Even in the desperate depths of the Middle Ages, social, economic, and cultural events were underway which would burst forth in the mid-fifteenth century in that unparalleled phenomenon known as the Renaissance.
Giorgio Vasari (1511-74), Florentine artist, architect, and man of letters, dubbed the period a rinascita, or rebirth, because of a common belief that the major force in its evolution was a return to the cultural priorities of ancient Rome and Greece. Although this was important, especially since the ancient civilizations were being looked at directly through their original writings, architecture, and works of art, other factors were also crucial. The invention of printing from movable metal type permitted the general dissemination of information at markedly reduced costs. The development of trade resulting from the Crusades and the establishment of local industry led to the creation of a money economy, and sophisticated speculative ventures were therefore possible in the private sector. The discovery of sea routes to India and the Americas suddenly opened up a vastly enlarged world with immense potential for exploration and exploitation.
Whereas these developments initially increased social and political tensions in most of Europe, in northern Italy conditions were ideal for their positive evolution. The political stalemate between the papacy and the Holy Roman emperors had permitted the development of several relatively independent city-states whose increasingly industrial and mercantile economies resulted in trading and banking empires which embraced the entire continent. The Turkish capture of Constantinople in 1453 led to an influx of Greek refugee scholars into Italy, greater than to any other country, and the universities of northern Italy, especially of Bologna, Padua, Ferrara, and Pavia, attracted students and scholars from all over Europe. Movable-type printing, invented just north of the Alps, was quickly introduced into Italy, and before long the publishing houses of Venice and Florence were among the best in all Europe. Thus, in the latter half of the fifteenth century, this constellation of social, economic, and political conditions in northern Italy encouraged a veritable burst of intellectual and creative activity which was further accentuated by the appearance of many individuals with excellent and even superlative talents.
The Medical Humanists
The earliest medical humanists tended to live in or, at least, to have studied at the universities of northern Italy, and the term “Renaissance man” has much historical justification. The first “modern” physicians were often also well-versed in physics and astronomy, like Copernicus (1473-1543), partly because of a continued interest in magic and astrology. Especially after the arrival of the Greek scholars from Constantinople, Italian philosophy took on a different, neoplatonic cast, and Aristotelian thought was in decline. Directly transferred to medicine, this meant that the study of Hippocrates and open-minded observation of natural phenomena were ascendant and Galenism and Scholasticism were increasingly out of favor. Until the controversy generated by the Reformation and Counter Reformation stamped out ease of intellectual discourse, the academic world of northern Italy was not only tolerant of new ideas but also extremely cosmopolitan. Nearly all the major courts and cities of Europe sent their finest to Italy for training and advanced education. This may have been just as important as printing to the victory of empiricism and (later) scientific experimentalism over Scholasticism.
Niccolo Leoniceno (1428-1524), one of the early medical humanists, taught medicine at the universities of Padua, Bologna, and Ferrara. “An elegant Latinist,” he translated the Aphorisms of Hippocrates and worked on the writings of Galen. When he noted some five hundred botanical errors in Pliny’s Natural History, Leoniceno refused to follow the humanist philological tradition of his day and he published them. The suggestion that this giant of ancient days might have erred threatened the early humanists and showed how many attributes of medieval thinking outlived the Middle Ages.
Thomas Linacre (1460?-1524) also belonged to the early Renaissance period of philological study. Educated at Padua and Oxford, he was later physician to the English kings Henry VII and Henry VIII. Because of his Latin translations of Galen’s treatises on hygiene, therapeutics, temperaments, natural faculties, the pulse, and semiology, he was responsible for the transmission back to England of an awareness of the importance of a critical and accurate reading of the authorities, earning him the title of “restorer of learning” in England.
Theophrastus Bombastus von Hohenheim, or Paracelsus (1493-1541), shirked neither challenging the ancients nor suggesting chemical therapeutics. Born near Zurich, he obtained his doctor’s degree under Leoniceno at Ferrara. He also developed considerable interest in alchemy, astrology, and the occult sciences. With a reverence for Hippocrates, Paracelsus was a wandering spirit and, except for brief stays in Freiburg, Strassburg, and Basel where several remarkable cures gained him considerable fame, he journeyed about the German world quarreling with those in authority, especially for their blind and total acceptance of the classics. He sharply broke with tradition by teaching not in Latin but in the vernacular. More revolutionary was his growing tendency to subject the ancients (and their followers as well) to an unmitigatedly hostile criticism. To the same extent that he angered those in authority, he attracted the young and those in training. He took his considerable interest in alchemy to heart and, in applying this to the treatment of disease, earned for himself the title “father of pharmacology”—in spite of his limited pharmaceutical arsenal and his highly medieval pathophysiology wherein diseases were caused by influences of the stars and planets upon the “astral body” of man.
