the home and body), and so herbs were used to mask or remove bad smells.
• Prevention: Change


  - Decline of bathing: became much less fashionable after the arrival of syphilis which spread quickly among people who visited bath houses. Henry VIII closed down bath houses, but the link between washing and syphilis was not easily forgotten. People washed with linen cloths instead.

  - Regimen Sanitatis was updated so that prevention was often about changing your surroundings, or the importance of certain weather conditions. New instruments such as barometers and thermometers were used to measure and record weather conditions over a long period of time.

  - More steps were taken to remove miasmata: English homeowners were fined for not cleaning the street outside their home and removing sewage/picking up rubbish became a punishment for minor criminals.
• Medical care: continuity


  - Same range of medics would provide treatment as in the medieval period e.g. surgeons still carried out simple operations and apothecaries sold herbs and prayers.

  - Heavy reliance still on care offered in the home.

  - Physicians still attended universities for 7-10 years, with most learning still taking place from book reading and lectures dictated in Latin.
• Medical care: change


  - Apothecaries and surgeons were now organised into guild systems which meant men would carry out an apprenticeship and then work as a journeyman under the supervision of a master for several years.

  - Surgeons and apothecaries now had to possess licences to be able to practise their trade, with iatrochemistry adding new ingredients to an apothecary's store cupboard and new wounds on the battlefield making more surgery necessary.

  - Physicians had new subjects introduced at university such as iatrochemistry and anatomy. Dissection was legalised and so gradually became part of a physician's training.

  - Printing press allowed physicians to have much better access to medical textbooks, with a wider variety. Fugitive sheets were available for those who couldn't afford a whole book.
• Vesalius


  - Flemish anatomist who had a huge impact on medical knowledge and training

  - Published On the Fabric of the Human Body in 1543 with detailed drawings of human muscle and skeletal systems and accompanied by descriptions written in several languages.

  - Corrected over 300 of Galen's errors e.g. that the human jaw was in one part not two or that the vena cava did not lead to the liver.

  - Encouraged other doctors to base their work on dissection and said it was vital for anatomy professors to dissect themselves.
• Vesalius' impact


  - Made study of anatomy fashionable and a central part of medical study

  - Work was heavily copied and plagiarised, but spread via the printing press

  - Inspired other anatomists who corrected further mistakes e.g. inspired Fabricius (who discovered valves) and William Harvey (Fabricius' student).
• Caring for the sick: continuity

  - Most sick people continued to be cared for at home... local communities were close knit and so there were many people to give advice or mix remedies.

  - Women still played an important role in care of the sick and the London College of Physicians prosecuted many women for practising medicine without a licence.
• Caring for the sick: change

  - Some changes to hospitals in early 16th century in that they started to admit patients with wounds and curable diseases such as fevers and skin conditions.

  - Patients could now expect a good diet, a visit from a physician and medication as many hospitals had their own pharmacies and apothecaries on site.

  - However, the dissolution of the monasteries in 1536 led to a dramatic decline in the number of hospitals... by 1700 there were only 5 in England, all in London.

  - Pest houses appeared in order to specialise in a particular disease. e.g. plague or pox as there was a growing recognition that disease could be spread from person to person.
• Harvey


  - English physician who discovered that blood circulated around the body in 1628 through observation and experimentation.

  - Disproved Galenic theory that blood was made in the liver as Harvey calculated that the liver would need to produce 1,800l of blood a day for a person to survive.

  - Influenced by new inventions of the Renaissance such as fire engines which used mechanical pumps to provide water to put out fires.
• Harvey's impact


  - Encouraged other scientists to experiment on actual bodies and correct further mistakes/ask further questions.

  - Limited impact in many ways as there was little practical use in medical treatment.

  - Lots of doctors at the time ignored or criticised him because there was no practical application for the discovery... English medical textbooks gave Galen's account until 1651 and Harvey's ideas only appeared in universities from 1673.
• The Great Plague


  - In 1665, a serious outbreak of plague swept across England

  - 100,000 Londoners died (1/5 people)

  - Spread by fleas carried on rats, as before

  - Proved that people were as helpless to resist the plague as 300 years earlier.
• The Great Plague: causes

  - Astrology: There had been an unusual alignment between Saturn and Jupiter in October 1664 and this was thought to be unlucky.

  - God: a result of mankind's wickedness and that God needed to clean his kingdom

  - Miasma : this was now the most popular theory and people believed this miasma had been created by the stinking rubbish and dunghills in cities.

  Other people - people believed that the plague was spreading from person to person and therefore quarantine was introduced.
• The Great Plague: treatment

  - Quarantine was popular, with people being shut up with family members for up to 6 weeks - red crosses were marked on their doors.

  - New treatments had an impact on plague treatments e.g. physicians advised their patients to be wrapped in a woollen cloth and laid by a fire to sweat the disease out

  - Transference was popular e.g. strap a live chicken to the bubo or lance it with a feather plucked from a live chicken!

  - Recipes for herbal remedies were extremely popular

  - Quack doctors took advantage of the general panic, mixing remedies and advertising fabulous cures hoping to make easy money.
• The Great Plague: prevention

  Local governments took far more action...

  - Charles II decreed that people should fast regularly and made a list of actions to stop plague spreading e.g. banning public meetings and large funerals, closing theatres, sweeping alley ways

  - Fires were burned on street corners to drive away miasma

  - Cats and dogs were killed if they were seen on the street (approx 40,000 dogs and 200,000 cats

  - Searchers and wardens were appointed to monitor the spread of the disease, with searchers going from house to house to check for plague victims.