of the arts and sciences that accompanied the complex and often painful economic, social, political, and intellectual transformations that took place in Europe between about 1300 and 1650. The Renaissance was a new age of exploration of the word, the world, the mind, and the human body. The Renaissance era may have ultimately transformed European culture in a profound and permanent way that led to the modern world, but it was also a period in which superstition, mysticism, intolerance, and epidemic disease flourished. During this period, Europe experienced the disintegration of medieval economic, social, and religious patterns, the expansion of commerce, cities, and trade, and the growth of the modern state. While such a profound transformation might seem to imply a sharp break with the past, in many ways the Renaissance was the natural culmination of the Middle Ages. Scholars have argued that the Renaissance was not yet an age of individualism, as indicated by the importance of kinship ties and the growth of religious and professional associations. For the most part, towns and cities were urban islands surrounded by traditional rural life. Moreover, medievalists have argued that the outlines of modern society were already being formed between the late tenth century and the early thirteenth. As an era of scientific and philosophical interest, if not therapeutic advances, the Renaissance is a time of special importance for medicine. The death rate circa 1500 was about three times the present level, and life expectancy was perhaps half that of modern Europe. War, famine, and epidemic disease appeared so often that fears of the imminent end of the world were widespread. However, the exact relationship between the Renaissance and the renaissance of medicine is extremely complicated. It is possible to speak of a long medical renaissance that began in the twelfth
century, a distinct medical renaissance of
the sixteenth century, and a medical revolution of the seventeenth century.
INVENTIONS THAT CHANGED THE WORLD
Francis Bacon (15611639), Englands premier
philosopher of science and Lord High Chancellor, said that if we considered the force, effect, and consequences of all the products of human ingenuity, the three most important inventions were printing, gunpowder, and the compass. PRINTING The establishment of printing presses throughout Europe in the 1460s launched a communications revolution that might, at least in part, account for the permanence of the Renaissance. Jean Charlier de Gersons writings on selfabuse, De pollutione nocturna, printed in Cologne about 1466, may have been the first printed medical book. Some historians emphasize the importance of the printing press in standardizing and preserving texts, as well as increasing the numbers of texts available. Of course, careless and ignorant printers could introduce errors and multiply errors more rapidly than scribes could corrupt hand-made books. But copy editors, proofreaders (correctors), and skillful editors understood the danger of introducing errors. Errors in the text or the illustrations and captions could be particularly dangerous in medical and surgical books. When editing medical texts for a printer in Lyon, the French humanist Francois Rabelais (1490?1553), who is best known for his satirical attacks on superstition and scholasticism, allegedly said: One wrong word may now kill thousands of men! An avalanche of advice literature, especially texts dealing with health and diet, was a major product of the print revolution. Popular texts in the vernacular told people what foods, drugs, and spices were good or bad for their health, explaining
proper food choices in terms of humoral and
medical theories. Advice on hygiene still discussed the Galenic rules of health or regimen in terms of the six non-naturals: food and drink, air or the environment, exercise and rest, sleep and waking, evacuation and repletion, and the passions of the soul or the emotions. Similar formats were adopted by texts that gave advice to wealthy readers about sex, clothing, cosmetics, health, family life, managing pregnancy and childbirth, wet-nursing, child rearing, and so forth. Medical writers had to find ways of adapting medical theories to New World plantssuch as tomatoes, potatoes, and tobaccothat were being used as foods and drugs. Written advice could get very detailed without causing embarrassment to the advisor or the patient. Of course, the advice literature was probably consulted more often by those who were ill than by those who might learn to preserve their health by actually following lifestyle advice. The authors of advice literature often complained that people only worried about diet and proper regimen when they were already sick. Despite the inevitable grumbling about the vulgarity of printed books as compared to manuscripts and the fear that an excess of literacy might be subversive, scholars and an increasingly literate populace were generally more concerned with acquiring the new treasures than in complaining about the end of scribal culture. Once in print, a text could speak to students directly, rather than through the professor or keeper of manuscripts. The massproduced book made it possible for the young to study, and perhaps even learn, by reading on their own. Without the art of papermaking, which originated in China, the knowledge revolution launched by the printing press would have been impossible. GUNPOWDER Gunpowder weapons have an important place in the history of medicine because they forced surgeons to deal with problems unknown to Hippocrates and Galen. COMPASS The Chinese probably invented gunpowder and the compass, but others have claimed prior or independent invention. As Europeans followed the compass around the world, they brought back new plants, animals, and remedies and left in their wake a series of ecological and demographic catastrophes that
THE MEDICAL HUMANISTS
transformed the world.