Jean Fernel (1497-1588) was trained at Paris and proved that not all medical progress during the Renaissance was directly dependent upon northern Italy. Though much of his time was somewhat reluctantly filled in treating the royal family, he did complete a masterly work entitled A Universal Medicine, in which he for the first time divided the study of medicine into the now standard disciplines of physiology (the normal functioning of the body), pathology (the abnormal functioning of the body), and therapeutics (those things which might resolve abnormalities). He also joined the debate as to whether syphilis and gonorrhea were different diseases or two forms of the same disease. Though most likely found in Europe at low incidence since primeval times, the first major epidemic of syphilis occurred among the sailors returning from Columbus’s first voyage to the New World. The disease was then passed on to Spanish soldiers fighting for the king of Naples and finally reached the French troops of Charles VIII who had forced Naples to surrender after a three weeks’ siege. As Charles’s army returned north, the Italian peninsula was inundated with syphilis, which became known as the morbo gallico, or French disease. Girolamo Fracastoro of Verona (1483-1553), a poet, classicist, physicist, geologist, astronomer, and pathologist in addition to being a physician, gained fame through his Syphilis sive Morbus Gallicus (1530), a Latin poem drawing heavily on Ovid which not only gave the “French disease” its more general name but also suggested its venereal spread. His later treatise, De Contagione (1546), stated with marked clarity the modern theory of infection by invisible germs, which he called seminaria, except that he may not have viewed these contagious elements as living organisms. As the two venereal diseases syphilis and gonorrhea continued to overrun Europe, much interest was devoted to their nature and causation but also to their treatment. The ancients’ lack of consideration of these diseases was bothersome, for it not only suggested that there were things of importance which had escaped the notice of classical authorities but which also required independent thinking. Fernel was the first to suggest that gonorrhea and syphilis were quite separate illnesses, sharing only a common mode of transmission.
Clinical surgery during the Renaissance also owed much to France, though almost entirely because of a single person. Ambroise Pare (1517?-90) came from unusual circumstances for one who was to be so influential in the history of medicine. From the countryside, he was first apprenticed to a barber and later a wound-dresser at the Hotel-Dieu in Paris. Snubbed by the College de St. Come, in 1537 he joined the army, where he was to achieve his fame. Giovanni da Vigo (1460-1525) had written in his Practica copiosa in arte chirurgica (1514) that gunshot wounds were poisonous, and from the pseudo-Hippocratic doctrine that “wounds which are not curable by iron are curable by fire” Vigo and others concluded that gunshot wounds should be first dressed with boiling oil. As Pare later related (in French, for he knew no Latin) in The Method of Treatment for Wounds Caused by Firearms (1545), one night after treating many gunshot wounds with boiling oil he ran out of oil although many wounded remained uncared for. With trepidation, he merely cleansed their wounds and dressed them. Arising before dawn the following day, he dashed off to see how poorly those not treated with oil had done. To his amazement, they were sleeping comfortably and their wounds were healing well. In marked contrast, the soldiers treated with boiling oil were feverish and in much pain, and their wounds were inflamed. As Pare’s fame grew and this story was made common knowledge, boiling oil was no longer used on the battlefield.
During later campaigns, Pare reintroduced the ancient method of stopping hemorrhage by using ligatures and abandoned the cauterizing irons. In 1554 Henri II made him a master surgeon (in spite of his poor education), and in 1561 he published his magnificent treatise A Universal Surgery, wherein many novel procedures and types of apparatus were presented.
Epidemic diseases of the sixteenth century were quite different from those of the preceding century. The sweating sickness, leprosy, and epidemic chorea had almost ceased to exist. Syphilis, though less virulent, continued to be common, and the favored treatment was with mercury or guaiac. Gonorrhea became even more common. These two venereal diseases were directly responsible for the suppression of communal baths, which had been especially popular in the German countries (for both sexes, though usually segregated). In many areas this meant a loss of the only convenient means of personal hygiene, since adequate water was still generally unavailable to most of the population, at least in amounts sufficient for daily bathing or waste removal.
Other epidemic diseases became inexplicably more common in the sixteenth century, among them typhus, diphtheria, smallpox, and measles. In the north of Europe and among sailors, scurvy also increased in frequency, though neither cause nor cure was suggested.
Hospitals continued to be established and supported by municipalities. As leprosy became increasingly rare, most of the thousands of leprosaria closed. In their place, however, institutions were increasingly built for the “lunatic” and the poor, who had been displaced from their feudal position without being made a part of the more urbanized society in which they lived. “Witch hunting” also grew by leaps and bounds. With the developing passions generated by the Reformation and Counter-Reformation, it was no longer necessary to blame misfortunes on Jews, for in the Catholic South a Protestant “heretic” would do quite nicely, as would a papist in the Protestant North.
It was to be some time before these attitudes would affect the universities. Many new ones were founded in the sixteenth century, especially in Germany and in central and eastern Europe. In the medical schools, the mainstays remained Avicenna’s Canon, Galen’s Ars parva, the Aphorisms of Hippocrates, and the works of Dioscorides. In 1543, Giambattista da Monte, or Montanus, (1498-1552) revived the Hippocratic form of bedside teaching at Padua. Though this was to lapse after 1551, it was later revived by his students Albertinon Bottoni and Marco degli Oddi. But this change was minor relative to the revolutions going on in the study of botany and anatomy, changes so important in the later development of the history of medicine that the next chapter will be devoted to them.