The work of Thomas Linacre (1460?1524) and John Caius (15101573), outstanding English medical humanists, exemplifies the nature of scholarship and medical education during the Renaissance period. University of Padua began teaching medicine in 1222 and played a leading role in the identification and treatment of diseases and ailments, specializing in autopsies and the inner workings of the body. Thomas Linacre studied Greek in Florence and Rome before receiving the degree of Doctor of Medicine from the University of Padua in 1496. In addition to his scholarly work, he maintained a lucrative private medical practice, taught Greek, and served as personal physician to King Henry VII. Linacre edited and translated Galens writings on hygiene, therapeutics, disease symptoms, the pulse, and so forth. As founder and guiding light of the College of Physicians, Linacre helped to mold the character of the English medical profession. He and other elite English physicians gained the power to determine who could legally practice medicine in the Greater London area. The Royal College of Physicians had the power to fine and imprison unlicensed medical practitioners. Graduates of Cambridge and Oxford, which Linacre himself had attended, were exempted from these harsh penalties. Under the leadership of Linacres devoted disciple John Caius, the College of Physicians grew in power and prestige, taking control of medical licensing away from religious authorities, and using strict regulations to enhance the status of approved physicians. Nevertheless, Caius was troubled by what he saw as a decline in English medical humanism. In terms of the development of institutions of higher learning, England lagged behind the universities and professional schools of the continent. Thus, like other English scholars, Caius had to pursue his studies abroad. After abandoning his theological studies, Caius became a medical student at the University of Padua, where he met Andreas Vesalius (1514 1564), the rising star of Renaissance anatomy. Both men were involved in editing and publishing new Latin versions of Galenic texts, but their reactions to discrepancies between Galenic anatomy and the human cadaver were quite different. While Vesalius insisted on returning to the true book of the human body, Caius was confident that once all the writings of Galen were critically
edited, medical knowledge would be virtually
complete. In 1546, Caius was appointed anatomical demonstrator to the United Company of Barbers and Surgeons. Since 1540, the Company of Barbers and Surgeons had been allotted the bodies of four convicted felons per year for anatomical demonstrations. After considerable lobbying by Caius and other elite physicians, the College of Physicians received a similar bequest in 1565. Whereas other presidents of the College of Physicians had generally ignored unqualified practitioners, especially outside London, Caius wanted to control medical licensing for all of England. Although his goal of raising standards for medical education and practice was laudable, efforts to limit the number of practitioners by dictating their credentials had adverse effects, especially for women and the poor. Obviously, the needs of the common people could not be met by the small numbers of physicians who belonged to the medical aristocracy, which was not necessarily a meritocracy. Because women were not admitted to the universities, female practitioners were easy targets for licensing reforms. In addition to his campaigns against unlicensed practitioners, quackery, witchcraft, and superstition, Caius challenged those who dared to criticize Galen. Respect for the ancients did not blunt Caius ability to observe and describe new phenomena, as shown in his account of an illness known as the English sweating sickness. His remarkable Boke or Counseill against the Disease Called the Sweate (1522) was the first original description of disease to be written in England in English. In all probability, Caius would be distressed to know that his vernacular description of the sweats is now regarded as his most important medical work. At least five severe outbreaks of Sudor Britanica, or sudor anglicus, apparently occurred between 1480 and 1580. The disease was characterized by copious sweat, fever, nausea, headache, cramps, pain in the back and extremities, delirium, hallucinations, and a profound stupor. Within about 24 hours the disease reached a critical stage, when either the disease or the patient came to an abrupt end. Even among strong, healthy men, the mortality rate was extremely high. Many victims lapsed into coma and died within 24 to 48 hours. Moreover, the disease seemed to seek out Englishmen even if potential Scottish, Irish, and Welsh victims were available. According to
Caius, a stricken town was fortunate if only half
of all souls were claimed by the disease. After carefully evaluating the clinical pattern and natural history of the disease, he concluded that the sweating sickness was a new disease. Some historians believe that the disease was brought to London in 1485 when Henry VIIs mercenaries returned from France and Flanders. The disease might have been a virulent form of influenza, ergotism (a reaction to fungal toxins), food poisoning, or a totally unknown and extinct disease, but the exact nature of these epidemics and the reason for their peculiar geographical distribution are still obscure. AUTOPSIES, ART, AND ANATOMY ANDREAS VESALIUS ON THE FABRIC OF THE HUMAN BODY MEDICINE AND SURGERY AMBROISE PARE AND THE ART OF SURGERY THE OCCULT SCIENCES: ASTROLOGY AND ALCHEMY SYPHILIS, THE SCOURGE OF THE RENAISSANCE SYPHILIS AND HUMAN EXPERIMENTATION THE DISCOVERY OF THE CIRCULATION OF BLOOD WILLIAM HARVEY AND THE CIRCULATION OF BLOOD HARVEYS PARADOXICAL INFLUENCE: THERAPY BY LEECH AND LANCET BLOOD TRANSFUSION NEW HEARTS FOR OLD SANTORIO SANTORIO AND THE QUANTITATIVE METHOD